Adult-Gerontology Primary Care Nurse Practitioner Exam Pharmacology & Medication Management in Aging Patients 2 — Questions and Answers
Question 1: A 79-year-old is prescribed warfarin for atrial fibrillation. Which factor unique to aging increases bleeding risk?
- Increased hepatic first-pass metabolism
- Increased sensitivity to vitamin K antagonism and altered CYP2C9 activity (Correct answer)
- Increased renal clearance of warfarin
- Decreased albumin binding of warfarin
Correct answer: Increased sensitivity to vitamin K antagonism and altered CYP2C9 activity
Older adults have increased pharmacodynamic sensitivity to warfarin and reduced CYP2C9 metabolism, requiring lower doses and more frequent INR monitoring.
Question 2: The STOPP criteria (Screening Tool of Older Persons' Potentially inappropriate Prescriptions) is used alongside the START criteria to:
- Identify medications to stop AND medications that should be started (Correct answer)
- Calculate pill burden
- Assess drug cost effectiveness
- Monitor therapeutic drug levels
Correct answer: Identify medications to stop AND medications that should be started
STOPP identifies inappropriate medications to discontinue, while START identifies evidence-based medications that are indicated but potentially omitted in older patients.
Question 3: An older adult is started on a fluoroquinolone antibiotic. The AGPCNP should monitor for which serious adverse effect particularly concerning in this age group?
- Hypertension
- Tendonitis or tendon rupture (Correct answer)
- Hypothyroidism
- Hyperkalemia
Correct answer: Tendonitis or tendon rupture
Fluoroquinolones carry an FDA black box warning for tendinopathy and tendon rupture, with older adults and those on corticosteroids at highest risk.
Question 4: Which of the following opioid analgesics should be avoided in older adults due to accumulation of toxic metabolites causing neurotoxicity?
- Morphine
- Meperidine (Demerol) (Correct answer)
- Hydromorphone
- Oxycodone
Correct answer: Meperidine (Demerol)
Meperidine accumulates its active metabolite normeperidine in older adults, causing CNS toxicity including tremors, myoclonus, and seizures.
Question 5: A patient taking methotrexate for rheumatoid arthritis should also receive which supplement to reduce toxicity?
- Vitamin B12
- Folic acid (Correct answer)
- Vitamin D
- Magnesium
Correct answer: Folic acid
Folic acid supplementation reduces methotrexate-associated mucositis, GI toxicity, and hepatotoxicity without compromising its therapeutic efficacy.
Question 6: In polypharmacy management, deprescribing refers to:
- Switching to generic medications
- The planned and supervised process of dose reduction or stopping medications no longer needed (Correct answer)
- Refusing to prescribe new medications
- Automatic refill programs
Correct answer: The planned and supervised process of dose reduction or stopping medications no longer needed
Deprescribing is an evidence-based, patient-centered process of withdrawing inappropriate medications to reduce polypharmacy burden and improve outcomes.
Adult-Gerontology Primary Care Nurse Practitioner Exam Pharmacology & Medication Management in Aging Patients 2
A 79-year-old is prescribed warfarin for atrial fibrillation.
Which factor unique to aging increases bleeding risk?