Adult-Gerontology Primary Care Nurse Practitioner Exam Pharmacology & Medication Management in Aging Patients 1 — Questions and Answers
Question 1: How does aging primarily affect drug distribution in older adults?
- Increased total body water increases volume of distribution for water-soluble drugs
- Increased body fat increases volume of distribution for lipid-soluble drugs (Correct answer)
- Decreased protein binding increases free fraction of albumin-bound drugs
- Decreased renal blood flow reduces first-pass metabolism
Correct answer: Increased body fat increases volume of distribution for lipid-soluble drugs
With aging, body fat increases relative to lean mass, increasing the volume of distribution and prolonging the half-life of lipophilic drugs such as benzodiazepines.
Question 2: The Cockcroft-Gault formula is used by the AGPCNP to estimate:
- Liver function for drug metabolism
- Creatinine clearance as a surrogate for GFR to guide drug dosing (Correct answer)
- Body surface area for chemotherapy dosing
- Nutritional status in older adults
Correct answer: Creatinine clearance as a surrogate for GFR to guide drug dosing
The Cockcroft-Gault equation estimates creatinine clearance using age, weight, sex, and serum creatinine, guiding renally-cleared drug dosing in older adults.
Question 3: Which of the following benzodiazepines is considered relatively safer in older adults due to its lack of active metabolites?
- Diazepam
- Chlordiazepoxide
- Lorazepam (Correct answer)
- Flurazepam
Correct answer: Lorazepam
Lorazepam is preferred when a benzodiazepine is necessary in older adults because it has no active metabolites and a shorter half-life, reducing accumulation risk.
Question 4: The prescribing cascade occurs when:
- Multiple providers prescribe the same medication
- A drug side effect is misinterpreted as a new condition and treated with another drug (Correct answer)
- A patient takes medications at the wrong time
- Generic substitution causes unexpected effects
Correct answer: A drug side effect is misinterpreted as a new condition and treated with another drug
The prescribing cascade is the process whereby an adverse drug effect is mistaken for a new medical condition, leading to additional prescriptions and compounding harm.
Question 5: Which class of medications is listed on the Beers Criteria as potentially inappropriate in older adults due to anticholinergic effects?
- Selective serotonin reuptake inhibitors (SSRIs)
- First-generation antihistamines (e.g., diphenhydramine) (Correct answer)
- ACE inhibitors
- Calcium channel blockers
Correct answer: First-generation antihistamines (e.g., diphenhydramine)
First-generation antihistamines like diphenhydramine have strong anticholinergic activity, causing confusion, urinary retention, constipation, and falls in older adults.
Question 6: An AGPCNP conducts medication reconciliation at every visit. This process is most important for preventing:
- Drug-food interactions
- Omission errors, duplication, and drug-drug interactions (Correct answer)
- Medication non-adherence due to cost
- Side effects from newly approved drugs
Correct answer: Omission errors, duplication, and drug-drug interactions
Medication reconciliation systematically identifies discrepancies between prescribed, dispensed, and taken medications, reducing omissions, duplications, and harmful interactions.
Adult-Gerontology Primary Care Nurse Practitioner Exam Pharmacology & Medication Management in Aging Patients 1
How does aging primarily affect drug distribution in older adults?