Chronic Disease Management in Older Adults Flashcards

In managing osteoporosis in a 72-year-old postmenopausal woman with a T-score of -2.8, the first-line pharmacological treatment is:

Answer: Alendronate (bisphosphonate)

Bisphosphonates such as alendronate are the first-line pharmacotherapy for osteoporosis due to their proven efficacy in reducing vertebral and hip fractures.

The AGPCNP is managing a 78-year-old with chronic pain from osteoarthritis. Which of the following is the preferred first-line pharmacological option?

Answer: Acetaminophen

Acetaminophen is recommended as the first-line oral analgesic for osteoarthritis pain in older adults due to its favorable safety profile compared to NSAIDs and opioids.

A 68-year-old with atrial fibrillation has a CHA₂DS₂-VASc score of 4. The most appropriate management is:

Answer: Oral anticoagulation with DOAC or warfarin

A CHA₂DS₂-VASc score ≥2 in men or ≥3 in women indicates high stroke risk; oral anticoagulation is strongly recommended to reduce thromboembolic events.

For an older adult with hypothyroidism, the TSH target during levothyroxine therapy is:

Answer: 1.0–4.0 mIU/L (or slightly higher for elderly)

For older adults, particularly those with cardiovascular disease or osteoporosis risk, a TSH target in the upper-normal range (1.0–4.0 or slightly higher) is often acceptable to avoid overtreatment.

Which vaccine is specifically recommended for adults aged 65 and older to prevent severe pneumococcal disease?

Answer: PCV15 or PCV20 (pneumococcal conjugate vaccine)

Current CDC recommendations for adults ≥65 who have not previously been vaccinated include PCV15 followed by PPSV23, or a single dose of PCV20.

An 80-year-old with moderate Alzheimer's disease and new behavioral symptoms (agitation, aggression) should first be evaluated for:

Answer: Reversible causes such as pain, infection, medication side effects

Before initiating pharmacotherapy for dementia-related behavioral symptoms, all potentially reversible triggers (pain, UTI, constipation, medication toxicity) must be identified and addressed.