BCG BCG Pharmacology & Medication Management in Older Adults 2 — Questions and Answers
Question 1: Why is anticholinergic burden a special concern in gerontological pharmacology?
- Older adults have more muscarinic receptors, increasing sensitivity
- Cumulative anticholinergic effects increase risk of cognitive impairment, urinary retention, and constipation (Correct answer)
- Anticholinergics are metabolized faster in older adults
- Older adults are typically prescribed anticholinergics for age-related tremor
Correct answer: Cumulative anticholinergic effects increase risk of cognitive impairment, urinary retention, and constipation
Cumulative anticholinergic burden from multiple medications significantly increases risks of delirium, cognitive decline, constipation, and urinary retention in older adults.
Question 2: Which pain medication class requires particular caution in older adults due to the risk of GI bleeding, renal impairment, and cardiovascular events?
- Acetaminophen
- Opioids
- NSAIDs (Correct answer)
- Tricyclic antidepressants
Correct answer: NSAIDs
NSAIDs are associated with GI bleeding, acute kidney injury, and cardiovascular events, making them high-risk in older adults who often have multiple comorbidities.
Question 3: When adjusting opioid doses for older adults, the standard recommendation is to:
- Start with the same dose as younger adults and titrate up quickly
- Start low and go slow, beginning at 25–50% of the typical adult dose (Correct answer)
- Avoid opioids entirely and substitute NSAIDs
- Use only sustained-release formulations
Correct answer: Start low and go slow, beginning at 25–50% of the typical adult dose
The 'start low, go slow' principle reduces the risk of over-sedation, respiratory depression, and falls in older adults with altered opioid metabolism.
Question 4: A patient taking warfarin is started on a new antibiotic. What is the primary pharmacological concern?
- Antibiotics increase renal clearance of warfarin, reducing its effectiveness
- Antibiotics can alter gut flora and inhibit CYP enzymes, elevating INR and bleeding risk (Correct answer)
- The combination causes photosensitivity
- Antibiotics bind warfarin in the GI tract, preventing absorption
Correct answer: Antibiotics can alter gut flora and inhibit CYP enzymes, elevating INR and bleeding risk
Many antibiotics inhibit gut bacteria that produce vitamin K and inhibit CYP2C9, leading to elevated warfarin levels and increased bleeding risk.
Question 5: Which is the preferred approach for managing medication reconciliation during care transitions for older adults?
- Instruct the patient to bring a handwritten list of medications
- Conduct a comprehensive medication review comparing all medication lists from sending and receiving facilities (Correct answer)
- Let the new care team generate a fresh medication list based on the admission diagnosis
- Only reconcile medications that were changed in the past 30 days
Correct answer: Conduct a comprehensive medication review comparing all medication lists from sending and receiving facilities
Comparing medication lists from all care settings during transitions is essential to identify discrepancies, omissions, and duplications that cause adverse drug events.
Question 6: Which supplement commonly taken by older adults can significantly interact with blood thinners and increase bleeding risk?
- Calcium
- Vitamin D
- Fish oil (omega-3 fatty acids) (Correct answer)
- Magnesium
Correct answer: Fish oil (omega-3 fatty acids)
High-dose omega-3 fatty acids have antiplatelet properties and can potentiate the anticoagulant effects of warfarin and other blood thinners.
BCG BCG Pharmacology & Medication Management in Older Adults 2
Why is anticholinergic burden a special concern in gerontological pharmacology?