BCG BCG Pharmacology & Medication Management in Older Adults 1 — Questions and Answers
Question 1: Which physiological change in older adults most significantly slows drug metabolism?
- Decreased renal blood flow
- Reduced hepatic blood flow and enzyme activity (Correct answer)
- Increased gastric acid secretion
- Elevated plasma protein levels
Correct answer: Reduced hepatic blood flow and enzyme activity
Reduced hepatic blood flow and cytochrome P450 enzyme activity in older adults significantly prolongs the half-life of many drugs.
Question 2: The Beers Criteria is used in gerontological practice primarily to:
- Calculate renal dosing adjustments
- Identify potentially inappropriate medications for older adults (Correct answer)
- Standardize antibiotic selection in nursing homes
- Guide pain management titration
Correct answer: Identify potentially inappropriate medications for older adults
The AGS Beers Criteria lists medications considered potentially inappropriate for older adults due to elevated risk of adverse effects.
Question 3: An 80-year-old patient's creatinine is 1.0 mg/dL. What does this value indicate in the context of renal drug dosing?
- Normal kidney function requiring no dose adjustment
- Potentially significant renal impairment despite a 'normal' lab value (Correct answer)
- Hyperfiltration requiring increased doses
- End-stage renal disease
Correct answer: Potentially significant renal impairment despite a 'normal' lab value
Because muscle mass declines with age, serum creatinine can appear normal even when GFR is substantially reduced, so estimated GFR should always be calculated.
Question 4: Which drug class is most commonly associated with falls in older adults due to its central nervous system effects?
- ACE inhibitors
- Proton pump inhibitors
- Benzodiazepines (Correct answer)
- Thiazide diuretics
Correct answer: Benzodiazepines
Benzodiazepines cause sedation, impaired balance, and slowed reflexes, making them a leading pharmacological contributor to falls in older adults.
Question 5: Polypharmacy in older adults is generally defined as the concurrent use of how many or more medications?
- 3
- 5 (Correct answer)
- 8
- 10
Correct answer: 5
Polypharmacy is conventionally defined as the use of five or more medications simultaneously, which is common and associated with adverse drug events in older adults.
Question 6: Which of the following best describes the prescribing cascade?
- Titrating a single medication to maximum dose before adding another
- Prescribing a new drug to treat side effects of an existing drug, which are misidentified as a new condition (Correct answer)
- Using multiple drugs from the same class for synergistic effect
- Reducing all medications at the time of discharge
Correct answer: Prescribing a new drug to treat side effects of an existing drug, which are misidentified as a new condition
A prescribing cascade occurs when an adverse drug reaction is misdiagnosed as a new condition, leading to the addition of another medication.
BCG BCG Pharmacology & Medication Management in Older Adults 1
Which physiological change in older adults most significantly slows drug metabolism?