Certified Consultant Pharmacist (CCP) / Board Certified Geriatric Pharmacist (BCGP) — Questions and Answers

Question 1: A pharmacist is assessing functional status in a long-term care patient. Which tool evaluates Instrumental Activities of Daily Living (IADLs)?

Barthel Index
Katz Index of Independence
Tinetti Gait and Balance Assessment
Lawton-Brody IADL Scale (Correct answer)

Correct answer: Lawton-Brody IADL Scale

The Lawton-Brody IADL Scale assesses complex activities such as managing finances, using the telephone, and medication self-management that are necessary for independent living.

Question 2: A LTC resident with severe dysphagia cannot swallow tablets. The consultant pharmacist is asked whether omeprazole can be crushed. The MOST appropriate recommendation is:

Open the delayed-release capsule and sprinkle intact granules on applesauce (Correct answer)
Dissolve the whole capsule in apple juice for 24 hours before administration
Crush the enteric-coated omeprazole tablet and dissolve in water
Switch to IV pantoprazole immediately without considering oral alternatives

Correct answer: Open the delayed-release capsule and sprinkle intact granules on applesauce

Omeprazole delayed-release capsules can be opened and the intact enteric-coated granules sprinkled on acidic food like applesauce; crushing destroys the enteric coating and exposes the drug to gastric acid degradation.

Question 3: Which population requires special counseling considerations?

Middle-aged patients
College students
Healthy athletes
Pediatric and geriatric patients (Correct answer)

Correct answer: Pediatric and geriatric patients

Pediatric and geriatric patients require specific communication approaches and dosage considerations due to age-related factors.

Question 4: Which of the following best describes the 'corresponding responsibility' doctrine under DEA regulations for controlled substances?

The prescriber and pharmacist split liability equally for all Schedule II prescriptions
Pharmacists must verify all controlled substance prescriptions through the state PDMP before dispensing
The DEA is equally responsible for any dispensing errors made by pharmacists
A pharmacist shares legal responsibility for dispensing a controlled substance not issued for a legitimate medical purpose (Correct answer)

Correct answer: A pharmacist shares legal responsibility for dispensing a controlled substance not issued for a legitimate medical purpose

The corresponding responsibility doctrine (21 CFR 1306.04) holds that a pharmacist who knowingly fills a controlled substance prescription not issued for a legitimate medical purpose is equally liable with the prescriber.

Question 5: A patient receiving tube feedings is prescribed phenytoin. The pharmacist should monitor for which interaction-related problem?

Phenytoin toxicity due to increased absorption with tube feedings
Increased formula viscosity blocking feeding tubes
Hyperglycemia caused by phenytoin-formula interactions
Significantly reduced phenytoin absorption when given with enteral nutrition (Correct answer)

Correct answer: Significantly reduced phenytoin absorption when given with enteral nutrition

Enteral nutrition significantly reduces phenytoin absorption; the feeding should be held for at least 1-2 hours before and after each phenytoin dose.

Question 6: A consultant pharmacist working in an assisted living facility differs from one in a skilled nursing facility primarily because assisted living residents typically:

Are covered exclusively by Medicaid
Self-administer medications and have greater autonomy (Correct answer)
Require 24-hour nursing care
Cannot receive consultant pharmacist services

Correct answer: Self-administer medications and have greater autonomy

Assisted living residents generally have greater independence including self-administration of medications, requiring consultant pharmacists to focus on education and safety rather than direct administration oversight.

Question 7: A 85-year-old LTC resident with type 2 diabetes has an HbA1c of 9.2%. The consultant pharmacist recommends a less stringent glycemic goal. What HbA1c target is generally appropriate for frail elderly LTC residents?

<8.0% (Correct answer)
<6.5%
<7.0%
<9.0%

Correct answer: <8.0%

For frail elderly residents or those with limited life expectancy, ADA and geriatric guidelines recommend a relaxed HbA1c target of <8.0% to minimize hypoglycemia risk.

Question 8: Which element distinguishes a Comprehensive Medication Review (CMR) from a Targeted Medication Review (TMR) in the context of Medicare Part D MTM programs?

CMR is performed annually while TMR is performed monthly
CMR focuses only on high-cost drugs while TMR covers all medications
CMR is a complete review of all medications through an interactive patient consultation, while TMR addresses specific drug therapy problems (Correct answer)
CMR is done by the prescriber while TMR is done by the pharmacist

Correct answer: CMR is a complete review of all medications through an interactive patient consultation, while TMR addresses specific drug therapy problems

A CMR is a thorough, interactive consultation reviewing all medications with the patient, producing a written summary, while a TMR targets specific drug therapy problems between CMR cycles.

Question 9: Which of the following quality indicators from the Minimum Data Set (MDS) is MOST directly linked to pharmacist medication review quality?

Percentage of residents receiving antipsychotic medications without a diagnosis of psychosis (Correct answer)
Percentage of residents with a fall resulting in major injury
Percentage of residents with documented advance directives
Percentage of residents with pressure ulcers

Correct answer: Percentage of residents receiving antipsychotic medications without a diagnosis of psychosis

Antipsychotic use without a psychosis diagnosis is a CMS quality measure directly targeted by pharmacist DRR under OBRA '87 and the National Partnership to Improve Dementia Care.

Question 10: A nursing home patient on lithium for bipolar disorder develops tremor, confusion, and coarse trembling. What is the most likely explanation?

Subtherapeutic lithium level requiring a dose increase
A new neurological condition unrelated to lithium
Normal aging process in an elderly patient
Lithium toxicity requiring immediate level check and likely dose reduction or hold (Correct answer)

Correct answer: Lithium toxicity requiring immediate level check and likely dose reduction or hold

Tremor, confusion, and coarse trembling are classic signs of lithium toxicity, which is confirmed by serum level and managed by dose reduction or discontinuation.

Question 11: When documenting a CMR using the SOAP note format, the medication action plan (MAP) is best incorporated into which section?

Objective
Plan (Correct answer)
Assessment
Subjective

Correct answer: Plan

The MAP, which outlines recommended patient actions, is a patient-friendly document that corresponds to the Plan section of the SOAP note.

Question 12: Failure mode and effects analysis (FMEA) differs from root cause analysis (RCA) in that FMEA is:

Required by CMS for all medication errors in nursing facilities
Reactive: conducted after a serious adverse event has occurred
Focused solely on human errors rather than system failures
Proactive: conducted to identify and mitigate potential failures before they cause harm (Correct answer)

Correct answer: Proactive: conducted to identify and mitigate potential failures before they cause harm

FMEA is a prospective risk assessment tool used to identify potential failure modes and their effects before harm occurs, in contrast to the retrospective nature of RCA.

Question 13: Which of the following validated screening tools is specifically designed to identify both potentially inappropriate medications to STOP and potential prescribing omissions to START in older adults?

Beers Criteria®
Drug Burden Index (DBI)
STOPP/START Criteria (Correct answer)
Medication Appropriateness Index (MAI)

Correct answer: STOPP/START Criteria

The STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria are designed as a complementary pair. STOPP criteria identify potentially inappropriate medications that should be considered for discontinuation, while START criteria identify common prescribing omissions where a medication may be indicated but is not prescribed. The Beers Criteria® primarily focus on medications to avoid (potentially inappropriate) in older adults but do not explicitly address prescribing omissions. The MAI and DBI are other tools used to assess medication appropriateness and burden, respectively, but the STOPP/START tool is unique in its dual focus on both inappropriate prescriptions and omissions.

Question 14: Which schedule requires a new written prescription for each refill, with no refills permitted?

Schedule II (Correct answer)
Schedule III
Schedule IV
Schedule V

Correct answer: Schedule II

Schedule II controlled substances cannot be refilled; a new prescription is required for each dispensing.

Question 15: A skilled nursing facility fails a standard survey and is cited at the scope/severity level of 'G'. What does this designation indicate?

Widespread deficiency with no actual harm
Pattern of deficiency with actual harm that is not immediate jeopardy (Correct answer)
Isolated deficiency with immediate jeopardy
Isolated deficiency with no actual harm

Correct answer: Pattern of deficiency with actual harm that is not immediate jeopardy

Scope/severity level G indicates a pattern of deficiency that has resulted in actual harm to residents, but does not rise to the level of immediate jeopardy.

Question 16: Which of the following is an example of a 'forcing function' in medication safety design?

Training staff to double-check high-alert drugs
Configuring IV pumps so concentrated potassium cannot be programmed without an override alert (Correct answer)
Using tall-man lettering on medication labels
Posting LASA drug lists at nursing stations

Correct answer: Configuring IV pumps so concentrated potassium cannot be programmed without an override alert

A forcing function physically or electronically prevents an action unless a safety step is completed, making the unsafe action impossible or very difficult.

Question 17: Which Beers Criteria category is MOST relevant to a consultant pharmacist reviewing medications for fall risk in a long-term care resident?

Medications with narrow therapeutic index
Medications to avoid in older adults due to high risk of adverse effects (Correct answer)
Medications requiring renal dose adjustment
Medications with drug-drug interactions

Correct answer: Medications to avoid in older adults due to high risk of adverse effects

The Beers Criteria section on medications to avoid in older adults due to high adverse effect risk directly addresses fall-risk drugs like sedatives, anticholinergics, and certain antihypertensives.

Question 18: Which pharmacokinetic change is most consistently observed in elderly patients due to decreased lean body mass?

Increased renal clearance of hydrophilic drugs
Decreased volume of distribution for lipophilic drugs (Correct answer)
Increased volume of distribution for lipophilic drugs
Decreased protein binding of acidic drugs

Correct answer: Decreased volume of distribution for lipophilic drugs

Decreased lean body mass in elderly reduces the volume of distribution for lipophilic drugs, potentially increasing plasma concentrations.

Question 19: In contrast to a Root Cause Analysis (RCA), which is a reactive process, a Failure Mode and Effects Analysis (FMEA) is a proactive risk assessment tool. A facility decides to conduct an FMEA. Which of the following activities would be the primary focus of the FMEA team?

Interviewing the staff involved in a wrong-site medication patch application.
Investigating the contributing factors to a recent resident fall with major injury.
Analyzing trends in medication errors reported over the last quarter.
Identifying potential points of failure in the new automated medication dispensing system before it is implemented. (Correct answer)

Correct answer: Identifying potential points of failure in the new automated medication dispensing system before it is implemented.

FMEA is a systematic, proactive method for evaluating a process to identify where and how it might fail and to assess the relative impact of different failures. The goal is to identify and address potential failure modes *before* they result in harm. Analyzing a new system prior to implementation is a classic application of FMEA, whereas the other options are reactive analyses of events that have already occurred.

Question 20: Which age-related change in hepatic function primarily reduces the clearance of high-extraction drugs like propranolol and lidocaine?

Decreased albumin binding
Impaired glucuronidation conjugation
Decreased CYP2D6 enzyme activity
Reduced hepatic blood flow (Correct answer)

Correct answer: Reduced hepatic blood flow

High-extraction drugs depend on hepatic blood flow for clearance; since blood flow decreases 30-40% with aging, these drugs' clearance falls and bioavailability increases.

Question 21: Which statement best describes the concept of deprescribing in geriatric pharmacotherapy?

Reducing all medication doses by 50% in patients over 65
Eliminating all medications in patients receiving palliative care
The systematic process of identifying and discontinuing drugs where potential harms outweigh benefits (Correct answer)
Switching brand-name drugs to generic equivalents to reduce costs

Correct answer: The systematic process of identifying and discontinuing drugs where potential harms outweigh benefits

Deprescribing is a patient-centered process of tapering or stopping medications when their risks outweigh benefits, particularly in older adults with polypharmacy.

Question 22: A patient with chronic kidney disease stage 3b is prescribed an NSAID for arthritis pain. What is the pharmacist's primary concern?

NSAIDs are safe in all stages of CKD
NSAIDs improve renal function by reducing inflammation
NSAIDs can further reduce renal blood flow and accelerate CKD progression (Correct answer)
NSAIDs require dose reduction but are otherwise safe in CKD

Correct answer: NSAIDs can further reduce renal blood flow and accelerate CKD progression

NSAIDs inhibit prostaglandin synthesis and reduce renal perfusion, which can accelerate the decline in renal function in CKD patients.

Question 23: Which of the following is TRUE regarding controlled substance disposal in long-term care facilities under DEA regulations?

Controlled substances may be discarded in regular trash if mixed with cat litter
Non-registrant facilities must transfer waste controlled substances to a DEA-registered reverse distributor or authorized collector (Correct answer)
Facilities may flush controlled substances down the drain if witnessed by two nurses
The state board of pharmacy must witness all controlled substance destructions

Correct answer: Non-registrant facilities must transfer waste controlled substances to a DEA-registered reverse distributor or authorized collector

DEA regulations require that long-term care facilities transfer unwanted controlled substances to a DEA-registered reverse distributor or authorized take-back collector for proper disposal.

Question 24: When counseling LTC staff on recognizing signs of opioid-induced constipation (OIC) in a non-verbal resident, which assessment tool is most appropriate?

Bristol Stool Form Scale with nursing observation (Correct answer)
Mini Nutritional Assessment (MNA)
SLUMS cognitive assessment
Braden Scale for skin integrity

Correct answer: Bristol Stool Form Scale with nursing observation

The Bristol Stool Form Scale combined with nursing observation of stool frequency and consistency is a validated, practical tool to monitor bowel function in residents who cannot self-report.

Question 25: Which DEA form is required when a DEA registrant discovers a theft or significant loss of controlled substances?

DEA Form 106 (Correct answer)
DEA Form 41
DEA Form 224
DEA Form 222

Correct answer: DEA Form 106

DEA Form 106 (Report of Theft or Significant Loss of Controlled Substances) must be completed and submitted to the DEA upon discovery of theft or significant loss.

Question 26: A 75-year-old with chronic pain is prescribed an NSAID. Which complication is most concerning due to age-related changes in renal prostaglandin dependence?

Hepatotoxicity
Peripheral neuropathy
Acute kidney injury (Correct answer)
Pulmonary fibrosis

Correct answer: Acute kidney injury

Elderly patients rely more heavily on prostaglandins to maintain renal blood flow, making NSAID-induced acute kidney injury especially common in this population.

Question 27: In a hospice setting, a consultant pharmacist's primary role shifts to focus on:

Disease prevention and curative therapy
Antibiotic stewardship and infection prevention
Medication cost reduction and formulary adherence
Symptom management and comfort-focused medication optimization (Correct answer)

Correct answer: Symptom management and comfort-focused medication optimization

In hospice care, the consultant pharmacist prioritizes palliative goals by optimizing medications for symptom control, comfort, and quality of life rather than curative treatment.

Question 28: A patient receiving warfarin has an INR of 4.8 with no signs of bleeding. What is the most appropriate pharmacist recommendation?

Administer vitamin K 10 mg IV immediately
Switch to direct oral anticoagulant immediately
Continue current dose and recheck INR in 1 week
Hold warfarin for 1-2 doses and recheck INR (Correct answer)

Correct answer: Hold warfarin for 1-2 doses and recheck INR

For an elevated INR without bleeding, holding 1-2 doses of warfarin and rechecking INR is appropriate per ACCP guidelines.

Question 29: A nursing home patient develops confusion after receiving diphenhydramine for insomnia. What is the mechanism underlying this reaction?

Diphenhydramine causes serotonin excess in the elderly brain
Diphenhydramine induces hypoglycemia causing altered mental status
Diphenhydramine's anticholinergic properties impair central cholinergic neurotransmission (Correct answer)
Diphenhydramine activates dopamine receptors causing psychosis

Correct answer: Diphenhydramine's anticholinergic properties impair central cholinergic neurotransmission

Diphenhydramine's strong anticholinergic activity blocks central muscarinic receptors, causing delirium, confusion, and cognitive impairment especially in the elderly.

Certified Consultant Pharmacist (CCP) / Board Certified Geriatric Pharmacist (BCGP)

The CCP/BCGP credential, administered by the Board of Pharmacy Specialties in partnership with ASCP, certifies pharmacists in the specialized practice of geriatric pharmacy and medication management for older adults in long-term care and senior care settings.

Questions

35 min

Time Limit

70%

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