Clinical Care in Long-Term Care Flashcards

A LTC resident with osteoporosis and a recent hip fracture is started on alendronate. She also takes calcium carbonate 500 mg with meals. The consultant pharmacist should recommend:

Answer: Taking alendronate 30 minutes before breakfast with plain water, calcium taken at other meals

Calcium and other polyvalent cations chelate bisphosphonates and drastically reduce absorption; alendronate must be taken on an empty stomach with plain water, separated from calcium by at least 30 minutes.

Which of the following represents an appropriate non-pharmacological intervention that should be documented as trialed BEFORE initiating a new antipsychotic for a LTC resident with dementia-related sundowning?

Answer: Structured daytime activities, consistent sleep schedule, and bright light therapy

CMS regulations and clinical guidelines mandate documented trials of non-pharmacological interventions including environmental modifications, activity scheduling, and light therapy before initiating antipsychotics for behavioral symptoms.

A 79-year-old LTC resident's serum digoxin level is 2.4 ng/mL (therapeutic range 0.5–0.9 ng/mL for heart failure). He complains of nausea and visual changes. What is the MOST important laboratory value to check immediately?

Answer: Serum potassium

Hypokalemia potentiates digoxin toxicity by competing for the same Na+/K+-ATPase binding sites; correcting hypokalemia is critical as the toxic effects occur at lower digoxin levels when potassium is depleted.

A consultant pharmacist is conducting a drug regimen review and finds a 92-year-old resident with advanced dementia is taking a statin for primary cardiovascular prevention. The most appropriate recommendation based on current deprescribing evidence is:

Answer: Recommend discontinuation given limited life expectancy and no secondary prevention indication

For patients with advanced dementia and limited life expectancy, statins for primary prevention offer no meaningful benefit within the remaining time horizon and increase pill burden and adverse effect risk.

A resident develops new-onset confusion and agitation 3 days after a Foley catheter was placed for urinary incontinence. Urinalysis shows bacteriuria. The consultant pharmacist should advise:

Answer: Treat only if the resident has fever, costovertebral tenderness, or new-onset delirium attributed to UTI

IDSA and SHEA guidelines recommend against treating asymptomatic bacteriuria in catheterized patients; antibiotic treatment is indicated only when systemic signs of infection are present.

Which FDA black box warning applies to both conventional and atypical antipsychotics used in elderly patients with dementia-related psychosis in LTC settings?

Answer: Increased risk of death, primarily from cardiovascular or infectious causes

The FDA black box warning states that elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death (1.6–1.7 times higher), predominantly from cardiovascular events and infections like pneumonia.

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

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.