CCP Clinical Care in Long-Term Care 3 — Questions and Answers
Question 1: 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?
- <6.5%
- <7.0%
- <8.0% (Correct answer)
- <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 2: Which medication class is considered most appropriate for short-term management of acute agitation in a LTC resident with no prior psychiatric history, according to current geriatric guidelines?
- Benzodiazepines as first-line
- Low-dose haloperidol with close monitoring (Correct answer)
- Long-acting antipsychotics immediately
- Stimulant medications for behavioral activation
Correct answer: Low-dose haloperidol with close monitoring
Low-dose haloperidol may be used cautiously for acute agitation posing safety risks when non-pharmacological interventions fail, though risks must be documented and monitored closely.
Question 3: A resident on metformin 1000 mg BID is ordered for a contrast CT scan. The consultant pharmacist should recommend:
- Continue metformin without interruption as contrast is safe with metformin
- Hold metformin 48 hours before and 48 hours after contrast administration (Correct answer)
- Switch to insulin permanently before contrast
- Administer sodium bicarbonate prophylaxis with metformin continuation
Correct answer: Hold metformin 48 hours before and 48 hours after contrast administration
Metformin should be held 48 hours before and after iodinated contrast in patients with renal impairment risk due to the rare but serious risk of contrast-induced nephropathy leading to metformin accumulation and lactic acidosis.
Question 4: Which of the following is a key component of a comprehensive medication review (CMR) conducted by a consultant pharmacist in a LTC facility under CMS guidelines?
- Evaluating only newly initiated medications
- Assessing all medications for appropriateness, efficacy, safety, and adherence (Correct answer)
- Focusing exclusively on controlled substance utilization
- Reviewing lab values only when ordered by the physician
Correct answer: Assessing all medications for appropriateness, efficacy, safety, and adherence
A comprehensive medication review evaluates the complete medication regimen for clinical indications, drug interactions, adverse effects, and opportunities for deprescribing in alignment with OBRA regulations.
Question 5: A LTC resident develops C. difficile infection (CDI) after a course of clindamycin. Which is the MOST appropriate first-line treatment for a non-severe initial episode?
- Oral metronidazole 500 mg TID x 10 days
- Oral vancomycin 125 mg QID x 10 days (Correct answer)
- IV metronidazole 500 mg TID x 14 days
- Oral fidaxomicin 200 mg BID x 10 days as first-line regardless of severity
Correct answer: Oral vancomycin 125 mg QID x 10 days
IDSA guidelines now recommend oral vancomycin 125 mg QID for 10 days as first-line for non-severe CDI, as it is superior to metronidazole in achieving clinical cure.
Question 6: A consultant pharmacist notes a LTC resident is receiving both an ACE inhibitor and an ARB for hypertension. The primary concern with dual renin-angiotensin system blockade is:
- Additive hypotensive effects and renal failure risk (Correct answer)
- Reduced efficacy due to receptor competition
- Increased risk of hypernatremia
- Excessive diuresis requiring potassium supplementation
Correct answer: Additive hypotensive effects and renal failure risk
Dual RAAS blockade significantly increases the risk of hypotension, hyperkalemia, and acute kidney injury without additional cardiovascular benefit, and is contraindicated per JNC and AHA guidelines.
Question 7: Which validated tool is recommended by AMDA for screening depression in LTC residents who have cognitive impairment?
- PHQ-9
- Cornell Scale for Depression in Dementia (CSDD) (Correct answer)
- Geriatric Depression Scale (GDS)
- Beck Depression Inventory (BDI)
Correct answer: Cornell Scale for Depression in Dementia (CSDD)
The Cornell Scale for Depression in Dementia relies on caregiver observations and clinician interview rather than self-report, making it valid for residents who cannot reliably self-assess.
CCP Clinical Care in Long-Term Care 3
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?