CCP Geriatric Pharmacology 3 — Questions and Answers
Question 1: 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
- Acute kidney injury (Correct answer)
- Pulmonary fibrosis
- Peripheral neuropathy
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 2: Which antihypertensive drug class is associated with increased risk of hyponatremia in elderly patients, particularly women?
- ACE inhibitors
- Beta-blockers
- Thiazide diuretics (Correct answer)
- Calcium channel blockers
Correct answer: Thiazide diuretics
Thiazide diuretics, especially hydrochlorothiazide, frequently cause hyponatremia in elderly patients due to impaired water excretion and syndrome of inappropriate ADH.
Question 3: An elderly patient on digoxin develops nausea, visual disturbances, and bradycardia. Which electrolyte abnormality most likely precipitated toxicity?
- Hyperkalemia
- Hyponatremia
- Hypokalemia (Correct answer)
- Hypercalcemia
Correct answer: Hypokalemia
Hypokalemia sensitizes the myocardium to digoxin toxicity by competing for the same Na-K-ATPase binding site, even at therapeutic digoxin levels.
Question 4: According to the STOPP/START criteria, which medication should be STARTED in an eligible elderly patient that is commonly omitted?
- Prophylactic anticoagulation in atrial fibrillation with high stroke risk (Correct answer)
- Long-acting benzodiazepines for insomnia
- Routine NSAIDs for osteoarthritis pain
- Antipsychotics for mild dementia behavioral symptoms
Correct answer: Prophylactic anticoagulation in atrial fibrillation with high stroke risk
START criteria identify underuse of beneficial therapies; anticoagulation for AF with high stroke risk (CHA2DS2-VASc ≥2) is frequently omitted in elderly due to bleeding concerns.
Question 5: Which opioid is listed on the Beers Criteria as particularly problematic in elderly patients due to its toxic metabolite accumulation?
- Oxycodone
- Morphine
- Meperidine (Correct answer)
- Tramadol
Correct answer: Meperidine
Meperidine's metabolite normeperidine accumulates in elderly due to reduced renal clearance and causes CNS excitation, seizures, and delirium.
Question 6: What is the primary pharmacodynamic change that makes elderly patients more sensitive to benzodiazepines at lower plasma concentrations?
- Increased hepatic metabolism producing more active metabolites
- Increased GABA-A receptor sensitivity in the CNS (Correct answer)
- Decreased protein binding increasing free drug levels
- Enhanced intestinal absorption of benzodiazepines
Correct answer: Increased GABA-A receptor sensitivity in the CNS
Aging increases sensitivity of GABA-A receptors to benzodiazepines, causing greater CNS effects (sedation, cognitive impairment, falls) at the same plasma levels.
Question 7: A consultant pharmacist reviews a 78-year-old's medication list and identifies anticholinergic burden as high. Which tool is most appropriate for quantifying this risk?
- Beers Criteria score
- Anticholinergic Cognitive Burden (ACB) scale (Correct answer)
- Morisky Medication Adherence Scale
- STOPP/START version 2 checklist
Correct answer: Anticholinergic Cognitive Burden (ACB) scale
The Anticholinergic Cognitive Burden (ACB) scale assigns scores to individual medications to quantify cumulative anticholinergic burden and cognitive risk.
CCP Geriatric Pharmacology 3
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?