CCP Polypharmacy & Medication Reconciliation 2 — Questions and Answers
Question 1: A 78-year-old patient is admitted with confusion. Her medication list includes an anticholinergic, a benzodiazepine, and an opioid. Which tool is most appropriate to assess her anticholinergic burden?
- Beers Criteria
- Anticholinergic Cognitive Burden (ACB) scale (Correct answer)
- STOPP/START criteria
- Medication Appropriateness Index (MAI)
Correct answer: Anticholinergic Cognitive Burden (ACB) scale
The Anticholinergic Cognitive Burden (ACB) scale specifically quantifies cumulative anticholinergic drug effects linked to cognitive impairment.
Question 2: During medication reconciliation at hospital discharge, a discrepancy is found between the patient's home medication list and the discharge prescription. What is the FIRST action the care coordinator should take?
- Dispense medications as listed on the discharge prescription
- Contact the prescribing physician to clarify the discrepancy (Correct answer)
- Educate the patient about both versions of the medication list
- Document the discrepancy and schedule a follow-up call
Correct answer: Contact the prescribing physician to clarify the discrepancy
Unexplained discrepancies must be resolved with the prescribing provider before the patient leaves to prevent medication errors.
Question 3: Which of the following medication combinations most commonly causes a clinically significant drug-drug interaction leading to bleeding risk?
- Metformin and lisinopril
- Warfarin and NSAIDs (Correct answer)
- Metoprolol and amlodipine
- Atorvastatin and levothyroxine
Correct answer: Warfarin and NSAIDs
NSAIDs combined with warfarin increase bleeding risk through both antiplatelet effects and GI mucosal damage.
Question 4: A care manager reviews a patient on 12 medications. Which outcome is MOST directly associated with polypharmacy in older adults?
- Improved medication adherence
- Increased fall risk (Correct answer)
- Reduced healthcare utilization
- Better chronic disease control
Correct answer: Increased fall risk
Polypharmacy in older adults significantly increases fall risk due to sedative, hypotensive, and anticholinergic drug effects.
Question 5: A patient taking metformin is prescribed contrast dye for a CT scan. What medication management step is required?
- Increase the metformin dose 24 hours before the procedure
- Hold metformin before and 48 hours after contrast administration (Correct answer)
- Switch to insulin permanently before the procedure
- No change is needed as metformin is safe with contrast
Correct answer: Hold metformin before and 48 hours after contrast administration
Metformin must be held around contrast use to prevent lactic acidosis if contrast-induced nephropathy occurs.
Question 6: In medication reconciliation, which setting presents the HIGHEST risk for medication discrepancies due to incomplete information transfer?
- Primary care office visit
- Care transitions between hospital and skilled nursing facility (Correct answer)
- Annual wellness visit
- Telephonic medication review
Correct answer: Care transitions between hospital and skilled nursing facility
Care transitions between facilities carry the highest discrepancy risk because medication lists must be transferred across different healthcare systems.
Question 7: Which class of medications is most commonly identified as potentially inappropriate in older adults according to the Beers Criteria?
- ACE inhibitors
- Benzodiazepines (Correct answer)
- Beta-blockers
- Thiazide diuretics
Correct answer: Benzodiazepines
Benzodiazepines are prominently listed on the Beers Criteria due to cognitive impairment, delirium, falls, and fracture risk in older adults.
CCP Polypharmacy & Medication Reconciliation 2
A 78-year-old patient is admitted with confusion.
Her medication list includes an anticholinergic, a benzodiazepine, and an opioid.
Which tool is most appropriate to assess her anticholinergic burden?