MTM Geriatric Pharmacotherapy 2 — Questions and Answers
Question 1: Which pharmacokinetic change in older adults most significantly increases the risk of accumulation of lipophilic drugs like diazepam?
- Decreased renal clearance
- Increased volume of distribution due to higher body fat (Correct answer)
- Reduced hepatic first-pass metabolism
- Decreased protein binding
Correct answer: Increased volume of distribution due to higher body fat
Aging increases body fat relative to lean mass, expanding the volume of distribution for lipophilic drugs and prolonging their half-life.
Question 2: An 80-year-old woman is prescribed naproxen for osteoarthritis. Which risk is of greatest concern in this patient?
- Serotonin syndrome
- GI bleeding and renal impairment (Correct answer)
- QT prolongation
- Hepatotoxicity
Correct answer: GI bleeding and renal impairment
NSAIDs in older adults carry significant risk of GI bleeding and renal impairment, making them potentially inappropriate per Beers Criteria.
Question 3: A 75-year-old male with heart failure and atrial fibrillation is on digoxin. His renal function has declined (CrCl 30 mL/min). What is the most appropriate action?
- Increase the dose to compensate for reduced absorption
- Reduce the digoxin dose and monitor serum levels closely (Correct answer)
- Switch to amiodarone immediately
- Discontinue digoxin without replacement
Correct answer: Reduce the digoxin dose and monitor serum levels closely
Digoxin is renally cleared and requires dose reduction in renal impairment to avoid toxicity; serum level monitoring is essential.
Question 4: Which medication class is most associated with causing orthostatic hypotension and falls in elderly patients?
- Proton pump inhibitors
- Alpha-1 adrenergic blockers (Correct answer)
- Inhaled corticosteroids
- Topical antihistamines
Correct answer: Alpha-1 adrenergic blockers
Alpha-1 blockers reduce vascular tone and can cause significant orthostatic hypotension, increasing fall risk in older adults.
Question 5: What is the recommended starting principle when initiating pharmacotherapy in geriatric patients?
- Start high, go slow
- Start low, go slow (Correct answer)
- Use standard adult doses to ensure efficacy
- Avoid all medications until non-pharmacologic options fail for 6 months
Correct answer: Start low, go slow
'Start low, go slow' minimizes the risk of adverse effects due to age-related pharmacokinetic and pharmacodynamic changes in older adults.
Question 6: Which antihypertensive class is considered first-line and well-tolerated in older adults with isolated systolic hypertension?
- Non-selective beta-blockers
- Central alpha-2 agonists like clonidine
- Thiazide diuretics or calcium channel blockers (Correct answer)
- Loop diuretics
Correct answer: Thiazide diuretics or calcium channel blockers
Thiazide diuretics and dihydropyridine calcium channel blockers are preferred first-line agents for isolated systolic hypertension in older adults.
Question 7: An older patient is on multiple medications including a tricyclic antidepressant. Which anticholinergic side effect is most dangerous in the elderly?
- Dry mouth
- Urinary retention and cognitive impairment (Correct answer)
- Mild constipation
- Reduced sweating
Correct answer: Urinary retention and cognitive impairment
Anticholinergic drugs in the elderly commonly cause urinary retention and cognitive impairment, which are serious and often underrecognized adverse effects.
MTM Geriatric Pharmacotherapy 2
Which pharmacokinetic change in older adults most significantly increases the risk of accumulation of lipophilic drugs like diazepam?