MTM Geriatric Pharmacotherapy 3

Question 1

Which lab finding would most strongly suggest digoxin toxicity in an elderly patient?

Accepted Answer

Serum digoxin level of 2.5 ng/mL with nausea and bradycardia

Answer

A digoxin level above 2.0 ng/mL combined with symptoms like nausea and bradycardia is consistent with toxicity, especially in older adults.

Question 2

Which opioid is considered INAPPROPRIATE for use in older adults due to toxic metabolite accumulation?

Accepted Answer

Meperidine

Answer

Meperidine accumulates normeperidine, a neurotoxic metabolite that can cause seizures, especially in patients with renal impairment common in the elderly.

Question 3

A 78-year-old woman with a history of falls is prescribed a long-acting benzodiazepine for anxiety. What is the MTM pharmacist's most appropriate intervention?

Accepted Answer

Recommend switching to a short-acting agent or non-benzodiazepine anxiolytic

Answer

Long-acting benzodiazepines increase fall and fracture risk in older adults; transitioning to safer alternatives is recommended per Beers Criteria.

Question 4

Which parameter best reflects kidney function for dosing purposes in older adults when using creatinine-based estimates?

Accepted Answer

Creatinine clearance estimated by Cockcroft-Gault using actual body weight

Answer

Cockcroft-Gault using actual body weight is most commonly used for drug dosing in older adults despite its limitations with very low muscle mass.

Question 5

Which condition makes warfarin therapy particularly challenging to manage in older adults, increasing bleeding risk?

Accepted Answer

Polypharmacy with drug-drug interactions and variable dietary vitamin K

Answer

Polypharmacy and inconsistent dietary vitamin K intake in older adults cause INR fluctuations, significantly increasing the risk of over-anticoagulation and bleeding.

(MTM) Medication Therapy Management Board Certification Practice Test

(MTM) Medication Therapy Management Board Certification Practice Test

MTM Geriatric Pharmacotherapy 3