MTM Geriatric Pharmacotherapy 4 — Questions and Answers
Question 1: An elderly patient with type 2 diabetes is prescribed glipizide. What is the primary concern specific to older adults with this medication?
- Hyperkalemia
- Hypoglycemia due to prolonged insulin secretion (Correct answer)
- Lactic acidosis
- Fluid retention
Correct answer: Hypoglycemia due to prolonged insulin secretion
Sulfonylureas like glipizide stimulate insulin secretion regardless of glucose level, increasing hypoglycemia risk in older adults who may not recognize symptoms.
Question 2: Which statement best describes the pharmacodynamic changes relevant to geriatric patients receiving warfarin?
- Older adults require higher doses due to increased clotting factor production
- Older adults have increased sensitivity to warfarin's anticoagulant effect (Correct answer)
- Renal elimination of warfarin is significantly faster in older adults
- Hepatic metabolism of warfarin is enhanced in elderly patients
Correct answer: Older adults have increased sensitivity to warfarin's anticoagulant effect
Older adults exhibit increased pharmacodynamic sensitivity to warfarin, requiring lower doses to achieve the same anticoagulant effect.
Question 3: A 72-year-old man on levodopa/carbidopa for Parkinson's disease develops confusion after starting a new medication. Which drug class is the most likely culprit?
- ACE inhibitors
- Antipsychotics (especially first-generation) (Correct answer)
- Beta-2 agonists
- Calcium supplements
Correct answer: Antipsychotics (especially first-generation)
First-generation antipsychotics block dopamine receptors and can worsen Parkinson's symptoms and cause confusion in older patients.
Question 4: What is the significance of the Medication Appropriateness Index (MAI) in geriatric pharmacotherapy?
- It calculates drug dosing based on kidney function
- It provides a structured 10-criterion tool to assess appropriateness of each medication (Correct answer)
- It ranks medications by their cost-effectiveness in elderly patients
- It is used exclusively to screen for drug-drug interactions
Correct answer: It provides a structured 10-criterion tool to assess appropriateness of each medication
The MAI evaluates each medication against 10 criteria including indication, effectiveness, dosage, directions, interactions, and practicality to ensure appropriateness.
Question 5: An 85-year-old patient with osteoporosis is prescribed alendronate. Which counseling point is most critical to prevent adverse effects?
- Take with a full glass of milk for better absorption
- Take with a full glass of water and remain upright for at least 30 minutes (Correct answer)
- Take at bedtime to improve bone uptake during sleep
- Crush the tablet for easier swallowing
Correct answer: Take with a full glass of water and remain upright for at least 30 minutes
Bisphosphonates must be taken upright with a full glass of water to prevent esophageal irritation and ulceration.
Question 6: Which of the following is a validated screening tool used in clinical practice to identify potentially inappropriate medications in older adults?
- CAGE questionnaire
- American Geriatrics Society Beers Criteria (Correct answer)
- CIWA-Ar scale
- MELD score
Correct answer: American Geriatrics Society Beers Criteria
The AGS Beers Criteria is a widely used evidence-based list of potentially inappropriate medications for adults aged 65 and older.
Question 7: A geriatric patient develops hyponatremia after starting an SSRI. What is the most likely mechanism?
- Sodium wasting through increased renal excretion from direct tubular effects
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH) (Correct answer)
- Increased aldosterone release triggered by the SSRI
- Reduced dietary sodium intake due to nausea
Correct answer: Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
SSRIs can cause SIADH in older adults, leading to dilutional hyponatremia, a potentially serious adverse effect that occurs more commonly in this population.
MTM Geriatric Pharmacotherapy 4
An elderly patient with type 2 diabetes is prescribed glipizide.
What is the primary concern specific to older adults with this medication?