MTM Geriatric Pharmacotherapy 5 — Questions and Answers
Question 1: Which antidiabetic medication is generally preferred in older adults due to its low hypoglycemia risk and cardiovascular benefits?
- Glipizide
- Metformin (if renal function permits) (Correct answer)
- Insulin glargine
- Chlorpropamide
Correct answer: Metformin (if renal function permits)
Metformin does not cause hypoglycemia on its own and has established cardiovascular benefits, making it a preferred first-line agent in eligible older adults.
Question 2: A 77-year-old patient with moderate Alzheimer's disease is prescribed memantine. What is its primary mechanism of action?
- Acetylcholinesterase inhibition
- NMDA receptor antagonism reducing glutamate excitotoxicity (Correct answer)
- Dopamine reuptake inhibition
- GABA-A receptor potentiation
Correct answer: NMDA receptor antagonism reducing glutamate excitotoxicity
Memantine is an NMDA receptor antagonist that reduces pathological glutamate activity believed to contribute to Alzheimer's neurodegeneration.
Question 3: What is the most appropriate blood pressure target for a frail elderly patient (≥80 years) with multiple comorbidities per current guidelines?
- <120/80 mmHg following SPRINT intensive targets
- Individualized target around <150/90 mmHg balancing risk and benefit (Correct answer)
- <100/70 mmHg to fully protect against stroke
- No treatment needed if asymptomatic
Correct answer: Individualized target around <150/90 mmHg balancing risk and benefit
For very elderly or frail patients, individualized targets around 150/90 mmHg are recommended to avoid the harms of over-treatment such as falls and syncope.
Question 4: Which pharmacist intervention is most effective in reducing polypharmacy-related harm in older adults?
- Increasing adherence through automatic refills without review
- Conducting comprehensive medication reviews and deprescribing inappropriate drugs (Correct answer)
- Recommending OTC vitamins to offset drug side effects
- Standardizing all patients to the same medication regimen
Correct answer: Conducting comprehensive medication reviews and deprescribing inappropriate drugs
Comprehensive medication reviews with targeted deprescribing reduce adverse drug events, hospitalizations, and medication burden in geriatric patients.
Question 5: An elderly patient on chronic prednisone therapy should receive which preventive medication to reduce fracture risk?
- A thiazide diuretic to increase calcium reabsorption
- Calcium and vitamin D supplementation with a bisphosphonate (Correct answer)
- A calcitonin nasal spray alone
- A selective estrogen receptor modulator regardless of sex
Correct answer: Calcium and vitamin D supplementation with a bisphosphonate
Patients on chronic corticosteroids require calcium, vitamin D, and bisphosphonate therapy per guidelines to prevent glucocorticoid-induced osteoporosis.
Question 6: Which factor most contributes to altered drug absorption in elderly patients?
- Increased gastric acid secretion
- Delayed gastric emptying and reduced GI motility (Correct answer)
- Thickened intestinal mucosa increasing drug uptake
- Increased splanchnic blood flow
Correct answer: Delayed gastric emptying and reduced GI motility
Reduced GI motility and delayed gastric emptying in older adults slow drug absorption, though overall bioavailability changes are often modest.
Question 7: Which clinical syndrome in elderly patients is characterized by reduced reserve, vulnerability to stressors, and increased risk of adverse drug events?
- Sarcopenia
- Frailty (Correct answer)
- Delirium
- Presbycusis
Correct answer: Frailty
Frailty is a distinct clinical syndrome of diminished physiologic reserve that increases vulnerability to adverse drug reactions and poor outcomes in older adults.
MTM Geriatric Pharmacotherapy 5
Which antidiabetic medication is generally preferred in older adults due to its low hypoglycemia risk and cardiovascular benefits?