PSA Prescribing in Special Populations 1 — Questions and Answers
Question 1: Why do elderly patients require special prescribing considerations?
- Altered pharmacokinetics (reduced kidney/liver function, body composition changes) and increased sensitivity to many drugs (Correct answer)
- Elderly patients metabolize drugs faster
- No special considerations are needed
- Only psychological factors matter
Correct answer: Altered pharmacokinetics (reduced kidney/liver function, body composition changes) and increased sensitivity to many drugs
Aging reduces kidney and liver function, changes body fat distribution, and increases drug sensitivity, requiring lower doses and careful monitoring.
Question 2: What is the principle of 'start low, go slow' in elderly prescribing?
- Begin with the lowest effective dose and increase gradually to minimize adverse effects (Correct answer)
- Always use the maximum dose
- Start with a loading dose
- Change medications frequently
Correct answer: Begin with the lowest effective dose and increase gradually to minimize adverse effects
This approach minimizes adverse drug reactions in elderly patients by starting at a reduced dose and titrating up slowly based on response and tolerability.
Question 3: What prescribing risks exist during pregnancy?
- Drugs may cross the placenta and cause teratogenic effects on the developing fetus (Correct answer)
- All drugs are safe during pregnancy
- Only intravenous drugs pose risks
- Risk only exists in the third trimester
Correct answer: Drugs may cross the placenta and cause teratogenic effects on the developing fetus
Many drugs cross the placenta and can harm fetal development, especially during the first trimester. Benefits must clearly outweigh risks for any prescribed medication.
Question 4: Why is prescribing in children different from adults?
- Children have different body composition, metabolism rates, and organ maturity affecting drug handling (Correct answer)
- Children are just small adults
- The same doses work for all ages
- Only the route of administration changes
Correct answer: Children have different body composition, metabolism rates, and organ maturity affecting drug handling
Children are not miniature adults: their drug metabolism, body water content, organ function, and body surface area differ significantly, requiring weight-based or surface-area-based dosing.
Question 5: What considerations apply to prescribing in renal impairment?
- Drug accumulation risk requires dose reduction or interval extension for renally-eliminated drugs (Correct answer)
- All drugs are safe in renal impairment
- Only kidney drugs need adjustment
- Renal impairment does not affect drug levels
Correct answer: Drug accumulation risk requires dose reduction or interval extension for renally-eliminated drugs
Impaired kidneys cannot excrete drugs normally, causing accumulation. Dose adjustments based on creatinine clearance or eGFR are essential for renally-eliminated drugs.
Question 6: What is polypharmacy and why is it a concern?
- The use of multiple medications, increasing the risk of drug interactions, adverse effects, and non-adherence (Correct answer)
- Taking vitamins with medications
- Using more than one pharmacy
- Prescribing one drug for multiple conditions
Correct answer: The use of multiple medications, increasing the risk of drug interactions, adverse effects, and non-adherence
Polypharmacy (typically 5+ medications) exponentially increases interaction risks, adverse effects, medication errors, and makes adherence more difficult.
PSA Prescribing in Special Populations 1
Why do elderly patients require special prescribing considerations?