PSA Prescribing in Special Populations 2

Question 1

An 80-year-old patient with CrCl 25 mL/min is prescribed gentamicin for a severe infection. What is the most important prescribing consideration?

Accepted Answer

Reduce the dose and extend the dosing interval

Answer

Aminoglycosides are renally cleared and nephrotoxic; dose reduction and extended dosing intervals are essential in renal impairment to avoid accumulation and toxicity.

Question 2

A 70-year-old woman with type 2 diabetes is prescribed metformin. Her eGFR is 30 mL/min/1.73m². What is the most appropriate action?

Accepted Answer

Discontinue metformin due to risk of lactic acidosis

Answer

Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to accumulation and risk of lactic acidosis.

Question 3

Which drug is MOST likely to require dose reduction in a patient with severe hepatic impairment?

Accepted Answer

Morphine

Answer

Morphine undergoes extensive hepatic metabolism; severe hepatic impairment reduces its clearance, leading to accumulation and increased risk of toxicity.

Question 4

An 85-year-old patient on warfarin is given a new prescription for ibuprofen. What is the most significant prescribing concern?

Accepted Answer

Increased bleeding risk and potential renal impairment

Answer

NSAIDs inhibit platelet function and increase GI bleeding risk while also potentially causing renal impairment, particularly dangerous in elderly patients on warfarin.

Question 5

A patient with CrCl 15 mL/min requires regular analgesia. Which opioid should be used with the most caution?

Accepted Answer

Morphine

Answer

Morphine's active metabolite morphine-6-glucuronide accumulates in renal failure, causing prolonged sedation and respiratory depression.

(PSA) Prescribing Safety Assessment Practice Test

(PSA) Prescribing Safety Assessment Practice Test

PSA Prescribing in Special Populations 2