Drug safety evaluation in geriatrics MCQs With Answer

Drug safety evaluation in geriatrics is an essential subject for B.Pharm students learning to reduce medication-related harm in older adults. Age-related changes in pharmacokinetics and pharmacodynamics, plus comorbidities and polypharmacy, increase risks of adverse drug reactions, drug–drug interactions, and prescribing cascades. Important keywords include drug safety evaluation, geriatrics, pharmacokinetics, pharmacodynamics, polypharmacy, adverse drug reactions, dose adjustment, renal dosing, Beers criteria, therapeutic drug monitoring, and medication reconciliation. Practical knowledge of frailty, cognitive impairment, adherence, formulation choice, and deprescribing strategies helps optimize therapy and patient outcomes. This concise, clinically focused overview prepares you for applied questions. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which age-related pharmacokinetic change most commonly increases the half-life of lipophilic drugs in older adults?

• Increased total body water
• Decreased body fat
• Increased hepatic blood flow
• Increased body fat

Correct Answer: Increased body fat

Q2. Which renal function estimate is most appropriate for drug dosing in elderly patients with reduced muscle mass?

• Serum creatinine alone
• Cockcroft-Gault creatinine clearance
• Ideal body weight formula only
• Measured 24-hour urine creatinine without adjustment

Correct Answer: Cockcroft-Gault creatinine clearance

Q3. According to Beers criteria, which class of drugs is generally considered high-risk and should be avoided for insomnia in older adults?

• Selective serotonin reuptake inhibitors (SSRIs)
• Benzodiazepines
• Zinc supplements
• Beta blockers

Correct Answer: Benzodiazepines

Q4. A prescribing cascade is best described as:

• Adding a drug to treat a symptom caused by another drug
• Switching brands of the same drug
• Stopping all medications abruptly
• Converting oral drugs to transdermal forms

Correct Answer: Adding a drug to treat a symptom caused by another drug

Q5. Which monitoring is most critical when initiating digoxin in a frail elderly patient?

• Serum potassium and renal function with therapeutic drug monitoring
• Complete blood count weekly
• Liver function tests monthly
• Fasting lipid profile

Correct Answer: Serum potassium and renal function with therapeutic drug monitoring

Q6. Older adults often have decreased serum albumin. Which effect on highly protein-bound drugs is expected?

• Decreased free drug concentration
• Increased protein binding capacity
• Increased free (unbound) drug concentration and potential toxicity
• No change in pharmacologic effect

Correct Answer: Increased free (unbound) drug concentration and potential toxicity

Q7. Polypharmacy is commonly defined in geriatrics as the concurrent use of how many medications?

• 2 or more
• 5 or more
• 10 or more
• 20 or more

Correct Answer: 5 or more

Q8. Which of the following changes in pharmacodynamics increases sensitivity to anticoagulants like warfarin in older adults?

• Enhanced hepatic CYP2C9 activity
• Increased vitamin K intake
• Reduced homeostatic reserve and greater bleeding risk
• Increased muscle mass

Correct Answer: Reduced homeostatic reserve and greater bleeding risk

Q9. When assessing medication appropriateness in an elderly patient, which tool focuses on STOPP (Screening Tool of Older Persons’ Prescriptions) criteria?

• NIH Stroke Scale
• STOPP/START criteria
• APGAR score
• Framingham risk score

Correct Answer: STOPP/START criteria

Q10. Which adverse effect risk is particularly increased with anticholinergic burden in older adults?

• Hypoglycemia
• Cognitive impairment and delirium
• Neutropenia
• Ototoxicity

Correct Answer: Cognitive impairment and delirium

Q11. For an elderly patient with reduced creatinine clearance, which antibiotic dosage adjustment principle is most appropriate?

• Increase dose and shorten interval
• Reduce dose or extend dosing interval depending on drug elimination
• No adjustment required for time-dependent antibiotics
• Avoid all antibiotics

Correct Answer: Reduce dose or extend dosing interval depending on drug elimination

Q12. Which class of analgesics poses the highest risk for gastrointestinal bleeding and renal impairment in older adults?

• Acetaminophen
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Topical lidocaine
• Tricyclic antidepressants

Correct Answer: Nonsteroidal anti-inflammatory drugs (NSAIDs)

Q13. Therapeutic drug monitoring (TDM) is especially useful for which scenario in geriatrics?

• Short-acting antihistamines
• Drugs with narrow therapeutic index and variable pharmacokinetics (e.g., lithium, digoxin)
• Over-the-counter vitamins
• Topical emollients

Correct Answer: Drugs with narrow therapeutic index and variable pharmacokinetics (e.g., lithium, digoxin)

Q14. Which intervention most effectively reduces polypharmacy-related harm during care transitions?

• Increasing all chronic medication doses
• Medication reconciliation and review at admission and discharge
• Stopping all preventive medications
• Switching to brand-name drugs only

Correct Answer: Medication reconciliation and review at admission and discharge

Q15. Which pharmacokinetic change commonly reduces clearance of renally excreted drugs in elderly patients?

• Increased glomerular filtration rate
• Reduced renal blood flow and GFR
• Enhanced tubular secretion
• Increased renal mass

Correct Answer: Reduced renal blood flow and GFR

Q16. In geriatric prescribing, what is the main purpose of deprescribing?

• To add more specialist medications
• To systematically reduce or stop medicines that are no longer beneficial or cause harm
• To switch from generic to brand-name formulations
• To increase the total number of medications

Correct Answer: To systematically reduce or stop medicines that are no longer beneficial or cause harm

Q17. Which oral formulation change is often appropriate for older patients with dysphagia?

• Converting all tablets to crushed forms without checking stability
• Using liquid formulations, dispersible tablets, or transdermal options when appropriate
• Doubling tablet sizes to improve swallowing
• Switching to injectable formulations for convenience

Correct Answer: Using liquid formulations, dispersible tablets, or transdermal options when appropriate

Q18. An elderly patient on warfarin starts amiodarone. Which interaction is most likely?

• Decreased INR due to induction of warfarin metabolism
• Increased INR due to inhibition of warfarin metabolism
• No interaction
• Immediate warfarin inactivation

Correct Answer: Increased INR due to inhibition of warfarin metabolism

Q19. Which assessment is most useful to evaluate fall risk associated with medications in older adults?

• Fracture risk only
• Medication review emphasizing sedatives, antihypertensives, and anticholinergics
• Dental check-up
• Hearing test

Correct Answer: Medication review emphasizing sedatives, antihypertensives, and anticholinergics

Q20. In older patients, decreased first-pass hepatic metabolism typically results in:

• Lower systemic bioavailability of orally administered drugs
• Higher systemic bioavailability of certain drugs and increased effect/toxicity
• No change in oral drug absorption
• Faster elimination of drugs

Correct Answer: Higher systemic bioavailability of certain drugs and increased effect/toxicity

Q21. Which anticoagulant consideration is particularly relevant for elderly patients with fluctuating renal function?

• DOAC dosing may require adjustment or avoidance for low creatinine clearance
• Warfarin does not require INR monitoring
• All anticoagulants are safe without monitoring
• Aspirin provides equivalent stroke prevention in atrial fibrillation

Correct Answer: DOAC dosing may require adjustment or avoidance for low creatinine clearance

Q22. Which adverse effect is commonly associated with tricyclic antidepressants in the elderly?

• Improved urinary flow
• Anticholinergic effects like urinary retention, constipation, and confusion
• Enhanced cognitive function
• Reduced fall risk

Correct Answer: Anticholinergic effects like urinary retention, constipation, and confusion

Q23. What is the best pharmacovigilance action when a new serious adverse drug reaction is suspected in an elderly inpatient?

• Ignore mild symptoms
• Report the event through institutional pharmacovigilance channels and reassess therapy
• Immediately switch to a similar class drug without reporting
• Document only in nursing notes

Correct Answer: Report the event through institutional pharmacovigilance channels and reassess therapy

Q24. Which parameter should be prioritized when using aminoglycosides in older adults?

• Peak levels only
• Trough levels and renal function monitoring to avoid nephrotoxicity
• No monitoring required
• Daily liver function tests

Correct Answer: Trough levels and renal function monitoring to avoid nephrotoxicity

Q25. Which strategy reduces anticholinergic burden in older patients with multiple medications?

• Add an anticholinergic to counter side effects
• Perform medication review and substitute or stop anticholinergic drugs
• Increase dose of anticholinergic drugs to overcome tolerance
• Ignore anticholinergic scoring tools

Correct Answer: Perform medication review and substitute or stop anticholinergic drugs

Q26. A drug with a large volume of distribution that is lipophilic will likely show which change in elderly patients?

• Decreased apparent volume of distribution due to lower fat
• Increased half-life due to increased adipose storage
• Rapid elimination with unchanged half-life
• Complete renal elimination

Correct Answer: Increased half-life due to increased adipose storage

Q27. Which of the following is a common cause of non-adherence to medications in older adults?

• Perfect vision and hearing
• Complex regimens, cost, cognitive impairment, and side effects
• Excessive patient education
• Only single-pill once-daily regimens

Correct Answer: Complex regimens, cost, cognitive impairment, and side effects

Q28. Which statement about benzodiazepine use in the elderly is correct?

• Short-term use carries no risk and requires no monitoring
• They increase risk of cognitive impairment, falls, and should be minimized or avoided
• They are first-line for chronic insomnia in older adults
• They have faster metabolism in older adults

Correct Answer: They increase risk of cognitive impairment, falls, and should be minimized or avoided

Q29. When evaluating a suspected adverse drug reaction in an elderly patient, which approach is recommended?

• Maintain all current drugs and assume disease progression
• Use a systematic causality assessment, consider dechallenge/rechallenge where safe, and review interactions
• Immediately stop every medication
• Ignore medication history

Correct Answer: Use a systematic causality assessment, consider dechallenge/rechallenge where safe, and review interactions

Q30. Which educational intervention most effectively helps reduce medication errors in older outpatients?

• One-time verbal instructions without written summary
• Clear patient-centered counseling, written medication list, and follow-up
• Only prescribing more medications to cover symptoms
• Providing complex medical journals to patients

Correct Answer: Clear patient-centered counseling, written medication list, and follow-up

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