In a world of polypharmacy, sometimes the best prescription is a ‘discontinuation.’ Deprescribing is the planned, supervised process of stopping medications that are no longer beneficial or may be causing harm. This essential practice, particularly in geriatric care, improves quality of life and reduces the risk of adverse events. This quiz for PharmD students will test your knowledge on the principles, processes, and patient-centered communication skills required for safe and effective deprescribing.
1. Deprescribing is best defined as:
- The patient deciding on their own to stop taking a medication.
- The planned and supervised process of dose reduction or stopping of a medication that is no longer of benefit.
- Switching a brand-name drug to a generic equivalent.
- A failure of the medication to achieve its therapeutic effect.
Answer: The planned and supervised process of dose reduction or stopping of a medication that is no longer of benefit.
2. Which patient population is the primary target for deprescribing initiatives?
- Pediatric patients with acute infections.
- Healthy young adults.
- Older adults with polypharmacy and multiple comorbidities.
- Pregnant patients.
Answer: Older adults with polypharmacy and multiple comorbidities.
3. A “prescribing cascade” is a key trigger for deprescribing. It occurs when:
- A patient is prescribed multiple medications by different specialists.
- An adverse drug reaction is mistaken for a new medical condition, and a new drug is prescribed to treat it.
- A patient refuses to take a prescribed medication.
- A drug’s dose is slowly titrated up to the maximum level.
Answer: An adverse drug reaction is mistaken for a new medical condition, and a new drug is prescribed to treat it.
4. The first step in the deprescribing process is:
- Immediately stopping the target medication.
- Conducting a comprehensive medication review to get an accurate list of all medications the patient is taking.
- Calling the patient’s insurance company.
- Asking the patient which medication they would like to stop.
Answer: Conducting a comprehensive medication review to get an accurate list of all medications the patient is taking.
5. Tools like the Beers Criteria are used to help clinicians:
- Calculate drug dosages for pediatric patients.
- Identify Potentially Inappropriate Medications (PIMs) in older adults that could be targets for deprescribing.
- Choose the most expensive therapy available.
- Diagnose new medical conditions.
Answer: Identify Potentially Inappropriate Medications (PIMs) in older adults that could be targets for deprescribing.
6. Which of the following represents a valid reason to consider deprescribing a medication?
- The medication is treating a condition that has resolved.
- The patient is experiencing a significant adverse drug event from the medication.
- The goals of care have changed, and the medication no longer aligns with those goals (e.g., aggressive statin therapy in a hospice patient).
- All of the above.
Answer: All of the above.
7. A pharmacist is considering recommending the discontinuation of a benzodiazepine that an older adult has been taking for years. A major concern that must be managed is:
- The risk of a hypertensive crisis.
- The risk of withdrawal symptoms.
- The development of a severe skin rash.
- The potential for liver damage.
Answer: The risk of withdrawal symptoms.
8. The most effective way to approach deprescribing with a patient is through:
- A paternalistic approach where the pharmacist dictates which medications will be stopped.
- A shared decision-making process, discussing the risks and benefits with the patient and/or caregiver.
- Sending the patient a letter in the mail informing them of the change.
- Stopping the medication without informing the patient.
Answer: A shared decision-making process, discussing the risks and benefits with the patient and/or caregiver.
9. Which class of medications is a common target for deprescribing in older adults due to its high risk of anticholinergic side effects, confusion, and falls?
- Statins
- First-generation antihistamines like diphenhydramine.
- Vitamin supplements
- ACE inhibitors
Answer: First-generation antihistamines like diphenhydramine.
10. After a medication has been deprescribed, what is the crucial final step of the process?
- Assuming the patient will be fine and no further action is needed.
- Monitoring the patient for withdrawal symptoms or the return of the condition being treated, and documenting the outcome.
- Immediately starting a new medication in its place.
- Removing the medication from the patient’s profile without any notes.
Answer: Monitoring the patient for withdrawal symptoms or the return of the condition being treated, and documenting the outcome.
11. Identifying “unnecessary drug therapy” is a core part of a Comprehensive Medication Review (CMR) and a primary driver for:
- Prescribing more medications.
- Deprescribing.
- Increasing the dose of a medication.
- Switching to a more expensive alternative.
Answer: Deprescribing.
12. When should a pharmacist create a tapering plan for a medication?
- When the medication is known to cause significant withdrawal effects upon abrupt discontinuation.
- For all medications, regardless of their mechanism.
- Only when the patient requests it.
- Never; all medications can be stopped abruptly.
Answer: When the medication is known to cause significant withdrawal effects upon abrupt discontinuation.
13. A patient’s goal of care has shifted from curative treatment to palliative comfort care. This change is a strong trigger to:
- Increase the number of preventive medications.
- Deprescribe medications that are unlikely to provide benefit in the patient’s remaining lifespan (e.g., statins for primary prevention).
- Start aggressive, high-dose chemotherapy.
- Add more complex medications to the regimen.
Answer: Deprescribe medications that are unlikely to provide benefit in the patient’s remaining lifespan (e.g., statins for primary prevention).
14. A common barrier to deprescribing from a patient’s perspective is:
- The desire to take fewer pills.
- The belief that every medication they take is essential for their health.
- The high cost of stopping a medication.
- A lack of side effects from their current regimen.
Answer: The belief that every medication they take is essential for their health.
15. To overcome a patient’s reluctance to stop a medication, a sensitive pharmacist could say:
- “You must stop this medication immediately.”
- “This pill isn’t doing anything for you.”
- “I understand you’ve been taking this for a long time. Let’s talk about the potential risks of continuing it versus the benefits you are getting from it now.”
- “Your doctor was wrong to prescribe this.”
Answer: “I understand you’ve been taking this for a long time. Let’s talk about the potential risks of continuing it versus the benefits you are getting from it now.”
16. Which of the following drug classes is a common target for deprescribing due to concerns about long-term risks like fractures and infections, especially when the indication is not strong?
- Metformin
- Lisinopril
- Atorvastatin
- Proton Pump Inhibitors (PPIs)
Answer: Proton Pump Inhibitors (PPIs)
17. The pharmacist’s communication with the primary prescriber about a deprescribing recommendation should include:
- A clear rationale for why the medication should be stopped.
- A suggested tapering schedule, if applicable.
- A plan for monitoring the patient after discontinuation.
- All of the above.
Answer: All of the above.
18. What is the difference between deprescribing and non-adherence?
- They are the same thing.
- Non-adherence is a planned process, while deprescribing is not.
- Deprescribing is a supervised, clinical decision, while non-adherence is the patient not taking the medication as prescribed.
- Deprescribing is always initiated by the patient.
Answer: Deprescribing is a supervised, clinical decision, while non-adherence is the patient not taking the medication as prescribed.
19. A key skill for a pharmacist leading a deprescribing initiative is:
- Effective communication with patients and providers.
- A deep understanding of geriatric pharmacology.
- The ability to evaluate evidence.
- All of the above.
Answer: All of the above.
20. A “drug holiday” can be considered a form of temporary deprescribing to:
- Assess if an adverse effect resolves.
- Determine if the medication is still providing a benefit.
- Give the patient a break from a complex regimen.
- All of the above.
Answer: All of the above.
21. In which patient would a pharmacist be most likely to question the appropriateness of tight glycemic control (e.g., A1c < 7%) and consider deprescribing?
- A 45-year-old with newly diagnosed type 2 diabetes.
- A 55-year-old with diabetes and hypertension.
- A frail 88-year-old with dementia and multiple comorbidities.
- A 65-year-old who is otherwise healthy and active.
Answer: A frail 88-year-old with dementia and multiple comorbidities.
22. A major system-level barrier to widespread deprescribing is:
- A healthcare culture that often favors starting medications over stopping them (“prescribing inertia”).
- A lack of medications that can be safely stopped.
- The refusal of all patients to stop any medication.
- The high cost of stopping a medication.
Answer: A healthcare culture that often favors starting medications over stopping them (“prescribing inertia”).
23. The evidence evaluation skills learned in pharmacy school are crucial for deprescribing because:
- They help a pharmacist determine if the original evidence for a drug’s use applies to their specific elderly patient.
- They are only useful for starting new medications.
- They allow the pharmacist to ignore all clinical guidelines.
- They are not relevant to the process.
Answer: They help a pharmacist determine if the original evidence for a drug’s use applies to their specific elderly patient.
24. Which of the following is NOT a good reason to deprescribe a medication?
- The patient is experiencing intolerable side effects.
- The medication is treating a problem that no longer exists.
- The patient is adherent and the medication is effectively treating a chronic condition with no side effects.
- A safer or more effective alternative is available.
Answer: The patient is adherent and the medication is effectively treating a chronic condition with no side effects.
25. A pharmacist’s role in deprescribing aligns with which ethical principle?
- Non-maleficence (do no harm) by removing a potentially harmful agent.
- Beneficence by improving quality of life.
- Autonomy by involving the patient in the decision.
- All of the above.
Answer: All of the above.
26. A common challenge in deprescribing is:
- The lack of clear guidelines on how to stop many chronic medications.
- The fact that all medications have clear stopping instructions on the label.
- The ease of communicating with all of a patient’s prescribers.
- The universal agreement among all clinicians on when to stop a drug.
Answer: The lack of clear guidelines on how to stop many chronic medications.
27. A patient says, “My doctor started me on this pill 20 years ago, so it must be important.” This statement represents:
- A patient-level barrier to deprescribing.
- A valid clinical reason to continue the medication.
- A sign that the medication is working effectively.
- A request to increase the dose.
Answer: A patient-level barrier to deprescribing.
28. An effective strategy to manage benzodiazepine withdrawal during deprescribing is:
- Abrupt discontinuation.
- A slow, gradual taper over several weeks or months.
- Switching to a different benzodiazepine.
- Adding another sedative to the regimen.
Answer: A slow, gradual taper over several weeks or months.
29. The ultimate goal of deprescribing is to:
- Stop as many medications as possible, regardless of the outcome.
- Improve the patient’s overall health outcomes and quality of life.
- Reduce the pharmacy’s inventory.
- Save the insurance company money.
Answer: Improve the patient’s overall health outcomes and quality of life.
30. Which of the following is a common symptom of antidepressant discontinuation syndrome?
- Dizziness, fatigue, and “zapping” sensations.
- Improved mood.
- Increased energy.
- Weight loss.
Answer: Dizziness, fatigue, and “zapping” sensations.
31. Involving a caregiver in a deprescribing conversation is important because:
- The caregiver may be the one administering the medication.
- The caregiver can provide valuable insight into the patient’s daily function and side effects.
- The caregiver will need to understand and support the tapering plan.
- All of the above.
Answer: All of the above.
32. Deprescribing is an essential component of managing which geriatric syndrome?
- Polypharmacy.
- Hearing loss.
- Vision impairment.
- Arthritis.
Answer: Polypharmacy.
33. Before recommending to stop a medication, the pharmacist must confirm:
- The original indication for the medication.
- That the medication has a generic available.
- The patient’s preferred pharmacy.
- The color of the tablet.
Answer: The original indication for the medication.
34. A deprescribing “algorithm” or “protocol” can help a clinician:
- Make decisions without any clinical judgment.
- Follow a structured, evidence-based process for considering when and how to stop a medication.
- Replace the need for patient communication.
- Guarantee a successful outcome.
Answer: Follow a structured, evidence-based process for considering when and how to stop a medication.
35. A pharmacist is reviewing an 85-year-old patient on 15 medications who just had a fall. This event should trigger the pharmacist to:
- Add a calcium supplement to the regimen.
- Review the medication list for drugs that increase fall risk and could be candidates for deprescribing.
- Recommend a walker.
- Assume the fall was accidental and unrelated to medications.
Answer: Review the medication list for drugs that increase fall risk and could be candidates for deprescribing.
36. Communicating a deprescribing plan to the community pharmacy is crucial to prevent:
- The patient from having to pay a copay.
- The pharmacy from automatically refilling a discontinued medication.
- The pharmacist from counseling the patient.
- The prescription from being transferred.
Answer: The pharmacy from automatically refilling a discontinued medication.
37. Which of the following is a key component of the “monitoring” plan after deprescribing?
- Monitoring for the return of the original symptom or condition.
- Monitoring for withdrawal symptoms.
- Monitoring for improvement in quality of life.
- All of the above.
Answer: All of the above.
38. The “prescribing cascade” can be prevented by:
- Recognizing that new symptoms in a patient on multiple medications may be an ADR.
- Prescribing a new drug for every new symptom.
- Avoiding all communication with the patient.
- Using only brand-name medications.
Answer: Recognizing that new symptoms in a patient on multiple medications may be an ADR.
39. Deprescribing a sliding-scale insulin regimen in a frail, elderly patient with dementia is often appropriate because:
- The risks of hypoglycemia and the burden of frequent monitoring outweigh the benefits of tight glycemic control.
- These patients no longer need insulin.
- It is too difficult for the nurse to administer.
- The insulin has expired.
Answer: The risks of hypoglycemia and the burden of frequent monitoring outweigh the benefits of tight glycemic control.
40. A pharmacist’s patient advocacy role often involves initiating conversations about:
- Starting new medications.
- Deprescribing potentially unnecessary or harmful medications.
- The cost of OTC products.
- The pharmacy’s hours of operation.
Answer: Deprescribing potentially unnecessary or harmful medications.
41. Which question can help a pharmacist initiate a deprescribing conversation?
- “Do you feel you are taking any medications that you no longer need?”
- “Are any of your medications causing side effects that bother you?”
- “What are your goals for your health and your medication therapy?”
- All of the above.
Answer: All of the above.
42. A major success of deprescribing is when a patient reports:
- “I feel much better and have fewer side effects since we stopped that one pill.”
- “I want to be put back on all my old medications.”
- “My copays have increased.”
- “I am confused about my medication schedule.”
Answer: “I feel much better and have fewer side effects since we stopped that one pill.”
43. A pharmacist reviewing a patient’s profile sees they are taking two drugs from the same therapeutic class for the same indication. This is a trigger to consider:
- Increasing the dose of both drugs.
- Adding a third drug from the same class.
- Deprescribing one of the drugs as it may be a therapeutic duplication.
- Switching both drugs to a different class.
Answer: Deprescribing one of the drugs as it may be a therapeutic duplication.
44. The “start low, go slow” principle for prescribing in geriatrics has a corresponding principle for deprescribing, which could be described as:
- “Stop high, go fast.”
- “Taper low, go slow.”
- “Stop all at once.”
- “Never stop any medication.”
Answer: “Taper low, go slow.”
45. Which of the following is a leadership practice in the context of deprescribing?
- Developing a systematic deprescribing service or protocol within a healthcare setting.
- Avoiding all conversations about stopping medications.
- Following the prescriber’s orders without question.
- Allowing technicians to make all deprescribing decisions.
Answer: Developing a systematic deprescribing service or protocol within a healthcare setting.
46. Deprescribing is considered a(n) __________, not just a single event.
- Process
- Medication
- Diagnosis
- Side effect
Answer: Process
47. The most important stakeholder in any deprescribing decision is the:
- Pharmacist
- Physician
- Patient.
- Insurance company
Answer: Patient.
48. What is a common fear that acts as a barrier for clinicians to deprescribe?
- The fear of causing harm by stopping a medication that might be providing some benefit.
- The fear of the patient getting better.
- The fear of having less work to do.
- The fear of having to document the change.
Answer: The fear of causing harm by stopping a medication that might be providing some benefit.
49. A pharmacist can overcome a prescriber’s reluctance to deprescribe by:
- Providing a strong, evidence-based rationale for the recommendation.
- Demanding the change be made.
- Stopping the medication without telling the prescriber.
- Telling the patient to find a new doctor.
Answer: Providing a strong, evidence-based rationale for the recommendation.
50. Ultimately, deprescribing is a key professional practice for achieving:
- Medication optimization.
- Higher pharmacy sales.
- More complex regimens.
- Faster dispensing times.
Answer: Medication optimization.
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com