Geriatric patient care is a specialized field that requires a unique approach to medication management. Older adults often experience age-related physiological changes that alter drug pharmacokinetics and pharmacodynamics, increasing their susceptibility to adverse drug events. As highlighted in the advanced patient care and skills lab curricula, pharmacists are central to optimizing therapy in this population by addressing challenges like polypharmacy, applying tools like the AGS Beers Criteria® to identify potentially inappropriate medications, and leading deprescribing efforts. This quiz will test your knowledge on the key principles of geriatric pharmacotherapy, from understanding physiological changes to managing complex medication regimens in older adults.
1. Which age-related physiological change most significantly impacts the clearance of renally eliminated drugs in older adults?
- a) Increased liver blood flow.
- b) Decreased gastric acid production.
- c) A decline in glomerular filtration rate (GFR).
- d) An increase in total body water.
Answer: c) A decline in glomerular filtration rate (GFR).
2. The AGS Beers Criteria® is a clinical tool designed to help healthcare providers:
- a) Diagnose dementia in older adults.
- b) Improve medication safety by identifying potentially inappropriate medications (PIMs) in older adults.
- c) Calculate the appropriate dose of antibiotics.
- d) Determine a patient’s insurance eligibility.
Answer: b) Improve medication safety by identifying potentially inappropriate medications (PIMs) in older adults.
3. According to the AGS Beers Criteria®, which class of medications is considered potentially inappropriate for most older adults due to its strong anticholinergic effects and risk of confusion, dry mouth, and constipation?
- a) First-generation antihistamines (e.g., diphenhydramine)
- b) Beta-blockers
- c) Statins
- d) ACE inhibitors
Answer: a) First-generation antihistamines (e.g., diphenhydramine)
4. The term “polypharmacy” in geriatrics refers to:
- a) The use of a single, high-dose medication.
- b) The use of multiple medications, often defined as five or more.
- c) A patient’s refusal to take any medication.
- d) The practice of compounding medications.
Answer: b) The use of multiple medications, often defined as five or more.
5. A “prescribing cascade” occurs when:
- a) A new medication is prescribed to treat the side effect of another medication, which is mistaken for a new medical condition.
- b) A medication is discontinued.
- c) A generic medication is substituted for a brand-name drug.
- d) A patient is prescribed a medication for a valid indication.
Answer: a) A new medication is prescribed to treat the side effect of another medication, which is mistaken for a new medical condition.
6. Deprescribing is the systematic process of:
- a) Adding new medications to a patient’s regimen.
- b) Tapering or stopping medications for which the potential harms outweigh the benefits.
- c) Switching all medications to their most expensive alternatives.
- d) Increasing the dose of every medication a patient is taking.
Answer: b) Tapering or stopping medications for which the potential harms outweigh the benefits.
7. Benzodiazepines are generally considered potentially inappropriate in older adults due to an increased risk of:
- a) Hypertension and tachycardia.
- b) Cognitive impairment, falls, and fractures.
- c) Weight gain.
- d) Improved memory.
Answer: b) Cognitive impairment, falls, and fractures.
8. An older adult is prescribed amitriptyline for neuropathic pain. The pharmacist should be concerned due to this medication’s potent:
- a) Beta-blocking effects.
- b) Anticholinergic and sedative properties.
- c) Antiplatelet effects.
- d) Effect on blood glucose.
Answer: b) Anticholinergic and sedative properties.
9. When estimating renal function in an elderly patient who has low muscle mass, the Cockcroft-Gault equation may:
- a) Overestimate their true renal function.
- b) Underestimate their true renal function.
- c) Provide a result that is always accurate.
- d) Not be used in any circumstances.
Answer: a) Overestimate their true renal function.
10. Which of the following is a common age-related change in body composition?
- a) Increased total body water and decreased body fat.
- b) Decreased total body water and increased body fat.
- c) Increased muscle mass and bone density.
- d) No significant changes occur.
Answer: b) Decreased total body water and increased body fat.
11. The increased percentage of body fat in older adults can affect the pharmacokinetics of which type of drug?
- a) It can increase the volume of distribution of lipophilic drugs, potentially prolonging their half-life.
- b) It can decrease the volume of distribution of lipophilic drugs.
- c) It has no effect on drug distribution.
- d) It only affects water-soluble drugs.
Answer: a) It can increase the volume of distribution of lipophilic drugs, potentially prolonging their half-life.
12. According to the Beers Criteria®, sliding scale insulin (SSI) is considered potentially inappropriate in older adults because:
- a) It is the most effective way to control blood glucose.
- b) It has a higher risk of causing hypoglycemia without a clear benefit over basal-bolus regimens.
- c) It is too difficult for nurses to administer.
- d) It is only approved for use in younger adults.
Answer: b) It has a higher risk of causing hypoglycemia without a clear benefit over basal-bolus regimens.
13. A pharmacist is counseling an elderly patient on a new medication. An effective communication strategy to address potential hearing impairment would be to:
- a) Shout at the patient.
- b) Speak clearly in a low-pitched tone and face the patient directly.
- c) Write everything down and do not speak.
- d) Have a family member explain it to them later.
Answer: b) Speak clearly in a low-pitched tone and face the patient directly.
14. An older adult patient with a history of falls and syncope should avoid which class of medications if possible?
- a) Statins
- b) Vitamin D supplements
- c) Alpha-blockers (e.g., doxazosin) for hypertension.
- d) Calcium supplements
Answer: c) Alpha-blockers (e.g., doxazosin) for hypertension.
15. What is the primary purpose of the “START/STOPP” criteria?
- a) To guide the initiation of antibiotic therapy.
- b) To help clinicians identify potentially inappropriate prescribing (STOPP) and potential prescribing omissions (START) in older adults.
- c) To manage patients in the intensive care unit.
- d) To determine when to start and stop CPR.
Answer: b) To help clinicians identify potentially inappropriate prescribing (STOPP) and potential prescribing omissions (START) in older adults.
16. An example of applying the “START” criteria would be identifying an older patient with osteoporosis who is not on:
- a) A benzodiazepine.
- b) An antipsychotic.
- c) A calcium and vitamin D supplement, or other bone-active agent.
- d) A proton pump inhibitor.
Answer: c) A calcium and vitamin D supplement, or other bone-active agent.
17. Why is glyburide, a long-acting sulfonylurea, considered potentially inappropriate for older adults?
- a) It has a prolonged duration of action, increasing the risk of severe, protracted hypoglycemia.
- b) It causes significant weight gain.
- c) It is not effective at lowering blood glucose.
- d) It is significantly more expensive than other options.
Answer: a) It has a prolonged duration of action, increasing the risk of severe, protracted hypoglycemia.
18. When counseling an older adult, it is helpful to simplify their medication regimen by:
- a) Increasing the number of doses per day.
- b) Using once-daily formulations when possible.
- c) Switching all medications to separate prescriptions.
- d) Using multiple pharmacies.
Answer: b) Using once-daily formulations when possible.
19. Which of the following is a common drug-disease interaction to avoid, according to the Beers Criteria®?
- a) Using a beta-blocker in a patient with heart failure.
- b) Using NSAIDs in a patient with chronic kidney disease.
- c) Using metformin in a patient with type 2 diabetes.
- d) Using a statin in a patient with high cholesterol.
Answer: b) Using NSAIDs in a patient with chronic kidney disease.
20. A pharmacist is reviewing a medication list for an 80-year-old patient that includes oxybutynin for incontinence, diphenhydramine for sleep, and amitriptyline for pain. The pharmacist is concerned about the cumulative risk of:
- a) Anticholinergic side effects.
- b) Nephrotoxicity.
- c) Hepatotoxicity.
- d) Bleeding.
Answer: a) Anticholinergic side effects.
21. A common self-care challenge in the elderly is the management of constipation. Which of the following is an appropriate first-line recommendation?
- a) Daily use of a stimulant laxative like bisacodyl.
- b) Increased fluid intake, dietary fiber, and a bulk-forming laxative like psyllium.
- c) A mineral oil enema.
- d) An opioid antagonist.
Answer: b) Increased fluid intake, dietary fiber, and a bulk-forming laxative like psyllium.
22. An older adult’s increased sensitivity to the CNS effects of medications like opioids and benzodiazepines is an example of an age-related change in:
- a) Pharmacokinetics
- b) Pharmacodynamics
- c) Absorption
- d) Metabolism
Answer: b) Pharmacodynamics
23. “Brown bag review” is a useful tool in geriatric care where the pharmacist:
- a) Reviews a list of medications from the patient’s chart.
- b) Asks the patient to bring in all of their medications, including OTCs and supplements, for a comprehensive review.
- c) Provides all medications in a single brown bag.
- d) Checks the patient’s blood pressure.
Answer: b) Asks the patient to bring in all of their medications, including OTCs and supplements, for a comprehensive review.
24. The skills lab module on geriatric patient care is designed to help students:
- a) Apply the PPCP to older adult patients with complex medication regimens.
- b) Learn how to use the Beers Criteria®.
- c) Practice counseling and communication skills tailored to older adults.
- d) All of the above.
Answer: d) All of the above.
25. A frail, 85-year-old resident of a nursing home has a blood pressure of 135/85 mmHg. The most appropriate management approach is to:
- a) Immediately add a fourth antihypertensive agent to get the BP below 120/80 mmHg.
- b) Recognize that intensive BP targets may not be appropriate and could increase the risk of falls, focusing instead on the patient’s overall function and goals of care.
- c) Stop all blood pressure medications.
- d) Switch all medications to their most potent alternatives.
Answer: b) Recognize that intensive BP targets may not be appropriate and could increase the risk of falls, focusing instead on the patient’s overall function and goals of care.
26. Which of the following drugs has strong anticholinergic properties and is on the Beers Criteria® list to avoid in older adults?
- a) Acetaminophen
- b) Metformin
- c) Lisinopril
- d) Meclizine
Answer: d) Meclizine
27. The first step in a deprescribing process is to:
- a) Stop all of the patient’s medications at once.
- b) Conduct a comprehensive medication review to identify all current medications and their indications.
- c) Tell the patient their medications are no longer necessary.
- d) Increase the dose of every medication.
Answer: b) Conduct a comprehensive medication review to identify all current medications and their indications.
28. An older adult presents with acute confusion and delirium. Before attributing this to dementia, the pharmacist should first suspect:
- a) An underlying infection (like a UTI) or an adverse effect from a medication.
- b) Normal aging.
- c) That the patient is not telling the truth.
- d) A nutritional deficiency.
Answer: a) An underlying infection (like a UTI) or an adverse effect from a medication.
29. Which of the following is a key consideration when dosing medications for a geriatric patient?
- a) “Start low and go slow.”
- b) “Start high and titrate down quickly.”
- c) Use the same standard dose for all patients regardless of age.
- d) Dose based on the patient’s height only.
Answer: a) “Start low and go slow.”
30. The use of proton pump inhibitors (PPIs) in older adults is on the Beers Criteria® for long-term use without a clear indication due to an increased risk of:
- a) Hypertension.
- b) Clostridioides difficile infection and bone fractures.
- c) Hypoglycemia.
- d) Gout.
Answer: b) Clostridioides difficile infection and bone fractures.
31. When counseling an older adult on a complex regimen, a useful tool to improve adherence is a:
- a) Pillbox or medication organizer.
- b) A simplified, large-print medication schedule.
- c) Regular follow-up with the pharmacist.
- d) All of the above.
Answer: d) All of the above.
32. A geriatric patient with dementia should avoid medications with strong anticholinergic properties because they can:
- a) Improve memory.
- b) Worsen cognitive function.
- c) Lower blood pressure.
- d) Cure dementia.
Answer: b) Worsen cognitive function.
33. What is a “geriatric syndrome”?
- a) A specific disease with a single cause.
- b) A common health condition in older adults that does not fit into a discrete disease category, such as falls or frailty.
- c) Any condition that occurs after the age of 65.
- d) An infection common in nursing homes.
Answer: b) A common health condition in older adults that does not fit into a discrete disease category, such as falls or frailty.
34. Phase I metabolism (oxidation, reduction) via cytochrome P450 enzymes in the liver tends to __________ with age.
- a) Increase
- b) Decrease
- c) Remain unchanged
- d) Fluctuate daily
Answer: b) Decrease
35. A “medication-related problem” in a geriatric patient is often:
- a) Easily identifiable.
- b) The cause of a new symptom that may be mistaken for a new disease.
- c) Rare.
- d) Caused only by over-the-counter medications.
Answer: b) The cause of a new symptom that may be mistaken for a new disease.
36. A key part of the pharmacist’s assessment in geriatric care is to determine if a medication is:
- a) Still necessary and achieving its therapeutic goal.
- b) Causing adverse effects.
- c) The most appropriate choice for the patient’s current condition.
- d) All of the above.
Answer: d) All of the above.
37. Which muscle relaxant is on the Beers Criteria® list due to its high rate of anticholinergic side effects and sedation?
- a) Baclofen
- b) Tizanidine
- c) Cyclobenzaprine
- d) Metaxalone
Answer: c) Cyclobenzaprine
38. The goal of medication management in a frail, elderly patient with multiple comorbidities is often to:
- a) Adhere strictly to all single-disease-state guidelines.
- b) Add as many new medications as possible.
- c) Focus on the patient’s goals of care, such as maintaining function and improving quality of life, rather than on treating every number.
- d) Achieve perfect laboratory values at all costs.
Answer: c) Focus on the patient’s goals of care, such as maintaining function and improving quality of life, rather than on treating every number.
39. A patient is taking digoxin and their renal function declines. The pharmacist should recommend:
- a) Increasing the digoxin dose.
- b) Checking a digoxin level and likely decreasing the dose.
- c) No change is needed.
- d) Adding a diuretic.
Answer: b) Checking a digoxin level and likely decreasing the dose.
40. An important aspect of self-care in the elderly is recognizing that:
- a) Older adults have a lower risk of side effects from OTC medications.
- b) OTC medications can have significant drug interactions and may be inappropriate for their age or health conditions.
- c) All herbal supplements are safe for older adults.
- d) The doses on OTC labels are always correct for older adults.
Answer: b) OTC medications can have significant drug interactions and may be inappropriate for their age or health conditions.
41. Which of the following is an example of a potentially inappropriate duplication of therapy in an older adult?
- a) An ACE inhibitor and a beta-blocker for heart failure.
- b) An SSRI and a TCA for depression.
- c) Calcium and Vitamin D for osteoporosis.
- d) A statin and aspirin for secondary stroke prevention.
Answer: b) An SSRI and a TCA for depression.
42. The “Advanced Topics in Geriatrics” unit in the curriculum is designed to prepare students to:
- a) Manage the most complex older adult patients.
- b) Understand the nuances of applying evidence-based medicine to the geriatric population.
- c) Lead deprescribing initiatives.
- d) All of the above.
Answer: d) All of the above.
43. A pharmacist is reviewing a nursing home resident’s medication list. This type of review is often called a:
- a) Brown bag review
- b) Drug Regimen Review (DRR)
- c) Therapeutic drug monitoring
- d) Welcome to Medicare visit
Answer: b) Drug Regimen Review (DRR)
44. What is the most important reason to avoid NSAIDs for chronic pain in an older adult on an anticoagulant?
- a) They are not effective for pain.
- b) The combined use significantly increases the risk of a major gastrointestinal bleed.
- c) They are too expensive.
- d) They cause constipation.
Answer: b) The combined use significantly increases the risk of a major gastrointestinal bleed.
45. When a new medication is started in an older adult, the pharmacist should:
- a) Assume it will be safe and effective.
- b) Counsel the patient and/or caregiver on what new symptoms to watch for and report.
- c) Tell the patient not to worry about side effects.
- d) Wait one year before following up.
Answer: b) Counsel the patient and/or caregiver on what new symptoms to watch for and report.
46. A decrease in serum albumin in a frail, malnourished older adult can lead to:
- a) Higher levels of free (active) drug for highly protein-bound medications.
- b) Lower levels of free drug.
- c) No change in drug concentration.
- d) Better therapeutic outcomes.
Answer: a) Higher levels of free (active) drug for highly protein-bound medications.
47. For an older adult with insomnia, the Beers Criteria® recommends which approach first?
- a) A prescription for a benzodiazepine.
- b) A trial of a non-pharmacologic, sleep hygiene approach.
- c) A prescription for diphenhydramine.
- d) A low dose of amitriptyline.
Answer: b) A trial of a non-pharmacologic, sleep hygiene approach.
48. Why are older adults more susceptible to orthostatic hypotension from medications?
- a) Their baroreceptor reflex is more robust.
- b) Their baroreceptor reflex, which helps maintain blood pressure upon standing, becomes less sensitive with age.
- c) They have a higher percentage of total body water.
- d) They metabolize drugs more quickly.
Answer: b) Their baroreceptor reflex, which helps maintain blood pressure upon standing, becomes less sensitive with age.
49. A key skill for managing geriatric patient care, as taught in the skills lab, is:
- a) The ability to integrate data from multiple sources (patient interview, labs, medication list) to make a clinical assessment.
- b) The ability to perform a physical exam.
- c) The ability to draw blood.
- d) The ability to work in isolation.
Answer: a) The ability to integrate data from multiple sources (patient interview, labs, medication list) to make a clinical assessment.
50. The ultimate goal of geriatric pharmacotherapy is to:
- a) Discontinue all of a patient’s medications.
- b) Use evidence-based and patient-centered approaches to maximize function and quality of life while minimizing harm.
- c) Ensure the patient is taking at least ten different medications.
- d) Treat every abnormal lab value, regardless of the patient’s clinical status.
Answer: b) Use evidence-based and patient-centered approaches to maximize function and quality of life while minimizing harm.
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