MCQ Quiz: Introduction to the Geriatric Patient Population

Caring for the geriatric population requires a specialized approach due to the complex interplay of aging physiology, multiple chronic conditions, and polypharmacy. As individuals age, significant changes in pharmacokinetics and pharmacodynamics occur, increasing the risk of adverse drug events. For PharmD students, understanding these age-related differences, recognizing geriatric syndromes, and mastering communication strategies are crucial for optimizing medication therapy, ensuring safety, and improving the quality of life for older adult patients.

1. Which physiological change common in older adults most significantly impacts the renal elimination of drugs

• Increased liver blood flow
• Decreased glomerular filtration rate (GFR)
• Increased total body water
• Increased serum albumin Answer: Decreased glomerular filtration rate (GFR)

2. Polypharmacy in the geriatric population is best defined as:

• The use of multiple pharmacies.
• The concurrent use of multiple medications.
• The use of drugs for multiple indications.
• The use of over-the-counter medications only. Answer: The concurrent use of multiple medications.

3. Age-related changes in body composition that affect drug distribution in the elderly include:

• Increased total body water and decreased body fat.
• Decreased total body water and increased body fat.
• Increased muscle mass and decreased body fat.
• No significant changes in body composition. Answer: Decreased total body water and increased body fat.

4. A decrease in serum albumin in an older adult can lead to what effect for a highly protein-bound drug like phenytoin?

• A lower concentration of free, active drug.
• A higher concentration of free, active drug.
• Faster renal elimination of the drug.
• Decreased metabolism of the drug. Answer: A higher concentration of free, active drug.

5. The “prescribing cascade” occurs when:

• A medication is prescribed at the lowest possible dose.
• A new medication is prescribed to treat the side effect of another medication.
• A prescription is transferred from one pharmacy to another.
• A patient refuses to take a prescribed medication. Answer: A new medication is prescribed to treat the side effect of another medication.

6. Which pharmacokinetic process is generally least affected by aging?

• Absorption
• Distribution
• Metabolism
• Elimination Answer: Absorption

7. Hepatic Phase I metabolism (oxidation, reduction, hydrolysis) often declines with age, potentially leading to:

• Decreased concentrations of parent drugs.
• Increased concentrations and prolonged half-lives of affected drugs.
• Faster drug clearance.
• No change in drug metabolism. Answer: Increased concentrations and prolonged half-lives of affected drugs.

8. Which of the following is a key aspect of “Geriatric Wellness” management?

• Encouraging a sedentary lifestyle to prevent injury.
• Focusing only on treating acute diseases.
• Promoting immunizations (e.g., influenza, pneumococcal, zoster) and proper nutrition.
• Discontinuing all medications to avoid side effects. Answer: Promoting immunizations (e.g., influenza, pneumococcal, zoster) and proper nutrition.

9. When communicating with an older adult patient who has hearing or vision impairment, a pharmacist should:

• Speak very loudly and quickly.
• Turn off the lights to help them focus.
• Use written materials with large print and ensure a well-lit, quiet environment.
• Ask only the caregiver questions. Answer: Use written materials with large print and ensure a well-lit, quiet environment.

10. The Beers Criteria is a resource used by pharmacists to identify:

• The most expensive medications for older adults.
• The best medications for pediatric patients.
• Potentially inappropriate medications (PIMs) for use in older adults.
• The correct dosing for all antibiotics. Answer: Potentially inappropriate medications (PIMs) for use in older adults.

11. The age-related increase in body fat can cause the volume of distribution for lipophilic drugs to:

• Decrease, leading to higher plasma concentrations.
• Increase, potentially prolonging their duration of action.
• Remain unchanged.
• Fluctuate unpredictably. Answer: Increase, potentially prolonging their duration of action.

12. Why is the Cockcroft-Gault equation often used to estimate renal function in the elderly for drug dosing purposes?

• It is the most accurate measure of true GFR.
• Serum creatinine alone can be a misleading marker due to decreased muscle mass.
• It is a legal requirement for all geriatric prescriptions.
• It is the only equation available. Answer: Serum creatinine alone can be a misleading marker due to decreased muscle mass.

13. Which of the following is considered a “geriatric syndrome”?

• Acute appendicitis
• Type 1 diabetes
• Recurrent falls
• Childhood asthma Answer: Recurrent falls

14. What is a primary goal when managing medications in clinically complex elders?

• To add a new medication for every symptom.
• To maximize the number of pills taken daily.
• To simplify the medication regimen and minimize adverse drug events.
• To use only brand-name medications. Answer: To simplify the medication regimen and minimize adverse drug events.

15. Pharmacodynamics in the elderly can be altered, meaning there can be a change in the:

• Rate of drug absorption.
• Sensitivity of receptors to a drug.
• Rate of drug metabolism.
• Percentage of drug bound to plasma proteins. Answer: Sensitivity of receptors to a drug.

16. Older adults often have an increased sensitivity to which class of medications, increasing the risk of confusion and falls?

• Vitamins
• Anticholinergics
• Proton pump inhibitors
• Statins Answer: Anticholinergics

17. What does the principle “start low, go slow” refer to in geriatric dosing?

• Starting with a sub-therapeutic dose and never increasing it.
• Initiating therapy with a low dose and titrating upwards cautiously based on response and tolerance.
• Speaking slowly to the patient.
• Walking slowly to avoid falls. Answer: Initiating therapy with a low dose and titrating upwards cautiously based on response and tolerance.

18. A key aspect of wellness in the geriatric population is maintaining:

• Social isolation.
• A high-fat diet.
• Functional independence.
• A strict, unchanging routine. Answer: Functional independence.

19. When taking a medication history from an older adult, it is important to specifically ask about:

• Their favorite television shows.
• Over-the-counter medications, herbal supplements, and vitamins.
• Their political affiliations.
• Their childhood memories. Answer: Over-the-counter medications, herbal supplements, and vitamins.

20. According to the “Pharmacokinetics of Aging” reading, the most predictable pharmacokinetic change is:

• Increased drug absorption.
• Increased Phase I metabolism.
• Decreased renal excretion.
• Increased protein binding. Answer: Decreased renal excretion.

21. An older adult with decreased total body water will have a smaller volume of distribution for which type of drugs?

• Lipophilic (fat-soluble) drugs
• Hydrophilic (water-soluble) drugs
• Highly protein-bound drugs
• Drugs that undergo hepatic metabolism Answer: Hydrophilic (water-soluble) drugs

22. Which of the following is a common communication barrier when interacting with geriatric patients?

• They are all proficient with technology.
• They never have questions about their health.
• Cognitive impairment or memory loss.
• They speak too quickly. Answer: Cognitive impairment or memory loss.

23. The concept of “deprescribing” in geriatric care refers to the planned process of:

• Adding new preventative medications.
• Switching from brand to generic medications.
• Stopping or reducing the dose of medications that are potentially inappropriate or no longer beneficial.
• Prescribing medications for off-label uses. Answer: Stopping or reducing the dose of medications that are potentially inappropriate or no longer beneficial.

24. The homeostatic mechanisms in older adults are often blunted, leading to an increased risk of:

• Orthostatic hypotension with antihypertensive agents.
• Increased thirst and hydration.
• Stable blood glucose levels.
• Resistance to infections. Answer: Orthostatic hypotension with antihypertensive agents.

25. A pharmacist’s role in geriatric care extends to educating not only the patient but also:

• The patient’s family members and caregivers.
• The patient’s neighbors.
• The local news reporters.
• The mail carrier. Answer: The patient’s family members and caregivers.

26. What is a primary consideration when choosing a dosage form for a geriatric patient with dysphagia (difficulty swallowing)?

• The color of the tablet.
• The availability of a liquid, crushable, or patch formulation.
• The cost of the medication.
• The brand name of the medication. Answer: The availability of a liquid, crushable, or patch formulation.

27. The epidemiology of aging involves the study of:

• The geographic distribution of older adults.
• The patterns and determinants of health and disease in older populations.
• The economic impact of the aging population.
• The history of retirement communities. Answer: The patterns and determinants of health and disease in older populations.

28. Why is medication reconciliation particularly important for geriatric patients, especially during transitions of care?

• To ensure they are taking the most expensive drugs available.
• To prevent medication discrepancies, omissions, and duplications.
• To complete a legal requirement for hospital discharge.
• To create a more complicated regimen. Answer: To prevent medication discrepancies, omissions, and duplications.

29. The “Sounds of My Father” reading in the PHA5070 syllabus likely serves to improve student understanding of:

• The pathophysiology of heart disease.
• The patient and caregiver experience from a personal perspective.
• The pharmacokinetics of geriatric medications.
• The latest clinical trial data. Answer: The patient and caregiver experience from a personal perspective.

30. Which organ’s function is most critical to consider when dosing a water-soluble drug that is eliminated unchanged?

• Liver
• Lungs
• Kidneys
• Spleen Answer: Kidneys

31. The Beers Criteria classifies amitriptyline as potentially inappropriate for older adults due to its strong:

• Beta-blocking effects.
• Anticholinergic and sedative effects.
• Anti-inflammatory properties.
• ACE-inhibiting properties. Answer: Anticholinergic and sedative effects.

32. What is a key strategy to improve medication adherence in an elderly patient with cognitive impairment?

• Prescribing more medications.
• Using complex dosing schedules (e.g., four times daily).
• Using pill organizers and simplifying the regimen.
• Providing all instructions verbally with no written reinforcement. Answer: Using pill organizers and simplifying the regimen.

33. An age-related decline in hepatic blood flow will most impact the clearance of:

• Low extraction ratio drugs.
• High extraction ratio drugs.
• Drugs eliminated solely by the kidneys.
• Drugs administered topically. Answer: High extraction ratio drugs.

34. The “brown bag review,” where a patient brings all their medications to the pharmacist, is a useful tool for:

• Estimating the patient’s socioeconomic status.
• Identifying all medications a patient is actually taking, including OTCs and supplements.
• Determining the weight of the medications.
• Organizing the medications by color. Answer: Identifying all medications a patient is actually taking, including OTCs and supplements.

35. A functional assessment of a geriatric patient evaluates their ability to:

• Recite the alphabet backwards.
• Perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
• Run a marathon.
• Solve complex mathematical equations. Answer: Perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

36. The risk of adverse drug reactions in the elderly increases with:

• The number of medications taken.
• The patient’s level of physical activity.
• The patient’s educational level.
• The number of green vegetables in their diet. Answer: The number of medications taken.

37. Which of these is a common age-related change in the gastrointestinal tract?

• Increased gastric acid secretion.
• Faster gastric emptying.
• Decreased gastric motility.
• Increased absorptive surface area. Answer: Decreased gastric motility.

38. When counseling a geriatric patient, it is crucial to:

• Rush through the information.
• Use the teach-back method to confirm understanding.
• Stand far away from the patient.
• Avoid making eye contact. Answer: Use the teach-back method to confirm understanding.

39. Geriatric drug dosing is a “transcending concept” because it:

• Is an ancient practice that is no longer relevant.
• Is a simple calculation that never changes.
• Applies across multiple disease states and clinical settings.
• Is only important for one specific medication. Answer: Applies across multiple disease states and clinical settings.

40. A common nutritional concern in the elderly that can affect health and medication tolerance is:

• Anorexia of aging and unintended weight loss.
• A desire to eat only fast food.
• Excessive hydration.
• Overconsumption of vitamins. Answer: Anorexia of aging and unintended weight loss.

41. Which of the following immunizations is specifically recommended for older adults to prevent a painful, blistering rash?

• Tdap (Tetanus, Diphtheria, Pertussis)
• MMR (Measles, Mumps, Rubella)
• Varicella (Chickenpox)
• Zoster (Shingles) Answer: Zoster (Shingles)

42. The primary goal of geriatric pharmacotherapy is to:

• Cure all of the patient’s diseases.
• Maintain or improve the patient’s quality of life.
• Ensure the patient is on at least ten medications.
• Reduce the pharmacy’s inventory. Answer: Maintain or improve the patient’s quality of life.

43. A pharmacist notes an elderly patient is prescribed a new medication to treat constipation that began after they started taking an opioid. This is a classic example of:

• Excellent preventative care.
• A prescribing cascade.
• Deprescribing.
• Off-label drug use. Answer: A prescribing cascade.

44. Which factor is LEAST likely to directly influence a geriatric patient’s pharmacokinetic parameters?

• Renal function
• Liver function
• Body composition
• Marital status Answer: Marital status

45. The term “frailty” in a geriatric context describes a state of:

• Increased financial wealth.
• Increased vulnerability to stressors due to cumulative declines in multiple physiological systems.
• Strong emotional resilience.
• A preference for frail, delicate objects. Answer: Increased vulnerability to stressors due to cumulative declines in multiple physiological systems.

46. Non-adherence in the elderly can often be unintentional and due to:

• A willful desire to be non-compliant.
• Forgetfulness, complex regimens, or physical inability to administer medication.
• A dislike of the pharmacist.
• A protest against high drug prices. Answer: Forgetfulness, complex regimens, or physical inability to administer medication.

47. Patient assessment in the elderly should always include a review of:

• The patient’s driving record.
• The risk of falls and any history of falling.
• The patient’s favorite hobbies.
• The number of grandchildren the patient has. Answer: The risk of falls and any history of falling.

48. Why would a non-sterile compounding pharmacy be important for geriatric care?

• To prepare unique dosage forms like flavored liquids or lower-strength capsules to meet individual patient needs.
• To make medications look more appealing.
• To sell medications without a prescription.
• To create placebo medications. Answer: To prepare unique dosage forms like flavored liquids or lower-strength capsules to meet individual patient needs.

49. An ethical dilemma in geriatric care can arise when a patient with capacity refuses a treatment that the family and provider believe is beneficial. This highlights the conflict between:

• Beneficence and justice.
• Justice and non-maleficence.
• Patient autonomy and beneficence.
• Autonomy and justice. Answer: Patient autonomy and beneficence.

50. The overarching theme of “Managing Medications in Clinically Complex Elders” is that it requires a(n):

• Standardized, one-size-fits-all approach.
• Approach that prioritizes cost above all else.
• Individualized, patient-centered, and thoughtful approach.
• Rapid approach that limits patient interaction. Answer: Individualized, patient-centered, and thoughtful approach.