Geriatric Review

Geriatric Review

Case 1: Mrs. P

Multiple Select

Which medications are MOST likely to contribute to her falls? (select all that apply)

• Lorazepam

• Donepezil

• Oxybutynin

• Risperdone

Multiple Select

Which medications are most likely contributing to her cognitive decline? (select all that apply)

• Escitalopram

• Oxybutynin

• Amlodipine

• Risperidone

Multiple Choice

Which has the shortest half-life?

• Lorazepam

• Diazepam

• Alprazolam

​Benzodiazepines

Multiple Choice

What would be the best plan to help Mrs. P with her anxiety?

• Schedule lorazepam 0.5 mg po TID

• Increase escitalopram to 10 mg po QAM

• Add buspirone 5 mg po TID PRN anxiety

• Reduce levothyroxine to 75 mcg po daily

Multiple Choice

Oxybutynin is commercially available in the following formulations EXCEPT:

• Transdermal patch

• Extended-release tablet

• Topical gel

• Nasal spray

Multiple Choice

Myrbetriq acts as a/an

• inhibitor of the muscarinic action of the acetylcholine on smooth muscle

• selective alpha1A adrenergic receptor antagonist

• agonist of the Beta3 adrenergic receptor

• selective norepinehrine reuptake inhibitor

Multiple Choice

What is the BEST recommendation for treating Mrs. P's dementia?

• Nursing home placement

• Add Namenda IR 5 mg po daily; titrating to a max dose of 10 mg PO BID

• Increase donepezil to 15 mg PO daily

• Add rivastigmine 1.5 mg po BID; titrating to a max dose of 6 mg PO BID

Multiple Select

A black box warning is found in the package insert for: (select all that apply)

• Escitalopram

• Risperidone

• Amlodipine

• Lorazepam

Multiple Select

What are the most common side effects of donepezil? (select all that apply)

• Increased urination

• Hyperglycemia

• Syncope

• Nausea/Vomiting

Multiple Select

Which of Mrs. P's medications comes in an ODT formulation? (select all that apply)

• Escitalopram

• Risperidone

• Donepezil

• Levothyroxine

Multiple Choice

Anticholinergic medications are relatively contraindicated in the treatment of:

• Stress incontinence

• Urge incontinence

• Overflow incontinence

• Functional incontinence

Incontinence

​Type Helps Worsens

Urge anticholinergic cholinergic

Overflow cholinergic anticholinergic

Multiple Select

Which vaccine(s) are indicated for annual administration? (Select all that apply)

• Zostavax

• Fluzone

• Shingrex

• Trumenba

Multiple Select

As the pharmacist, what should you include in your counseling to Mr. P about his wife’s osteoporosis medication?  (Select all that apply)

• For maximum benefit, she should take calcium citrate 1000 mg concurrently with each dose

• She should sit upright for a minimum of 30 min after each dose

• She should take the medication with the largest meal of the day

• Notify her dentist that she is taking the medicine if she requires any dental procedure

Case 2: Mr. Q

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​ (140-age) * IBW

Clcr = ____________ * 0.85 if female Cr * 72

Multiple Select

Which is/are the reasons to avoid an NSAID in this patient? (select all that apply)

• Renal function

• History of GERD

• Weight

• Diabetes

Multiple Choice

Why should cyclobenzaprine be stopped?

• Extrapyramidal symptoms

• Pulmonary toxicity

• Anticholinergic side effects

• Increased risk of hepatoxicity

Multiple Choice

Which best describes Amaryl's mechanism of action?

• Stimulates the release of insulin from pancreatic islet beta cells

• Reversibly and competitively inhibits dipeptidyl peptidase-4

• Binds to GLP-1 receptors and stimulates insulin release

• Acts on the liver to lower glucose production and acts on the gut to increase glucose utilization

Multiple Choice

Which is the best recommendation for Mr. Q's glimepride?

• Stop taking it

• Change to glyburide

• Change to glipizide

• Change to saxagliptin

Multiple Select

Which medication(s) require renal dose adjustment in this patient? (select all that apply)

• Lisinopril

• Metformin

• Omeprazole

• Gabapentin

Multiple Select

What needs to be monitored while taking lisinopril? (Select all that apply)

• Albumin

• Chloride

• Renal function

• Potassium

Multiple Choice

How does lisinopril protect the kidneys?

• Decrease proteninuria

• Decrease serum potassium

• Increase aldosterone secretion

• Increase vasopressor activity

Multiple Select

Risks associated with proton pump inhibitors in the elderly include: (select all that apply)

• Increase B12 levels

• Increased C. Difficile infection

• Increased depression

• Increased bone loss and fractures

Multiple Choice

Which medication requires precautions for handling?

• Metformin

• Gabapentin

• Finasteride

• Cyclobenzaprine

Multiple Choice

What is the best recommendation for his GERD?

• Continue omeprazole 20 mg PO daily

• Change to esomperazole 40 mg PO daily

• Change to famotidine 10 mg PO BID

• Change to sucralfate 1 g four times a day

Multiple Choice

What is the RDA of vitamin D for the patient?

• 400 IU PO daily

• 800 IU PO daily

• 2000 IU PO daily

• 5000 IU PO every other day

Multiple Choice

When should Mr. Q expect to see benefit after starting finasteride?

• 1 day

• 1 week

• 1 month

• 6 months

Multiple Choice

What lab result changes after starting finasteride?

• Serium creatinine

• Potassium

• Prostate specific antigen

• Hemoglobin

Multiple Choice

Which of Mr. Q’s medications should not be opened or crushed and administered via a naso-gastric tube?

• Tamsulosin

• Amaryl

• Finasteride

• Lisinopril

Multiple Select

EMS was called when Mr. Q began having chest pain and heart palpitations.  At the ED, his potassium was reported to be 6.8 mEq/L.  He states that he has been using a salt substitute (for his HTN) and nutritional supplements to help with his prostate problems.  What medication(s) could be used to remove potassium from his body?  (Select all that apply)

• Spironolactone 50 mg PO

• Kayexalate 15 g PO

• Humulin R 10 Units IV

• Lasix 40 mg IV

Multiple Choice

What herbal supplement is most commonly used to treat symptoms of benign prostatic hypertrophy? 

• Saw palmetto

• Yohimbine

• Ginsing

• Kava Kava