Chapter 003 Geriatric Pharmacology

Multiple Choice Questions 1. After 25 or 30 years of age what will be reduced by approximately 1 percent each year? A. Cardiac output B. Heart rate C. Blood pressure D. Blood sugar

2. The term used to describe a patient who is on multiple prescriptions is: A. Medication error B. Polypharmacy C. Therapeutic duplication D. Subtherapeutic response

3. Which of the following may contribute to drug toxicity in the geriatric population? A. Increased activity of liver enzymes B. Stable creatinine levels C. Reduced production of plasma proteins D. Leukopenia

4. The pharmacokinetic process most affected by age is: A. Absorption B. Metabolism C. Distribution D. Elimination

5. A patient having multiple chronic diseases can expect the consequences of a drug's action to be: A. Enhanced. B. Reduced. C. The same. D. All of these are correct.

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Chapter 003 Geriatric Pharmacology

6. One way to improve compliance for a patient with arthritis would be to: A. Encourage the patient to take medication on an empty stomach. B. Suggest not using child safety caps on medication bottles. C. Encourage the patient to read medication information literature. D. Suggest drinking plenty of fluids when taking medications.

7. An elderly patient who drinks lots of water and takes a water-soluble drug can expect: A. A toxic effect B. A subtherapeutic effect C. A therapeutic effect D. Competitive antagonism

8. How would one expect the plasma creatinine levels to change with age? A. Slight decrease B. Remain unchanged C. Dramatic decrease D. Increase

9. Pharmacologic compounds that are most affected by liver enzymes in elderly patients are: A. Oxidizing B. Reducing C. Chelating D. Alkylating

10. A reduction in organ function affecting drug metabolism can occur from: A. Genetics. B. Nutritional deficiency. C. Disease. D. All of these are correct.

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Chapter 003 Geriatric Pharmacology

11. In which situation would you expect nutritional status to play a major role in an impaired drug response? A. A comatose patient on TPN B. A patient living with family members C. A nursing home patient D. A physically active senior citizen

12. An elderly patient was on medication for diabetes and hypertension before suffering a heart attack. Her cardiologist gave thorough directions on taking her new heart medications. A probable outcome to this situation would be: A. Patient compliance remaining the same B. A slight increase in patient compliance C. A substantial increase in patient compliance D. A decrease in patient compliance

13. An elderly woman taking calcium supplements could improve absorption by: A. Taking medication on an empty stomach B. Increasing the medication dosage C. Increasing the medication frequency D. Taking medication with food

14. An elderly man has been given an adult-strength dose of the topical steroid hydrocortisone for the past four weeks. He has developed thin skin and stria along his back, suggesting toxicity. The cause of the toxicity would be: A. Decreased absorption through interactions reducing the half-life B. Increased distribution to adipose tissues, prolonging the half-life C. Increased metabolism in liver, increasing the half-life D. Increased excretion from the kidneys, increasing the half-life

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Chapter 003 Geriatric Pharmacology

15. How would an elderly patient who smokes and consumes alcohol tolerate an adultstrength dose of actively oxidized medication compared to an elderly patient who did neither of these activities? A. Could not tolerate B. Would tolerate the same C. Would tolerate better D. Would need a higher dose

16. Morphine, which has a high first-pass metabolism, would require what type of dosing change in an elderly patient? A. Higher dose B. Same dose C. Tapered dose D. Lower dose

17. In relation to their medications, why is it important for elderly patients to increase their dietary protein intake? A. To maintain appropriate albumin levels B. To increase serum potassium levels C. To lower serum triglyceride levels D. To maintain serum calcium levels

18. Adequate nutrition in elderly patients is important for synthesizing drug-metabolizing enzymes. The body produces these enzymes from foods that are high in: A. Fat B. Protein C. Carbohydrate D. Nucleic acid

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Chapter 003 Geriatric Pharmacology

19. A chief complaint from elderly patients taking potassium bromide tablets would be: A. Dosing frequency B. Dietary restrictions C. Difficulty swallowing D. Small size

20. One approach that can be used to facilitate decisions and enhance compliance when explaining medications to an elderly patient is to: A. Provide current pharmaceutical literature B. Speak loudly C. Use proper medical terminology D. Use proper demeanor

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Chapter 003 Geriatric Pharmacology Key

Multiple Choice Questions 1. (p. 37) After 25 or 30 years of age what will be reduced by approximately 1 percent each year? A. Cardiac output B. Heart rate C. Blood pressure D. Blood sugar It has been estimated that after 25 or 30 years of age, the cardiac output, the amount of blood pumped by the heart per minute, decreases by approximately 1 percent per year.

ABHES Competency: 2. Anatomy and Physiology b. Identify and apply the knowledge of all body systems; their structure and functions; and their common diseases, symptoms, and etiologies. Bloom's: Remembering CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. Difficulty: Easy Learning Outcome: 3.1 Describe the main physiological changes that occur with aging.

2. (p. 40) The term used to describe a patient who is on multiple prescriptions is: A. Medication error B. Polypharmacy C. Therapeutic duplication D. Subtherapeutic response The term polypharmacy is used to describe the situation that involves multiple drug prescriptions.

ABHES Competency: 2. Anatomy and Physiology c. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system. 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. Bloom's: Remembering CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. 12. Describe the relationship between anatomy and physiology of all body systems and medications used for treatment in each. Difficulty: Easy Learning Outcome: 3.5 Explain the problems associated with drug compliance in the elderly.

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Chapter 003 Geriatric Pharmacology Key

3. (p. 38) Which of the following may contribute to drug toxicity in the geriatric population? A. Increased activity of liver enzymes B. Stable creatinine levels C. Reduced production of plasma proteins D. Leukopenia The concentration of plasma proteins, mainly albumin, decreases with age. Since most drugs are bound to some extent to plasma proteins and it is only the concentration of "free drug" that produces the pharmacological effect, any decrease in plasma proteins and plasma protein drug binding will increase the amount of free drug (unbound) and, therefore, the intensity of drug effect.

ABHES Competency: 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. Bloom's: Understanding CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. Difficulty: Easy Learning Outcome: 3.1 Describe the main physiological changes that occur with aging.

4. (p. 38) The pharmacokinetic process most affected by age is: A. Absorption B. Metabolism C. Distribution D. Elimination Renal excretion is probably the most important pharmacokinetic process that is affected by age.

ABHES Competency: 2. Anatomy and Physiology b. Identify and apply the knowledge of all body systems; their structure and functions; and their common diseases, symptoms, and etiologies. 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. Bloom's: Understanding CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. Difficulty: Easy Learning Outcome: 3.3 List several factors that affect the metabolism and excretion of drugs in the elderly.

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Chapter 003 Geriatric Pharmacology Key

5. (p. 39) A patient having multiple chronic diseases can expect the consequences of a drug's action to be: A. Enhanced. B. Reduced. C. The same. D. All of these are correct. The consequences of disease on drug action increase as the number of diseases in any one individual increases.

ABHES Competency: 2. Anatomy and Physiology b. Identify and apply the knowledge of all body systems; their structure and functions; and their common diseases, symptoms, and etiologies. c. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system. 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. 9. Medical Office Clinical Procedures d. Recognize and understand various treatment protocols. Bloom's: Understanding CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. 12. Describe the relationship between anatomy and physiology of all body systems and medications used for treatment in each. Difficulty: Easy Learning Outcome: 3.4 Recognize the effect of nutrition and age-related diseases on drug response.

6. (p. 41) One way to improve compliance for a patient with arthritis would be to: A. Encourage the patient to take medication on an empty stomach. B. Suggest not using child safety caps on medication bottles. C. Encourage the patient to read medication information literature. D. Suggest drinking plenty of fluids when taking medications. There are easy-to-open lids for the elderly, available upon request.

ABHES Competency: 2. Anatomy and Physiology c. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system. 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. 9. Medical Office Clinical Procedures d. Recognize and understand various treatment protocols. Bloom's: Understanding CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. Difficulty: Easy Learning Outcome: 3.5 Explain the problems associated with drug compliance in the elderly.

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Chapter 003 Geriatric Pharmacology Key

7. (p. 38) An elderly patient who drinks lots of water and takes a water-soluble drug can expect: A. A toxic effect B. A subtherapeutic effect C. A therapeutic effect D. Competitive antagonism Water-soluble drugs will have less body fluid in which to dissolve and are less widely distributed out to the organs with high fat content.

ABHES Competency: 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. Bloom's: Applying CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. 12. Describe the relationship between anatomy and physiology of all body systems and medications used for treatment in each. Difficulty: Medium Learning Outcome: 3.1 Describe the main physiological changes that occur with aging.

8. (p. 38) How would one expect the plasma creatinine levels to change with age? A. Slight decrease B. Remain unchanged C. Dramatic decrease D. Increase The plasma concentration of creatinine increases with age and renal disease and reflects the effects of age and disease to decreased renal function.

ABHES Competency: 2. Anatomy and Physiology b. Identify and apply the knowledge of all body systems; their structure and functions; and their common diseases, symptoms, and etiologies. 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. Bloom's: Applying CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. 12. Describe the relationship between anatomy and physiology of all body systems and medications used for treatment in each. Difficulty: Medium Learning Outcome: 3.3 List several factors that affect the metabolism and excretion of drugs in the elderly.

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Chapter 003 Geriatric Pharmacology Key

9. (p. 38) Pharmacologic compounds that are most affected by liver enzymes in elderly patients are: A. Oxidizing B. Reducing C. Chelating D. Alkylating The enzymes that are most affected appear to be the enzymes that oxidize drugs, referred to as the mixed-function oxidase system.

ABHES Competency: 2. Anatomy and Physiology b. Identify and apply the knowledge of all body systems; their structure and functions; and their common diseases, symptoms, and etiologies. 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. Bloom's: Applying CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. 12. Describe the relationship between anatomy and physiology of all body systems and medications used for treatment in each. Difficulty: Medium Learning Outcome: 3.3 List several factors that affect the metabolism and excretion of drugs in the elderly.

10. (p. 39) A reduction in organ function affecting drug metabolism can occur from: A. Genetics. B. Nutritional deficiency. C. Disease. D. All of these are correct. The major chronic diseases of aginghypertension, coronary artery disease, diabetes, cancer, and many othersall have effects that reduce vital organ function, especially of the heart, liver, and kidneys. The time from drug administration to the first observable effect is known as the onset of action.

ABHES Competency: 2. Anatomy and Physiology b. Identify and apply the knowledge of all body systems; their structure and functions; and their common diseases, symptoms, and etiologies. c. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system. Bloom's: Applying CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 12. Describe the relationship between anatomy and physiology of all body systems and medications used for treatment in each. Difficulty: Medium Learning Outcome: 3.4 Recognize the effect of nutrition and age-related diseases on drug response.

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Chapter 003 Geriatric Pharmacology Key

11. (p. 39) In which situation would you expect nutritional status to play a major role in an impaired drug response? A. A comatose patient on TPN B. A patient living with family members C. A nursing home patient D. A physically active senior citizen Nutrition is extremely important to the state of health. Many of the elderly live alone or in unfamiliar surroundings such as nursing homes.

ABHES Competency: 2. Anatomy and Physiology b. Identify and apply the knowledge of all body systems; their structure and functions; and their common diseases, symptoms, and etiologies. c. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system. 9. Medical Office Clinical Procedures d. Recognize and understand various treatment protocols. Bloom's: Applying CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. Difficulty: Medium Learning Outcome: 3.4 Recognize the effect of nutrition and age-related diseases on drug response.

12. (p. 40) An elderly patient was on medication for diabetes and hypertension before suffering a heart attack. Her cardiologist gave thorough directions on taking her new heart medications. A probable outcome to this situation would be: A. Patient compliance remaining the same B. A slight increase in patient compliance C. A substantial increase in patient compliance D. A decrease in patient compliance The confusion increases in direct proportion to the number of different drugs and administration devices with which the individual is confronted.

ABHES Competency: 2. Anatomy and Physiology c. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system. 9. Medical Office Clinical Procedures d. Recognize and understand various treatment protocols. Bloom's: Applying CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. Difficulty: Medium Learning Outcome: 3.5 Explain the problems associated with drug compliance in the elderly.

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Chapter 003 Geriatric Pharmacology Key

13. (p. 37) An elderly woman taking calcium supplements could improve absorption by: A. Taking medication on an empty stomach B. Increasing the medication dosage C. Increasing the medication frequency D. Taking medication with food While the peak drug level may be lower, the total amount of drug absorbed is usually not significantly affected. Consequently, the main effect of aging is to slow drug absorption and delay the onset of drug action.

ABHES Competency: 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. Bloom's: Analyzing CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. Difficulty: Hard Learning Outcome: 3.2 List several factors that affect absorption and distribution of drugs in the elderly.

14. (p. 38) An elderly man has been given an adult-strength dose of the topical steroid hydrocortisone for the past four weeks. He has developed thin skin and stria along his back, suggesting toxicity. The cause of the toxicity would be: A. Decreased absorption through interactions reducing the half-life B. Increased distribution to adipose tissues, prolonging the half-life C. Increased metabolism in liver, increasing the half-life D. Increased excretion from the kidneys, increasing the half-life The percentage of body fat (adipose tissue) increases with age. This causes lipid-soluble drugs to be more widely distributed to the body organs that have a high fat content, such as adipose tissue and muscle (modest fat content, but large mass) and away from the liver and kidneys.

ABHES Competency: 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. Bloom's: Analyzing CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. Difficulty: Hard Learning Outcome: 3.2 List several factors that affect absorption and distribution of drugs in the elderly.

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Chapter 003 Geriatric Pharmacology Key

15. (p. 38) How would an elderly patient who smokes and consumes alcohol tolerate an adultstrength dose of actively oxidized medication compared to an elderly patient who did neither of these activities? A. Could not tolerate B. Would tolerate the same C. Would tolerate better D. Would need a higher dose Other factors such as smoking, alcohol consumption, and the administration of certain drugs, all of which may cause microsomal enzyme induction, will increase the rate of drug metabolism.

ABHES Competency: 2. Anatomy and Physiology b. Identify and apply the knowledge of all body systems; their structure and functions; and their common diseases, symptoms, and etiologies. 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications Bloom's: Analyzing CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. Difficulty: Hard Learning Outcome: 3.3 List several factors that affect the metabolism and excretion of drugs in the elderly.

16. (p. 38) Morphine, which has a high first-pass metabolism, would require what type of dosing change in an elderly patient? A. Higher dose B. Same dose C. Tapered dose D. Lower dose In addition, drugs that normally undergo first-pass metabolism are not as extensively metabolized during the first pass through the liver.

ABHES Competency: 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. Bloom's: Analyzing CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. 12. Describe the relationship between anatomy and physiology of all body systems and medications used for treatment in each. Difficulty: Hard Learning Outcome: 3.3 List several factors that affect the metabolism and excretion of drugs in the elderly.

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Chapter 003 Geriatric Pharmacology Key

17. (p. 39) In relation to their medications, why is it important for elderly patients to increase their dietary protein intake? A. To maintain appropriate albumin levels B. To increase serum potassium levels C. To lower serum triglyceride levels D. To maintain serum calcium levels Lack of adequate protein intake lowers the concentration of plasma proteins, especially albumin, necessary for plasma protein drug binding.

ABHES Competency: 2. Anatomy and Physiology b. Identify and apply the knowledge of all body systems; their structure and functions; and their common diseases, symptoms, and etiologies. 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. Bloom's: Analyzing CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. 12. Describe the relationship between anatomy and physiology of all body systems and medications used for treatment in each. Difficulty: Hard Learning Outcome: 3.4 Recognize the effect of nutrition and age-related diseases on drug response.

18. (p. 39) Adequate nutrition in elderly patients is important for synthesizing drug-metabolizing enzymes. The body produces these enzymes from foods that are high in: A. Fat B. Protein C. Carbohydrate D. Nucleic acid Protein intake is also important for synthesis of drug-metabolizing enzymes.

ABHES Competency: 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. Bloom's: Analyzing CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. 12. Describe the relationship between anatomy and physiology of all body systems and medications used for treatment in each. Difficulty: Hard Learning Outcome: 3.4 Recognize the effect of nutrition and age-related diseases on drug response.

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Chapter 003 Geriatric Pharmacology Key

19. (p. 41) A chief complaint from elderly patients taking potassium bromide tablets would be: A. Dosing frequency B. Dietary restrictions C. Difficulty swallowing D. Small size Many elderly patients have difficulty swallowing large capsules.

ABHES Competency: 2. Anatomy and Physiology c. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system. 6. Pharmacology b. Properly utilize PDR, drug handbook, and other drug references to identify a drug's classification, usual dosage, usual side effects, and contraindications. 9. Medical Office Clinical Procedures d. Recognize and understand various treatment protocols. Bloom's: Analyzing CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. 11. Identify the classifications of medications, including desired effects, side effects, and adverse reactions. Difficulty: Hard Learning Outcome: 3.5 Explain the problems associated with drug compliance in the elderly.

20. (p. 40) One approach that can be used to facilitate decisions and enhance compliance when explaining medications to an elderly patient is to: A. Provide current pharmaceutical literature B. Speak loudly C. Use proper medical terminology D. Use proper demeanor The attitude and demeanor of the person providing drug prescribing instructions are sometimes the key ingredients to successful drug compliance.

ABHES Competency: 2. Anatomy and Physiology c. Assist the physician with the regimen of diagnostic and treatment modalities as they relate to each body system. 9. Medical Office Clinical Procedures d. Recognize and understand various treatment protocols. Bloom's: Analyzing CAAHEP Competency: I. Anatomy and Physiology 10. Compare body structure and function of the human body across the life span. Difficulty: Hard Learning Outcome: 3.5 Explain the problems associated with drug compliance in the elderly.

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