Special Pops- Test 1 Exam Guide Actual Exam Questions and CORRECT Answers
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Special Pops- Test 1 Exam Guide Actual
Exam Questions and CORRECT Answers
What are the categories of geriatric patients? - CORRECT ANSWER- "Youngest Old":
65-74
"Middle Old": 75-84
"Oldest Old" 85 to 99
"Centenarians": 100 and older
What age is an important cutoff age in clinical studies? ...
Special Pops- Test 1 Exam Guide Actual
Exam Questions and CORRECT Answers
What are the categories of geriatric patients? - CORRECT ANSWER- ✔✔"Youngest Old":
65-74
"Middle Old": 75-84
"Oldest Old" 85 to 99
"Centenarians": 100 and older
What age is an important cutoff age in clinical studies? - CORRECT ANSWER- ✔✔80 years
and older
Why do we focus on geriatric patients with regard to med errors? - CORRECT ANSWER-
✔✔- Decreased medication clearance (continue as you age)
- Increased medication sensitivity
- Physical limitations
- Greater likelihood of confusion when taking multiple medications
- Potential multiple medical conditions
> Increased risk of drug interactions /side effects
> Treatment even more confusing for the patient
- Cost issues may be more likely (and may affect adherence)
What is Beers Criteria? - CORRECT ANSWER- ✔✔American Geriatrics Society 2019 Beers
Criteria Update Expert Panel. American Geriatrics Society 2019 updated Beers Criteria for
potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019; 67:674-694.
Gold Standard for *potentially inappropriate medications in older adults* but does generate
some controversy in how it is applied by some practitioners or regulators.
Why are medications placed on the Beers list? - CORRECT ANSWER- ✔✔- Some meds
considered to have a high potential risk level
- For other meds better alternatives (either more effective or safer) may be available even if
that medication itself is not a high risk level
,Will all patients have a problem with Beers criteria? Why? - CORRECT ANSWER- ✔✔-
Beers Criteria is very useful when considering a medication for a newly diagnosed condition
- If a patient has been taking a Beers Criteria medication for some time, it is important to
assess for any actual problems experienced by patients rather than simply suggesting the
medication is inappropriate
What must a pharmacist do before pointing out a med is inappropriate? - CORRECT
ANSWER- ✔✔1. Evaluate the patient situation as fully as possible
o How long has patient been taking the medication?
o Is the current potentially inappropriate medication even causing a problem?
o Did the preferred med already fail to help?
o Can the patient not tolerate preferred medications?
o Med cost
- Is the preferred med more expensive than other alternatives?
- Was it not affordable even with insurance?
2. Be prepared to offer an appropriate alternative
o Difficult for prescriber if there is not a viable alternative
o Opportunity to offer expertise if there would be an appropriate patient alternative
Why should alternatives be considered for benzodiazepines? - CORRECT ANSWER- ✔✔-
Remember that all benzos can have significant CNS depressant effects
- Note that accumulation of benzodiazepines can be an issue for older patients
- If switching must be careful to taper the benzo down rather than stop abruptly
- Assess the reason for the benzo
What can you do if the benzo is used for anxiety? - CORRECT ANSWER- ✔✔- If the benzo
is used for anxiety, there are often other alternatives better than a benzodiazepine
- *citalopram or other anti-depressants are often the best choice*
- buspirone may be appropriate but does cause drowsiness
- trazodone in low doses (25-50 mg) sometimes used for anxiety as a prn agent
,What can you do if the benzo is for sleep? - CORRECT ANSWER- ✔✔- Sleep hygiene
always important but a medication can still be needed in some cases
- *For geriatric patients a daily nap (if not too late) may be appropriate because an older
patient may lose the ability to sleep all night*
- An insomnia medication should not be used if a patient falls asleep easily and sleeps most of
the night (but a med is appropriate if the patient falls asleep and wakes up shortly after)
1. melatonin or ramelteon (ramelteon is very expensive) are options, though they are
generally best for more mild sleep difficulties
2. Trazodone is an option, though still has its own risks. Trazodone is used off label for sleep,
but in geriatrics considered a better option than the benzodiazepine receptor agonists
3. benzodiazepine receptor agonists (zolpidem) may be effective but are usually weaker than
benzos and do have addiction and other risks, including falls, and are generally recommended
to be avoided in older patients
4. diphenhydramine is often taken by patients (sometimes by suggestion from pharmacists)
since it is an OTC, but note significant anti-cholinergic effects and the potential for tolerance
to develop quickly. However, some older patients will tolerate diphenhydramine and we
therefore must evaluate the situation to determine if it is appropriate. Note that it should be
avoided in anyone with dementia or confusion due to its anti-cholinergic effects.
What should you do *IF* a benzo is needed? - CORRECT ANSWER- ✔✔The following
(though they are intermediate acting) are less likely to accumulate due to lack of or a minimal
active metabolite and are generally preferred benzos: LOT
- lorazepam
- oxazepam
- temazepam
If a long-acting is needed, clonazepam is preferred due to lack of an active metabolite
- May be helpful for chronic anxiety if non-benzodiazepine options not sufficient
- May be needed for treatment of severe spasticity
*Though, remember from this list that clonazepam is used when a long-acting
benzodiazepine is needed and the others in the acronym are considered intermediate acting
benzodiazepines*
Why is it problematic for geriatric patients to take anticholinergics? - CORRECT ANSWER-
✔✔Anticholinergics are one of the key areas of potential concern in geriatrics but also are
potentially necessary for some patients. They can cause side effects similar to some problems
seen in elderly patients but also can help to treat some problems as well.
, Drugs termed "anticholinergic" block the effect of the neurotransmitter *acetylcholine at
muscarinic receptors* at key organs.By filling in and understanding this chart, you will have
a good idea of the key effects of the anticholinergics.Please note that for many of these
organs, an *adrenergic agonist* (such as a Beta2 agonist) will have the same effect as a
*muscarinic antagonist*. Basically, the parasympathetic system and the adrenergic system
balance each other.Understanding this well will help with a significant amount of
pharmacology you will see in practice
What is the key anticholinergic effect on each of these organs:
Brain
Bowels
Bladder
Lungs
Heart
Mouth
Why do anticholinergics have different degrees of effect? - CORRECT ANSWER- ✔✔-
Some will not be as strongly anti-cholinergic even when binding to the same muscarinic
receptor
- Others will be more selective for certain muscarinic receptors
> Darifenacin is more selective for (has greater affinity for) M3 muscarinic receptors in the
detrusor muscle of the bladder compared to other muscarinic receptors
> Note that even selective agents will still have an effect on other muscarinic receptors; the
goal is to reduce the effect. Therefore, these can have anti-cholinergic side effects depending
on how sensitive an individual patient is
- Other anti-muscarinics do not cross the blood-brain barrier as easily. These will reduce the
risk of confusion but may still cause other anti-cholinergic effects because they are not
selective for specific muscarinic receptors
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