MTM Geriatric Pharmacotherapy 3 — Questions and Answers
Question 1: Which lab finding would most strongly suggest digoxin toxicity in an elderly patient?
- Serum potassium of 5.2 mEq/L
- Serum digoxin level of 2.5 ng/mL with nausea and bradycardia (Correct answer)
- BUN of 20 mg/dL
- Serum sodium of 138 mEq/L
Correct answer: Serum digoxin level of 2.5 ng/mL with nausea and bradycardia
A digoxin level above 2.0 ng/mL combined with symptoms like nausea and bradycardia is consistent with toxicity, especially in older adults.
Question 2: Which opioid is considered INAPPROPRIATE for use in older adults due to toxic metabolite accumulation?
- Morphine
- Oxycodone
- Meperidine (Correct answer)
- Hydromorphone
Correct answer: Meperidine
Meperidine accumulates normeperidine, a neurotoxic metabolite that can cause seizures, especially in patients with renal impairment common in the elderly.
Question 3: A 78-year-old woman with a history of falls is prescribed a long-acting benzodiazepine for anxiety. What is the MTM pharmacist's most appropriate intervention?
- Continue the current therapy and monitor annually
- Recommend switching to a short-acting agent or non-benzodiazepine anxiolytic (Correct answer)
- Increase the dose for better anxiolytic effect
- Add a second benzodiazepine for breakthrough anxiety
Correct answer: Recommend switching to a short-acting agent or non-benzodiazepine anxiolytic
Long-acting benzodiazepines increase fall and fracture risk in older adults; transitioning to safer alternatives is recommended per Beers Criteria.
Question 4: Which parameter best reflects kidney function for dosing purposes in older adults when using creatinine-based estimates?
- Serum creatinine alone
- Creatinine clearance estimated by Cockcroft-Gault using actual body weight (Correct answer)
- eGFR from CKD-EPI without age correction
- BUN-to-creatinine ratio
Correct answer: Creatinine clearance estimated by Cockcroft-Gault using actual body weight
Cockcroft-Gault using actual body weight is most commonly used for drug dosing in older adults despite its limitations with very low muscle mass.
Question 5: Which condition makes warfarin therapy particularly challenging to manage in older adults, increasing bleeding risk?
- Isolated vitamin D deficiency
- Polypharmacy with drug-drug interactions and variable dietary vitamin K (Correct answer)
- Increased platelet activity with age
- Reduced albumin causing higher free warfarin
Correct answer: Polypharmacy with drug-drug interactions and variable dietary vitamin K
Polypharmacy and inconsistent dietary vitamin K intake in older adults cause INR fluctuations, significantly increasing the risk of over-anticoagulation and bleeding.
Question 6: A geriatric patient is started on a statin. Which monitoring parameter is especially important in older adults?
- Serum calcium levels
- Muscle symptoms and CK levels for myopathy (Correct answer)
- Thyroid function tests
- Serum potassium levels
Correct answer: Muscle symptoms and CK levels for myopathy
Older adults are at higher risk for statin-induced myopathy, so monitoring for muscle pain, weakness, and CK elevation is essential.
Question 7: Which non-pharmacologic strategy should be integrated into the MTM care plan for an elderly patient with chronic insomnia before initiating hypnotics?
- Recommend low-dose alcohol as a sleep aid
- Cognitive behavioral therapy for insomnia (CBT-I) (Correct answer)
- Increase caffeine intake to reset sleep cycle
- Advise extended bed rest regardless of sleep quality
Correct answer: Cognitive behavioral therapy for insomnia (CBT-I)
CBT-I is the first-line treatment for chronic insomnia and is preferred over hypnotics in older adults due to safety concerns with sedatives.
MTM Geriatric Pharmacotherapy 3
Which lab finding would most strongly suggest digoxin toxicity in an elderly patient?