CHAPTER 27: DRUGS AND OLDER ADULTS

MATCHING a. Absorption b. Cumulative effect c. Distribution d. Beera List drugs e. Polypharmacy f. Metabolism

Match each term to the definition listed below.

1. Increased effect of a drug that results from its accumulation in the body

2. Passage of a substance through a membrane into body fluids or tissues

3. Biotransformation of a drug or substance for use by the body

4. Delivery of a substance to body organs through circulation

5. Excessive use of drugs or prescriptions or many drugs given at one time

6. Drugs considered inappropriate for nursing home residents based on a national survey of geriatric experts

1. ANS: B PTS: 1

2. ANS: A PTS: 1

3. ANS: F PTS: 1

4. ANS: C PTS: 1

5. ANS: E PTS: 1

6. ANS: D PTS: 1 a. Can be habitforming b. GI bleeding c. Respiratory depression in COPD d. May lower seizure threshold

Match the following medications with the reason they are considered inappropriate for adults over 65 years of age.

7. Methyldopa

8. Buproprion/Wellbutrin

9. Digoxin

10.Long-acting benzodiazepines

11.Ketorolac

12.Decongestants e. Breast and endometrial cancer f. Bradycardia g. Toxicity due to renal clearance h. Increased blood pressure

13.Short-acting benzodiazepines

14.Premarin

7. ANS: F PTS: 1

8. ANS: D PTS: 1

9. ANS: G PTS: 1

10.ANS: C PTS: 1

11.ANS: B PTS: 1

12.ANS: H PTS: 1

13.ANS: A PTS: 1

14.ANS: E PTS: 1

Multiple Choice

1. A notable increase in serious complications resulting from adverse drug reactions is said to be related to: a. increased life span leading to an increased older adult population. b. increased abuse of prescription drugs by the elderly. c. people taking fewer but stronger medications. d. subdued responses to medications. ANS: A Feedback

A Correct! An increased older population of adults taking more medications has resulted in an increase in serious medicationrelated complications.

B This population is not the primary group who abuse prescription drugs although a notable trend in inappropriate prescribing has been seen.

C

D

PTS: 1 a. A normal consequence of aging b. Behavioral changes

Older adults taking MORE medications would have been correct.

Older adults often have EXAGGERATED responses to medications.

2. MRPs or medication-related problems may be mistaken for which problem?

ANS: D c. Cognitive impairment d. All of the above

This makes it imperative that members of the health care community work together to reverse this dangerous trend.

PTS: 1

3. All of the following are bodily processes that affect drugs, EXCEPT: a. absorption. b. distribution.

ANS: D PTS: 1 c. metabolism. d. cognition.

4. Impaired distribution of drugs in older adults is most likely related to: a. hepatic dysfunction. b. poor gas exchange. c. inadequate circulatory function and decreased muscle mass. d. slowed GI motility and reduced fluid intake.

ANS: C

A

Feedback

Hepatic dysfunction is more likely to affect metabolism.

B Poor gas exchange is more likely to affect exchange.

C Correct! This would more likely affect DELIVERY of medications to different organs.

D Slowed GI motility and reduced fluid intake is more likely to affect absorption.

PTS: 1

5. Hepatic dysfunction more likely affects: a. absorption. c. distribution. b. metabolism. d. excretion.

ANS: B

Feedback

A Absorption is more impaired by factors that slow motility in the GI tract.

B Correct! Metabolism is more affected by the liver.

C Distribution is decreased where circulatory function is impaired.

D Excretion is altered in patients who have renal dysfunction or who have impaired gas exchange in the lungs.

PTS: 1 a. Increased food intake in the elderly slows gastric emptying. b. Gastric acid production is diminished in the elderly. c. Older patient’s sometimes refuse to use antacids. d. Increased gastric motility in the elderly does not allow for absorption of the medication.

6. Which of the following best describes how absorption is affected in the GI tract?

ANS: B

A

Feedback

The elderly typically have decreased appetites and often inadequate nutritional intake.

B Correct!

C

D

Older patients tend to USE medications that reduce gastric acid.

Older adults have a diminished production of gastric acid.

PTS: 1 a. Aging, thinner skin b. Decrease in muscle mass c. Decreased gastric motility

7. Absorption of medications may be affected by which of the following?

ANS: D PTS: 1 d. All of the above e. None of the above

8. Distribution in older adults is affected by all of the following, EXCEPT: a. decreased albumin production by the liver. b. circulatory compromise. c. decrease in total body water. d. decreased renal function.

ANS: D

Feedback

A Decreased albumin production allows more of the drug to unbound and to reach receptor sites with a resultant greater than expected response.

B Disease processes, such as heart disease, impair the delivery of medications to target organs.

C Older adults have less body water, and drugs that are more water soluble become concentrated, resulting in adverse reactions and/or additive effects of the drug over time.

D Correct! Renal function primarily affects the body’s ability to excrete drugs.

PTS: 1 a. Start at the lowest dose possible and increase the dose gradually. b. Increase the frequency of dosing. c. Monitor the patient frequently. d. All of the above.

9. What would be the most appropriate intervention with regard to medication administration in the older adult who has an impaired circulatory process?

ANS: A

Feedback

A Correct! Additional doses/increased frequency of administration might be required.

B Increasing the frequency of dosing WITHOUT decreasing the dose would likely result in overdose.

C Monitoring is not the MOST appropriate intervention as it does not change the dose or the schedule of dosing; however, this is a necessary practice.

D

PTS: 1 a. Renal

There is only one correct answer.

10.Metabolism is primarily affected by which organ/system?

Circulatory

ANS: C PTS: 1 a. Decrease in blood flow to the liver b. Decreased glomerular filtration c. Decreased GI motility

11.What aging processes affect the functionality of the liver?

ANS: A

Hepatic

Respiratory d. Decreased body water e. All of the above

B

This is related to decreased renal function.

C GI motility is decreased, but the decrease is not related to liver function.

D Decrease in body water is not related to liver function, but the decrease may affect distribution and/or excretion.

E There is only one correct answer.

PTS: 1 a. They are long-acting benzodiazepines. b. They inhibit liver enzymes from breaking down long-acting benzodiazepines. c. They inhibit liver enzymes from breaking down short-acting benzodiazepines. d. They result in decreased absorption of medications.

12.Omeprazole and Cimetidine might be avoided in older patients due to which of the following?

ANS: B

Feedback

A They are PPIs.

B Correct!

C Short-acting benzodiazepines are recommended for use in older adults to avoid prolonged effects or accumulation

D They result in INCREASED absorption of medications because they interfere with the breakdown of benzodiazepines

PTS: 1 a. Circulatory c. Cardiovascular b. Hepatic d. Renal

13.Excretion is the primary role of which organ/system?

ANS: D PTS: 1

14.Impaired excretion in older adults results from all of the following, EXCEPT: a. decrease in glomerular filtration. c. decreased renal blood flow. b. increased kidney size. d. diabetes.

ANS: B

Decreased kidney size in the elderly contributes to impaired excretion.

PTS: 1

15.Creatinine clearance is reduced by: a. heart disease. c. hypertension. b. diabetes. d. all of the above.

ANS: D PTS: 1

16.The Beers List Drugs refers to: a. inappropriate drugs used in hospitalized, young adults. b. most common abused prescriptions in older adults. c. medications that should not be used in those who are cognitively impaired. d. inappropriate drugs used in the ambulatory elderly population.

ANS: D PTS: 1

17.To help prevent medication errors in older patients, they should: a. be provided medications by the pharmacist in child-resistant containers. b. be encouraged to see their physician only when they experience a side effect of a medication. c. be advised to stop any medication as soon as signs of side effects occur. d. make a list of all medications and carry it in their wallet at all times.

ANS: D

A

Feedback

Pharmacists should dispense elderly patients’ medications in easy-toopen, easy-to-hold containers to facilitate administration.

B Older adults should see their physician every 6 months to a year or more frequently if indicated.

C Some medications should not be discontinued abruptly; the patient should inform the physician immediately in order to take the appropriate steps to avoid further side effects.

D Correct! PTS: 1 a. Prolonged bleeding time b. Silent bleeding ulcer

18.Which of the following are potential side effects of NSAIDs in older adults?

ANS: D PTS: 1 c. Hypertension d. All of the above a. It may cause auditory nerve damage. b. It causes oversedation in patients. c. It is cleared through the kidneys. d. It inhibits liver enzymes from breaking down other medications.

19.Why is Metformin not the best antidiabetic agent for an older adult with renal insufficiency?

ANS: C Feedback

A

Auditory nerve damage is associated with aminoglycosides and loop diuretics.

B Metformin is not known to cause sedation.

C Correct!

D Metformin does not inhibit hepatic enzymes.

PTS: 1 a. Starlix c. Omeprazole b. Glucophage d. Activase

20.There are several oral antidiabetic agents available for use in older adults. Which might be the BEST choice?

ANS: A

Feedback

A Correct!

B Glucophage is not a good choice in older adults.

C Omeprazole is not an antidiabetic agent, rather it is a PPI.

D Activase is not an antidiabetic agent, rather it is a thrombolytic.

PTS: 1 a. Hydrochlorothiaz ide c. Valsartan b. Altace d. Metoprolol

21.Which of the following is NOT an appropriate antihypertensive in a patient who is over 65 years of age with a history of gout?

ANS: A

Feedback

A Correct! Thiazide diuretics may precipitate gout attacks.

B This is an ACE-Inhibitor.

C This is an ARB.

D This is a beta blocker that has less CNS penetration than Propanolol.

PTS: 1 a. NSAIDs c. Long-acting benzodiazepines b. Estrogens d. Decongestants

22.An increase of falls is seen in older adults taking which group of medications?

ANS: C PTS: 1

23.The following drugs are all protein-bound and affected by changes in plasma albumin levels, EXCEPT: a. Dilantin. c. Warfarin. b. Diazepam. d. Actos.

ANS: D PTS: 1

TRUE/FALSE

1. Prescribing of medications is the third leading intervention experienced by older adult patients.

ANS: F

It is THE most common intervention.

PTS: 1

2. Medication-related problems may be easily mistaken for a normal consequence of aging or a progression of an existing disease.

ANS: T PTS: 1

3. In older adults, cognitive impairment is rarely the result of drug therapy.

ANS: F PTS: 1

4. Thinning skin associated with the aging process may impair absorption of transdermal medications.

ANS: T PTS: 1

5. As a result of the aging process, the liver produces more albumin allowing more unbound drug to reach receptor sites.

ANS: F

The liver produces LESS albumin with age.

PTS: 1

6. The liver is a major site of drug metabolism.

ANS: T PTS: 1

7. Actos is a more appropriate drug in older adults with decreased creatinine clearance.

ANS: T PTS: 1

8. If a patient has taken Lanoxin for many years, the same dose is considered to be safe and effective as he grows older because he will have built a tolerance for it.

ANS: F PTS: 1

9. Adalat is a safe alternative antihypertensive in older adults.

ANS: F PTS: 1

10.Propoxyphen is not recommended for use in older adults because it provides no better pain control than acetaminophen, but its CNS side effects are potentiated in older adults.

ANS: T PTS: 1

11.Benadryl is not considered to be an alternative to hypnotics in older adults.

ANS: T

It has anticholinergic effects and should only be used as a short-term medication for conditions other than allergies.

PTS: 1

12.Polypharmacy refers to pharmacy shopping by patients.

ANS: F

The term describes the excessive use of drugs or prescriptions, or many drugs given at one time

PTS: 1

13.Polypharmacy may result in serious side effects.

ANS: T PTS: 1

14.One way to avoid serious side effects associated with polypharmacy is to request the physician to substitute a more effective or safer medication.

ANS: T PTS: 1

15.The health care worker should never question potentially inappropriate medicines or dosages once the doctor has written the order.

ANS: F

Every health care worker has a moral and ethical responsibility to question potentially erroneous orders and to call to the provider’s attention possible interactions.

PTS: 1