NR 508 Pharm week 8 Exam

NR 508 Pharm week 8 Exam

Principles of prescribing for older adults include:

• Avoiding prescribing any newer high-cost medications
• Starting at a low dose and increasing the dose slowly
• Keeping the total dose at a lower therapeutic range
• All of the above(Answer) - 2. Starting at a low dose and increasing the dose

slowly Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie?

• Increased volume of distribution
• Decreased lipid solubility
• Decreased plasma proteins
• Increased muscle-to-fat ratio(Answer) - 3. Decreased plasma proteins

Glen is an 82-year-old patient who needs to be prescribed a new drug. What changes in elimination should be taken into consideration when prescribing for Glen?

• Increased glomerular filtration rate (GFR) will require higher doses of some

renally excreted drugs.

• Decreased tubular secretion of medication will require dosage adjustments.
• Thin skin will cause increased elimination via sweat.
• Decreased lung capacity will lead to measurable decreases in lung excretion of

drugs.(Answer) - 2. Decreased tubular secretion of medication will require dosage adjustments.

A medication review of an elderly person's medications involves:

• Asking the patient to bring a list of current prescription medications to the visit
• Having the patient bring all of their prescription, over-the-counter, and herbal

medications to the visit

• Asking what other providers are writing prescriptions for them
• All of the above(Answer) - 4. All of the above 1 / 3

Steps to avoid polypharmacy include:

• Prescribing two or fewer drugs from each drug class
• Reviewing a complete drug history every 12 to 18 months
• Encouraging the elderly patient to coordinate their care with all of their

providers

• Evaluating for duplications in drug therapy and discontinuing any

duplications(Answer) - 4. Evaluating for duplications in drug therapy and discontinuing any duplications Robert is a 72-year-old patient who has hypertension and angina. He is at risk for

common medication practices seen in the elderly including:

• Use of another person's medications
• Hoarding medications
• Changing his medication regimen without telling his provider
• All of the above(Answer) - 4. All of the above

To improve positive outcomes when prescribing for the elderly the nurse

practitioner should:

• Assess cognitive functioning in the elder
• Encourage the patient to take a weekly "drug holiday" to keep drug costs down
• Encourage the patient to cut drugs in half with a knife to lower costs
• All of the above(Answer) - 1. Assess cognitive functioning in the elder

When an elderly diabetic patient is constipated the best treatment options include:

• Mineral oil
• Bulk-forming laxatives such as psyllium
• Stimulant laxatives such as senna
• Stool softeners such as docusate(Answer) - 4. Stool softeners such as docusate

Delta is an 88-year-old patient who has mild low-back pain. What guidelines should be followed when prescribing pain management for Delta?

• Keep the dose of oxycodone low to prevent development of tolerance.
• Acetaminophen is the first-line drug of choice.
• Avoid prescribing NSAIDs.
• Add in a short-acting benzodiazepine for a synergistic effect on pain.(Answer) -
• Acetaminophen is the first-line drug of choice. 2 / 3

Robert is complaining of poor sleep. Medications that may contribute to sleep

problems in the elderly include:

• Diuretics
• Trazodone
• Clonazepam
• Levodopa(Answer) - 1. Diuretics

The GFRs for a 91-year-old woman who weighs 93 pounds and is 5'1" with a serum creatinine of 1.1, and for a 202-pound, 25-year-old male who is 5'9" with

the same serum creatinine according to the Cockcroft Gault formula are:

• 25ml/ min and 133 mL/min respectively
• 25 mL/min and 103 mL/min respectively
• 22 ml/min and 133 mL/min respectively
• 22 ml/min and 103 mL/min respectively(Answer) - 2. 25 mL/min and 103

mL/min respectively

RAT: Remember to use ideal body weight (IBW) in the formula. The woman's

IBW is 105 pounds and the man's is 156 pounds. Note the huge difference in GFR based on weight and age and the fact that looking at the serum creatinine alone can be very misleading in predicting GFR.In geriatric patients, the percentage of body fat is increased. What are the pharmacologic implications of this physiologic change?

• A lipid-soluble medication will be eliminated more quickly and not work as

well.

• A lipid-soluble medication will accumulate in fat tissue and its duration of

action may be prolonged.

• Absorption of lipid-soluble drugs is impaired in older adults.
• The bioavailability of the lipid-soluble drug will be increased in older adults.

(Answer) - 2. A lipid-soluble medication will accumulate in fat tissue and its duration of action may be prolonged.RAT: Lipid medications will accumulate in fatty tissues prolonging the half-lives of these drugs.

All of the following statements about the Beer's List are true except:

• It is a list of medications or medication classes that should generally be avoided

in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available.

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