Geriatrics

An 82-year-old with new confusion, inattention, and fluctuating course after surgery most likely has which syndrome?

First-line management for hyperactive delirium in a 79-year-old without Parkinson’s or QT prolongation is:

Which medication class is high-risk for falls and fractures in older adults and should be deprescribed for insomnia?

A 76-year-old with urge incontinence and mild cognitive impairment should avoid which drug?

Which antidepressant is preferred in a frail 80-year-old with depression and insomnia/weight loss?

A 78-year-old with osteoarthritis knee pain and CKD3a—safest initial pharmacologic option:

For chronic low back pain in an 82-year-old, first-line nonopioid recommendation is:

A 85-year-old with AF on apixaban needs dose selection; reduce to 2.5 mg BID when:

An 83-year-old with mechanical aortic valve needs anticoagulation; the agent of choice is:

Best initial step to prevent opioid-induced constipation in a 79-year-old starting oxycodone:

A 77-year-old with recurrent falls is on amitriptyline at night; best action:

Nitrofurantoin for UTI in an 82-year-old with eGFR 25 mL/min/1.73 m² should be:

A 78-year-old with heart failure and edema takes ibuprofen daily; primary pharmacist concern:

A sedentary 81-year-old on glipizide with recurrent hypoglycemia—best diabetes strategy:

Which long-acting sulfonylurea should be avoided in older adults due to prolonged hypoglycemia?

A 80-year-old with symptomatic orthostatic hypotension on multiple antihypertensives—first approach:

Chronic PPI therapy >8 weeks in an 82-year-old without high-risk indications should be:

A 79-year-old with dementia and severe agitation harming staff—pharmacologic choice after nonpharm failure:

A 84-year-old with chronic pain on amitriptyline and oxybutynin has confusion and dry mouth; likely cause:

Diagnostic clue distinguishing delirium from dementia in an 86-year-old:

A 78-year-old with osteoporosis and GERD is starting alendronate; key counseling:

Alendronate is generally avoided when eGFR is below:

An 83-year-old with T-score −2.7 and fragility fracture—first-line pharmacotherapy:

A 76-year-old with mild Alzheimer disease—drug that may offer modest cognitive benefit:

Important adverse effect to monitor with cholinesterase inhibitors in older adults:

For BPH with lower urinary tract symptoms and orthostasis risk, the α1-blocker with relatively lower BP effect:

A 82-year-old with neuropathic pain and CKD3b—gabapentin should be:

Which drug is preferred to avoid for insomnia in older adults due to anticholinergic effects and next-day sedation?

A 79-year-old with Parkinson disease and psychosis—safer antipsychotic option:

A 85-year-old with chronic AF on warfarin starts trimethoprim–sulfamethoxazole; pharmacist action:

Which lab abnormality suggests thiazide-induced hyponatremia in an 82-year-old with confusion?

A 80-year-old with asymptomatic bacteriuria before cataract surgery—appropriate management:

Which medication increases risk of SIADH/hyponatremia in older adults?

A 77-year-old with HFpEF and edema asks for NSAIDs for knee pain; best answer:

Long-term metformin in a 79-year-old with neuropathy—screen for which deficiency?

A 82-year-old on digoxin for AF and CKD—safe daily dose ceiling generally is:

A 78-year-old with depression and neuropathic pain—best SNRI option with lower anticholinergic burden:

A 86-year-old with polypharmacy—most appropriate global strategy:

In advanced dementia with poor oral intake, best approach to weight loss:

A 83-year-old with chronic constipation and hemorrhoids—first-line pharmacologic therapy:

In older adults, which analgesic is specifically inappropriate due to neurotoxic metabolite accumulation and seizure risk?

A 79-year-old with type 2 diabetes is on sliding-scale insulin only; pharmacist recommendation?

What is the maximum recommended daily citalopram dose in adults ≥60 years to limit QT prolongation?

Antipsychotics used for dementia-related psychosis carry which FDA warning in older adults?

A healthy 70-year-old asks about shingles prevention; best vaccine plan?

Pneumococcal vaccination in an immunocompetent 68-year-old not previously vaccinated—simplest current option:

Which influenza vaccination approach is preferred for adults ≥65 years when available?

For primary prevention in a 78-year-old without ASCVD, aspirin should generally be:

An 80-year-old on chronic prednisone 10 mg/day needs bone protection; best regimen:

Tramadol in a 77-year-old on sertraline—key safety concern:

Codeine for chronic pain in an 82-year-old—best recommendation:

Target therapeutic serum range for digoxin in heart failure for older adults:

Memantine in severe renal impairment (CrCl <30 mL/min) should be:

A 81-year-old on clopidogrel needs a PPI for GI protection; preferred choice:

Which antihypertensive class is potentially inappropriate as first-line for uncomplicated HTN in older adults due to orthostasis/fall risk?

After hospital discharge, which intervention best reduces adverse drug events in older adults?

An 82-year-old with prior MI asks about statins; best approach:

Which diabetes medication class has the lowest hypoglycemia risk as monotherapy in older adults?

Combining opioids with benzodiazepines in geriatric patients primarily increases risk of:

Which medication combination is notorious for precipitating acute kidney injury in older adults?