FLORIDA BOARD OF PHARMACY
GERIATRIC PHARMACIST CERTIFICATION
EXAM WITH ACTUAL QUESTIONS AND
VERIFIED ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
Question 1
An 82-year-old woman residing in an assisted-living facility takes
warfarin, digoxin, furosemide, lisinopril, metformin, oxybutynin, and
diphenhydramine at bedtime. She reports dizziness, two recent falls,
constipation, dry mouth, and difficulty initiating urination. Her serum
creatinine is 1.1 mg/dL, but her estimated creatinine clearance is
substantially reduced because of advanced age and low body weight.
Which medication combination is MOST likely contributing to her
current geriatric syndrome?
A. Lisinopril and metformin
B. Warfarin and furosemide
C. Oxybutynin and diphenhydramine
D. Digoxin and lisinopril
Answer: C. Oxybutynin and diphenhydramine
Rationale: Oxybutynin is a strongly anticholinergic medication, while
diphenhydramine also has substantial anticholinergic activity. In an
older adult, their combined anticholinergic burden can produce dry
mouth, constipation, urinary retention, blurred vision, cognitive
impairment, delirium, dizziness, and increased fall risk. The
combination is particularly concerning because older adults have
1
,greater pharmacodynamic sensitivity to anticholinergic effects. A
medication review should consider deprescribing or replacing these
agents with safer alternatives based on the indications.
Question 2
A 79-year-old man with hypertension, benign prostatic hyperplasia,
chronic kidney disease, and recurrent falls is taking doxazosin 8 mg
nightly. His blood pressure is 118/64 mmHg sitting and 94/52 mmHg
after standing for three minutes. He reports lightheadedness when
getting out of bed. What is the MOST appropriate pharmacotherapy
concern?
A. Drug-induced orthostatic hypotension
B. Drug-induced hyperkalemia
C. Drug-induced hypoglycemia
D. Drug-induced nephrolithiasis
Answer: A. Drug-induced orthostatic hypotension
Rationale: Alpha-1 blockers such as doxazosin can cause vasodilation
and significant orthostatic blood-pressure reductions. Older adults are
particularly vulnerable because impaired baroreceptor responses,
reduced physiologic reserve, and multiple medications can magnify the
effect. The patient's symptomatic blood-pressure drop and falls make
this clinically important. The pharmacist should evaluate whether
doxazosin remains necessary, whether the dose can be reduced, and
whether an alternative BPH strategy would be safer.
Question 3
An 88-year-old nursing-home resident has chronic atrial fibrillation and
is prescribed digoxin 0.125 mg daily. She weighs 48 kg and has a serum
creatinine of 1.0 mg/dL. She develops nausea, anorexia, confusion, and
2
,yellow-green visual disturbances. Which pharmacokinetic principle is
MOST important in explaining her increased toxicity risk?
A. Increased hepatic first-pass metabolism
B. Reduced renal elimination associated with aging
C. Increased renal clearance in older adults
D. Increased plasma albumin concentration
Answer: B. Reduced renal elimination associated with aging
Rationale: Digoxin is substantially dependent on renal elimination.
Older adults can have markedly reduced renal function despite a
serum creatinine that appears “normal,” particularly when muscle
mass is low. Reduced clearance can increase digoxin exposure and
toxicity risk. The patient's gastrointestinal, neuropsychiatric, and
visual symptoms are classic warning signs. Renal function,
electrolytes, interacting medications, dose appropriateness, and serum
digoxin concentration should be evaluated.
Question 4
A 76-year-old patient with type 2 diabetes has an HbA1c of 6.1%. She
takes glyburide and has experienced three episodes of symptomatic
hypoglycemia during the previous month. Which intervention is MOST
appropriate?
A. Increase glyburide to achieve an HbA1c below 6%
B. Continue glyburide because sulfonylureas are preferred in older
adults
C. Reassess glycemic goals and discontinue or replace glyburide when
appropriate
D. Add bedtime insulin
Answer: C. Reassess glycemic goals and discontinue or replace
glyburide when appropriate
3
, Rationale: Glyburide is particularly problematic in older adults
because its prolonged hypoglycemic effect can result in serious and
sometimes prolonged hypoglycemia. The patient's recurrent
symptomatic hypoglycemia and very low HbA1c strongly suggest
overtreatment. Geriatric diabetes management emphasizes
individualized goals based on health status, life expectancy, cognition,
functional status, and hypoglycemia risk rather than automatically
pursuing very low HbA1c values.
Question 5
A 91-year-old woman develops acute confusion, agitation, visual
hallucinations, and fluctuating attention two days after admission for
pneumonia. Her daughter reports that she was cognitively intact before
hospitalization. Which diagnosis is MOST likely?
A. Major neurocognitive disorder
B. Delirium
C. Depression
D. Normal cognitive aging
Answer: B. Delirium
Rationale: Delirium is characterized by an acute and fluctuating
disturbance in attention and awareness, often accompanied by
cognitive changes, perceptual disturbances, and altered behavior.
Infection, hospitalization, dehydration, pain, sleep disruption,
metabolic abnormalities, and medications can precipitate delirium in
older adults. The abrupt onset and fluctuating attention distinguish
delirium from chronic dementia. The pharmacist should urgently
review medications with anticholinergic, sedative, psychoactive, or
other delirium-provoking effects.
4
GERIATRIC PHARMACIST CERTIFICATION
EXAM WITH ACTUAL QUESTIONS AND
VERIFIED ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
Question 1
An 82-year-old woman residing in an assisted-living facility takes
warfarin, digoxin, furosemide, lisinopril, metformin, oxybutynin, and
diphenhydramine at bedtime. She reports dizziness, two recent falls,
constipation, dry mouth, and difficulty initiating urination. Her serum
creatinine is 1.1 mg/dL, but her estimated creatinine clearance is
substantially reduced because of advanced age and low body weight.
Which medication combination is MOST likely contributing to her
current geriatric syndrome?
A. Lisinopril and metformin
B. Warfarin and furosemide
C. Oxybutynin and diphenhydramine
D. Digoxin and lisinopril
Answer: C. Oxybutynin and diphenhydramine
Rationale: Oxybutynin is a strongly anticholinergic medication, while
diphenhydramine also has substantial anticholinergic activity. In an
older adult, their combined anticholinergic burden can produce dry
mouth, constipation, urinary retention, blurred vision, cognitive
impairment, delirium, dizziness, and increased fall risk. The
combination is particularly concerning because older adults have
1
,greater pharmacodynamic sensitivity to anticholinergic effects. A
medication review should consider deprescribing or replacing these
agents with safer alternatives based on the indications.
Question 2
A 79-year-old man with hypertension, benign prostatic hyperplasia,
chronic kidney disease, and recurrent falls is taking doxazosin 8 mg
nightly. His blood pressure is 118/64 mmHg sitting and 94/52 mmHg
after standing for three minutes. He reports lightheadedness when
getting out of bed. What is the MOST appropriate pharmacotherapy
concern?
A. Drug-induced orthostatic hypotension
B. Drug-induced hyperkalemia
C. Drug-induced hypoglycemia
D. Drug-induced nephrolithiasis
Answer: A. Drug-induced orthostatic hypotension
Rationale: Alpha-1 blockers such as doxazosin can cause vasodilation
and significant orthostatic blood-pressure reductions. Older adults are
particularly vulnerable because impaired baroreceptor responses,
reduced physiologic reserve, and multiple medications can magnify the
effect. The patient's symptomatic blood-pressure drop and falls make
this clinically important. The pharmacist should evaluate whether
doxazosin remains necessary, whether the dose can be reduced, and
whether an alternative BPH strategy would be safer.
Question 3
An 88-year-old nursing-home resident has chronic atrial fibrillation and
is prescribed digoxin 0.125 mg daily. She weighs 48 kg and has a serum
creatinine of 1.0 mg/dL. She develops nausea, anorexia, confusion, and
2
,yellow-green visual disturbances. Which pharmacokinetic principle is
MOST important in explaining her increased toxicity risk?
A. Increased hepatic first-pass metabolism
B. Reduced renal elimination associated with aging
C. Increased renal clearance in older adults
D. Increased plasma albumin concentration
Answer: B. Reduced renal elimination associated with aging
Rationale: Digoxin is substantially dependent on renal elimination.
Older adults can have markedly reduced renal function despite a
serum creatinine that appears “normal,” particularly when muscle
mass is low. Reduced clearance can increase digoxin exposure and
toxicity risk. The patient's gastrointestinal, neuropsychiatric, and
visual symptoms are classic warning signs. Renal function,
electrolytes, interacting medications, dose appropriateness, and serum
digoxin concentration should be evaluated.
Question 4
A 76-year-old patient with type 2 diabetes has an HbA1c of 6.1%. She
takes glyburide and has experienced three episodes of symptomatic
hypoglycemia during the previous month. Which intervention is MOST
appropriate?
A. Increase glyburide to achieve an HbA1c below 6%
B. Continue glyburide because sulfonylureas are preferred in older
adults
C. Reassess glycemic goals and discontinue or replace glyburide when
appropriate
D. Add bedtime insulin
Answer: C. Reassess glycemic goals and discontinue or replace
glyburide when appropriate
3
, Rationale: Glyburide is particularly problematic in older adults
because its prolonged hypoglycemic effect can result in serious and
sometimes prolonged hypoglycemia. The patient's recurrent
symptomatic hypoglycemia and very low HbA1c strongly suggest
overtreatment. Geriatric diabetes management emphasizes
individualized goals based on health status, life expectancy, cognition,
functional status, and hypoglycemia risk rather than automatically
pursuing very low HbA1c values.
Question 5
A 91-year-old woman develops acute confusion, agitation, visual
hallucinations, and fluctuating attention two days after admission for
pneumonia. Her daughter reports that she was cognitively intact before
hospitalization. Which diagnosis is MOST likely?
A. Major neurocognitive disorder
B. Delirium
C. Depression
D. Normal cognitive aging
Answer: B. Delirium
Rationale: Delirium is characterized by an acute and fluctuating
disturbance in attention and awareness, often accompanied by
cognitive changes, perceptual disturbances, and altered behavior.
Infection, hospitalization, dehydration, pain, sleep disruption,
metabolic abnormalities, and medications can precipitate delirium in
older adults. The abrupt onset and fluctuating attention distinguish
delirium from chronic dementia. The pharmacist should urgently
review medications with anticholinergic, sedative, psychoactive, or
other delirium-provoking effects.
4
