Advanced Competency Assessment in
Geriatric Pharmacotherapy: Clinical
Knowledge & Application
150Qs&A,Rationale (2025/2026)
1. Which of the following is a common physiological change in older
adults that affects drug metabolism?
A. Increased liver mass
B. Decreased hepatic blood flow
C. Increased renal clearance
D. Increased gastric emptying
Rationale: Hepatic metabolism often declines in older adults due
to decreased liver mass and blood flow, affecting drug clearance.
2. Older adults are more sensitive to benzodiazepines primarily
because of:
A. Increased renal excretion
B. Increased body water
C. Changes in CNS receptor sensitivity
D. Increased metabolism
Rationale: Aging increases CNS sensitivity to benzodiazepines,
leading to heightened sedation and fall risk.
3. Which of the following drugs has a high risk of causing orthostatic
hypotension in the elderly?
A. Metformin
B. Alpha-blockers
C. Acetaminophen
D. Levothyroxine
Rationale: Alpha-blockers can cause vasodilation leading to
, orthostatic hypotension, which is particularly risky in older
adults.
4. Polypharmacy in geriatric patients is defined as:
A. Use of more than 2 medications
B. Use of more than 5 medications
C. Use of multiple medications, often 5 or more, regardless of
indication
D. Use of only prescription drugs
Rationale: Polypharmacy refers to the use of multiple
medications and increases risk of adverse drug reactions in older
adults.
5. Which of the following pharmacokinetic changes is common in
elderly patients?
A. Increased absorption of oral medications
B. Increased first-pass metabolism
C. Decreased renal clearance
D. Increased distribution of water-soluble drugs
Rationale: Renal function declines with age, reducing clearance
of renally-excreted drugs, increasing risk of toxicity.
6. The Beers Criteria are used to:
A. Assess liver function
B. Determine drug cost-effectiveness
C. Identify potentially inappropriate medications in older adults
D. Measure renal clearance
Rationale: Beers Criteria is a guideline to help clinicians avoid
medications that are high-risk in the elderly.
7. Which drug class is most associated with confusion and delirium
in elderly patients?
A. ACE inhibitors
, B. Statins
C. Anticholinergics
D. Beta-blockers
Rationale: Anticholinergic drugs can cross the blood-brain
barrier and cause CNS side effects like confusion in older adults.
8. An elderly patient has a reduced glomerular filtration rate. Which
drug adjustment is most appropriate?
A. Increase the dose
B. Reduce the dose or extend the dosing interval
C. Continue the same dose
D. Discontinue all medications
Rationale: Drugs excreted renally may accumulate in elderly
patients with reduced GFR, so dosing adjustment is necessary.
9. Which class of drugs is associated with increased fall risk in elderly
patients?
A. ACE inhibitors
B. Benzodiazepines
C. Statins
D. Metformin
Rationale: Benzodiazepines cause sedation, impaired balance,
and cognitive impairment, increasing fall risk.
10. Which of the following is a major concern when prescribing
NSAIDs to older adults?
A. Sedation
B. Gastrointestinal bleeding and renal impairment
C. Bradycardia
D. Hyperglycemia
Rationale: NSAIDs can cause GI ulcers and reduce renal
perfusion, both risks heightened in elderly patients.
, 11. Which pharmacokinetic change in elderly patients affects
water-soluble drugs?
A. Increased clearance
B. Decreased volume of distribution
C. Increased protein binding
D. Decreased absorption
Rationale: Decreased total body water reduces the volume of
distribution for water-soluble drugs, leading to higher plasma
concentrations.
12. Warfarin dosing in elderly patients requires careful
monitoring because:
A. Liver metabolism is increased
B. Risk of bleeding is higher due to altered pharmacodynamics
and drug interactions
C. Renal clearance is enhanced
D. Elderly patients are resistant to anticoagulants
Rationale: Elderly patients are more sensitive to warfarin and
have higher bleeding risks, necessitating careful INR monitoring.
13. Which drug class can exacerbate urinary retention in elderly
men with benign prostatic hyperplasia (BPH)?
A. ACE inhibitors
B. Diuretics
C. Anticholinergics
D. Beta-blockers
Rationale: Anticholinergic drugs reduce bladder contractility,
worsening urinary retention in BPH patients.
14. Which of the following is a common adverse effect of
digoxin in older adults?
A. Hypertension
Geriatric Pharmacotherapy: Clinical
Knowledge & Application
150Qs&A,Rationale (2025/2026)
1. Which of the following is a common physiological change in older
adults that affects drug metabolism?
A. Increased liver mass
B. Decreased hepatic blood flow
C. Increased renal clearance
D. Increased gastric emptying
Rationale: Hepatic metabolism often declines in older adults due
to decreased liver mass and blood flow, affecting drug clearance.
2. Older adults are more sensitive to benzodiazepines primarily
because of:
A. Increased renal excretion
B. Increased body water
C. Changes in CNS receptor sensitivity
D. Increased metabolism
Rationale: Aging increases CNS sensitivity to benzodiazepines,
leading to heightened sedation and fall risk.
3. Which of the following drugs has a high risk of causing orthostatic
hypotension in the elderly?
A. Metformin
B. Alpha-blockers
C. Acetaminophen
D. Levothyroxine
Rationale: Alpha-blockers can cause vasodilation leading to
, orthostatic hypotension, which is particularly risky in older
adults.
4. Polypharmacy in geriatric patients is defined as:
A. Use of more than 2 medications
B. Use of more than 5 medications
C. Use of multiple medications, often 5 or more, regardless of
indication
D. Use of only prescription drugs
Rationale: Polypharmacy refers to the use of multiple
medications and increases risk of adverse drug reactions in older
adults.
5. Which of the following pharmacokinetic changes is common in
elderly patients?
A. Increased absorption of oral medications
B. Increased first-pass metabolism
C. Decreased renal clearance
D. Increased distribution of water-soluble drugs
Rationale: Renal function declines with age, reducing clearance
of renally-excreted drugs, increasing risk of toxicity.
6. The Beers Criteria are used to:
A. Assess liver function
B. Determine drug cost-effectiveness
C. Identify potentially inappropriate medications in older adults
D. Measure renal clearance
Rationale: Beers Criteria is a guideline to help clinicians avoid
medications that are high-risk in the elderly.
7. Which drug class is most associated with confusion and delirium
in elderly patients?
A. ACE inhibitors
, B. Statins
C. Anticholinergics
D. Beta-blockers
Rationale: Anticholinergic drugs can cross the blood-brain
barrier and cause CNS side effects like confusion in older adults.
8. An elderly patient has a reduced glomerular filtration rate. Which
drug adjustment is most appropriate?
A. Increase the dose
B. Reduce the dose or extend the dosing interval
C. Continue the same dose
D. Discontinue all medications
Rationale: Drugs excreted renally may accumulate in elderly
patients with reduced GFR, so dosing adjustment is necessary.
9. Which class of drugs is associated with increased fall risk in elderly
patients?
A. ACE inhibitors
B. Benzodiazepines
C. Statins
D. Metformin
Rationale: Benzodiazepines cause sedation, impaired balance,
and cognitive impairment, increasing fall risk.
10. Which of the following is a major concern when prescribing
NSAIDs to older adults?
A. Sedation
B. Gastrointestinal bleeding and renal impairment
C. Bradycardia
D. Hyperglycemia
Rationale: NSAIDs can cause GI ulcers and reduce renal
perfusion, both risks heightened in elderly patients.
, 11. Which pharmacokinetic change in elderly patients affects
water-soluble drugs?
A. Increased clearance
B. Decreased volume of distribution
C. Increased protein binding
D. Decreased absorption
Rationale: Decreased total body water reduces the volume of
distribution for water-soluble drugs, leading to higher plasma
concentrations.
12. Warfarin dosing in elderly patients requires careful
monitoring because:
A. Liver metabolism is increased
B. Risk of bleeding is higher due to altered pharmacodynamics
and drug interactions
C. Renal clearance is enhanced
D. Elderly patients are resistant to anticoagulants
Rationale: Elderly patients are more sensitive to warfarin and
have higher bleeding risks, necessitating careful INR monitoring.
13. Which drug class can exacerbate urinary retention in elderly
men with benign prostatic hyperplasia (BPH)?
A. ACE inhibitors
B. Diuretics
C. Anticholinergics
D. Beta-blockers
Rationale: Anticholinergic drugs reduce bladder contractility,
worsening urinary retention in BPH patients.
14. Which of the following is a common adverse effect of
digoxin in older adults?
A. Hypertension
