GAPNA/Pharmacogenomics/Ethics – Qs & As
The best way to practice medicine is by using ✔️Ans - Evidence based
medicine
Treatment of anorexia or cachexia in older adults ✔️Ans - Avoid using
prescription appetite stimulants or high calorie supplements
Instead optimize social supports, discontinue meds that interfere with eating,
provide appealing food
Mirtazapine can be used to ✔️Ans - Promote appetite and weight gain in
those with depression
NOT to be used without depression to promote weight gain
Vaccines the elderly should have ✔️Ans - Flu vaccine
Pneumonia
TD
Shingles
Treatment for asymptomatic bacteria in the elderly ✔️Ans - NONE
NEEDED
Glycemic targets in the elderly ✔️Ans - 7-7.5% in healthy w long life
expectancy
7.5-8.0% in those w moderate comorbidity and life expectancy <1 yr
8.0-9.0% in those w multiple morbidities and short life expectancy
Use of benzodiazepines should be reserved for ✔️Ans - Alcohol withdrawal
symptoms/delirium tremens
OR
Severe generalized anxiety disorder unresponsive to other therapies
NOT insomnia, agitation, or delirium
How often do you check blood sugars in a patient with type two diabetes on
metformin ✔️Ans - Only during titration of medication doses or during
periods of changes in diet and exercise routine
NOT DAILY
, Annually scheduled general health checks ✔️Ans - Have not been shown to
reduce morbidity, hospitalizations, or mortality
May increase frequency of non-evidence based testing
What are optimal doses of calcium and vitamin D to prevent fractures and
post menopausal women and men ✔️Ans - Insufficient evidence for any
benefit
USPSTF recommends against daily supplementation
How helpful our ABI, CRP, and coronary calcium scores in assessing
asymptomatic patients ✔️Ans - Evidence is insufficient to assess balance of
benefits and harms
Patient has CDiff and has successfully treated, recurrence of non foul-smelling
diarrhea two weeks later ✔️Ans - Only sx pts should be tested
CDiff tests may remain positive 30 days after
What is the best sliding scale insulin regimen in nursing facilities ✔️Ans -
NONE! No sliding scale is appropriate for nursing facilities unless old type one
diabetic isn't it
90 year old with dementia has stopped eating, when do you place the feeding
tube? ✔️Ans - Never! Instead offer oral assistant feedings
80-year-old patient with severe dementia is screaming and wandering in the
halls, what treatment is appropriate? ✔️Ans - Do not prescribe
antipsychotic medication for behavioral and psychological symptoms of
dementia and individuals without an assessment for an underlying cause of
the behavior
Most patients with acute sinusitis ✔️Ans - DO NOT require abx
50 year old presents to the ED with new onset syncope, physical exam and
Neuro exam are within normal limits. What test is appropriate ✔️Ans -
Labs, EKG
NO CT SCAN
The best way to practice medicine is by using ✔️Ans - Evidence based
medicine
Treatment of anorexia or cachexia in older adults ✔️Ans - Avoid using
prescription appetite stimulants or high calorie supplements
Instead optimize social supports, discontinue meds that interfere with eating,
provide appealing food
Mirtazapine can be used to ✔️Ans - Promote appetite and weight gain in
those with depression
NOT to be used without depression to promote weight gain
Vaccines the elderly should have ✔️Ans - Flu vaccine
Pneumonia
TD
Shingles
Treatment for asymptomatic bacteria in the elderly ✔️Ans - NONE
NEEDED
Glycemic targets in the elderly ✔️Ans - 7-7.5% in healthy w long life
expectancy
7.5-8.0% in those w moderate comorbidity and life expectancy <1 yr
8.0-9.0% in those w multiple morbidities and short life expectancy
Use of benzodiazepines should be reserved for ✔️Ans - Alcohol withdrawal
symptoms/delirium tremens
OR
Severe generalized anxiety disorder unresponsive to other therapies
NOT insomnia, agitation, or delirium
How often do you check blood sugars in a patient with type two diabetes on
metformin ✔️Ans - Only during titration of medication doses or during
periods of changes in diet and exercise routine
NOT DAILY
, Annually scheduled general health checks ✔️Ans - Have not been shown to
reduce morbidity, hospitalizations, or mortality
May increase frequency of non-evidence based testing
What are optimal doses of calcium and vitamin D to prevent fractures and
post menopausal women and men ✔️Ans - Insufficient evidence for any
benefit
USPSTF recommends against daily supplementation
How helpful our ABI, CRP, and coronary calcium scores in assessing
asymptomatic patients ✔️Ans - Evidence is insufficient to assess balance of
benefits and harms
Patient has CDiff and has successfully treated, recurrence of non foul-smelling
diarrhea two weeks later ✔️Ans - Only sx pts should be tested
CDiff tests may remain positive 30 days after
What is the best sliding scale insulin regimen in nursing facilities ✔️Ans -
NONE! No sliding scale is appropriate for nursing facilities unless old type one
diabetic isn't it
90 year old with dementia has stopped eating, when do you place the feeding
tube? ✔️Ans - Never! Instead offer oral assistant feedings
80-year-old patient with severe dementia is screaming and wandering in the
halls, what treatment is appropriate? ✔️Ans - Do not prescribe
antipsychotic medication for behavioral and psychological symptoms of
dementia and individuals without an assessment for an underlying cause of
the behavior
Most patients with acute sinusitis ✔️Ans - DO NOT require abx
50 year old presents to the ED with new onset syncope, physical exam and
Neuro exam are within normal limits. What test is appropriate ✔️Ans -
Labs, EKG
NO CT SCAN
