Geriatric Pharmacy Specialty Review Course, Workbook Chapters, and Practice Exam (No Recert Credit) - (Cert # L249102)

These activities are intended for pharmacists who are seeking to update their knowledge and skills commensurate with a board certification examination in the areas listed below.

This course consists of 4 groups of activities, containing a total of 12 topics (see table below) and provides up to 22.5 contact hours of continuing pharmacy education credit The Review Course includes case-based presentations for application to real-life scenarios, a practice exam along with correct answers, and links to the reference sources, and domains, tasks, and knowledge statements. To help you further prepare, this package includes a compilation of practice questions in the same format and rigor to help you prepare for the BPS Specialty Examination.  

After participating in this CPE activity, learners should be able to: 

Group 1
ACPE #: 0204-9999-24-929-H01-P

Complex Case: Inpatient to Family Medicine Clinic

• Interpret results of screening and assessments in the management of the geriatric patient.
• Select the appropriate treatment and monitoring for a complex patient-case with multiple conditions, including:
  • Atrial fibrillation
  • Post-myocardial infarction
  • Heart failure
  • Hypertension
  • Hyperlipidemia
  • Peripheral vascular disease
  • Insomnia
  • Drug induced urinary retention
  • Dry eyes
  • C. difficile infection
• Identify potentially inappropriate medications (PIM) for older adults, as well as medications that contribute to geriatric syndromes or conditions (e.g., falls, cognitive impairment). 

Complex Case: Ambulatory - Family Medicine Clinic

• Interpret results of screening and assessments in the management of the geriatric patient.
• Select the appropriate treatment and monitoring for a complex patient-case with multiple conditions, including:
  • Atrial fibrillation, post-MI
  • Heart failure
  • Coronary artery disease
  • Hypothyroidism
  • Diabetes mellitus, new onset
  • Benign prostatic hyperplasia
  • Hypotension
  • Gastroesophageal reflux disease
• Evaluate financial/reimbursement issues (e.g., formularies, insurance coverage) when making therapeutic recommendations.
• Explain steps to assist a patient with payment issues for medications, medication therapy management services, and medical equipment.
• Describe strategies to assess caregiver knowledge and expectations regarding advanced age and disease on health risks, needs, and treatment of health conditions.
• Evaluate the appropriateness of care plans and services based on older adults and caregivers’ changes in age, health status, and function; assist caregivers in altering plans and actions as needed.
• Apply strategies for improvement of adherence in older adults, their caregivers and the interprofessional care team.
• Give examples of how to collaborate with older adults, their caregivers, and the healthcare team during care planning and implementation. 
• Explain the need for continuity of treatment and communication across the spectrum of services and during transitions between care settings.
• Apply outcomes of investigations to optimize care of older adults. 

Complex Case: Ambulatory - Geriatric Clinic

• Interpret the results of screening and assessments in the management of the geriatric patient.
• Select the appropriate treatment and monitoring for a complex patient-case with multiple conditions, including:
  • Chronic obstructive pulmonary disease
  • Osteoarthritis
  • Depression
  • Urinary tract infection
  • Glaucoma
  • Herpes Zoster
• Evaluate strategies to promote evidence-based approaches for screening, immunizations, health promotion, and disease prevention for older adults.
• Assess a patient medication list, including prescription and over-the-counter medications, and complementary and alternative therapies.
• Identify the components of an interprofessional, comprehensive geriatric assessment and the roles individual disciplines play in conducting and interpreting a comprehensive geriatric assessment.
• Assess specific risks to older adult safety, including falls, abuse, physical/chemical restraints, and other environmental hazards.
• Explain the role of advanced directives and living wills, do not resuscitate, power of attorney, and other substitute decision-makers documents in medication use decisions. 

Group 2
ACPE #: 0204-9999-24-930-H01-P

Complex Case: Inpatient-Surgery to Skilled Nursing Facility

•          Interpret results of screening and assessments in the management of the geriatric patient.
•          Select the appropriate treatment and monitoring for a complex patient-case with multiple conditions, including:
  • Delirium
  • Deep vein thrombosis prophylaxis
  • Pneumonia
  • Anxiety
  • Pain management (acute)
  • Fluid & electrolyte disorder
  • Falls
• Define Describe the continuum of care available to geriatric patients, such as community resources, home care, assisted living facilities, nursing facilities, sub-acute care facilities, hospice care, and hospitals.
• Explain the need for continuity of treatment and communication across the spectrum of services and during transitions between care settings.
• Identify potential hazards of hospitalization for older adults, including immobility, delirium, medication side effects, malnutrition, pressure ulcers, procedures, and hospital acquired infections.
• Assess specific risks to older adult safety, including falls, abuse, physical/chemical restraints, and other environmental hazards.
• Identify iatrogenic conditions (e.g., healthcare associated infections, falls, pressure ulcers, medication-induced). 

 Complex Case: Skilled Nursing Care

• Interpret results of screening and assessments in the management of the geriatric patient.
• Select the appropriate treatment and monitoring for a complex patient-case with multiple conditions, including:
  • Anemia
  • Anxiety
  • Deep vein thrombosis prophylaxis
  • Osteoporosis
  • Pain management
  • SIADH
  • Falls
  • Constipation
• Explain the need for continuity of treatment and communication across the spectrum of services and during transitions between care settings.
• Identify potential medication-related causes of declining physical and cognitive function.
• Select methods to facilitate medication reconciliation during transitions of care.
• Summarize limitations of biomedical information for the care of older adults.
• Apply outcomes of investigations to optimize care of older adults.
• Develop strategies to prevent or resolve iatrogenic conditions.
• Identify elder abuse/neglect (e.g., physical, psychological, and financial).
• Identify resources to assist in prevention, reporting, and treatment of elder abuse/neglect. 

Statistics, Evidence-based Medicine, and Research Design

• Evaluate quality and appropriateness, with specific attention to study design, statistical analysis, internal/external validity, source of bias/confounders, and quality of conclusions and interpretation of graphs.
• Explain why a statistical test is appropriate or not appropriate, based on the sample distribution, data type, and study design.
• Interpret clinical and statistical significance for results from commonly used statistical tests.
• Explain the strengths and limitations of different types of measures of central tendency (mean, median, and mode) and data spread (standard deviation, standard error of the mean, range, and interquartile range).
• Evaluate odds ratio, risk/incidence rate, relative risk, number needed to treat, number needed to harm, and other risk estimates.
• Assess whether the study applies to a specified patient population. 

Group 3
ACPE #: 0204-9999-24-931-H01-P

Complex Case: Long-term Care

• Interpret results of screening and assessments in the management of the geriatric patient.
• Select the appropriate treatment and monitoring for a complex patient-case with multiple conditions, including:
  • Alzheimer’s with behaviors
  • Hypertension
  • T2DM
  • Geriatric syndromes – malnutrition/failure to thrive/weight loss
  • Renal dysfunction/CKD
• Summarize ethical issues that arise during therapy with individuals who have diminished decision-making capacity.
• Identify potential medication-related causes of declining physical and cognitive function.
• Identify clinical situations where life expectancy, functional status, patient preference or goals of care should override standard recommendations for screening/ treatment.
• Summarize care need priorities considering severity of illness, patient preference, quality of life, and time to benefit.
• Select interventions and behaviors that promote physical and mental health, nutrition, function, safety, social interactions, independence, and quality of life to older adults and their caregivers.
• Assess specific risks to older adult safety, including falls, abuse, physical/chemical restraints, and other environmental hazards.
• Apply the findings of research to the care of older adults.
• Evaluate the relevancy of clinical practice guidelines and standards of care for older adults.
• Describe the medication utilization process in the long-term care setting as it relates to the consultant pharmacist. 

Geriatric Practice Administration

• Describe integration of evidence-based geriatric literature into institutional guidelines and processes.
• Develop a plan to monitor and evaluate compliance with, and impact of, policies and guidelines (e.g., institutional, evidence based).
• Select quality assurance methods, metrics, and improvement activities, including needs assessment techniques, aimed at enhancing the safety and effectiveness of medication-use processes in the geriatric settings.
• Explain regulatory/IRB requirements relative to conducting geriatric research.
• Describe regulatory requirements and organizational structure of long-term care facilities as it relates to the consultant pharmacist.
• Design education programs/materials/tools for geriatric patient populations.
• Assess formulary management protocols in geriatric practice settings.
• Develop systems to identify risk factors and prevention for adverse drug events/medication incidents/errors in the geriatric patient population.
• Apply protocols for managing high-risk medications in older adults. 

Complex Case: Assisted Living

• Interpret results of screening and assessments in the management of the geriatric patient.
• Select the appropriate treatment and monitoring for a complex patient-case with multiple conditions, including:
  • Urinary incontinence
  • Dysphagia
  • Stroke
  • Neuropathic pain
  • Gout
  • Seizure disorder
  • Substance abuse
• Evaluate self-care capacity, including medication self-administration.
• Identify signs of substance and medication misuse/abuse in older adults.
• Assess the impact of social behaviors, including use of tobacco, caffeine, alcohol, and illicit drugs.
• Identify need for referral of patients to other healthcare professionals.
• Apply verbal and nonverbal communication strategies to overcome potential sensory, language, and cognitive limitations in older adults.
• Evaluate improvement strategies for adherence in older adults, their caregivers and the interprofessional team. 

Group 4
ACPE #: 0204-9999-24-932-H01-P

Principles of Aging

• Summarize the spectrum of aging and physiological heterogeneity of older adults.
• Apply the knowledge of physiologic changes associated with aging to the clinical use of medications (e.g., pharmacokinetics and pharmacodynamics).
• Describe social and financial issues that impact therapeutic recommendations for geriatric patients.
• Select the appropriate treatment and monitoring for a patient with frailty. 

Complex Case: Hospice/Palliative Care

• Interpret results of screening and assessments in the management of the geriatric patient.
• Select the appropriate treatment and monitoring for a complex patient-case with multiple conditions, including:
  • Parkinson’s disease
  • Pressure ulcers
  • Dry mouth
  • Pain management
• Summarize care need priorities considering severity of illness, patient preference, quality of life, and time to benefit.
• Identify iatrogenic conditions (e.g., healthcare associated infections, falls, pressure ulcers, medication-induced conditions).
• Apply cultural competency concepts (e.g., ethnic/racial, religion, spiritual, age-related, language) and guidelines to healthcare decisions.
• Identify clinical situations where life expectancy, functional status, patient preference or goals of care should override standard recommendations for screening/ treatment.
• Identify need for referral of patients to other healthcare professionals.
• Explain the altered benefit-risk ratio of medications at the end of life.
• Discuss end of life issues as they relate to medication appropriateness. 

Infectious Disease Considerations and Antimicrobial Stewardship Principles in Geriatric Patients and Care Settings

• Describe regulations and government guidance statements calling for use of antimicrobial stewardship in geriatric care settings.
• Summarize the implications of infectious disease guidelines for use of antimicrobial agents in the geriatric patient population.
• Select appropriate antimicrobial therapy for a geriatric patient, taking into consideration infectious-diseases management principles and patient-specific variables.
• Recommend appropriate antimicrobial monitoring recommendations for a geriatric patient based on patient-specific variables and antimicrobial stewardship principles.
• Develop methods for monitoring trends and identifying opportunities for improvement in antimicrobial use within geriatric care settings.

The Core Therapeutic Modules Review Package consists of 10 activities in which faculty review clinical topics and practice skills using a case-based approach. The activities are designed to assist the learner in identifying knowledge gaps in preparation for a pharmacy specialty board examination. In addition to a recorded presentation, each activity includes links to resources for further self-study and a practice test developed in the same format and rigor as the specialty exam.

After participating in these CPE activities, learners should be able to:

Select Topics in Acid-Base Disorders
ACPE #: 0204-0000-21-610-H01-P

For the following specific acid/base disorders - respiratory, metabolic acid base disorders including anion gap/non-anion gap acidosis, renal tubular acidosis, as well as delta gap equation:

•  Interpret laboratory and diagnostic tests.
• Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines

Select Topics in Infectious Diseases in Critical Care Patients
ACPE #: 0204-0000-22-643-H01-P

For the following specific infectious disease topics: urinary tract infections, meningitis, catheter related infections, bacteremia, and infective endocarditis:

• Interpret laboratory and diagnostic tests.
• Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines.

Select Neurology Topics in Critical Care Patients
ACPE #: 0204-0000-20-990-H01-P

• For the following specific critical care topics: status epilepticus, traumatic brain injury, ischemic stroke, subarachnoid hemorrhage:
  • Interpret laboratory and diagnostic tests.
  • Evaluate benefits and risks of drug therapy considering other medication, and other patient-specific factors.
  • Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines.

Alterations in Pharmacokinetics and Pharmacodynamics in Critical Care
ACPE #: 0204-0000-21-611-H01-P

• Identify pharmacokinetic and pharmacodynamic (PK/PD) changes that occur in critical illness, and the impact on commonly administered medications in this setting.
• Apply knowledge of general PK/PD changes in critical illness to the following patient-specific factors that further complicate drug dosing:
  • Burns
  • Obesity
  • Pregnancy
  • Continuous renal replacement therapy (CRRT)
  • Extracorporeal membrane oxygenation (ECMO)

• Develop a therapeutic strategy to optimize PK/PK for commonly used medications in the intensive care unit. "

Select Topics in Prevention and Supportive Care in Critical Care Patients
ACPE #: 0204-0000-20-991-H01-P

For the following specific critical care topics─stress ulcer prophylaxis (SUP), venous thromboembolism (VTE) prophylaxis, bowel regimens, and ventilator associated pneumonia (VAP) prevention:

• Interpret laboratory and diagnostic tests.
• Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines.

Select Topics in Toxicology
ACPE #: 0204-0000-21-612-H01-P

For the following specific toxicology topics: acetaminophen, toxic alcohols, calcium channel blockers, beta blockers, opioids, and ecstasy:

• Interpret laboratory and diagnostic tests
• Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines.

Select Topics in Pulmonary Disorders
ACPE #: 0204-0000-22-644-H01-P

For the following specific pulmonary disease topics: asthma exacerbation, acute exacerbation of chronic obstructive pulmonary disease, pulmonary embolism, and pulmonary arterial hypertension:

• Interpret laboratory and diagnostic tests.
• Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines.

Cardiac Arrhythmias and Advanced Cardiac Life Support
ACPE #: 0204-0000-20-992-H01-P

• Interpret signs, symptoms and diagnostic tests for cardiac arrhythmias.
• Identify drug-related problems, including drug interactions and adverse effects, associated with pharmacotherapy of cardiac arrhythmias.
• Identify strategies to prevent drug-induced arrhythmias.
• Recommend therapy and monitoring for cardiac arrhythmias based on patient-specific information, current guidelines and Advanced Cardiac Life Support guided therapies.

Pharmacotherapy Considerations in the Management of Shock
ACPE #: 0204-0000-20-993-H01-P

• Interpret diagnostic and/or laboratory tests, vital signs, and clinical presentation in order to differentiate types of shock (hypovolemic, distributive, cardiogenic)
• Compare and contrast the pharmacologic agents utilized in shock
• Recommend therapy and monitoring based on patient-specific information and current guidelines for the treatment of shock

Fluid, Electrolytes, and Nutrition
ACPE #: 0204-0000-22-617-H01-P

• Interpret laboratory and diagnostic tests for fluid, electrolyte, and nutrition status.
• Recommend the most appropriate therapy and monitoring in patients with fluid, electrolyte, and nutritional disorders based on patient-specific information and current guidelines.
• Apply strategies to manage drug-related electrolyte interactions and nutrient interactions.

Faculty Bios

Trista Bailey, PharmD, BCGP, BCPS, FASCP
Associate Professor
Texas Tech University Health Sciences Center - School of Pharmacy
Abilene, Texas 

Claire Bainbridge, PharmD, BCCCP, BCGP
Clinical Pharmacist
UCSF Health
Assistant Clinical Professor
UCSF School of Pharmacy
San Francisco, California 

Amie Taggart Blaszczyk, PharmD, BCGP, BCPS, FASCP*
Professor and Division Head – Geriatrics
Texas Tech University Health Sciences Center - School of Pharmacy
Dallas, Texas 

Dana G. Carroll, PharmD, BCGP, BCPS, CDCES*
Clinical Professor / Adjunct Faculty
Auburn University Harrison College of Pharmacy
University of Alabama College of Community Health Services
Auburn, Alabama 

Nakia Duncan, PharmD, BCGP, BCPS
Associate Professor of Pharmacy Practice, Geriatrics Division
Texas Tech HSC Jerry H. Hodge School of Pharmacy
Pain & Palliative Care Clinical Pharmacy Specialist
UT Southwestern Medical Center
Dallas, Texas 

Emily Ellsworth, PharmD, BCGP
Home-Based Primary Care Clinical Pharmacy Practitioner
Edward Hines, Jr. Veterans Affairs Hospital
Hines, Illinois 

Carol Fox, PharmD, BCGP, CPh
Associate Professor and Department Chair
University of South Florida Taneja College of Pharmacy
Tampa, Florida 

Emily Frederick, PharmD, BCPS
Associate Professor and Vice Chair
Sullivan University College of Pharmacy and Health Sciences
Clinical Pharmacist
University of Louisville Hospital
Louisville, Kentucky 

Lisa C. Hutchison, PharmD, MPH, BCGP, BCPS, FCCP
Professor and Vice Chair, Pharmacy Practice / Professor, Department of Geriatrics
University of Arkansas for Medical Sciences
Little Rock, Arkansas 

Heather L. Ourth, PharmD, BCGP, BCPS, FASHP
Assistant Chief Consultant for Clinical Pharmacy Practice, Outcomes, Analytics, Legislation and Compensation
Department of Veterans Affairs Pharmacy Benefits Management
Washington, DC 

Maria Shin, PharmD, BCGP, BCPS*
Clinical Pharmacy Practitioner / Adjunct Assistant Professor
Robley Rex Louisville Veterans Affairs Medical Center
Sullivan University College of Pharmacy
Louisville, Kentucky

*Content Matter Experts

Amy Holmes, PharmD, BCPPS
Susan R. Dombrowski, MS, RPh

In accordance with our accreditor’s Standards of Integrity and Independence in Accredited Continuing Education, ASHP requires that all individuals in control of content disclose all financial relationships with ineligible companies. An individual has a relevant financial relationship if they have had a financial relationship with an ineligible company in any dollar amount in the past 24 months and the educational content that the individual controls is related to the business lines or products of the ineligible company.

An ineligible company is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The presence or absence of relevant financial relationships will be disclosed to the activity audience. 

No one in control of the content of this activity has a relevant financial relationship (RFR) with an ineligible company.

Activities can be completed in any order. Each activity consists of audio, video, and/or PDFs and evaluations. Learners must review all content and complete the evaluations to receive continuing pharmacy education credit for each activity. 

Follow the prompts to claim, view, or print the statement of credit within 60 days after completing the activity. 

ASHP and ASHP collaborate on geriatric pharmacy activities.

To maintain its strict, independent standards for certification, BPS does NOT endorse or provide review information, preparatory courses, or study guides for Board Certification Examinations.