We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

SAMP

An 83-year-old woman presents with recurrent falls. Medications: lorazepam 1 mg HS, metoprolol, amlodipine, sertraline, omeprazole, and OTC diphenhydramine for sleep. (8 points)

1. Most significant contributor to fall risk? (1 point)
   1. Amlodipine
   2. Sertraline
   3. Metoprolol
   4. Lorazepam
   5. Omeprazole

   Answer: D

2. Which OTC medication should be stopped first? (1 point)
   1. Multivitamin
   2. Diphenhydramine
   3. Calcium
   4. Vitamin D
   5. Magnesium

   Answer: B

3. Best next step to reduce fall risk? (1 point)
   1. Increase omeprazole dose
   2. Switch lorazepam to long-acting benzo
   3. Gradually taper off lorazepam
   4. Add melatonin 10 mg
   5. Stop metoprolol

   Answer: C

4. Which adverse effect is most associated with diphenhydramine in geriatric patients? (1 point)
   1. Hypertensive crisis
   2. Bradycardia
   3. Anticholinergic toxicity
   4. Hepatotoxicity
   5. Renal impairment

   Answer: C

5. Which interventions reduce fall risk? Select all that apply. (4 points)
   1. Home hazard assessment
   2. Strength and balance training
   3. Vitamin D optimization
   4. Routine CT head screening
   5. Polypharmacy reduction

   Answer: A, B, C, E