QuestionPrescription
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3586
Prescribing emergency oral contraception
Topic
66
Obstetrics & Gynaecology
## Drug choice feedback

This patient is asking for emergency contraception in the form of a pill. There are two options you can prescribe - levonorgestrel or ulipristal acetate. Levonorgestrel is only effective if the episode of unprotected sex has occurred within 72 hours of presentation whereas ulipristal is effective up to 120 hours after the episode of unprotected sex.

## Dose/Route/Frequency/Duration feedback

The following prescriptions would provide emergency contraception for this patient:

- Levonorgestrel (Levonelle) 1.5mg PO ONCE
- Ulipristal acetate (ellaOne) 30mg PO ONCE
10053
PrescriptionAnswer
PrescribeAnswerData
1.5 mg
PrescribeAnswerData
levonorgestrel 1.5 mg tablet
PrescribeAnswerData
Once-off
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
1.5 mg
PrescribeAnswerData
levonorgestrel 1.5 mg tablet
PrescribeAnswerData
Once-off
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
30 mg
PrescribeAnswerData
ulipristal acetate 30 mg tablets
PrescribeAnswerData
Once-off
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
1.5 mg
PrescribeAnswerData
levonorgestrel 1.5 mg tablet
PrescribeAnswerData
Once-off
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
oral (PO)
Case Presentation: A 19-year-old woman attends her GP asking for emergency contraception. She has had unprotected sex 48 hours ago. She does not want an invasive procedure or injection.


## PH
Nil.

## DH
Nil.

## On examination

Nil.

## Investigations

Nil.

## Prescribing Request

Write a prescription for one drug that is most appropriate to provide her with emergency contraception.