QuestionPrescription
QuestionComment
Nice recommend - "Arrange initial review after one week if the person is aged 18–25 years or there is a particular concern for risk of suicide, and ensure a risk management strategy is in place.", all other patients are review in 2 weeks
17230
User
subscriber
Odor Poisoning
QuestionComment
would it be wrong if i wrote sertraline 25mg in medicine option
58393
QuestionComment
I think it would be wrong in the actual PSA as you can't cut tablets in half
61759
User
subscriber
Syed
User
subscriber
Kussmaul Sign
QuestionComment
how can you dose 50mg tablets at 25mg per dose 
61276
User
subscriber
H
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
3630
First line management of generalised anxiety disorder
Topic
90
Psychiatry
## Drug choice feedback

This gentleman has generalised anxiety disorder. They require pharmacological intervention alongside psychological intervention. The first line medication to treat generalised anxiety disorder is sertraline.

## Dose/Route/Frequency/Duration feedback

The first line treatment for this gentleman's anxiety is Sertraline 25mg PO OD. NICE advise: *if sertraline is ineffective,* offer an alternative SSRI, for example, paroxetine or escitalopram, or a selective serotonin-noradrenaline re-uptake inhibitor (SNRI), such as duloxetine or venlafaxine. 


Initially, 25 mg daily is prescribed for 1 week, then increased to 50 mg daily, then increased in steps of 50 mg at intervals of at least 1 week if required, increase only if response is partial and if drug is tolerated; maximum 200 mg per day.
10101
PrescriptionAnswer
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10 mg
PrescribeAnswerData
escitalopram 10 mg tablets
PrescribeAnswerData
2 weeks
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
25 mg
PrescribeAnswerData
sertraline 50 mg tablets
PrescribeAnswerData
2 weeks
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
20 mg
PrescribeAnswerData
paroxetine 20 mg tablets
PrescribeAnswerData
2 weeks
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
Case Presentation: A 24-year-old man attends his GP due to feelings of social anxiety. He has been struggling to sleep and is constantly worrying about university interactions with his tutor, his relationship and his friendships. He does not report any suicidal ideations or any plans to harm others. He has tried cognitive behavioural therapy but he feels it has not made much of a difference.


## PH
Type 1 diabetes mellitus

## DH
Humulin I 10 units subcutaneous OD, actrapid 6 units subcutaneous BD (after breakfast and dinner). NKDA.

## On examination

He appears low in mood, his speech is quiet and laboured. He doesn't particularly engage with the review.

Temperature 36.4°C, HR 106, RR 19, BP 118/78, O<sub>2</sub> 99% RA, GCS 15, Weight 64kg

## Investigations

Nil.

## Prescribing Request

Write a prescription for one drug that is most appropriate to treat his anxiety.