QuestionMultiA
QuestionChoice
50249
a
Omeprazole;20mg;PO;OD
QuestionChoice
50255
g
Ibuprofen;400mg;PO;QDS
QuestionChoice
50256
h
Tamsulosin;400mg;PO;OD
QuestionChoice
50253
e
Ramipril;10mg;PO;OD
QuestionChoice
50254
f
Bisoprolol;10mg;PO;OD
QuestionChoice
50250
b
Atorvastatin;80mg;PO;OD
QuestionChoice
50252
d
Clopidogrel;75mg;PO;OD
QuestionChoice
50257
i
Cetirizine;10mg;PO;OD
QuestionChoice
50251
c
Aspirin;75mg;PO;OD
QuestionComment
I swear PPI causes loose stools

40233
User
subscriber
Neoplasia Nightshift
QuestionComment
Isn't constipation a common side-effect for ibuprofen as well?

43724
User
subscriber
NICU Gastro
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
3637
Omeprazole, atorvastatin and ramipril all commonly cause constipation and a dosing error in tamsulosin.
Topic
129
Elderly medicine
1. PPIs, ACE inhibitors, beta blockers and statins commonly cause constipation. Whilst other medications that this patient is on such as clopidogrel, tamsulosin and ibuprofen can cause constipation, these aren't listed as common/very common side effects unlike the omeprazole, ramipril, bisoprolol and atorvastatin.

2. The normal dose for tamsulosin when treating benign prostatic hyperplasia is 400 micrograms. This patient is receiving 400 milligrams of tamsulosin which is much higher than the maximum dose he should be receiving.
10108
a b e f
h
Case presentation: A 72-year-old gentleman attends his GP complaining of constipation


**PH** Benign prostatic hyperplasia, osteoarthritis, hypertension, prior myocardial infarction, hypercholesterolaemia, allergic rhinitis, gastro-oesophageal reflux disease,

**DH** His current medicines are listed (below). Weight 81kg.

Question 1: Select the FOUR prescriptions that are most likely to be contribute to his constipation (mark them with a tick in column A)

Question 2: Select the ONE prescription that contains a serious dosing error (mark it with a tick in column B).