QuestionMultiA
QuestionChoice
50084
h
Lansoprazole;30mg;PO;OD
QuestionChoice
50078
b
Amlodipine;10mg;PO;OD
QuestionChoice
50077
a
Ramipril;10mg;PO;OD
QuestionChoice
50079
c
Atorvastatin;20mg;PO;OD
QuestionChoice
50080
d
Apixaban;5mg;PO;BD
QuestionChoice
50085
i
Paracetamol;1g;PO;QDS
QuestionChoice
50082
f
Salbutamol;200 micrograms;INH;QDS
QuestionChoice
50083
g
Ibuprofen;400mg;PO;QDS
QuestionChoice
50081
e
Bisoprolol;5 micrograms;PO;OD
QuestionComment
surely the cause of the bleeding is the ibuprofen and therefore the cause of the anaemia, no?
42365
User
subscriber
ButtMuncher
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
3596
Apixaban can cause anaemia and a dosing error in bisoprolol
Topic
129
Elderly medicine
1. Apixaban is a common cause of anaemia. As apixaban is a blood thinner, one of its common side effects is bleeding. This in turn then leads to anaemia. Ibuprofen and lansoprazole can also cause anaemia however this is much rarer.
2. Bisoprolol dosages come in milligrams, not micrograms. This patient is receiving a much lower dose than they should be.
10064
d
e
Case presentation: A 74-year-old gentleman attends his GP complaining of dizziness. 




 **PH** Hypertension, atrial fibrillation, COPD, hypercholesterolaemia, osteoarthritis


 **DH** His regular medicines are listed (below). Weight 83kg.


 **Investigations**



||||
|--------------|:-------:|---------------|
|Haemoglobin|111 g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|4.8x10<sup>9</sup>/L|3.0 - 10.0|
|Platelets|236x10<sup>9</sup>/L|150 - 400|
|Mean Cell Volume (MCV)|72 fL|80 - 96|
|Neutrophils|2.2x10<sup>9</sup>/L|2.0 - 7.5|
|Lymphocytes|1.3x10<sup>9</sup>/L|1.5 - 4.0|
|Monocytes|0.4x10<sup>9</sup>/L|0.2 - 1.0|
|Eosinophils|0.1x10<sup>9</sup>/L|0 - 0.4|
|Basophils|0.03x10<sup>9</sup>/L|0 - 0.1|


Question 1: Select the ONE prescription that is most likely to be a cause of his anaemia (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).