QuestionSBA
QuestionChoice
Renal function tests are not required before starting sertraline.
50138
c
He will need renal function tests before starting sertraline
QuestionChoice
The use of antidepressants such as sertraline have been linked to suicidal thoughts and behaviour. This predominantly occurs near the beginning of treatment and should be monitored for.
50136
a
His mood may worsen for a few weeks after starting sertraline
QuestionChoice
Liver function tests are not required before starting sertraline.
50140
e
He will need liver function tests before starting sertraline
QuestionChoice
There is no listed interaction between sertraline and omeprazole. The ibuprofen he is taking does however interact with sertraline to increase the risk of bleeding.
50137
b
He will need to stop taking his omeprazole due to it increasing the risk of bleeding when taken with sertraline
QuestionChoice
Periorbital oedema is an uncommon side effect of sertraline, therefore it is not very likely to occur.
50139
d
It is very likely that he will experience periorbital swelling after starting sertraline
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
3607
Sertraline (SSRIs) increase the risk of a worsened mental state shortly after initiating treatment
Topic
90
Psychiatry
10075
Case presentation: A 26-year-old man attends his GP with low mood. This has persisted for 6 months. He has lost interest in his hobbies, has difficulty sleeping, has low energy levels and a low appetite. He has no active plans to harm himself or others although he does state 'sometimes I wish I wouldn't wake up'. He has no periods of heightened mood or psychotic symptoms. 



**PH**
Ankylosing spondylitis

**DH**
Ibuprofen 600mg QDS, omeprazole 20mg OD

One of the medications offered to treat his depression includes a sertraline which is offered to the patient to help treat his low moods.

Question: Select the most important information that should be provided for this patient.
a