QuestionMultiA
QuestionChoice
50040
i
Folic Acid;5mg;PO (Oral);Once Weekly
QuestionChoice
50033
b
Lisinopril;20mg;PO (Oral);Once Daily
QuestionChoice
50039
h
Senna;15mg;PO (Oral);Nightly
QuestionChoice
50038
g
Prednisolone;15mg;PO (Oral);Once Daily
QuestionChoice
50034
c
Amlodipine;5mg;PO (Oral);Once Daily
QuestionChoice
50037
f
Colecalciferol;400 units;PO (oral);Once Daily
QuestionChoice
50035
d
Carbamazepine;500mg;PO (Oral);Twice Daily
QuestionChoice
50032
a
Methotrexate;10mg;PO (Oral);Once Weekly
QuestionChoice
50036
e
Alendronic Acid;700mcg;PO (Oral);Once Weekly
QuestionComment
The folic acid is also a serious error here, this should be prescribed daily (other than the day mtx is taken), not weekly.. 
17576
QuestionComment
No its given once a week for patients taking methotrexate 
17620
User
subscriber
Hereditary Hematoma
User
subscriber
Neoplasia Dominant
QuestionComment
Methotrexate has osteoporosis in the uncommon side effects list
44400
User
subscriber
Endoscope Hematoma
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
3591
Bisphosphonates dosing errors and Osteoporosis
Topic
9
Internal Medicine
1. Long-term use of glucocorticoids such as prednisolone increase the risk of osteoporosis. Glucocorticoids should therefore only be used in short courses (up to 4 weeks) to treat flares of rheumatoid arthritis. Some antiepileptics (carbamazepine, phenytoin and sodium valproate) have been shown to increase the risk of osteoporosis when used long term.
2. Alendronic Acid is used to treat osteoporosis, it should be prescribed in a weekly dose of 70mg or a daily dose of 10mg. 700mcg = 0.7mg. 700mcg would not be an effective dose to treat osteoporosis.
10059
d g
e
Case presentation: A 66-year-old female comes to the GP for a medication review. She reports that she currently has pain in her hands. 


**PH** Hypertension, Epilepsy, Rheumatoid Arthritis, Osteoporosis, Constipation

**DH** Her regular medicines are listed (below).

**On Examination** - Patient looks well, Hands: red erythematous swelling of metacarpophalangeal (MCPs) joints in the left hand, swelling of third proximal interphalangeal (PIPs) joint on the left hand. Pain on palpation of MCPs and PIPs. Reduced range of movement of left hands and wrists.

Temperature 37.5°C, HR 88, RR 18, BP 134/94

**Investigation** - Recent X-Ray of left-hand shows loss of joint space at MCPs and PIPs, Erosion at the third PIP and soft tissue swelling around the MCPs and third PIP.

Weight 56kg.

Question 1: Select the TWO prescriptions that increase the risk of osteoporosis (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)