QuestionMultiA
QuestionChoice
50258
a
Lithium carbonate (Liskonum);450mg;PO;OD
QuestionChoice
50259
b
Captopril;10mg;PO;OD
QuestionChoice
50265
h
Salbutamol;200 micrograms;INH;QDS
QuestionChoice
50266
i
Sertraline;50mg;PO;OD
QuestionChoice
50262
e
Carbamazepine;400mg;PO;TDS
QuestionChoice
50264
g
Lansoprazole;30mg;PO;OD
QuestionChoice
50260
c
Amlodipine;10 mg;PO;OD
QuestionChoice
50263
f
Ibuprofen;400mg;PO;QDS
QuestionChoice
50261
d
Bendroflumethiazide;2.5g;PO;OD
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
3638
Lithium concentration can be increased when takin captopril or bendroflumethiazide and a dosing error in bendroflumethiazide
Topic
90
Psychiatry
1. ACE inhibitors, NSAIDs and thiazide like diuretics all increase the serum concentration of lithium. This is due to their effects on kidney function, a reduction in kidney function results in a reduced clearance of lithium. This in turn then leads to higher serum concentration of lithium.
2. Bendroflumethiazide should be given as a 2.5mg tablet once daily in hypertensive patients, NOT 2.5g.
10109
b d f
d
Case presentation: A 69-year-old gentleman attends his lithium clinic appointment  




 **PH** Bipolar disorder, seizures, hypertension, depression, asthma, osteoarthritis


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


 **Investigation**


Lithium concentration 1.5 mEq/L (0.8-1.2 mEq/L)


Question 1: Select the THREE prescriptions that are most likely to be interacting with his lithium to increase its serum concentration (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).