QuestionSBA
QuestionChoice
Atorvastatin does not commonly interact with morphine.
50162
b
Atorvastatin 20mg PO OD
QuestionChoice
Salmeterol does not commonly interact with morphine.
50163
c
Salmeterol 50micrograms INH BD
QuestionChoice
Tiotropium does not commonly interact with morphine.
50164
d
Tiotropium 5micrograms INH OD
QuestionChoice
Paracetamol does not commonly interact with morphine.
50165
e
Paracetamol 1g PO QDS
QuestionChoice
This patient is experiencing opioid toxicity. Tranylcypromine is a monoamine oxidase B inhibitor that is used to treat major depressive disorder. It has been shown to potentially increase the risk of opioid toxicity if taken alongside morphine.
50161
a
Tranylcypromine 10mg 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
3612
The use of trancylpromine alongside morphine increases the risk of opioid toxicity
Topic
13
Neurosurgery
10080
Case Presentation: A 62-year-old gentleman has recently undergone surgery for a broken neck of femur which was treated with a total hip replacement. He has been managing his post-operative pain with morphine. His regular medicines are listed (below). Weight 85kg.




 **PH** Depression, COPD, Hypercholesterolaemia, Ethanol excess


 **DH** Tranylcypromine 10mg PO OD, Atorvastatin 20mg PO OD, Salmeterol 50micrograms INH BD, Tiotropium 5micrograms INH OD, Paracetamol 1g PO QDS


 **On examination**
BP 109/68mmHg, HR 88, RR 4


Neurological exam: Difficult to rouse the patient. Pupils appear small.


 **Investigation**



||||
|--------------|:-------:|------------------|
|pH|7.24|7.35 - 7.45|
|PaO₂|6.0 kPa|11 - 15|
|PaCO₂|9.4kPa|4.6 - 6.4|
|Bicarbonate|18 mmol/L|22 - 30|



Question: Select the medication that is most likely to have contributed to this patient's clinical condition.
a