QuestionPrescription
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
3634
Treating anaphylaxis
Topic
9
Internal Medicine
## Drug choice feedback

This patient is in acute anaphylaxis. The treatment for this is adrenaline (also known as epinephrine). As this patient is an adult the standard dose that he should be given is 500 micrograms IM in the anterolateral aspect of his thigh. There is a reduced dose of 300 micrograms for children aged 6-11 years, 150 micrograms for children aged 6 months-5years

## Dose/Route/Frequency/Duration feedback

The following prescription is appropriate to treat this patient's anaphylaxis:

- Adrenaline/Epinephrine 1 in 1000 (1 mg/mL) 500 micrograms  IM every 5 minutes
10105
PrescriptionAnswer
PrescribeAnswerData
500 micrograms
PrescribeAnswerData
adrenaline 500 micrograms/mL injection
PrescribeAnswerData
Review based on patient response
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
intramuscular (IM)
PrescriptionAnswer
PrescribeAnswerData
0.5 mL
PrescribeAnswerData
adrenaline 1 mg/mL injection
PrescribeAnswerData
Review based on patient response
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
intramuscular (IM)
PrescriptionAnswer
PrescribeAnswerData
500 micrograms
PrescribeAnswerData
adrenaline 500 micrograms/mL injection
PrescribeAnswerData
Review based on patient response
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
intramuscular (IM)
PrescriptionAnswer
PrescribeAnswerData
500 micrograms
PrescribeAnswerData
adrenaline 1 mg/mL injection
PrescribeAnswerData
Review based on patient response
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
intramuscular (IM)
Case Presentation: A 18-year-old gentleman is brought to the emergency department with a swollen face, widespread rash and difficulty breathing. His friend with him says that the symptoms randomly happened during a meal at a restaurant.


## PH
Asthma

## DH
Salbutamol 200 micrograms INH QDS. NKDA.

## On examination

Airway patent, patient is alert and orientated.

Temperature 37.3°C, HR 128, RR 26, BP 101/653, O<sub>2</sub> 94% RA, GCS 15, Weight 60kg

Respiratory exam: widespread wheeze heard on auscultation.

Cardiovascular exam: HS 1 + 2 + 0, his pulse feels weak.

Abdominal exam: abdomen soft and non tender with no palpable organomegaly

Neurological exam: grossly intact

Multiple hives are seen over his abdomen and thorax when his top is removed.

## Investigations

FBC: Hb 139, WCC 4.6, Plts 255 x 10^9

CRP 18

U&Es: Na 140, K 4.2, Ur 4.9, Cr 54, eGFR >90mL/min/1.73m<sup>2</sup>

Ca2+ (adjusted): 2.3

Mg2+: 0.9

Phosphate: 0.81

LFTs: ALP 30, ALT 24, bilirubin 13

ECG - sinus tachycardia

## Prescribing Request

Write a prescription for one drug that is most appropriate to treat this condition.