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
3585
First-line hypertension management in patients >55 years old
Topic
92
General Practice
## Drug choice feedback

This gentleman has hypertension. This is confirmed based on the readings at the GP and the at home readings he has measured himself. As he is older than 55 years of age, the first line medication he should be prescribed is a calcium channel blocker.

## Dose/Route/Frequency/Duration feedback

The options to treat this gentleman's hypertension are as follows:

- Amlodipine 5mg PO OD
- Felodipine 5mg PO OD
- Lacidipine 2mg PO OD
- Lercanidipine hydrochloride 10mg PO OD
- Nicardipine hydrochloride 20mg PO TDS
10052
PrescriptionAnswer
PrescribeAnswerData
5 mg
PrescribeAnswerData
felodipine 5 mg m/r tablets
PrescribeAnswerData
To be reviewed
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
1 tablet
PrescribeAnswerData
amlodipine 5 mg tablets
PrescribeAnswerData
To be reviewed
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
10 mg
PrescribeAnswerData
lercanidipine hydrochloride 10 mg tablets
PrescribeAnswerData
To be reviewed
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
2 mg
PrescribeAnswerData
lacidipine 2 mg tablets
PrescribeAnswerData
To be reviewed
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
20 mg
PrescribeAnswerData
nicardipine hydrochloride 20 mg capsules
PrescribeAnswerData
To be reviewed
PrescribeAnswerData
three times daily (TDS)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
5 mg
PrescribeAnswerData
amlodipine 5 mg tablets
PrescribeAnswerData
To be reviewed
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
Case Presentation: A 67-year-old gentleman attends his GP for a blood pressure review. He had high blood pressure at a previous review and has returned with his home blood pressure monitoring.



## PH
Nil.

## DH
Nil. NKDA.

## Investigations

Blood pressure at previous visit: 151/88 mmHg

Blood pressure at today's visit: 148/90 mmHg

Home blood pressure reading average: 149/89 mmHg

## Prescribing Request

Write a prescription for one drug that is most appropriate to treat his hypertension.