QuestionSBA
QuestionChoice
Paracetamol does not commonly interact with insulin to precipitate hypoglycaemia.
50169
d
Paracetamol 1g PO QDS
QuestionChoice
Clarithromycin can increase the likelihood of hypoglycaemia when taken alongside insulin. Clarithromycin is a macrolide antibiotic that works by inhibiting bacterial protein synthesis by binding to the 50s ribosomal subunit.
50166
a
Clarithromycin 500mg PO BD
QuestionChoice
Hydromol cream does not commonly interact with insulin to precipitate hypoglycaemia.
50168
c
Hydromol cream one application to affected area BD
QuestionChoice
Cetirizine does not commonly interact with insulin to precipitate hypoglycaemia.
50170
e
Cetirizine 10mg PO OD
QuestionChoice
Sertraline does not commonly interact with insulin to precipitate hypoglycaemia.
50167
b
Sertraline 50mg 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
3613
Taking both clarithromycin and insulin increases the risk of hypoglycaemia
Topic
91
Paediatrics
10081
Case Presentation: A 16-year-old boy is brought to A&E by his mother as he is very drowsy. He is a known type 1 diabetic and treats this with insulin. He has recently had an ear infection, which is currently being treated with antibiotics by his GP. His regular medicines are listed (below).




 **PH** Type 1 diabetes mellitus, Depression, Eczema, Allergic Rhinitis


 **DH** Sertraline 50mg PO OD, Hydromol cream one application to affected area BD, Clarithromycin 500mg PO BD, Paracetamol 1g PO QDS, Cetirizine 10mg PO OD


Allergic to penicillin - comes out in a rash


 **On examination**
BP 109/68mmHg, HR 108, RR 24


Neurological exam: Difficult to rouse the patient.


 **Investigation**


||||
|--------------|:-------:|------------------|
|pH|7.27|7.35 - 7.45|
|PaO₂|10.0 kPa|11 - 15|
|PaCO₂|3.4 kPa|4.6 - 6.4|
|Bicarbonate|14 mmol/L|22 - 30|
|Lactate|3 mmol/L|0.6 - 1.4|


Serum BM 2.6 mmol/L (Fasting: 4.0 - 5.4 mmol/L, 2hrs post prandial: <7.8 mmol/L) , ketones 0.4mmol/L (<0.6 mmol/L)


Question: Select the medication that is most likely to have interacted with this patient's diabetes medication to produce this clinical picture.
a