QuestionMultiA
QuestionChoice
50234
d
Atorvastatin;80mg;PO;OD
QuestionChoice
50231
a
Ramipril;20mg;PO;OD
QuestionChoice
50235
e
Bisoprolol;7.5 mg;PO;OD
QuestionChoice
50233
c
Spironolactone;100mg;PO;OD
QuestionChoice
50239
i
Sertraline;50mg;PO;OD
QuestionChoice
50236
f
Metformin;500mg;PO;BD
QuestionChoice
50237
g
Methylphenidate hydrochloride;20 mg;PO;TDS
QuestionChoice
50232
b
Furosemide;40mg;PO;OD
QuestionChoice
50238
h
Paracetamol;500mg;PO;BD
QuestionComment
where does it say in the BNF that methylphenidate causes cold peripheries?
39634
QuestionComment
its under side effects as 'peripheral coldness' annoyingly
40000
User
subscriber
Prone Cystic
User
subscriber
Myotonia Serotonin
QuestionComment
methylphenidate 'coldness' is literally under rare S/E
40444
User
subscriber
RNA Retrograde
QuestionComment
doesnt ramipril cause raynauds though

59451
User
subscriber
NICU Jaundice
QuestionComment
Who on earth is giving this woman methylphenidate 
60596
User
subscriber
Myopathy Z-line
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
3635
Taking bisoprolol and methylphenidate together increase the risk of cold peripheries and a dosing error in furosemide
Topic
9
Internal Medicine
1. Both bisoprolol and methylphenidate can cause patient's to experience cold peripheries. Bisoprolol commonly causes cold peripheries as they reduce the amount of blood that is delivered to the fingers and toes.
2. The maximum dose of ramipril that a patient can take is 10mg PO OD therefore this prescription contains a mistake.
10106
e g
a
Case presentation: A 78-year-old female is admitted to the cardiology ward. During her stay she has been complaining of cold peripheries.


**PH** Congestive cardiac failure, type 2 diabetes mellitus, hypertension, oseteoarthritis hypercholesterolaemia, COPD, ADHD, depression

**DH** Her current medications are listed (below). Weight 110kg.

**On Examination**

HR 88/min, BP 114/89mm Hg, RR 24, O2 sats 92% RA. HS I + II with no added heart sounds. Bilateral basal crepitations heard on auscultation of the lungs.

**Investigation**

CXR shows bilateral pleural effusions

Question 1: Select the TWO prescriptions that are most likely to be the cause of her cold peripheries (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).