QuestionMultiA
QuestionChoice
50273
g
Ibuprofen;400mg;PO;QDS
QuestionChoice
50275
i
Paracetamol;1g;PO;QDS
QuestionChoice
50270
d
Tramadol hydrochloride;1g;PO;QDS
QuestionChoice
50269
c
Gabapentin;300mg;PO;TDS
QuestionChoice
50267
a
Sertraline;50mg;PO;OD
QuestionChoice
50272
f
Hydroxychloroquine;200mg;PO;OD
QuestionChoice
50271
e
Nifedipine;5mg;PO;TDS
QuestionChoice
50274
h
Lansoprazole;30mg;PO;OD
QuestionChoice
50268
b
Lithium carbonate (Liskonum);450mg;PO;OD
QuestionComment
paracetamol 1g qds is right ?
40429
QuestionComment
yes max 4g/d
41821
User
subscriber
Myopathy Serotonin
User
subscriber
Traitor
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
3639
Taking both sertraline and lithium increases the risk of serotonin syndrome and a dosing error in tramadol
Topic
90
Psychiatry
1. This patient is experiencing serotonin syndrome. This can be inferred from the classic symptoms of diarrhoea, vomiting and muscle spasms combined with the dilated pupils and profuse sweating seen on examination. Tramadol and lithium increase the risk of serotonin syndrome in patient's taking sertraline. Tramadol is does this by increasing the concentration of serotonin in the synapses between the serotonergic neurones in the brain stem.
2. The max dose of tramadol should be 400mg daily. This patient would be receiving 10 times the maximum daily dose.
10110
b d
d
Case presentation: 


A 24-year-old woman attends the emergency department due to diarrhoea, vomiting and muscle spasms.

**PH** Depression, anxiety, bipolar disorder, fibromyalgia, Raynaud's syndrome, systemic lupus erythematosus

**DH** Her regular medicines are listed (below). Weight 67kg.

**On Examination**
HR 128/min regular rhythm, BP 164/97 mmHg, profusely sweating, dilated pupils.

Question 1: Select the TWO prescriptions that are most likely to have interacted with her sertraline to cause this presentation (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).