QuestionMultiA
QuestionChoice
50041
a
Alendronic Acid;70mg;PO (Oral);Once weekly
QuestionChoice
50045
e
Diazepam;5mg;PO (Oral);Once daily
QuestionChoice
50044
d
Mirtazapine;45mg;PO (Oral);Nightly
QuestionChoice
50049
i
Paracetamol;1g;PO (Oral);Six times daily
QuestionChoice
50048
h
Movicol;1 Sachet;PO (Oral);Once daily
QuestionChoice
50042
b
Ramipril;10mg;PO (Oral);Once daily
QuestionChoice
50043
c
Amlodipine;5mg;PO (Oral);Once daily
QuestionChoice
50047
g
Cholecalciferol;400 units;PO (Oral);Once daily
QuestionChoice
50046
f
Furosemide;40mg;PO (Oral);Once daily
QuestionComment
dizziness is also a common side effect of alendronic acid, i would say this can increase the patient's risk of falls too..?
40140
User
subscriber
Vaccine Ketone
QuestionComment
diazepam dose not too high for an elderly lady?
42366
QuestionComment
6g of paracetamol a day is a bit more overkill tbh
61855
User
subscriber
Miabetes Dellitus
User
subscriber
ButtMuncher
QuestionComment
am i just being stupid or is there not a risk with amlodipine? 
62717
User
subscriber
5 years and have never entered a ward - AMA
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
3592
Elderly Care: Falls Risk and Dosing Errors
Topic
9
Internal Medicine
1. Ramipril is an angiotensin-converting enzyme inhibitor (ACEi) used to treat hypertension and heart failure. Antihypertensive medications such as ACEi and diuretics (i.e Furosemide) increase the risk of postural hypotension and therefore falls. This patient has a significant postural drop in their blood pressure (>20mmHg systolic) and this may have contributed to their fall. Mirtazapine also lists postural hypotension as a common side effect. Diazepam is a benzodiazepine used to treat muscle spasms and anxiety. Diazepam has sedative effects and may impair balance, increasing the risk of falls. 

2. Paracetamol should be prescribed in 500mg-1g doses 4-6 times per day with a maximum daily dose of 4g. This patient has been prescribed 6g daily, exceeding the maximum dose and therefore putting this patient at risk of paracetamol toxicity.
10060
b d e f
i
Case presentation: A 93-year-old female is admitted to the elderly care ward after having a fall.  **PH** Heart Failure, Hypertension, Anxiety, Depression, Osteoporosis, Back Pain **DH** Her regular medicines are listed (below). 



**On Examination**

Temperature 37.3°C, HR 84, RR 16

Weight 54kg

**Investigations**  Lying and Standing Blood Pressure: Lying 136/92mmHg, Standing after 2 minutes 110/84mmHg.

Question 1: Select the FOUR prescriptions that are most likely to have increased this patient's risk of falls.

Question 2: Select the ONE prescription that contains a serious dosing error (mark it with a tick in column B).