QuestionSBA
QuestionChoice
This patient has depression, he is exhibiting a variety of psychological and biological symptoms of depression. Since his main issue is lack of appetite and weight loss it would make most sense to prescribe him mirtazapine. Fluoxetine is the first line medication for depression in children.
50317
d
Fluoxetine 20mg PO OD
QuestionChoice
This patient has depression, he is exhibiting a variety of psychological and biological symptoms of depression. Since his main issue is lack of appetite and weight loss it would make most sense to prescribe him mirtazapine as this is an antidepressant that is linked with increasing appetite the most.
50314
a
Mirtazapine 15mg PO OD
QuestionChoice
This patient has depression, he is exhibiting a variety of psychological and biological symptoms of depression. Since his main issue is lack of appetite and weight loss it would make most sense to prescribe him mirtazapine.
50318
e
Escitalopram 10mg PO OD
QuestionChoice
This patient has depression, he is exhibiting a variety of psychological and biological symptoms of depression. Sertraline would usually be the first line treatment however his issues with weight loss make mirtazapine a more appropriate choice.
50315
b
Sertraline 50mg PO OD
QuestionChoice
This patient has depression, he is exhibiting a variety of psychological and biological symptoms of depression. Since his main issue is lack of appetite and weight loss it would make most sense to prescribe him mirtazapine. Venlafaxine is often a second line medication in major depressive disorder.
50316
c
Venlafaxine 25mg PO TDS
QuestionComment
In another mock test it said to try sertraline first before mirtazapine kms
40271
QuestionComment
this exactly
40380
User
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Pudendal QRS
QuestionComment
its because he's struggling with sleeping and eating, both of which mirtazapine help so its a better choice
40619
User
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ButtMuncher
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Serpiginous Defibrillator
QuestionComment
where does it say on the BNF to use mirtazapine if appetite loss?
61480
QuestionComment
I think its just because of the additional side effects that it has
MMMirtaZZZapine; increases MMM's appetite and ZZZ's sleepiness
61823
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CT Kinase
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Stasis Flutter
QuestionComment
Thought mirtazapine was cautioned in elderly?
61801
User
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Epidermis Migraine
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
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3646
Mirtazapine prescription can alleviate a reduced appetite in patients with depression and appetite issues
Topic
90
Psychiatry
10117
Case Presentation: A 78 year old man attends his GP due to low mood. He has issues with getting to sleep, concentration, general low mood and appetite. His main complaint is his appetite, he no longer eats as he used to and subsequently has lost weight. He has no suicidal ideation or impulse to hurt others.


**PH** COPD, osteoarthritis

**DH** Salbutamol 200 micrograms INH QDS, ibuprofen 400mg PO QDS, lansoprazole 30mg PO OD. NKDA

**On examination**

Visibly low mood. Lacking in engagement throughout the consultation.

Weight 3 months ago: 76kg.

Weight today: 68kg.

Question: Select the most appropriate management at this stage.
a