QuestionMultiA
QuestionChoice
50075
h
Fluticasone;50 micrograms, one application per nostril; intranasal;OD
QuestionChoice
50070
c
Nifedipine;10mg;PO;TDS
QuestionChoice
50068
a
Paracetamol;1g;PO;QDS
QuestionChoice
50074
g
Carbamazepine;4g;PO;BD
QuestionChoice
50069
b
Cetirizine;10mg;PO;OD
QuestionChoice
50071
d
Omeprazole;20mg;PO;OD
QuestionChoice
50073
f
Salbutamol;200 micrograms;INH;QDS
QuestionChoice
50072
e
Sertraline;50mg;PO;OD
QuestionChoice
50076
i
Fluticasone;500 micrograms;INH;BD
QuestionComment
Patient borderline hypokalaemic. More likely salbutamol than the rare s/e of omeprazole causing Hyponatremia
44427
User
subscriber
Dan_brod
QuestionComment
Rare side effect of omeprazole and it doesn't appear in appendix 1 would this be in the exam?
60567
User
subscriber
Recessive Dominant
QuestionComment
Did somebody else think that the frequency of salbutamol (QDS) is the dosing mistake? 
61676
User
subscriber
Botox Ben
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
3595
Sertraline, omeprazole and carbamazepine can all commonly cause hyponatremia and a dosing error in carbamazepine
Topic
9
Internal Medicine
1. This patient is hyponatraemic. The three medications she is taking that are likely contributing to her hyponatremia are her omeprazole, carbamazepine and sertraline. It is thought that PPIs cause hyponatremia due to SIADH/salt-losing nephropathy due to acute interstitial nephritis however the mechanism is not fully understood. SSRIs cause hyponatremia due to SIADH, they inhibit the reuptake of noradrenaline which in turn stimulates ADH release. Finally, carbamazepine also causes hyponatremia due to SIADH. It does this via increasing ADH secretion, increasing sensitivity of the renal tubules to ADH activity and increasing aquaporin 2 channel expression.
2. This patient would be taking 8g of carbamazepine daily, the maximum daily dose of carbamazepine is 2g.
10063
d e g
g
Case presentation: A 33-year-old female attends the emergency department. She is complaining of feeling nauseous and has vomited 3 times. She also has a headache.




 **PH** Depression, seizures, gastro-oesophageal reflux disease, Raynaud's syndrome, asthma, allergic rhinitis


 **DH** Her current medications are listed (below). Weight 53kg.


 **On Examination**


 * GCS 15/15
 * Neurological examination: grossly intact
 * HS 1 + 2 + 0
 * Chest clear
 * Abdomen soft and non tender


 **Investigation**


Bloods:


||||
|---------------------------|:-------:|--------------------|
|Sodium|128 mmol/L|135 - 145|
|Potassium|3.9 mmol/L|3.5 - 5.3|
|Creatinine|67 µmol/L|60 - 120|
|eGFR|90 mL/min/1.73m<sup>2</sup>|> 60|


CT head - no abnormalities detected


Question 1: Select the THREE prescriptions that are most likely to be a cause of her abnormal blood results (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).