QuestionMultiA
QuestionChoice
50289
e
Allopurinol;200mg;PO;OD
QuestionChoice
50288
d
Salbutamol;200 micrograms;INH;PRN
QuestionChoice
50286
b
Bisoprolol;10mg;PO;OD
QuestionChoice
50287
c
Atorvastatin;40mg;PO;OD
QuestionChoice
50291
g
Tamsulosin;400 micrograms;PO;OD
QuestionChoice
50285
a
Apixaban;5mg;PO;BD
QuestionChoice
50292
h
Paracetamol;1g;PO;QDS
QuestionChoice
50290
f
Mirtazapine;30mg;PO;OD
QuestionChoice
50293
i
Felodipine;5mg;PO;OD
QuestionComment
this is wrong because you only reduce the dose of apixaban if there is at least 2 criteria, one being age. (this guy has), the others being weight of 60 or less (which he is not) and creat > 133 (not told)
61902
User
subscriber
Nandhos123
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
3641
A common side effect of beta blockers, statins and selective serotonin reuptake inhibitors is sleep disorders and a felodipine prescription error
Topic
92
General Practice
1. Beta blockers, statins and mirtazapine all commonly can cause sleep disorders. Beta-blockers interfere with sleep by reducing melatonin levels due to inhibition of beta-1 adrenergic receptors. SSRIs disturb the regulation of muscle tone during REM sleep and exacerbate bruxism.
2. The maximum dose of apixaban in this patient is 2.5mg BD, as they are >80 years of age and <60kg. Other indications for reduced apixaban usage include: serum creatinine 133 micromol/litre and over, and patients with two of these criteria require reduced dosing.
10112
b c f
a
Case presentation: A 83-year-old gentleman attends his GP due to issues with his sleep.


**PH** Atrial fibrillation, hypercholesterolaemia, COPD, gout, benign prostatic hyperplasia, hypertension, depression

**DH** His regular medicines are listed (below). Weight 54kg.

Question 1: Select the THREE prescriptions that are most likely to be a cause of his issues with sleeping (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).