GP Flashcards
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Menopause Diagnosis
Amenorrhoea for 12 months of more in a woman >40 who has previously been menstruating
Clinical features of menopause
When Menopause Hits I'll Have Sex, Not Babies W- weight gain M - mood lability, menstrual dysfunction H - hot flushes I - insomnia H - headaches/migraines S - sexual dysfunction, vaginal dryness, UTI N - night sweats B - breast tenderness
Contraindications to hormonal treatment in menopause
- > 60yo or >10 years after menopause
- Acute or severe-active liver disease
- Unknown cause of vaginal bleeding
- Oestrogen-dependent cancer
- Hx or ++ risk of thrombosis or IHD
- Untreated HTN
T score definitions: normal, osteopaenia, osteoporosis
Normal T score ≥ -1
Osteopaenia = -1 to -2.5
Osteoporosis = ≤ -2.5
RF for osteoporosis (personal)
Female sex Low BMI Old Caucasian or asian Previous minimal trauma fracture FHx of OP or fractures Hx of falls Propensity to fall
RF for osteoporosis (behavioural)
smoking \++ etoh Physical inactivity Poor calcium intake Lack of sunlight exposure
RF for osteoporosis (medical conditions)
Premature menopause
metabolic (hypogonadism)
RA
Malabsorption (coeliac, crohn’s)
Physical disability (can’t exercise)
Endocrine disorders (low sex hormone, cushing syndrome, hyperthyroidism, hyperparathyroidism)
Increased falls risk (balance disorder, visual impairment, muscle weakness, sedating/anti-HTN drugs)
RF for osteoporosis (medications)
steroids androgen-deprivaiton agents aromatase inhibitors PPIs SSRIs Excessive thyroxine
Conservative management of osteoporosis
Involve hospitals Osteoporosis re-fracture prevention (ORP) services (or GP in none) Falls risk reduction Exercise program Lifestyle modification - diet, smoking, EtOH --> Vit D and calcium supplementation if diet insufficient → must be corrected before pharmacological therapy Education and psychosocial support Self-management resources Access to falls-prevention programs Cease contributing meds
First-line agents for osteoporosis
Bisphosphonates (aledronate, risedronate, zoledronic acid (IV) )
OR
Denosumab (Prolia) - 6 monthly S/C injection
MoA of bisphosphonates
Analogues of pyrophosphonate –> decreased osteoclast-mediated bone resorption
Attach to binding sites on bony surfaces undergoing active resorption –> when osteoclasts begin to resorb bone that is impregnated with bisphosphonate, the bisphosphonate is released, impairing the ability of osteoclasts to form the ruffled border, to adhere to the bony surface, and to produce the protons necessary for continued bone resorption
MoA of denosumab
Physiology: Pre-osteoclasts (precursors to osteoclasts) express cell surface receptors called RANK → RANK is activated by RANKL (cell surface molecule on osteoblasts) → activation of RANK by RANKL promotes the maturation of pre-osteoclasts into osteoclasts
Denosumab is a monoclonal antibody that binds to RANKL preventing the activation of RANK and thus preventing the maturation of osteoclasts
List 5 pharmacological options for the management of osteoporosis
- Bisphosphonates
- Denosumab
- Teriparatide (synthetic PTH)
- Oestrogen (+/- progesterone) replacement therapy
- Oestrogen-receptor modulators
RF for carpal tunnel syndrome
Idiopathic Obesity Pregnancy DM Hypothyroidism Acromegaly CT disease Structural abnormality - fracture, ganglion, bleeding Repetitive movements Vibration Congenital narrowing of the carpal tunnel
Clinical maneuvers for carpal tunnel syndrome
Phalen - backs of hands together with wrist and elbow flexion - +ve if s/s after 1 min
Tinnel - tappy tappy on median nerve - +ve if s/s reproduced
