MSK

Question 1

Recommended daily intake of Ca and Vit D

Answer 1

Vit D: 600 IU/day (51-70 y.o.), 800 IU/day (>70 y.o.) [IOM recommendation]
Calcium: 800 mg/day (18-50 y.o.), 1000 mg/day (>50 y.o.) [HPB recommendation]

e.g. Calcium carbonate 450 mg + Cholecalciferol 200 IU combination TDS with meals

Question 2

Initiating treatment for osteoporosis

Answer 2

• Fragility fracture
• DXA scan T-score -2.5 or lower
• T-score -1.5 to -2.5 with FRAX score >10%

Question 3

Common doses for bisphosphonates

Answer 3

Alendronate: PO 70 mg/week or 10 mg/day
Risedronate: PO 35 mg/week or 150 mg/month

Question 4

Contraindications for bisphosphonates

Answer 4

CrCl <30 (PO) or <35 (IV)
Hypocalcemia
Aspiration risk

Question 5

Treatment targets for gout

Answer 5

ACR 2020 recommendation
Non-tophi: Uric acid <360 umol/L (<6 mg/dL)
Tophi: Uric acid <300 umol/L (<5 mg/dL)

Question 6

ADR associated with high dose Colchicine

Answer 6

Diarrhea, dysesthenia, peripheral neuropathy

Question 7

Recommended treatment duration for osteoporosis

Answer 7

Low risk
- 5 years PO
- 3 years IV

High risk
- 10 years PO
- 6 years IV

Question 8

Maximum duration for Prolia treatment

Answer 8

10 years

Question 9

Maximum duration for teriparatide

Answer 9

2 years

Question 10

Dose of Ibuprofen

Answer 10

OTC: 200 mg TDS

Rx: max 3200 mg/day or 2400 mg/day

Question 11

Dose of Naproxen

Answer 11

OTC: 220 mg q8-12 hours

Rx: 1375 mg/day or 1100 mg/day

Question 12

Dose of Celecoxib

Answer 12

Max 400 mg/day

Question 13

Dose of Diclofenac

Answer 13

50 mg q8-12 hours
Max 150 mg/day

Question 14

Dose of Tramadol

Answer 14

Max 400 mg/day

CrCl <30: Max 200 mg/day

Question 15

Dose cut off for Morphine

Answer 15

Initial dose not more than 50 mg/day split into q4 hours dosing

CrCl <60: reduce dose by 50-75%

CrCl <30: avoid

Question 16

Dose cut off for oxycodone

Answer 16

Initial dose not more than 50 mg of MME (25 mg of oxycodone) into q4 hours dosing

CrCl <60: reduce dose by 50-75%, not more than q6 hours dosing

CrCl <30: reduce dose to 50%, not more than q8 hours dosing

Question 17

Conversion between Pregabalin and Gabapentin

Answer 17

1:6

25 mg of Pregabalin = 150 mg of Gabapentin

Question 18

Conversion between morphine and tramadol

Answer 18

1:5 to 10

Morphine 10 mg = Tramadol 50-100 mg/day

Question 19

Conversion between morphine and fentanyl patch

Answer 19

2 mg morphine = 1 mcg/hr fentanyl

12 or 25 mcg/hr patches available

Question 20

Initiation dose for allopurinol

Answer 20

100 mg OD, increase q2-4 weeks

eGFR <60: 50 mg OD

Question 21

Drugs that increase the risk of allopurinol-induced SCAR

Answer 21

ACE inhibitors
Loop diurectis
Thiazide diuretics
Ampicillin, amoxicillin