RP osteoporosis

Question 1

what are some key risk factors for osteoporosis?

Answer 1

postmenopausal women
men over 50
long term oral corticosteroids (glucocorticoids)
low BMI
smoking
history of fractures

Question 2

what lifestyle chages can reduce risk of osteoporosis?

Answer 2

increase exercise
smoking cessation
maintain ideal BMI
reduce alcohol intake
sufficient intake of vit D and calcium

Question 3

when do you review bisphosphonates?

Answer 3

5 years
3 years for zoledronic

Question 4

what female pts need bisphosphonates for osteoporosis prophylaxis when starting glucocorticoids?

Answer 4

women
- 70yrs+
- previous fragility fracture
- large doses (7.5mg pred or above)

Question 5

do all males pts over 70 need bisphosphonates for osteoporosis prophylaxis?

Answer 5

no, only if previous fragility fractue or large dose

Question 6

what are the 3 MHRA warning s for bisphosphonates?

Answer 6

1. atypical femoral fractures: report any thigh hip or groin pain
2. osteonecrosis of the jaw
3. osteonecrosis of external auditory canal

Question 7

how long do you need to leave before eating something after taking risedronate?

Answer 7

2 hours

Question 8

what are the natural and synthetic oestrogens?

Answer 8

natiral = estradoil
synthetic = ethinylestradoil

Question 9

what activity does tibolone have?

Answer 9

oestrogenic, progestoegenic and weakly androgenic

Question 10

when do you give osetrogens with progesterone?

Answer 10

in women who still have a uterus

Question 11

what symptoms can oestrogens allevitate?

Answer 11

vaginal atrophy (topical)
vasomotor instability (systemic)
also reduce postmenopausal osteoporosis

Question 12

what an alternative drug to manage menopause sympomts - note not 1st line due to lots of SE

Answer 12

clonidine

Question 13

what are the cancer risks of HRT?

Answer 13

increased risk of breast cancer, endometrial cance,r ovarian cancer

Question 14

is breast cancer risk higher with oestrogen only or oestrogen and progesterone?

Answer 14

higher with combined

Question 15

how long does the risk of breast cancer last once someone has stopped taking HRT?

Answer 15

10 years

Question 16

is the endometrial cancer risk in women with a uterus higher with oestrogen only or combined?

Answer 16

risk of lower with combined
tibolone also increases risk

Question 17

how would you describe the risk of ovarian cancer?

Answer 17

only small increased risk, risk dissapears years after stopping HRT

Question 18

alongsied cancer risk, what other risks come with HRT?

Answer 18

VTE
stroke
coronoary heart disease

Question 19

what’s are the 3 HRT regimines for women with a uterus?

Answer 19

1. oestrogen with cyclical progestogen for the last 12 to 14 days of the cycle
2. continuous administration of an oestrogen and a progestogen
3. continous combined and tibolone

Question 20

when does tibolone need to be avoided?

Answer 20

avoided in perimenopausal phase or if within 12 months of last menstural period

Question 21

what are the options for HRT regimines in patients without a uterus?

Answer 21

• continuous oestrogen use

Question 22

when should patients stop HRT before elective surgery and when can it be restarted?

Answer 22

4 - 6 weeks
restart when fully mobile

Question 23

what should be given to a patient having non-elective surgery to prevent clots?

Answer 23

prophylactic heparin and compression stockings

Question 24

name some reasons why HRT should be stopped

Answer 24

1. sudden severe chest pain/breathlessness (PE)
2. unexplained swelling or severe pain in calf
3. severe stomach pain
4. serious neurological effects
5. hepatitis/jaundice
6. BP >160/95
7. prolonged immobility

Question 25

whats the 1st line treatment for hyperthyroidism?

Answer 25

carbimazole

Question 26

what are the 3 MHRA warnings for carbimazole?

Answer 26

1. neutropenia and agranulocytosis - sore throat, fever
2. congenital malformations - women to use contraception during treatment
3. actue pancreatitis - report and stop immediately

Question 27

what must you counsel pts taking propylthiouracil for hyperthyroidism?

Answer 27

signs of liver disorder

Question 28

what class of drug can be used to manange symptoms on hypoerthyroidism (increased activity, metabilosm, sweating, diarrohea, wieght loss)

Answer 28

beta blockers

Question 29

whats the 1st line for Grave’s disease?

Answer 29

radioactive iodine