- Doctors: Ramesh Mehay & Pardip Sandhu & Sadia Khan
Date of Next Review
If there is osteoporosis on DEXA scan…
- arrange for blood tests first (Bone Profile – FBC, Ca, vit D levels and U&E).
- Bring patient back 3w later – make sure bloods okay (esp Ca and vit D).
- If Ca or vit D low, it must be treated and corrected first (i.e. levels back to normal) before bisphosphonate therapy.
- If eGFR <35, seek advice from doctor as bisphosphonates should not be routinely used in CKD where eGFR<35.
- If bloods okay
- Give patient PIL on osteoporosis (www.patient.co.uk or this one http://www.shef.ac.uk/NOGG/NOGG_Information_for_patients.pdf )
- Start Ca, Vit D and Bisphosphates if report says so
- Educate – bisphosphonates can cause indigestion, so stay upright 60mins after taking it.
- Educate – bisphosophonates are associated with a very very small risk of osteonecrosis (decay and infection) of the jaw – emphasise this is rare. So good oral hygiene important as well as yearly dental checks. Also check to make sure no dental IMPLANTS are planned.
- Educate – Lifestyle on more exercise, stop smoking and reduce alcohol à consider use of health trainer, alcohol adviser and smoking cessation in-house services.
- If there is a high chance of falls – refer to DNs for falls risk assessment.
PRESCRIBING IN CHILDREN
- Slow down with children doses and esp infants >>> make sure doses are correct
- For liquids, put down the dose not the ml.
- For example, write 30mg bd rather than 1.5ml bd (the dispensing pharmacist will work out the ml).
Terms and Short Hand You May Be Unfamiliar With
- Abdominal Aorta – 5cm or more – should be followed up (the aorta is normally about 2-2.5 cm)
- Angiogram – a test to see if blood vessels are obstructed. Eg Coronary angiogram check the cornonaries (blood vessels which supply the heart)
- BCC – a slow growing skin cancer called Basal Cell Carcinoma
- BMD (Bone Mineral Density) / T scores / Z scores – this is all about bone scans and whether the patient has weak bones (a condition called osteoporosis, which is NOT the same as osteoarthritis – the latter is wearing of the bones).
- COPD – Chronic Obstructive Pulmonary Disease (permanent lung condition, usually from smoking).
- FESS – functional endoscopic sinus surgery – basically surgery on the sinuses.
- Incidentally/Incidental finding – something picked up by chance
- L3 L4 L5 S4 S5 – back problems – spine. L1, 2, 3 etc are different levels of the spine. Each building block of the spine has a corresponding number.
- LUTS – lower urinary tract symptoms
- Melanoma – a very serious skin cancer that kills people quickly if not picked up early.
- Squamous Cell Carcinoma – can happen anywhere – often the skin, but can be any where that has a lining like the lungs or even the tongue or mouth.
- STEMI – ST elevation Myocardial Infact = Heart Attack.
- Vasovagal syncope – fancy name for a simple faint; not serious