6.

Question 1

SEs of Phenytoin

Answer 1

• ataxia
• peripheral neuropathy
• gum hyperplasia
• hepatotoxicity

Question 2

SEs of sodium valproate

Answer 2

• tremor
• teratogenicity
• weight gain

Question 3

SEs of Levetiracetam

Answer 3

• fatigue
• mood disorders
• agitation

Question 4

(2) examples of stool softeners

Answer 4

• Docusate sodium (stimulant at higher doses)
• Arachis oil (rectal); contraindicated in nut allergy

Question 5

Indications for stool softeners use

Answer 5

Stool softeners: docusate sodium, Arachis oil

• good for faecal impaction
• good for reduced gut motility

Question 6

Example of stool bulking agent

Answer 6

Isphagula husk

Contraindication: faecal impaction, colonic atony, reduced gut mobility

Can take days to develop effect

Question 7

(2) examples of stimulant laxatives

Answer 7

• Senna
• Bisacodyl
• Bisacodyl is contraindicated in acute abdomen
• Both may exacerbate abdo cramps

Question 8

(2) example of osmotic laxatives

Answer 8

• Phosphate enema
• Lactulose

*may exacerbate bloating

Question 9

Contraindications to phosphate enema

Answer 9

• acute abdo
• IBD

Question 10

How to induce remission in a mild flare-up of Crohn’s?

Answer 10

Prednisolone 20-40 mg daily PO

Question 11

How to induce remission in a severe flare-up of Crohn’s?

Answer 11

• IV Hydrocortisone 100-500 mg three to four times daily or PRN
• supportive care: IV fluids, NBM, antibiotics

Question 12

What needs to be added to PO or IV treatment to induce remission in Crohn’s if patient has a rectal disease?

Answer 12

rectal hydrocortisone

Question 13

1st choice to maintain remission in Crohn’s

Answer 13

Azathioprine

Question 14

What must be checked before introducing Azathioprine therapy?

Answer 14

TPMT levels

Thiopurine S-methyl transferase (TMPT) is an enzyme that metabolises 6-mercaptopurine (Azathioprine -> 6 mercaptopurine)

10% population has the low activity of TPMT enzyme which predisposes them to the accumulation of 6 mercaptopurine (if given Azathioprine) and therefore liver and bone marrow toxicity

Question 15

What to do if we want to start Azathioprine and TPMT levels are:

a) low (but not absent)
b) absent

Answer 15

a) low: start azathioprine at lower dose
b) absent: offer methotrexate instead

Question 16

Typical therapy for RA

Answer 16

Commenced by a specialist

Methotrexate + DMARDs

Question 17

Flare-up of RA treatment

Answer 17

• short term glucocorticoids e.g. IV methylprednisolone
• short-term NSAIDS + PPI
• re-instate DMARDs (if dose previously reduced)

Question 18

What to do if two DMARDs fail to manage severely active RA?

Answer 18

Use TNF-alpha inhibitors e.g. Infliximab

Question 19

How to treat chronic diarrhoea (proven not to be infectious: negative stool cultures and microscopy)

Answer 19

• Loperamide 2 mg oral up to 3 hourly

OR

• Codeine 30 mg oral up to 6 hourly

Question 20

if Zoplclone is required in a hospital setting what doses to prescribe for adult and what for the elderly?

Answer 20

• Adult: 7.5 mg at night
• Elderly: 3.75 mg at night (as risk of falling when going to toilet)