On-call scenario 5: Introduction

Last updated: Thursday, June 06, 2024

"Hi. It's one of the medical doctors. I’ve got a patient who is nil-by-mouth, so they can’t take their usual tablets. I want to switch their carbamazepine tablets to suppositories instead, but need some advice on dosing please?"

You ask for further details and establish the following... 

Caller: Max Walker, FY2 , Neurology ward, ext. 3765. 

Patient: Christine Smith, hospital no. 1166791, age 70 years. 

Medicines: Carbamazepine modified-release tablets 400mg BD (Tegretol brand) and pramipexole 88 micrograms ON. No allergies. 

Clinical problem: Patient admitted to hospital following an ischaemic stroke. They have severe dysphagia and are therefore nil-by-mouth (NBM). The indication for carbamazepine is epilepsy, and the patient's seizures currently well controlled.

Where do you think you might look to answer this question?

Think about it, then click Next Page to see our suggestions.