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Bisphosphonate counselling — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsBisphosphonate counsellingGPhC CRA

A patient taking carbamazepine and bendroflumethiazide becomes confused and unsteady. Serum sodium is 118 mmol/L. Which response is most appropriate?

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Correct answer: C — Arrange urgent assessment and review both carbamazepine and the diuretic

Carbamazepine can cause hyponatraemia, with risk increased by sodium-lowering diuretics. SPS advises treatment review and correction when the patient is symptomatic or sodium is below 120 mmol/L; confusion and unsteadiness make this urgent. Water loading may worsen hyponatraemia, while abrupt unsupervised antiseizure withdrawal, increased diuretic exposure and OTC bicarbonate are unsafe.

Reference: SPS: carbamazepine monitoring. https://sps.nhs.uk/monitorings/carbamazepine-monitoring/