QuestionSBA
QuestionChoice
As the bone marrow disorder may happen at any time during the course of treatment, NICE currently does not recommend monitoring white blood cell count on a regular basis. Instead, white blood cell count will only be performed if there is any clinical evidence of infection
34186
b
A white blood cell count should be performed before the treatment and then three monthly throughout the course of treatment
QuestionChoice
Patients who are women of childbearing age are encouraged to use effective contraception during treatment because carbimazole is linked to an increased risk of congenital malformations during pregnancy
34187
c
It is safe for her to attempt to get pregnant during treatment
QuestionChoice
Carbimazole is a medication that is used to treat hyperthyroidism. A rare but serious side effect of carbimazole is bone marrow suppression leading to agranulocytosis. As the bone marrow disorder may happen at any time during the course of treatment, NICE currently does not recommend monitoring white blood cell count on a regular basis. Instead, white blood cell count will only be performed if there is any clinical evidence of infection. Hence, patients are advised to report immediately any signs and symptoms such as sore throat and infection
34185
a
She should immediately report to her doctor if sore throat develops
QuestionChoice
Haemolytic anaemia is a rare side effect of carbimazole
34189
e
Haemolytic anaemia is a common side effect of carbimazole
QuestionChoice
The starting dose of carbimazole will be reduced gradually once the patients have become euthyroid. Patients will usually be started on a dose of 15-40 mg daily, taken divided into 2-3 doses a day. This may then be reduced after 4-8 weeks to a lower maintenance dose of 5-15 mg, taken once daily
34188
d
She would be started on a low dose before the dose gets titrated upwards in a gradual manner in order to reduce risk of side effects
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2780
Carbimazole
Topic
92
General Practice
6848
Case presentation: A 35-year-old woman attends her GP with a two-month history of weight loss, heat intolerance and sweating.  


PMH: Vitiligo
Investigations:


||||
|---------------------------|:-------:|------------------------------|
|Thyroid Stimulating Hormone|0.1 mU/L|0.3 - 4.2|
|Free T4|30 pmol/L|9 - 25|

 - TSH receptor antibodies - Positive

#
The patient is advised to commence treatment with carbimazole 15mg PO daily.


Question: Select the most appropriate information that should be provided for this patient.
a