Hannah has spent an evening with friends at the Student Union bar. She has been drinking and, although she is not drunk, she could be described as 'merry.' Not wishing to walk home in the rain, she accepts a lift with Hywel, whom she knows has drunk a considerable amount of alcohol. Hannah does not put on her seat belt. Whilst driving home, the car collides with another vehicle and Hannah is rendered paralyzed. Would your answer differ if Hannah was extremely drunk?Discuss the imposition of liability and the availability of any defences in the above situation

Question 1

What is the maintenance dose of phenytoin in seizures arising as a

complication of chronic renal failure?

Question 2

I know that the loading dose of phenytoin in status epilepticus is

20 mg/kg with an upper limit of 1000 mg but if the same situation arose

as a complication of chronic renal failure (on regular dialysis), should

this dose remain the same or be reduced? If reduced, what should the

dose be?

Question 3

1. What is the most effective antiepileptic for a patient with simple

partial motor status epilepticus who is not responding to a loading

dose of phenytoin?

2. How long does phenytoin, given in a loading dose, take to work?

Question 4

Is valproate effective if given rectally in status epilepticus and, if so, what

dose is recommended?

Question 5

In simple partial motor status epilepticus, if the patient does not respond

to diazepam and phenytoin, is it justifiable to proceed to anaesthetic

medication?

Question 6

What is the recommended upper limit dose of lamotrigine when

combined with both carbamazepine and valproate?

Question 7

Is a valproate-lamotrigine combination more effective than

carbamazepine on its own against partial seizures?

Question 8

Why is the incidence of parkinsonism less common in smokers?

Question 9

Is it recommended to start the treatment of parkinsonism with dopamine

agonists alone in elderly (over 60 years old) patients, and to delay using

L-dopa until the disease has progressed much further? Is there a rationale

for this protocol in younger patients?

Question 10

Does amantadine increase the endogenous release of dopamine, thus

aiding early treatment of parkinsonism?