MRCP2-1664

MRCP2-1664

A 56-year-old woman was admitted due to abnormal blood tests during routine monitoring. She is currently receiving palliative chemotherapy for metastatic pancreatic cancer with FOLFIRINOX, which has caused her to experience vomiting, nausea, fatigue, and diarrhea. Her medical history includes hypothyroidism, epilepsy, and bipolar disorder, and she takes several medications regularly, including levothyroxine, levetiracetam, lithium, loperamide, paracetamol, oramorph, zomorph, movicol, and ondansetron.

Upon admission, her Na+ level was 142 mmol/l, K+ level was 3.8 mmol/l, urea level was 4.4mmol/l, creatinine level was 83µmol/l, and corrected calcium level was 3.3µmol/l. She was given IV 0.9% saline and 90 mg of IV alendronate after further blood tests were sent for and an ECG was performed. As part of her treatment plan, which of her regular medications should not be prescribed during her hospital stay?