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Difficulty: EasyBipolar and Related Disorders

Match each mood stabilizer commonly used in the management of bipolar disorder with its most characteristic adverse effect profile.

  • LithiumHypothyroidism, fine tremor, and nephrogenic diabetes insipidus
  • ValproateHepatotoxicity, pancreatitis, and neural tube defects
  • LamotrigineBenign maculopapular rash and Stevens-Johnson syndrome
  • CarbamazepineHyponatremia, agranulocytosis, and aplastic anemia

Answer

Lithium matches with Hypothyroidism/tremor/NDI; Valproate matches with Hepatotoxicity/pancreatitis/neural tube defects; Lamotrigine matches with Rash/Stevens-Johnson syndrome; Carbamazepine matches with Hyponatremia/agranulocytosis/aplastic anemia.
Matching mood stabilizers to their adverse effects requires recognizing classic, high-yield toxicity profiles. Lithium is notorious for thyroid and renal effects (hypothyroidism, nephrogenic diabetes insipidus). Valproate classically causes hepatotoxicity, pancreatitis, and neural tube defects. Lamotrigine is most feared for severe skin reactions like Stevens-Johnson syndrome. Carbamazepine is distinguished by its risk of blood dyscrasias (agranulocytosis) and hyponatremia from SIADH.

Step-by-Step Solution

1
Identify the characteristic adverse effects of Lithium.
Lithium is matched with hypothyroidism, fine tremor, and nephrogenic diabetes insipidus.
Lithium accumulates in the thyroid gland and the kidneys, interfering with normal hormone production and renal concentrating ability.
2
Identify the characteristic adverse effects of Valproate.
Valproate is matched with hepatotoxicity, pancreatitis, and neural tube defects.
Valproic acid exerts direct toxic effects on the liver and pancreas, and acts as a folate antagonist in utero, leading to neural tube closure defects.
3
Identify the characteristic adverse effects of Lamotrigine.
Lamotrigine is matched with benign maculopapular rash and Stevens-Johnson syndrome.
The primary dose-limiting toxicity of lamotrigine is a severe dermatologic reaction, necessitating very slow upward titration.
4
Identify the characteristic adverse effects of Carbamazepine.
Carbamazepine is matched with hyponatremia, agranulocytosis, and aplastic anemia.
Carbamazepine uniquely causes SIADH (leading to dilutional hyponatremia) and bone marrow suppression, requiring baseline and periodic blood count monitoring.

Key Concept

Adverse effect profiles and toxicity signs of primary mood stabilizers
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Topics

Bipolar and Related Disorders

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