Examkin

Question

Difficulty: EasyBipolar and Related Disorders

A medical student is reviewing the pharmacological management of bipolar disorder. Match each medication to its most appropriate baseline screening and monitoring requirement prior to initiation.

  • LithiumThyroid-stimulating hormone (TSH), blood urea nitrogen (BUN), and serum creatinine
  • ValproateLiver function tests (LFTs) and platelet count
  • CarbamazepineComplete blood count (CBC) and HLA-B*1502 screening in specific populations
  • ZiprasidoneElectrocardiogram (ECG) and serum electrolytes

Answer

Lithium matches with TSH/renal function; Valproate matches with LFTs/platelets; Carbamazepine matches with CBC/HLA-B*1502; Ziprasidone matches with ECG/electrolytes.
The correct matches directly correspond to the distinct, high-yield toxicity profiles of each medication used in bipolar disorder management.

Step-by-Step Solution

1
Identify the clearance mechanism and major organ toxicities for Lithium.
Lithium is renally excreted and strongly affects thyroid tissue. Therefore, TSH, BUN, and creatinine are required.
To establish a baseline before exposing the kidneys and thyroid to potential lithium-induced toxicity.
2
Identify the major black box warnings for Valproate.
Valproate is known for severe hepatotoxicity and thrombocytopenia, matching it directly to LFTs and platelet count.
To ensure normal hepatic function and hematologic status prior to initiation.
3
Recall the hematologic and dermatologic risks of Carbamazepine.
Carbamazepine can cause agranulocytosis and Stevens-Johnson syndrome (linked to the HLA-B*1502 allele), requiring a CBC and genetic screening.
To prevent severe hematologic dyscrasias and life-threatening dermatologic reactions.
4
Recognize the specific cardiac risk associated with Ziprasidone.
Ziprasidone is highly associated with QTc prolongation, necessitating a baseline ECG and electrolyte panel.
To avoid initiating a QTc-prolonging agent in a patient with pre-existing cardiac conduction delays.

Key Concept

Pre-treatment baseline laboratory and diagnostic workup for bipolar disorder pharmacotherapy
Rate this question

Topics

Bipolar and Related Disorders

More questions from this topic