A medical student on a psychiatry clerkship is reviewing the adverse effect profiles and monitoring requirements for various psychotropic medications used in the treatment of bipolar disorder. Match each medication below with its most characteristic adverse effect profile and required monitoring parameters.
- LithiumCan cause Ebstein anomaly in utero; chronic use may lead to hypothyroidism and nephrogenic diabetes insipidus.
- ValproateAssociated with hepatotoxicity, pancreatitis, teratogenic neural tube defects, and dose-related thrombocytopenia.
- LamotrigineCarries a risk of a severe, life-threatening dermatologic reaction (Stevens-Johnson syndrome) and requires very slow dose titration.
- OlanzapineCarries a high risk of weight gain and metabolic syndrome; requires baseline and routine monitoring of fasting lipids and glucose.
Answer
Lithium pairs with thyroid, renal, and cardiac teratogenic risks. Valproate pairs with hepatic, pancreatic, and hematologic risks. Lamotrigine pairs with severe rash risk. Olanzapine pairs with high metabolic syndrome risk.
Each medication used in the maintenance phase of bipolar disorder has a distinct side effect profile that dictates specific baseline and ongoing clinical monitoring. Lithium requires monitoring of TSH, renal function, and pregnancy status. Valproate requires monitoring of LFTs, CBC, and clinical signs of pancreatitis. Lamotrigine is monitored clinically for the emergence of rash. Olanzapine requires extensive metabolic monitoring, including BMI, fasting glucose, and lipid panels.
Step-by-Step Solution
Key Concept
Pharmacologic Adverse Effects and Monitoring in Bipolar Disorder