Match each clinical vignette describing a medication-specific complication, adverse effect, or pharmacokinetic requirement to the most likely offending psychotropic agent used in the context of bipolar disorder.
- A 28-year-old woman treated for bipolar I disorder presents with amenorrhea and bilateral galactorrhea. Laboratory evaluation reveals a negative serum beta-hCG and an elevated serum prolactin level.Risperidone
- A 45-year-old man on maintenance pharmacotherapy for bipolar disorder is found to have a serum sodium of 124 mEq/L (normal: 135-145) on routine lab monitoring. He is clinically euvolemic, and his urine osmolality is elevated.Carbamazepine
- A 32-year-old man is prescribed a second-generation antipsychotic for acute bipolar depression. To ensure adequate systemic absorption and therapeutic efficacy, the physician instructs him to take the medication with a meal of at least 350 calories.Lurasidone
- A 50-year-old man on long-term maintenance therapy complains of excessive thirst and urinating 6 to 8 liters per day. His urine specific gravity is low, and his symptoms do not improve after a period of water deprivation.Lithium carbonate
- A 24-year-old woman with a history of recurrent severe depression and a first-degree relative with bipolar disorder is prescribed a selective serotonin reuptake inhibitor. Two weeks later, she requires hospitalization for severe agitation, pressured speech, and a decreased need for sleep.Fluoxetine
Answer
The correct matches are: Galactorrhea and amenorrhea with Risperidone; Euvolemic hyponatremia with Carbamazepine; Required administration with a 350-calorie meal with Lurasidone; Nephrogenic diabetes insipidus with Lithium carbonate; and Antidepressant-induced manic switch with Fluoxetine.
Each medication utilized in bipolar disorder management has a distinct profile. Risperidone is highly associated with hyperprolactinemia. Carbamazepine causes SIADH (hyponatremia). Lurasidone necessitates administration with significant food (>350 calories) for absorption. Lithium causes nephrogenic diabetes insipidus by antagonizing ADH. Fluoxetine, an SSRI, can induce an acute manic episode if given as monotherapy to a patient with bipolar disorder.
Step-by-Step Solution
Key Concept
Pharmacotherapy for Bipolar Disorder: Specific Adverse Effects and Administration Requirements