American Board of Internal Medicine (ABIM) Certification Practice Exam

When evaluating for potential AED side effects, how frequently should patients undergo blood level monitoring during the first year?

1. Every 2 months

2. Every 6 months

3. At the start and then at 6 and 12 months

4. Every week for the first 3 months

The correct answer is: At the start and then at 6 and 12 months

The recommended protocol for monitoring blood levels of antiepileptic drugs (AEDs) during the first year is to assess levels at the start of treatment, followed by measurements at 6 and 12 months. This approach is rooted in the understanding that initial levels are crucial for determining an effective dosage and ensuring safety while initiating therapy. Early adjustment and monitoring are essential since patients may experience side effects or require dosage modifications as their body adapts to the medication. By evaluating blood levels at these intervals, healthcare providers can assess whether the drug concentration remains within the therapeutic window, adjust therapy as necessary, and monitor for any potential toxicities or adverse reactions. This systematic approach balances the need for effective management of epilepsy while minimizing the risks associated with AED therapy, making it an essential component of long-term patient care. The other options do not align as closely with standard clinical guidelines. For example, more frequent monitoring, such as every week for the first three months, may be excessive for many AEDs where stable therapeutic levels can often be achieved within that timeframe. Similarly, monitoring every 2 months or every 6 months does not account for the initial adjustments needed at the onset of treatment when optimal dosing and monitoring are most critical.