American Board of Internal Medicine (ABIM) Certification Practice Exam

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Which of the following should be monitored in patients taking carbamazepine?

Therapeutic drug levels
Serum potassium levels
Thyroid function tests
Blood glucose levels

The correct answer is: Therapeutic drug levels

Monitoring therapeutic drug levels in patients taking carbamazepine is essential due to the drug's narrow therapeutic index and the potential for significant interpatient variability in pharmacokinetics. Carbamazepine is primarily used as an anticonvulsant and for mood stabilization, and maintaining appropriate plasma levels is crucial to ensure both efficacy and safety. Regular monitoring helps in adjusting the dose to achieve optimal therapeutic levels while minimizing the risk of toxicity, which can manifest as symptoms like dizziness, diplopia, and ataxia. In addition to therapeutic levels, it is advantageous to monitor certain other parameters during carbamazepine therapy. For instance, it can induce liver enzymes, leading to alterations in drug metabolism, and may also cause hyponatremia, but these considerations do not take precedence over the importance of measuring carbamazepine levels to ensure appropriate dosing.