CNS drugs and antiepileptics: agomelatine monitoring: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · CNS drugs and antiepileptics: agomelatine monitoring

Sample item

A patient with major depression and insomnia is started on an antidepressant that agonises MT1 and MT2 receptors and blocks 5-HT2C receptors. Which monitoring is required?

ASerum lithium levelBAbsolute neutrophil count each weekCLiver function tests before and during treatmentDSerum sodium after each dose change

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Liver function tests before and during treatment

Agomelatine acts as a melatonin receptor agonist and a 5-HT2C antagonist, which resynchronises circadian rhythm. It can raise transaminases, so liver function is checked before starting and at intervals during treatment. It is contraindicated in hepatic impairment.

Option by option

A. Serum lithium level
Lithium is a separate drug and requires serum level monitoring.
B. Absolute neutrophil count each week
Weekly neutrophil counts are required with clozapine and not with agomelatine.
C. Liver function tests before and during treatment (correct)
Correct. Agomelatine can cause hepatotoxicity, so liver enzymes are monitored.
D. Serum sodium after each dose change
Hyponatraemia is a particular concern with SSRIs in the elderly and not with agomelatine.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Liver function tests before and during treatment. Agomelatine acts as a melatonin receptor agonist and a 5-HT2C antagonist, which resynchronises circadian rhythm.

Why is "Serum lithium level" not the answer?

Lithium is a separate drug and requires serum level monitoring.

Why is "Absolute neutrophil count each week" not the answer?

Weekly neutrophil counts are required with clozapine and not with agomelatine.

Why is "Serum sodium after each dose change" not the answer?

Hyponatraemia is a particular concern with SSRIs in the elderly and not with agomelatine.

What concept does this question test?

It tests CNS drugs and antiepileptics: agomelatine monitoring in Pharmacology. It can raise transaminases, so liver function is checked before starting and at intervals during treatment. It is contraindicated in hepatic impairment.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study CNS drugs and antiepileptics: agomelatine monitoring?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.