A 33-year-old woman is brought to the office by her husband due to bizarre and isolative behavior over the past 8 months. He often finds his wife whispering to the television, even when it is turned off. The patient says she communicates with dead people and hears the devil telling her that she should be dead. She has a history of schizoaffective disorder and has failed to respond to multiple antipsychotic medications, some of which caused severe muscle stiffness. To target psychotic symptoms, the patient is started on a new medication that requires frequent and regular blood draws. Over the next few weeks, she begins to show gradual improvement. This patient is likely being monitored for which of the following adverse reactions?

Question

A 33-year-old woman is brought to the office by her husband due to bizarre and isolative behavior over the past 8 months.  He often finds his wife whispering to the television, even when it is turned off.  The patient says she communicates with dead people and hears the devil telling her that she should be dead.  She has a history of schizoaffective disorder and has failed to respond to multiple antipsychotic medications, some of which caused severe muscle stiffness.  To target psychotic symptoms, the patient is started on a new medication that requires frequent and regular blood draws.  Over the next few weeks, she begins to show gradual improvement.  This patient is likely being monitored for which of the following adverse reactions?

Quizplus · Accepted Answer

Clozapine is a second-generation antipsychotic used in treatment-resistant schizophrenia and schizoaffective disorder (ie, patients who have failed ≥2 antipsychotic trials). It is associated with risk of neutropenia. Life-threatening agranulocytosis (ie, complete absence of neutrophils) has been reported in approximately 1% of patients treated, but this rate has been reduced with regular blood monitoring. Patients must participate in a computer-based registry that requires regular monitoring of the absolute neutrophil counts (ANCs) before dispensing of the drug. Prescribing guidelines dictate ANC cutoffs for continued prescription and provide guidance on how to manage low ANCs. Other adverse effects of clozapine include weight gain, metabolic syndrome, seizures, ileus, myocarditis, and hypotension. Compared to other antipsychotics, clozapine is the least likely to cause extrapyramidal symptoms and has not been shown to cause tardive dyskinesia. Clozapine is also indicated in schizophrenic and schizoaffective patients with recurrent suicidality. (Choices B, D, E, F, and G) Lymphocytopenia, neutrophilia, pancytopenia, thrombocytopenia, and thrombocytosis are not commonly associated with clozapine use. (Choice A) Eosinophilia may occur with clozapine treatment, but this is not the rationale for the frequent blood draws. Educational objective: Clozapine is indicated for the treatment of psychotic patients who do not respond to other antipsychotics. Patients must undergo regular monitoring of absolute neutrophil counts due to the risk of neutropenia and agranulocytosis. References: Clozapine's critical role in treatment resistant schizophrenia: ensuring both safety and use. (http://www.ncbi.nlm.nih.gov/pubmed/27207070) Clozapine: balancing safety with superior antipsychotic efficacy. (http://www.ncbi.nlm.nih.gov/pubmed/23006238)

A 33-Year-Old Woman Is Brought to the Office by Her