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{{WBRQuestion | {{WBRQuestion | ||
|QuestionAuthor={{YD}}, (Reviewed by {{YD}} and {{AJL}}) | |QuestionAuthor= {{YD}}, (Reviewed by {{YD}} and {{AJL}}) | ||
|ExamType=USMLE Step 1 | |ExamType=USMLE Step 1 | ||
|MainCategory=Behavioral Science/Psychiatry, Pharmacology | |MainCategory=Behavioral Science/Psychiatry, Pharmacology | ||
| Line 22: | Line 22: | ||
|SubCategory=Hematology | |SubCategory=Hematology | ||
|Prompt=A 24-year-old man is admitted to the hospital for auditory hallucinations and delusions. His older brother reports that the patient is diagnosed with treatment-resistant schizophrenia and has been administered several medications for the past 4 years without improvement. The physician then decides to start the patient on clozapine therapy. Which of the following lab tests should be routinely performed to monitor for clozapine-induced adverse events? | |Prompt=A 24-year-old man is admitted to the hospital for auditory hallucinations and delusions. His older brother reports that the patient is diagnosed with treatment-resistant schizophrenia and has been administered several medications for the past 4 years without improvement. The physician then decides to start the patient on clozapine therapy. Which of the following lab tests should be routinely performed to monitor for clozapine-induced adverse events? | ||
|Explanation=[[Clozapine]] is a second generation antipsychotic medication that has demonstrated significant efficacy for the treatment of schizophrenia and reduction in the frequency of relapses. [[Clozapine]] is reserved for refractory cases of schizophrenia due to its association with [[agranulocytosis]] in approximately 1% of cases. Periodic complete blood count (CBC) is usually | |Explanation=[[Clozapine]] is a second generation antipsychotic medication that has demonstrated significant efficacy for the treatment of schizophrenia and reduction in the frequency of relapses. [[Clozapine]] is reserved for refractory cases of schizophrenia due to its association with [[agranulocytosis]] in approximately 1% of cases. Periodic complete blood count (CBC) is usually performed in schizophrenic patients who are administered [[clozapine]] to monitor for any signs of leokopenia, granulocytopenia, and [[agranulocytosis]] by measurement of white blood cells (WBC) count and absolute neutrophil count (ANC). With initiation of clozapine therapy, WBC and ANC are monitored weekly for the first 6 months, then every other week for the next 6 months, then every 4 weeks thereafter. | ||
|AnswerA=Serum ALT level | |AnswerA=Serum ALT level | ||
|AnswerAExp=Although clozapine has been associated with hepatotoxicty, screening for hepatotoxicity by liver transaminase testing is currently not recommended following initiation of [[clozapine]] administration. Approximately 30 - 50% of patients have an asymptomatic elevation in liver transaminases. Fulminant hepatic failure has been reported in patients administered clozapine in rare instances. | |AnswerAExp=Although clozapine has been associated with hepatotoxicty, screening for hepatotoxicity by liver transaminase testing is currently not recommended following initiation of [[clozapine]] administration. Approximately 30 - 50% of patients have an asymptomatic elevation in liver transaminases. Fulminant hepatic failure has been reported in patients administered clozapine in rare instances. | ||
Latest revision as of 00:42, 28 October 2020
| Author | [[PageAuthor::Yazan Daaboul, M.D., (Reviewed by Yazan Daaboul, M.D. and Alison Leibowitz [1])]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Behavioral Science/Psychiatry, MainCategory::Pharmacology |
| Sub Category | SubCategory::Hematology |
| Prompt | [[Prompt::A 24-year-old man is admitted to the hospital for auditory hallucinations and delusions. His older brother reports that the patient is diagnosed with treatment-resistant schizophrenia and has been administered several medications for the past 4 years without improvement. The physician then decides to start the patient on clozapine therapy. Which of the following lab tests should be routinely performed to monitor for clozapine-induced adverse events?]] |
| Answer A | AnswerA::Serum ALT level |
| Answer A Explanation | [[AnswerAExp::Although clozapine has been associated with hepatotoxicty, screening for hepatotoxicity by liver transaminase testing is currently not recommended following initiation of clozapine administration. Approximately 30 - 50% of patients have an asymptomatic elevation in liver transaminases. Fulminant hepatic failure has been reported in patients administered clozapine in rare instances.]] |
| Answer B | AnswerB::Serum creatinine level |
| Answer B Explanation | [[AnswerBExp::Creatinine testing is not routinely performed upon clozapine administration.]] |
| Answer C | AnswerC::Absolute neutrophil count |
| Answer C Explanation | [[AnswerCExp::Due to the risk of agranulocytosis, white blood cell (WBC) count and absolute neutrophil count (ANC) must be routinely performed for patients administered clozapine.]] |
| Answer D | AnswerD::Electrolyte panel |
| Answer D Explanation | [[AnswerDExp::Electrolyte panel testing is not routinely performed upon clozapine administration.]] |
| Answer E | AnswerE::Hemoglobin level |
| Answer E Explanation | [[AnswerEExp::Generally, a complete blood count (CBC) is obtained for patients who are administered clozapine to monitor for leokopenia, granulocytopenia, and agranulocytosis by measurement of WBC and ANC levels. Although a CBC gives information about the hemoglobin levels, neither anemia nor polycythemia is the main concern following clozapine administration.]] |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::Clozapine is a second generation antipsychotic medication that has demonstrated significant efficacy for the treatment of schizophrenia and reduction in the frequency of relapses. Clozapine is reserved for refractory cases of schizophrenia due to its association with agranulocytosis in approximately 1% of cases. Periodic complete blood count (CBC) is usually performed in schizophrenic patients who are administered clozapine to monitor for any signs of leokopenia, granulocytopenia, and agranulocytosis by measurement of white blood cells (WBC) count and absolute neutrophil count (ANC). With initiation of clozapine therapy, WBC and ANC are monitored weekly for the first 6 months, then every other week for the next 6 months, then every 4 weeks thereafter. Educational Objective: Clozapine is a second generation antipsychotic medication that is highly effective in the treatment of symptoms of schizophrenia. Clozapine is reserved for treatment-resistant cases of schizophrenia due to its association with agranulocytosis in approximately 1% of cases. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Schizophrenia, WBRKeyword::Leukopenia, WBRKeyword::Granulocytopenia, WBRKeyword::Agranulocytosis, WBRKeyword::Adverse drug event, WBRKeyword::Adverse drug reaction, WBRKeyword::Side effect, WBRKeyword::Clozapine, WBRKeyword::WBC, WBRKeyword::ANC, WBRKeyword::Absolute neutrophil count, WBRKeyword::Screening, WBRKeyword::Antipsychotics |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |