WBR0477

Author	[[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry, MainCategory::Pharmacology
Sub Category	SubCategory::Hematology
Prompt	[[Prompt::A 19-year-old male is admitted to the hospital for auditory hallucinations and delusions, with a duration of over 1 year. The patient has schizophrenia and is refractory to antipsychotic treatment. The physician decides to start the patient on clozapine despite associated risks. Which of the following lab tests should be routinely performed to monitor for clozapine adverse reaction?]]
Answer A	AnswerA::Liver transaminases
Answer A Explanation	[[AnswerAExp::Liver transaminase testing is not routinely performed upon clozapine administration.]]
Answer B	AnswerB::Creatinine
Answer B Explanation	[[AnswerBExp::Creatinine testing is not routinely performed upon clozapine administration.]]
Answer C	AnswerC::Complete blood count (CBC)
Answer C Explanation	[[AnswerCExp::Due to the risk of agranulocytosis, a CBC must be routinely performed in 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::Fasting blood glucose
Answer E Explanation	[[AnswerEExp::Fasting blood glucose testing is not routinely performed upon clozapine administration.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::Clozapine, a second generation antipsychotic medication, is highly effective in the treatment of symptoms characteristic of schizophrenia. Clozapine is reserved for refractory cases of schizophrenia, due to its association with agranulocytosis in approximately 1% of patients. Periodic complete blood count (CBC) must be performed in patients administered clozapine, to monitor for any signs of agranulocytosis. Educational Objective: Clozapine, a second generation antipsychotic medication, is highly effective in the treatment of symptoms characteristic of schizophrenia. Clozapine is reserved for refractory cases of schizophrenia, due to its association with agranulocytosis in approximately 1% of patients. References: First Aid 2014 page 253]]
Approved	Approved::Yes
Keyword	WBRKeyword::schizophrenia, WBRKeyword::clozapine, WBRKeyword::antipsychotics, WBRKeyword::second generation antipsychotics, WBRKeyword::agranulocytosis, WBRKeyword::adverse drug reaction, WBRKeyword::side effect, WBRKeyword::CBC, WBRKeyword::complete blood count, WBRKeyword::monitoring, WBRKeyword::mental health, WBRKeyword::neurological
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