Psychiatric Medications Q 72
Which information is most important for the nurse Trinity to include in a teaching plan for a male schizophrenic client taking clozapine (Clozaril)?
A. Monthly blood tests will be necessary.
B. Report a sore throat or fever to the physician immediately.
C. Blood pressure must be monitored for hypertension.
D. Stop the medication when symptoms subside.
Correct Answer: B. Report a sore throat or fever to the physician immediately.
A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine. The risk of developing agranulocytosis is around 1% in patients who take clozapine, which may be independent of dosing. Most cases occur early in the treatment, within six weeks to six months, and require extensive monitoring of blood absolute neutrophil counts. The definition of neutropenia is an ANC level below 1500/mm, and agranulocytosis is an ANC level below 500/mm.
Option A: Because of the risk of agranulocytosis, white blood cell (WBC) counts are necessary weekly, not monthly. If the WBC count drops below 3,000/?l, the medication must be stopped. Many have tried to explain the link between clozapine and agranulocytosis by attributing this adverse effect to drug interactions with the immune system and genetic predisposition. A study in 2015 looked into the benefits of pharmacogenetic testing and how it may affect monitoring in patients at risk for clozapine-induced agranulocytosis. The study suggested that patients with a lower genetic risk may benefit from a more relaxed hematological monitoring schedule.
Option C: Hypotension may occur in clients taking this medication. Warn the client to stand up slowly to avoid dizziness from orthostatic hypotension. Risk factors include old age, female, genetics, and concurrent treatment with other drugs known to cause agranulocytosis. Clinicians must place patients taking clozapine on a national registry. Granulocyte colony-stimulating factor may be an option to increase levels of white blood cells.
Option D: The medication should be continued, even when symptoms have been controlled. If the medication must be stopped, it should be slowly tapered over 1 to 2 weeks and only under the supervision of a physician. Weekly complete blood count (CBC) to measure ANC levels. ANC levels less than 1500 indicate neutropenia. Levels less than 500 indicate agranulocytosis. A complete blood count should be taken weekly for the first six months, then every other week for the next six months. A national registry is in place to monitor for safe use.