Schizophrenia Q 51
A client begins clozapine (Clozaril) therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to assess for which adverse reaction?
A. Hepatitis
B. Infection
C. Granulocytopenia
D. Systemic dermatitis
Correct Answer: C. Granulocytopenia
Clozapine can cause life-threatening neutropenia or granulocytopenia. To detect this adverse reaction, a WBC count should be performed weekly. 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.
Option A: Hepatitis is not an adverse effect of clozapine. Clozapine is associated with significant weight gain, diabetes type 2, diabetic ketoacidosis, and increased lipid levels-all due to increased insulin resistance. Both clozapine and olanzapine have higher metabolic side effects than the other atypical and typical antipsychotics due to their high affinity for serotonin 5-HT2C receptors.
Option B: Infection does not occur with clozapine. Clozapine-induced myocarditis is a rare complication, affecting less than 3% of patients. This lethal dose-independent side effect appears more frequently during the first four weeks of treatment. In these patients, signs and symptoms of myocarditis may vary from having a flu-like illness to respiratory and cardiovascular symptoms.
Option D: Systemic dermatitis isn’t an adverse reaction of clozapine therapy. Clozapine, due to its many lethal adverse reactions, has become a drug that many clinicians are afraid to prescribe due to fear of patient safety. One of the greatest concerns for clozapine is the side effect of agranulocytosis. The FDA has required a registry to be in place to monitor weekly white blood cell count levels for anyone prescribed with clozapine.