A 34-year-old man is evaluated in the psychiatric clinic for a routine follow-up visit. He has a 10-year history of schizophrenia. Over the past several years, he has continued to experience frequent auditory hallucinations, profound negative symptoms, and persecutory delusions despite documented medication adherence and adequate therapeutic trials of olanzapine, risperidone, and haloperidol. The physician and patient agree to initiate clozapine therapy.
As part of this patient's long-term management, which of the following laboratory parameters require routine ongoing monitoring? (Select all that apply)
- Absolute neutrophil countCevap
- Fasting blood glucoseCevap
- Fasting lipid panelCevap
- DSerum creatinine
- ESerum prolactin
Cevap
The parameters that require routine ongoing monitoring for a patient on clozapine are the absolute neutrophil count, fasting blood glucose, and fasting lipid panel.
The correct options reflect the major risks associated with clozapine therapy: severe neutropenia and metabolic syndrome. To mitigate the risk of potentially fatal agranulocytosis, absolute neutrophil count monitoring is strictly mandated by the national REMS program. Furthermore, clozapine is highly obesogenic and carries a substantial risk of inducing diabetes and dyslipidemia. This necessitates routine ongoing monitoring of both fasting blood glucose and a fasting lipid panel to ensure timely intervention if metabolic derangements occur.
Adım Adım Çözüm
Anahtar Kavram
Patients prescribed clozapine require mandatory routine monitoring of their absolute neutrophil count to prevent agranulocytosis, as well as periodic assessment of fasting blood glucose and lipids due to a significantly elevated risk of metabolic syndrome.