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A 27 year old female is brought into the Emergency Department by her parents. The parents say she was chasing her favorite cat around the house trying to kill it with a butcher knife. The psychiatric resident on call asks the patient why she was doing this. She responds, “Because the demons told me too”. On further investigation the resident finds out she has a long history of visual and auditory hallucinations, that have been refractory to 3 different antipsychotic medications. The patient is admitted to the hospital and started on a new medication. Two months after admission her hallucinations have ceased, but a routine CBC reveals marked leukopenia with the greatest depletion of polymorphonuclear leukocytes. What drug was this patient started on?
A - Heloperidol
B - Clozapine
C - Risperdone
D - Olanzapine
E - Chlorpromazine
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yep b.... is right. for what I know is the only antipsichotic that needs constantly WBC evaluation.
Clozapine is an atypical antipsychotic medication used in the treatment of schizophrenia. Clozapine carries a black box warning for drug-induced agranulocytosis. Agranulocytosis occurs in about 1% of patients who take clozapine during the first few months of treatment. The risk of developing it is highest about three months into treatment, and decreases substantially thereafter, to less than 0.01% after one year. Other side effects include constipation, drooling, muscle stiffness, sedation, tremors, orthostasis, hyperglycemia, and weight gain.
A - Haloperidol is a typical antipsychotic. The drug is noted for its strong early and late extrapyramidal side-effects.
C - Risperidone is an atypical antipsychotic. Common side effects include akathisia, anxiety, insomnia, low blood pressure, muscle stiffness, muscle pain, sedation, sexual dysfunction, tremors, increased salivation, and stuffy nose.
D - Olanzapine is an atypical antipsychotic. As with all neuroleptic drugs, olanzapine can cause tardive dyskinesia and rare but life-threatening neuroleptic malignant syndrome.
E – Chlorpromazine is a typical antipsychotic. The main side effects of chlorpromazine are due to its anticholinergic properties. These include sedation, slurred speech, dry mouth, constipation, urinary retention and possible lowering of seizure threshold.
