Fever, sore throat, or signs of infection - possible agranulocytosis, hold and report immediately.
Before you read
Test yourself first: 4 questions
Question 1 of 4
A client taking clozapine, an atypical antipsychotic, must have routine laboratory monitoring. Which test is essential because of clozapine's most serious adverse effect?
Answer: B. Clozapine can cause agranulocytosis, a potentially fatal drop in white blood cells. Regular absolute neutrophil count (ANC) monitoring via a complete blood count is required. A sore throat, fever, or signs of infection must be reported immediately.
Question 2 of 4
A client taking clozapine reports a sore throat and fever. Which laboratory test is the priority for the nurse to review?
Answer: B. Clozapine carries a risk of agranulocytosis, a potentially fatal drop in white blood cells, so signs of infection such as fever and sore throat require an immediate check of the absolute neutrophil count (ANC) via a complete blood count. Clozapine therapy requires regular ANC monitoring. Liver enzymes, lipid panel, and TSH are relevant to other concerns but are not the priority when infection signs suggest possible agranulocytosis.
Question 3 of 4
A client taking clozapine for treatment-resistant schizophrenia is due for routine monitoring. Which laboratory test is most important for the nurse to ensure is completed?
Answer: B. Clozapine carries a risk of agranulocytosis, a potentially fatal drop in white blood cells (specifically neutrophils). The absolute neutrophil count (ANC) must be monitored regularly (weekly initially) before the drug is dispensed. This is the priority monitoring parameter.
Question 4 of 4
A client is prescribed clozapine after other antipsychotics failed. Which statement by the nurse about monitoring is correct?
Answer: A. Clozapine requires regular blood monitoring of the absolute neutrophil count because of the risk of agranulocytosis; this is mandatory and clients enroll in a monitoring program. Clozapine is typically reserved for treatment-resistant schizophrenia. Saying it needs no lab monitoring, that it is first-line, or that it never causes serious effects is inaccurate. The need for ongoing ANC monitoring is the key teaching point.
Keep the streak going with more questions like these, each with a full rationale.
What is clozapine?
It is highly effective but carries a serious risk of agranulocytosis, requiring mandatory ANC monitoring through a REMS program. It also lowers the seizure threshold and can cause myocarditis. Memory aid: Clozapine = mandatory blood counts.
Key points to remember
- Risk of agranulocytosis (severe neutropenia) requires regular ANC monitoring under a REMS program before dispensing.
- Reserved for treatment-resistant schizophrenia and to reduce suicide risk in schizophrenia.
- Lowers the seizure threshold (dose-related seizures) and can cause myocarditis and cardiomyopathy.
- Causes significant sedation, hypersalivation (drooling), weight gain, and metabolic syndrome.
- Carries risk of orthostatic hypotension and constipation (can progress to bowel obstruction).
- Has a low rate of EPS compared with typical antipsychotics.
Signs & symptoms
- Hypersalivation (drooling)
- Weight gain, sedation
Nursing priorities
- Ensure ANC/WBC is checked on schedule and within range before each dispense (REMS).
- Monitor for signs of infection (fever, sore throat, flu-like symptoms) indicating agranulocytosis.
- Assess for seizures, signs of myocarditis (chest pain, dyspnea, tachycardia), and constipation.
- Monitor weight, glucose, and lipids for metabolic syndrome.
- Teach the patient to never miss blood draws or doses without provider guidance.
Labs & values
Patient teaching
- You must have your blood counts drawn regularly; you cannot get the medication without it.
- Report fever, sore throat, or any infection signs right away.
- Report chest pain, shortness of breath, or fast heartbeat - and any seizures.
- Increase fiber and fluids for constipation; rise slowly to prevent dizziness.
Red flags: report now
- Fever, sore throat, or signs of infection - possible agranulocytosis, hold and report immediately.
- Chest pain, dyspnea, tachycardia, or unexplained fatigue - possible myocarditis.
- Seizures.
- Severe constipation/no bowel movement - risk of paralytic ileus.
References
Clinical references for this topic
