QuestionSBA
QuestionChoice
It is not necessary to check or monitor bone profile in treatment with clozapine
34391
b
Bone profile
QuestionChoice
A rare but serious adverse effect of clozapine is agranulocytosis. The white cell count must be checked at the start and closely monitored throughout the duration of treatment
34390
a
Full blood count
QuestionChoice
Clozapine is known to be cardiotoxic and serious adverse effects include myocarditis and cardiomyopathy. In the absence of symptoms or clinical suspicion it is not necessary to conduct routine monitoring with stress echocardiography
34394
e
Stress echocardiogram
QuestionChoice
It is not necessary to check or monitor serum magnesium in treatment with clozapine
34393
d
Serum magnesium
QuestionChoice
This may be checked at the start of treatment but it is not necessary to monitor renal function during treatment
34392
c
Renal function tests
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2821
Antipsychotic side effects
Topic
90
Psychiatry
6889
Case Presentation: A 24 year old man has been detained under a Section 2 order for an acute psychotic episode on a background of treatment-resistant schizophrenia. The consultant psychiatrist decides to commence clozapine (Clozaril) 12.5mg PO OD with dose escalation planned over the next few days and weeks.


Question: Select the most appropriate option to monitor for adverse effects of this treatment.
a