This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Schizophrenia Spectrum and Other Psychotic Disorders, Subject name: Psychiatry
[{'content': 'Not true about clozapine is: \nSelect and explain. \nA. Should be discontinued, if WBC counts < 3500/dl, B. Has no anti suicide propey, C. Should not be used along with carbamazepine, D. The action is more on D4 receptors than D2 receptors', 'role': 'user'}, {'content': 'Answer: B \nExplanation: Clozapine: It is a DOC for treatment resistant schizophrenia(TRS) TRS is defined as lack of response to 2 antipsychotics (atleast 1 atypical) at adequate dose for atleast 4-6 weeks It has more affinity for D4 receptors , less affinity for D2- [?] minimum EPS. It has anti- suicide propey It is an antipsychotic agent with maximum weight gain propey. Side effects: most common- sedation (due to H1 blocking propey) Sialorrhea Syncope, hypotension, tachycardia, nausea and vomiting Anticholinergic side effects like constipation Three life threatening side effects: Agranulocytosis(Idiosyncratic) Myocarditis Seizures(Dose dependent) Monitoring: TLC and ANC Once a week for first 6 months Once in two weeks for next 6 months Once a month till patient is on clozapine If WBC count falls below 3000/dL or ANC falls below 1500/dL, STOP the clozapine. Contraindications: WBC <3500/dL History of agranulocytosis on clozapine Use of bone marrow suppressants such as carbamazepine.', 'role': 'assistant'}]