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The patient is at a high risk for torsades de pointes
6%
1/16
There is a high risk for retinopathy
The patient has type 2 diabetes
75%
12/16
The patient may develop galactorrhea
Tardive dyskinesia will likely result from the prolonged use of olanzapine
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This patient has schizophrenia, type 2 diabetes, and would like to be treated with olanzapine. Olanzapine is associated with weight gain and increases the risk of developing metabolic syndrome. Olanzapine, along with clozapine, is an atypical antipsychotic known for its side effects of weight gain and metabolic syndrome. Patients who are obese or have type 2 diabetes mellitus should not be prescribed olanzapine as the drug may worsen these conditions. Likewise, if a patient is prescribed olanzapine he/she should be followed closely for increases in weight and blood sugar. Muench et al., in their review on the adverse effects of antipsychotics, found that olzanapine and clozapine carry the highest risk of weight gain, type 2 diabetes, and other complications of metabolic syndrome. In fact, the metabolic side effects of olanzapine may ensue shortly after the medication is prescribed. Patients should have frequent follow-up visits to monitor weight, waist circumference, blood pressure, lipids, and blood glucose levels. Komossa et al. reviewed the effectiveness and side effect profiles of olanzapine compared to other atypical antipsychotics. They found that olanzapine increased weight on average 2.1-5.6 kg more than other atypical antipsychotics, clozapine excluded. Olanzapine was also slightly more efficacious than other atypical antipsychotics except clozapine. Incorrect Answers: Answer 1: Although olanzapine may increase the QTc interval, the effect is moderate as compared to ziprasidone. Additionally, this patient does not have any history of conduction defects or cardiac disease. Answer 2: Retinopathy is a known side effect of thioridazine, a low-potency typical antipsychotic. Of note, thioridazine is also known to carry a high risk of QTc prolongation. Answer 4: Although hypothyroidism may increase the risk of galactorrhea, olanzapine is not known to cause this side effect. Risperidone is the atypical antipsychotic known to lead to galactorrhea. Answer 5: Tardive dyskinesia is seen mostly in patients who take typical high potency antipsychotics for longer periods of time.
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