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Old 12-04-2011
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Drug Starting the patient on systemic isotretinoin

An 18-year-old woman comes to the clinic for a routine followup visit. She has severe acne that has been unresponsive to a variety of treatments, including topical benzoyl peroxide, topical retinoic acid, and topical antibiotics. She recently was started on systemic minocycline and had her oral contraceptive changed. This has provided little improvement, however, and the patient remains distressed and embarrassed about her acne. Physical examination reveals persistent acne with numerous comedones and occasional papules, pustules, and nodules. The rest of the physical examination is unremarkable. After discussion of the risks and benefits of treatment with the patient, it is decided to start the patient on systemic isotretinoin. When prescribing this medication, it is necessary to monitor which of the following?

A. Pregnancy test
B. Pregnancy test and CBC
C. Pregnancy test, CBC, and liver tests
D. Pregnancy test, CBC, liver tests, and lipid panel
E. Pregnancy test, CBC, liver tests, lipid panel, and psychiatric symptoms
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Old 12-04-2011
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Pregnancy test, CBC, liver tests, lipid panel, and psychiatric symptoms
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Old 12-04-2011
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pregnancy test.
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Old 12-04-2011
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A. Pregnancy test
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Old 12-04-2011
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Pregnancy test, CBC, and liver tests
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Old 12-04-2011
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I know isotretinoin is a teratogen n causes hypertriglyceridemia too..
so will go with D or E.dont know abt psychiatric changes
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Old 12-05-2011
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Isotretinoin is a teratogen and can cause transient elevations of triglycerides, cholestrol and LFTs. Depression is seen in some patients. So the option is mostly E.
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Old 12-05-2011
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Based on:

Maybe it's E.

Nice question.

Last edited by neoeinstein; 12-05-2011 at 05:39 AM.
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Old 12-05-2011
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The correct answer is E. Isotretinoin requires close monitoring. As the drug is highly teratogenic, two pregnancy tests are required before starting the medication. A CBC is recommended as a baseline and every 4-6 weeks after starting therapy, as the medication can cause bone marrow suppression. Liver tests are necessary to monitor for hepatotoxicity. A lipid panel , particularly serum triglycerides, is needed on a routine basis, as hypertriglyceridemia and pancreatitis can occur. Finally, the prescribing physician should screen for psychiatric symptoms as depression and suicide (and associated law suits) have been linked to isotretinoin. All of these need to be monitored, therefore choices A, B, C and D are incorrect.
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