Azathioprine

Question 1

what is azathioprine

Answer 1

an antimetabolite which breaks down into mercaptopurine which inhibits the repairment and making of DNA

Question 2

how is azathioprine broken down

Answer 2

by TMPT = Thiopurine Methyltransferase

Question 3

what can underactive TPMT lead to and what is advised before giving Azathioprine

Answer 3

• can lead to myelosuppression
• pre-screening TPMT levels

Question 4

s/e of azathioprine

Answer 4

• hypersenstivity
• neutropenia and thrombocytopenia
• nausea
• teratogenic

Question 5

s/e of azathioprine

symptoms of hypersenstivity

Answer 5

• malaise
• dizziness
• D+V
• fever
• rash
• hypotension
• myalgia (muscle aches)

Question 6

s/e of azathioprine

which symptoms of neutropenia and thrombocytopenia should be REPORTED

Answer 6

• sore throat
• bruising
• bleeding

Question 7

S/E of azathioprine

when is nausea common with azathioprine

Answer 7

more common at start but resolve

Question 8

Monitoring requirements of azathioprine

Answer 8

• TPMT levels
• regular LFT and FBC (severe liver and renal impairment)
• FBC weekly 1st 4WK then at least every 3MT

Question 9

interactions of azathioprine

Answer 9

• allopurinol
• ACEI

Question 10

azathioprine + allopurinol interaction

Answer 10

• high risk of haematological toxicity
• decrease dose of azathioprine

Question 11

azathioprine + ACEI interaction

Answer 11

• high risk of anaemia/lucopenia
• avoid concommitant use