Medicines 45

Question 1

Why is it important to test TPMT levels before starting thiopurine treatment?

Answer 1

🧬 Drug:

Thiopurines (e.g., azathioprine)

🔎 Metabolism:

Metabolised by Thiopurine Methyltransferase (TPMT) enzyme.

⚠️ Problem:

TPMT Deficiency → ❗ Reduced breakdown of thiopurines → 🔥 Toxic accumulation → Severe side effects.

🧪 Clinical Action:

Test TPMT levels before starting treatment. 🩺

🛡️ If Deficient:

Consider:

⚖️ Dose adjustment

🔄 Alternative treatment to avoid toxicity.

📚 Summary:

Low TPMT = Higher risk of thiopurine toxicity → Always screen first! ✅

Question 2

When can Orlistat be sold over the counter (OTC)?

Answer 2

🏪 OTC Sale Criteria:

Medication: Orlistat

Condition: Can be sold over the counter to individuals who meet both:

BMI ≥ 28 kg/m² ⚖️

Following a reduced-calorie, lower-fat diet 🍽️🥑

🧠 Key Reminder:

Always advise dietary modification alongside Orlistat use for effective weight loss.

Not suitable for individuals with normal or underweight BMI. ❌

Question 3

When should a GLP-1 receptor agonist be considered in type 2 diabetes treatment?

Answer 3

🔄 When to Switch to a GLP-1 Receptor Agonist:
If triple therapy is:

❌ Ineffective

❌ Not tolerated

❌ Contraindicated

✅ Consider a GLP-1 receptor agonist for people with:

BMI ≥ 35 kg/m² ⚖️ (adjust for black, Asian, and minority ethnic groups) plus specific psychological or medical conditions related to obesity
OR

BMI < 35 kg/m² and either:

Insulin therapy would cause occupational problems 🛠️

Weight loss would benefit obesity-related comorbidities ❤️

📝 Important Note:

Continue GLP-1 therapy only if after 6 months:

HbA1c drops by ≥ 11 mmol/mol 📉

Weight loss of ≥ 3% of initial body weight ⚡