13.09.19 Gastroenterology + other notes

Azathioprine

• • Pre-administration

    • Check TPMT levels

      • Catalyzes S-methylation of thiopurine drugs (azathioprine, 6-mercaptopurine, 6-thioguanine)

      • Defects => decreased inactivation of 6MP leading to enhanced bone marrow toxicity

      • 10% have reduced activity => Reduce dose

      • 0.3% have no activity => Contraindication

  • Adverse effects

    • B: N+V, Generally unwell

    • C: Rash, Hepatitis, Pancreatitis, Bone marrow suppression, Photosensitivity

    • D: SCC, BCC, Lymphoma

  • Monitoring

    • Weekly FBC, LFTs, U+Es

    • Then 3-monthly

Notes

• • UC can actually cause upstream constipation if disease is predominantly left-sided => Laxatives

  • UC can cause a hypercoagulable state