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