QuestionSBA
QuestionChoice
There are no common ophthalmic side effects associated with azathioprine use. Therefore monitoring is not required.
50423
e
Fundoscopy
QuestionChoice
The enzyme thiopurine methyltransferase is responsible for the metabolism of thiopurine drugs. If TPMT activity is reduced, there is an increased risk of myelosuppression (and subsequent severe infection) as there is improper clearance of azathioprine.
50419
a
TPMT activity
QuestionChoice
There are no common cardiovascular side effects associated with azathioprine use. Therefore monitoring is not required.
50422
d
ECG
QuestionChoice
Azathioprine is not known to impair hepatic function. If hepatic function is impaired when taking azathioprine, a full blood count should be monitored more frequently.
50420
b
Liver function tests
QuestionChoice
Azathioprine is not known to impair renal function. If renal function is impaired when taking azathioprine, a full blood count should be monitored more frequently.
50421
c
Renal function
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3667
TPMT activity should be measured in patients before initiating azathioprine treatment
Topic
9
Internal Medicine
10138
Case Presentation: A 24-year-old gentleman is admitted to hospital following 2 weeks of abdominal pain, diarrhoea and blood in his stool. Weight 60kg.




 **Investigations**


CRP: 65 mg/L (< 5mg/L)


Imaging: Sigmoidoscopy shows oedematous mucosa, erythema and bowel inflammation shown up to the level of the sigmoid colon.


It is decided that based on his history and investigations that he has a diagnosis of ulcerative colitis. This is treated acutely with IV hydrocortisone.


To maintain remission, azathioprine 120mg PO OD is prescribed.


Question: Which investigation is necessary before this patient can start his azathioprine?
a