Comprehensive Nursing Pharmacology Q 155

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Which of the following laboratory tests should be monitored when a client is receiving azathioprine?

  

     A. CBC

     B. BUN

     C. Electrolytes

     D. Sedimentation rate

    

    

Correct Answer: A. CBC

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CBC will identify leukopenia, a common side effect. Complete blood count (CBC) and liver function test (LFT) monitoring weekly are recommended initially for the first 4 to 8 weeks. When maintenance dose achieved, CBC and LFT should get checked every three months for the rest of the treatment. Although it is advisable to check CBC and LFT more frequently in patients with kidney or renal diseases or elderly, patients on high dosages of AZA or with low TPMT activity.

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Option B: If patients have abdominal pain or severe nausea/vomiting, serum amylase requires checking to rule out pancreatitis. Lymph node and skin examination should be biannual. If generalized wart occurs, the AZA dose should be reduced or switched to another agent.

Option C: If labs show leukopenia (WBC less than 3 x 10^9/L), thrombocytopenia (platelet less than 120 x 10^9/L), or transaminitis (liver biochemistry more than half of the normal upper limit), the medication should be stopped.

Option D: Test the patient for hepatitis B and C and PPD. A pregnancy test before treatment initiation is also a recommendation. Checking TPMT activity is suggested before starting the medication. Misclassification of TPMT phenotype can occur by prior blood transfusion.

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