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Hyperlipidemia
7%
18/262
Osteoporosis
5%
13/262
Hirsutism
4%
10/262
Cytokine storm
3%
8/262
Pancytopenia
76%
198/262
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Azathioprine is an anti-inflammatory medication that is as a precursor to 6-mercaptopurine. Pancytopenia is a serious toxicity of azathioprine. Azathioprine is an antimetabolite medication that is a precursor to 6-mercaptopurine, leading to purine synthesis inhibition and subsequent inhibition of lymphocyte proliferation. It is indicated in patients with a history of organ transplant to reduce the risk of organ rejection. It is degraded by xanthine oxidase, so patients on allopurinol are at an increased risk of azathioprine toxicity. Since azathioprine suppresses bone marrow, patients should be closely monitored for anemia, leukopenia, and thrombocytopenia. Incorrect Answers: Answer 1: Hyperlipidemia is an adverse effect of sirolimus (rapamycin), an anti-inflammatory mTOR inhibitor. Other adverse effects of sirolimus include pancytopenia and insulin resistance. Answer 2: Osteoporosis is an adverse effect of glucocorticoids (steroids) such as prednisone. Other adverse effects of steroids include Cushing syndrome, hyperglycemia, and mood alterations. Answer 3: Hirsutism is an adverse effect of cyclosporine, an anti-inflammatory agent used in organ transplant rejection prophylaxis. Other adverse effects of cyclosporine include gingival hyperplasia and nephrotoxicity. Answer 4: Cytokine storm manifests clinically as pyrexia, and is a side effect of muromonab. Muromonab is a monoclonal antibody directed against the CD3 receptor. Bullet Summary: Azathioprine is an anti-inflammatory agent that impairs purine synthesis and is known to cause pancytopenia due to bone marrow suppression.
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