【最後一哩路加油】評論

藥理藥化全部忘記也沒有關係題目已經告訴你答案了  可以拆字thiopurine methyltransferase（TPMT）基因型有硫和purine而azathioprine   有 硫和purine

【IG:Pharmabook】評論

azathioprine最嚴重的副作用是骨髓抑制，通常在治療後7-14天出現骨髓抑制的強弱與thiopurine methyltransferase的活性有關thiopurine methyltransferase活性弱→增加更多6-MP、6-TG→azathioprine 骨髓抑制效果更強建議使用azathioprine前，先進行thiopurine methyltransferase（TPMT）基因型檢測ref：koda & kimble 10th applied p.833 The most common adverse effect of azathioprine is bone marrow suppression, which presents as leukopenia or, less commonly, as thrombocytopenia and megaloblastic anemia. Myelosuppression is dose-dependent and typically observed after 7 to14 days of therapy. Bone marrow suppression may be related to a genetic deficiency of the enzyme, thiopurine methyltransferase.Low activity of this enzyme is rare but in some individuals it leads to greater availability of 6-MP, elevated 6-thioguanine levels, and susceptibility to myelosuppression. Low levels of thiopurine methyltransferase  have been associated with severe azathioprine myelotoxicity  and reduced efficacy in some transplant recipients; testing for this polymorphism has been advocated

【吳富豪】評論

留意往右走的正常路徑會產生6-TG  (此6-TG產物具有治療白血病的療效)往下走的路徑是經由TPMT enzyme代謝成6-MMP倘若TPMT基因的某些多型性造成酵素活性降低，易造成6-MP代謝成6-TG增加，超過所需要的骨髓抑制劑量，造成骨髓過度被抑制而中毒、貧血、白血球過度減少、過多血小板減少Up to datePretreatment determination of TPMT genotype to guide dosing has been shown to be effective at reducing the risk of thiopurine-related bone marrow suppression (most frequently leukopenia)不過跟樓上說的一樣就算不用懂路徑只要知道結構上有硫即可選出答案

【OOO】評論

thiopurine methyltransferase（TPMT）基因型檢測thiopurine methyltransferase 當然是作用在thiopurine上，例如azathioprine