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Methotrexate

Methotrexate

QUESTION

The purpose of the presentation is for you to educate your colleagues on the drug “Methotrexate”. The presentation must include information about the:

-Drug pharmacology, pharmacokinetics
-Brand name
-Generic name
-Dosing
-Indications for use
-Side effects
-Contraindications
-Pregnancy class
-You must also perform a cost analysis of the drug.
-Provide a patient case study on a patient in which you would utilize the drug you have selected and include at least two peer-reviewed evidence-based studies related to the drug.
-Describe the appropriate patient education.
-What is your role as a Nurse Practitioner for prescribing this medication to this patient on your case study presentation?
-Describe the monitoring and follow-up.
Methotrexate
ANSWER

It inhibits the enzymes responsible for synthesis in the nucleotide hence prevention of cell division leading to anti inflammatory actions.
The action of methotrexate occurs for a long duration hence administered weekly (Hannoodee & Mittal, 2022).
The drug has a narrow therapeutic index
Methotrexate is a folate analog that distributes majorly on non fatty body tissues.
The transport of methotrexate in the capillaries, liver, kidney, skin and cell membranes is quiet rapid, hence enabling the tissue to plasma concentration equilibrium ratio to establish on a time scale which is uniform with the limitation of plasma flow.
The transport or methotrexate across the gastrointestinal tracts, bone marrow and the spleen is relatively lower hence initial delivery to those organs become limited to membrane transport. (Levêque et al., 2017)
The clearance of methotrexate in the body occurs via urinary and biliary routes.
Reditrex
Trexall
Xatmep
Rasuvo
Rheumatrex
Otrexup
The dosage is administered once a week for most illnesses in children and adults.
In some cases the doctor may recommend further dosage, however , they should restrict to a given quantity of milligram as per presenting patient condition. For example, for psoriasis the drug should not exceed 30mg per week (Levêque et al., 2017).
Methotrexate is indicated in the meningeal leukemia prophylaxis and can be applied in maintenance therapy
It is also indicated in symptomatic control of severe disabling psoriasis(Maiolatesi & Peddicord, 2020).
It is also indicated in the management of a given set of adults having rheumatoid arthritis or minors with the juvenile rheumatoid arthritis and did not get sufficient therapies.
Dizziness
Drowsiness
Headache
Decreased appetite
Hair loss
Reddened eyes
Blurred vision
Confusion
Seizures (Hannoodee & Mittal, 2022)
Having bad infection
Dehydration
Conditions prompting defective patient immune system’
Patients having low blood count because of bone marrow failures
Patient with decreased blood platelets
Alcoholism
Patient with fluids escaping to the lungs
Diarrhea
Pregnancy
Liver hardening among many more conditions (Hannoodee & Mittal, 2022).
Methotrexate is contraindicated in pregnancy
It has teratogenic effects which may cause abnormalities such as craniofacial abnormalities, child limb defects and child CNS defects (Maiolatesi & Peddicord, 2020).
Methotrexate is regarded as relatively expensive, however it has higher effectiveness like other bDMARDs
Methotrexate has the lowest incremental costs and higher efficacy (Betts et al., 2019).
Methotrexate is less expensive compared to other drugs of similar class, hence quiet cost effective.
For patients with MTX resistant RA, the most efficient option is a combination of methotrexate and etanercept
A 38 yr. old male presents to the physician with a history of joint pains for 4 months.
The pain occurs mostly at the joints in the wrists and upper part of the hand to the phalangeal joints.
The patients cites worse pains in the morning which disappears during the day as they use the hands
Upon examination, there are red swollen tender joints.
The start of medication is low dosage of methotrexate as a disease modifying antirheumatic drug DMARD in cases or rheumatoid arthritis.
The drug may cause kidney damage, patients must be educated to take more water and fluids during methotrexate treatment
Patients to mention any medication, vitamins, and nutritional supplements before dispensation of drugs
Patient to avoid alcoholic drinks
Patients to provide any information if there is about low blood count, anemia or other blood complication.
Patients to contact the doctors anytime they feel confuse, or dizzy, excessively tired or unable to fall asleep
Patients to beware of methotrexate side effects such as severe skin rash, intestinal damages, and skin sensitiveness so they can report to the doctors about the side effect whenever they experience it (Hannoodee & Mittal, 2022).
Patients to be advised to report to doctors incase of blood in urine, chest pains, slurred speech, blood in urines, seizures, leg or arm numbness , and difficulty to move body sides.
The nurses role is to explain the adverse side effects of the drugs which may include vomiting and many others.
The nurse to explain the effects of drug therapy such as increase in the patient abdominal pains (Cerminara et al., 2018).
Nurse to teach the patients the importance of communication in any case of physical changes experienced by the patient.
Patients to be monitored for CBC, and serum creatinine
Transaminases to be carried out at least weekly in the first one month and once in a fortnight on subsequent months.
The nurse to revise current medications to avoid chances of drug intercations before prescription.
Subsequent liver function tests to be carried out for serum AST, ALTS and levels of albumin(Karlsson Sundbaum et al., 2019) .
Monitoring for pulmonary toxicity to be carried out to avoid dry cough, dyspnoea and fever.
Chest radiograph checks to be administered to check interstitials, infiltrates in alveoli, pleural effusions and any chances of pulmonary fibrosis.
Further test to eliminate tuberculosis and bone marrow toxicity to be done
Betts, K. A., Griffith, J., Friedman, A., Zhou, Z.-Y., Signorovitch, J. E., & Ganguli, A. (2019). An indirect comparison and cost per responder analysis of Adalimumab, methotrexate and apremilast in the treatment of methotrexate-naïve patients with psoriatic arthritis. Current Medical Research and Opinion, 32(4), 721–729. https://doi.org/10.1185/03007995.2016.1140026
Cerminara, Z., Duffy, A., Nishioka, J., Trovato, J., & Gilmore, S. (2018). A single center retrospective analysis of a protocol for high-dose methotrexate and Leucovorin Rescue Administration. Journal of Oncology Pharmacy Practice, 25(1), 76–84. https://doi.org/10.1177/1078155217729744
Hannoodee, M., & Mittal, M. (2022, January 20). Methotrexate. National Center for Biotechnology Information. Retrieved June 10, 2022, from https://pubmed.ncbi.nlm.nih.gov/32310574/
Karlsson Sundbaum, J., Eriksson, N., Hallberg, P., Lehto, N., Wadelius, M., & Baecklund, E. (2019). Methotrexate treatment in rheumatoid arthritis and elevated liver enzymes: A long‐term follow‐up of predictors, surveillance, and outcome in clinical practice. International Journal of Rheumatic Diseases, 22(7), 1226–1232. https://doi.org/10.1111/1756-185x.13576
Levêque, D., Becker, G., Toussaint, E., Fornecker, L.-M., & Paillard, C. (2017). Clinical pharmacokinetics of methotrexate in oncology. International Journal of Pharmacokinetics, 2(2), 137–147. https://doi.org/10.4155/ipk-2016-0022
Maiolatesi, C. R., & Peddicord, K. (2020). Methotrexate for nonsurgical treatment of ectopic pregnancy: Nursing implications. Journal of Obstetric, Gynecologic & Neonatal Nursing, 25(3), 205–208. https://doi.org/10.1111/j.1552-6909.1996.tb02426.x
Methotrexate

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