Meds

Question 1

Nonbiologic (Traditional) DMARDs

Drug Class

Answer 1

Antimetabolite drugs

Question 2

Nonbiologic (Traditional) DMARDs

Mechanism of action

Answer 2

Decrease joint inflammation and subsequently joint damage

Exert their immunosuppressive effect by interfering with normal B and T lymphocytes activity

Question 3

Nonbiologic (Traditional) DMARDs

Examples

Answer 3

Methotrexate (Rheumatrexate, Trexall)

Question 4

Nonbiologic (Traditional) DMARDs

Contradictions/Precautions

Answer 4

Teratogenic medications (methotrexate)

Liver insufficiency or hepatitis

Renal insufficiency

Peptic ulcer or ulcerative colitis

Active bacterial or viral infections

Question 5

Nonbiologic (Traditional) DMARDs

Adverse Effects

Answer 5

Bone marrow suppression (decreased platelets, red and white blood
cells)

Increased risk of infection

Liver damage

Gastrointestinal ulceration

Pulmonary fibrosis

Dizziness and headache

Nausea and vomiting

Question 6

Nonbiologic (Traditional) DMARDs

Assessments

Answer 6

Monitor for decreased platelets, red and white blood cell counts.

Monitor for signs and symptoms of infection.

Monitor liver function tests and observe for jaundice.

Monitor for gastrointestinal bleeding (with methotrexate).

Monitor for respiratory distress and decreased oxygenation

Monitor for abdominal pain, diarrhea, nausea and vomiting

Question 7

Nonbiologic (Traditional) DMARDs

Toxic Effects

Answer 7

Concurrent use of warfarin may increase the risk for bleeding

Alcohol use may increase risk of hepatotoxicity.

Concurrent use of methotrexate and NSAIDs, salicylates, and
sulfonamides may cause toxicity.

Drink adequate amounts (2L) of water daily to ensure excretion of drug.

Folic acid supplement may be prescribed to decrease risk of toxicity.

Question 8

Nonbiologic (Traditional) DMARDs

Evaulation

Answer 8

Check for yellowing of skin

Signs of infection

Blood in vomit or stool

Difficulty breathing or shortness of breath

Abnormal bleeding, bruising, ulcers in mouth