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Ama - Musculoskeletal > Methotrexate > Flashcards

Methotrexate Flashcards

1
Q

Methotrexate - MoA

A

Anti-folate
Inhibits conversion of dihydrofolate (folic acid) to tetrahydrofolate.
Tetrohydrofolate is needed to make purines/pyrimidines and therefore DNA

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2
Q

Anti-folate drugs

A

Teratogenic
Blood dyscrasias

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3
Q

Methotrexate - use

A

RA
Cancer
Psoriasis
Crohns disease

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4
Q

Dose + prescription

A

Once WEEKLY
- same day each week
Prescription requirements:
- Dose and frequency (e.g. Xmg weekly)
- One strength tablet only

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5
Q

Methotrexate + folic acid

A

Helps reduce MTX side effects
Dose:
- 5 mg once weekly on diff day to MTX (BNF dose
- 5 mg OD except on MTX day
- 1 mg OD except on MTX day

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6
Q

Methotrexate - missed dose

A

< 3 days = take ASAP
> 3 days = take next scheduled dose on usual day

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7
Q

Methotrexate - patient counselling

A
  • Take full dose once a week
  • Avoid OTC NSAIDs (risk of toxicity)
  • Annual flu vaccination (MTX causes immunosuppresion)
  • MTX treatment book
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8
Q

Methotrexate - Side effects

A

Blood dyscrasias
- Low WBC
- Low RBC
- Low platelets
Hepatotoxicity
Nephrotoxicity
Pulmonary toxicity
GI toxicity

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9
Q

Blood dyscrasias - low WBC

A
  • Susceptible to infection
  • Report mouth ulcers, fever, malaise, sore throat
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10
Q

Blood dyscrasias - low RBC

A
  • Anaemia
  • Report extreme tiredness, pallor, dizziness
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11
Q

Blood dyscrasias - low platelets

A
  • Thrombocytopoenia
  • Report bruising/bleeding
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12
Q

Hepatotoxicity

A

Report:
- N + V
- Dark urine
- Jaundice
- Abdominal pain (upper right)
- Itching
- Malaise
- Pale coloured stools

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13
Q

Nephorotoxicity

A

MTX is renally excreted
Nephrotoxicity = risk of MTX toxicity

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14
Q

Pulmonary toxicity

A

Report:
- SoB
- Cough
- Fever

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15
Q

GI toxicity

A

Report:
- Stomatitis
- First sign of GI toxicity

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16
Q

Conception/pregnancy

A

TERATOGENIC
- Effective contraception during and 6 months after
- Men AND women

17
Q

Methotrexate - handling

A

Avoid contact with skin
Pregnant women should avoid handling at all

18
Q

Interactions - increased risk of blood disorders

A
  • Phenytoin
  • Trimethoprim/co-trimoxazole
  • Clozapine (neutropenia)
19
Q

Interaction - methotrexate toxicity

A

NSAIDs cause vasoconstriction of afferent renal arteriole
NSAIDs reduced renal excretion = MTX toxicity

20
Q

Interactions - Increased risk of hepatotoxicity

A
  • Isotretinoin
  • Phenothiazine antipsychotics
  • Rifampicin
  • Ketoconazole

Ama - Musculoskeletal (5 decks)

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