Methotrexate

Question 1

What is the therapeutic use?

Answer 1

• Treatment of several types of cancer : Acute leukemias, Lymphomas, Choriocarcinoma (uterine cancer associated with pregnancy), Cancer of the head, neck, and pelvis
• Treatment of rheumatoid arthritis and psoriasis; both disorders have an
  autoimmune component

Question 2

What are some adverse effects?

Answer 2

• Bone marrow suppression (decreased platelets, RBCs and WBCs)
• Oral and gastrointestinal ulceration
• Liver damage
• Pulmonary fibrosis

Question 3

What should the nurse look out for?

Answer 3

• Monitor CBC, thrombocyte counts, Hgb, and Hct before, during, and after
  therapy (bone marrow suppression).
• Monitor for fever frequently during treatment.
• Monitor for bleeding from common sites, such as gums.
• Use measures to avoid bruising, such as applying prolonged pressure to
  puncture sites and using small gauge needles if injection is necessary, or if
  thrombocytopenia is present.
• Monitor for oral and gastrointestinal ulcerations, including pain and blood
  in vomitus or stools.
• Monitor liver function tests and observe for jaundice.
• Monitor for respiratory distress and decreased oxygenation.

Question 4

How can it be administered?

Answer 4

orally, IM, or IV

Question 5

What signs should the client report?

Answer 5

• Report fever, sore throat, easy bruising, and unusual fatigue to provider.
• Report oral ulcerations.
• Report oral or abdominal pain.
• Report blood in vomitus or stools.
• Report yellowing of the skin or eyes immediately.
• Report difficulty breathing or shortness of breath.

Question 6

What is some education you’d want to give?

Answer 6

• Use scrupulous handwashing techniques; restrict visitors who are ill.
• Institute frequent oral care to prevent stomatitis (yeast superinfection in
  mouth).
• Use a soft toothbrush and electric razor to prevent bleeding; take measures
  to prevent bruising.
• Avoid ingesting alcohol
• Contraception should be used during and immediately following therapy,
  as prescribed by the healthcare provider

Question 7

What are some contraindications?

Answer 7

• Pregnancy risk – teratogenic
• Liver insufficiency or hepatitis
• Renal insufficiency

Question 8

What precautions should you be aware of?

Answer 8

active bacterial or viral infections

Question 9

What are some drug to drug interactions?

Answer 9

• Concurrent use of methotrexate and digoxin can reduce digoxin level.
• Concurrent use of methotrexate and NSAIDs, salicylates, and sulfonamides
  can cause toxicity.
• Alcohol use can increase risk of hepatotoxicity.
• Taking folic acid changes client response to methotrexate.