Methotrexate

Question 1

Max methotrexate dose for
Chrons
RA
Psoriasis

Answer 1

Chrons - 25mg
RA - 20mg
Psoriasis - 30mg
weekly

Question 2

What strength of tabs should be prescribed

Answer 2

only one strength - usually 2.5mg

Question 3

what should be stated on prescription and label for methotrex

Answer 3

Dose and frequency

Question 4

For methotrexate what s/e should the pt be councelled on

Answer 4

• Blood disorders (sore throat, bruising, mouth ulcers)
• Liver tox (nausea, vom, abdo discomfort, dark urine)
• Resp effects (SOB)

Question 5

4 main side-effects to look out for with methotrexate - and which can you resart treatment in if it revereses

Answer 5

Bone marrow supression
Liver toxicity - may restart once normalised
Pulmonary toxicity
GI toxicity (stomatitis)

Question 6

In what patients might methotrexate pulmonary tox be a particular problem?

Answer 6

Those with RA - discontinue if pnemonitis suspectected

Question 7

Factors that can increase chance of develpoing methotrexate bone marrow supression?3

Answer 7

• age
• renal impairment
• other antifolates (trimethoprim)

Question 8

Treatment with what may be required in acute methotrexate toxicity

Answer 8

folinic acid (calcium folinate)

Question 9

What is the purpose of folic acid on a different day to methotrexate

Answer 9

to reduce frequency of side-effects (for patients taking methotrexate for non-malignant conditions)

Question 10

How long must contraception be used for on methotreaxte? for men or women?

Answer 10

3 months after for men and women

Question 11

What is the routing monitoring tests for methotrexate

Answer 11

FBC, LFT and renal every 2-3 months

Question 12

what is the mode of action of methotrexate

Answer 12

dihydrofolate reductase inhibitor