Scraps and tidbits

Question 1

What is methotrexate used for?

Answer 1

Standard treatment for ectopic pregnancy

Question 2

Who prescribes methotrexate?

Answer 2

the gynecologist

Question 3

methotrexate nurse verification consists of what?

Answer 3

2 nurses

Question 4

what is the criteria for administration of methotrexate for ectopic pregnancy?
(4)

Answer 4

• Patient is hemodynamically stable with no S/S of bleeding
• Absence of fetal heart tones is desirable but not necessary
• Beta HCG is equal to or less than 15000
• The patient must be willing to comply with with post treatment monitoring

Question 5

what are some other considerations before administering methotrexate?
(3)

Answer 5

• Can not be used by a mother who is currently nursing and wants to continue to nurse
• Risk factors include chronic illnesses, chronic renal disease, severe anemia, and leukopenia
• Active pulmonary disease and peptic ulcer disease are contraindications

Question 6

what labs should be included in the administration of methotrexate?
(6)
One of these labs could result in the administration of something else, what is it?

Answer 6

CBC
 chem
liver functions
renal function
blood type
Rh, and antibody
Give Rh immune globulin if the patient is Rh neg

Question 7

What PPE should be donned in the handling of methotrexate?

Answer 7

PPE must be used while handling the drug

Powder free gloves, change every 30 minutes, gown, goggles, mask, face shield

Question 8

What are 4 considerations in the handling of methotrexate?

Answer 8

• Cannot be sent through the tube system, must be hand delivered
• At least one yellow rigid, chemo waste disposal kit should be available
• All needles, syringes, gowns, gloves, mask/goggles, should be disposed of in yellow rigid disposal container
• Do not empty contents of syringe

Question 9

What are 2 considerations in the administration of methotrexate?

Answer 9

For IM, expel air into gauze pad to absorb any liquid

50 mg per Q square meter of body surface IM, to be unit dosed by the pharmacy

Question 10

What are 9 considerations for the follow up after giving methotrexate?

Answer 10

• Repeat Beta HCG on days 4 and 7. On day 7, if HCG has not decreased by 15% or more, the patient may be given a 2nd dose if when still meets the criteria
• Check on day 14, if HCG has not decreased by 15% patient may get a third dose if still meets the criteria
• After 2 or 3 doses and no significant decrease in HCG, surgical intervention is required
• Repeat CBC weekly to look for and toxicity. Testing may continue for 3 weeks after the last dose
• Patient may experience NVD, gastric distress, dizziness, sore mouth, pain in lungs from pneumonitis, sometimes hair loss, vaginal spotting or bleeding
• Rupture can still happen
• Avoid taking prenatal vitamins
• Avoid intercourse and use contraception for 3 months, avoid NSAIDS and alcohol
• Flush the toilet twice after urination with the lid closed.