Skin And Bones

Question 1

What are the main indications for methotrexate?

Answer 1

Treatment of moderate to severe active rheumatoid arthritis, Crohn’s disease, malignant disease, and psoriasis

Question 2

What are the main side effects of methotrexate and what do you need to advise patience to look out for?

Answer 2

Blood dyscrasias: report, any signs of sore throat, infection, bruising or mouth ulcers
Liver toxicity/cirrhosis: report, any nausea, vomiting, abdominal discomfort, or dark urine
Pulmonary toxicity: report, any shortness of breath, cough, or fever

Question 3

What monitoring needs to be done for methotrexate?

Answer 3

Full blood count needed prior to treatment
Liver and renal function tests are needed prior to treatment

Question 4

What are the main interactions to methotrexate?

Answer 4

Aspirin and other NSAIDs: if aspirin or NSAIDs are taken at the same time, the dose of methotrexate needs to be carefully monitored as this leads to rise in methotrexate levels
Folic acid: methotrexate is a folate antagonist. Treatment with folic acid helps prevent methotrexate induced mucositis or myelosuppression, but don’t give it at the same time. Use Folic acid every day apart from the day you take methotrexate.

Question 5

What are the adverse effects of allopurinol?

Answer 5

• Rash - DISCONTINUE
• Flare up of gout
• Liver dysfunction
• Increase in TSH

Question 6

What are the main interactions with allopurinol?

Answer 6

• Azathioprine - increased risk of haematological reactions
• Carbamazepine - increase carbamazepine levels
• ACEi - increased risk of hypersensitivity reactions

Question 9

What are the main interactions with Allopurinol?

Answer 9

Mnemonic: CAR

Azathioprine: increased risk of haematological reactions
Carbamazepine: levels may be increased
Ramipril (ACE Inhibitors): increased risk of hypersensitivity reaction