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antimetabolite drugs which exert their immunosuppressive effect by interfering with normal B and T lymphocytes activity
Medication Names
Prototye Med |
Methotrexate (Rheumatrexate, Trexall) |
Other Meds |
Leflunomide (Arava) |
Drug Class: Antineoplastic
Action: Slows or stops the progression of RA because of their immunosuppressive effects, also treats cancer in much larger doses.
Therapeutic Use
Decrease joint inflammation and subsequently joint damage |
Adverse Drug Reactions
Bone marriw suppression (Decrease platelets, red and white blood cells) |
Increased risk of infection |
Liver damage |
Gastrointestinal ulceration |
Pulmonary fibrosis |
Dizziness and headache |
Neausea and vomiting |
Nursing Interventions
Monitor for decreased platelets, red and white blood cell counts |
Monitor for signs and symptoms of infection |
Monitor liver function tests and observe for jaundice |
Monitor for gastrointestinal bleeding (with methotrexate). |
Monitor for respiratory distress and decreased oxygenation |
Monitor for abdominal pain, diarrhea, nausea and vomiting |
Drug Administration
Give methotrexate once a week via route prescribed (oral, subcutaneous, or intramuscular) |
Folic acid supplement may be prescribed to decrease risk of toxicity |
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Patient Education
Report abnormal bleeding, bruising, or petechiae (pinpoint areas of blood under the skin). Report ulcerations of the mouth or tongue. |
Report signs and symptoms of infection immediately. |
Avoid ingesting alcohol. |
Report yellowing of the skin and eyes immediately. |
Report blood in vomitus or stools. |
Report difficulty breathing or shortness of breath. |
Drink adequate amounts (2L) of water daily to ensure excretion of drug. |
Follow advice of Healthcare provider regarding contraception for men and women of chold bearing age |
Avoid breastfeeding while on this drug. |
Contraindications
Teratogenic (methotrexate) |
Liver insufficiency or hepatitis |
Renal insufficiency |
Precautions
Peptic ulcer or ulcerative colitis |
Active bacterial or viral infections |
Interactions
Concurrent use of methotrexate and digoxin may reduce digoxin level |
Concurrent use of methotrexate and NSAIDs, salicylates, and sulfonamides may cause toxicity. |
Caffeine may reduce the effectiveness of methotrexate |
Concurrent use of warfarin may increase the risk for bleeding |
Alcohol use may increase risk of hepatotoxicity |
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