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Nonbiologic DMARDs - Methotrexate Cheat Sheet by

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

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.


Terato­genic (metho­tre­xate)
Liver insuff­iciency or hepatitis
Renal insuff­iciency


Peptic ulcer or ulcerative colitis
Active bacterial or viral infections


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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