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antimetabolite drugs which exert their immunosuppressive effect by interfering with normal B and T lymphocytes activity
Medication NamesPrototye 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 UseDecrease joint inflammation and subsequently joint damage |
Adverse Drug ReactionsBone 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 InterventionsMonitor 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 AdministrationGive methotrexate once a week via route prescribed (oral, subcutaneous, or intramuscular) | Folic acid supplement may be prescribed to decrease risk of toxicity |
| | Patient EducationReport 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. |
ContraindicationsTeratogenic (methotrexate) | Liver insufficiency or hepatitis | Renal insufficiency |
PrecautionsPeptic ulcer or ulcerative colitis | Active bacterial or viral infections |
InteractionsConcurrent 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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