DMARDs

Question 1

What is the therapeutic class of Methotrexate

Answer 1

Therapeutic Class:

• DMARD (Non-biologic)
• Immunosuppresant

Question 2

What is the pharmacologic class of Methotrexate

Answer 2

Pharmacologic Class:

• Folate Antagonist
  (TNF Antagonist - Humira)

Question 3

What is the MOA of Methotrexate

Answer 3

MOA

• Blocks an enzyme (DHFR) needed for making folate, which cells need to make new DNA
  -> This decreases inflammation

Question 4

What is the Indications of Methotrexate

Answer 4

• Rheumatoid Arthritis (RA)
• Psoriatic Arthritis
• Systemic Lupus Erythematosus (SLE)

Question 5

What are the Therapeutic Effects of Methotrexate

Answer 5

• Reduce inflammation
  -> Slow joint destruction
• Suppress immune system

Question 6

What are the Side Effects of Methotrexate

Answer 6

Side Effect

• Fever
• Diarrhea
  -> GI bleed
• Pain
• Erythema (redness)
• Myalgia (muscle pain)

Question 7

What are the Adverse Effects of Methotrexate

Answer 7

Adverse Effects

• Sepsis
• Neutropenia
  -> Invasive fungal infections
  -> URT infection
• Lupus-like syndrome

Question 8

What are the Contraindications of Methotrexate

Hint: Drug Interaction

Answer 8

Drug Interactions:

• Live vaccines
• Immunosuppressants

Question 9

A patient was just prescribed to start Methotrexate. What screenings will the nurse have to do prior to the patient starting Methotrexate?

Answer 9

Screen for latent TB

Question 10

Jessica was just started on Methotrexate. She is an avid runner who enjoys running outdoors in large marathons. What teaching would be appropriate for Jessica?

Answer 10

• Avoid crowds
• Wear sunscreen
  -> May cause photosensitivity

Question 11

A patient prescribed Methotrexate should perform what type of exams? How often?

Answer 11

Eye exams every 6 - 12 months

Question 12

A patient understands that Methotrexate can suppress the immune system. What should the nurse educate the patient on regarding vaccines?

Answer 12

Stay up to date with all current vaccines, but do NOT take LIVE vaccines

Question 13

A newly married women comes into the docotors for her ultrasound. Upon assessment the nurse learns she is on Methotrexate. What teaching would be appropriate for this patient?

Answer 13

• Use reliable contraceptives because Methotrexate may cause birth defects

Question 14

T/F: A person on Methotrexate can expect to have a fever due to its immunosuppresive effects, so it is not imperative for them to let their HCP know

Answer 14

False, they MUST notify their HCP if they have a fever of 100.4, malaise, weakness, etc as a fever can indicate an infection that will make it difficult for the patients body to naturally fight off due to the immunosuppressive effects of Methotrexate