Methotrexate

Question 1

Signs of liver toxicity?

Answer 1

Jaundice, abdo pain, vomiting/nausea, dark urine

Question 2

Side effects of methotrexate

Answer 2

Pulmonary toxicity
Hepatotoxicity
Nephrotoxicity
GI toxicity
Phototoxicity
Blood dyscrasias

Question 3

What is used to reduce mucosal and GI side effects of methotrexate?

Answer 3

Folic acid (To be taken on the days methotrexate isn’t taken on)

Question 4

Action taken if diarrhoea or stomatisis occurs

Answer 4

Withdraw treatment as can be first signs of GI toxicity

Question 5

What is stomatitis ?

Answer 5

Inflammation/sorness of mouth

Question 6

Contraception advice for men and women taking methotrexate?

Answer 6

Effective contraception during and 6 months after treatment

Question 7

Breastfeeding on methotrexate?

Answer 7

No

Question 8

Reversal agent for methotrexate

Answer 8

Folinic acid

Question 9

Monitoring requirements for Methotrexate

Answer 9

LFTs, U&Es, and FBC every 1-2 weeks until stable, then every 2-3 months.

Question 10

CI of methotrexate (4)?

Answer 10

Ascites (accumulates in ascites), Immunodeficiency conditions, pleural effusion, active infection

Question 11

Interactions with Methotrexate

Answer 11

Trimethoprim/ Co-trimoxazole (folate antagonists), NSAIDs, PPIs, CYP450 inhibitors)

Question 12

Increased risk of blood disorders with which medications?

Answer 12

Phenytoin, Clozapine, Trimethoprim/ Co-trimoxazole (folate antagonists)