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Questions and Answers
A client with rheumatoid arthritis is prescribed methotrexate. What supplement might the provider prescribe concurrently to decrease the risk of medication toxicity?
A client with rheumatoid arthritis is prescribed methotrexate. What supplement might the provider prescribe concurrently to decrease the risk of medication toxicity?
- Vitamin B12
- Calcium
- Vitamin C
- Folic acid (correct)
A client is starting methotrexate therapy for rheumatoid arthritis. Which instruction regarding hydration should the nurse include in the client's teaching?
A client is starting methotrexate therapy for rheumatoid arthritis. Which instruction regarding hydration should the nurse include in the client's teaching?
- Avoid drinking fluids with meals.
- Drink fluids only when feeling thirsty.
- Maintain a fluid intake of at least 2 liters per day. (correct)
- Restrict fluid intake to 1 liter per day to prevent edema.
A client with rheumatoid arthritis is prescribed methotrexate. What is the primary reason this medication is expected to slow or stop the progression of the disease?
A client with rheumatoid arthritis is prescribed methotrexate. What is the primary reason this medication is expected to slow or stop the progression of the disease?
- It increases the production of red blood cells, improving oxygen delivery to inflamed tissues.
- It suppresses the immune response, reducing the autoimmune attack on the joints. (correct)
- It directly repairs damaged joint tissue.
- It has analgesic properties which reduce pain and inflammation.
A client is prescribed methotrexate. Which of the following assessment findings should be immediately reported to the provider?
A client is prescribed methotrexate. Which of the following assessment findings should be immediately reported to the provider?
A female client of childbearing age is about to start methotrexate therapy. What is the most important instruction the nurse should give regarding pregnancy?
A female client of childbearing age is about to start methotrexate therapy. What is the most important instruction the nurse should give regarding pregnancy?
A patient taking a nonbiologic DMARD reports experiencing dizziness and blurred vision. What action should the nurse undertake first?
A patient taking a nonbiologic DMARD reports experiencing dizziness and blurred vision. What action should the nurse undertake first?
A client taking methotrexate reports ulcers in their mouth. What is the most appropriate action by the nurse?
A client taking methotrexate reports ulcers in their mouth. What is the most appropriate action by the nurse?
A client is starting on leflunomide for rheumatoid arthritis. Which pre-existing condition would be of greatest concern when considering the safety of this medication?
A client is starting on leflunomide for rheumatoid arthritis. Which pre-existing condition would be of greatest concern when considering the safety of this medication?
Which pre-existing condition would be a contraindication for a client considering nonbiologic DMARD therapy?
Which pre-existing condition would be a contraindication for a client considering nonbiologic DMARD therapy?
What laboratory finding would warrant the greatest immediate concern in a client receiving a csDMARD?
What laboratory finding would warrant the greatest immediate concern in a client receiving a csDMARD?
A client on methotrexate reports increasing shortness of breath and a dry cough. Which of the immediate actions is most important for the nurse to take?
A client on methotrexate reports increasing shortness of breath and a dry cough. Which of the immediate actions is most important for the nurse to take?
A client with rheumatoid arthritis who is taking warfarin begins methotrexate therapy. What is the primary concern the nurse should monitor for?
A client with rheumatoid arthritis who is taking warfarin begins methotrexate therapy. What is the primary concern the nurse should monitor for?
Which of the following instructions is most important for the nurse to emphasize to a client who is starting on a nonbiologic DMARD such as methotrexate, considering potential food and drink interactions?
Which of the following instructions is most important for the nurse to emphasize to a client who is starting on a nonbiologic DMARD such as methotrexate, considering potential food and drink interactions?
Which instruction is most critical for a nurse to emphasize when educating a client who is newly prescribed sulfasalazine?
Which instruction is most critical for a nurse to emphasize when educating a client who is newly prescribed sulfasalazine?
A client with rheumatoid arthritis is prescribed sulfasalazine and is also breastfeeding. What potential adverse effect in the infant should the nurse discuss with the client?
A client with rheumatoid arthritis is prescribed sulfasalazine and is also breastfeeding. What potential adverse effect in the infant should the nurse discuss with the client?
A client with RA is taking hydroxychloroquine. The nurse should emphasize the importance of regular screening for which adverse effect?
A client with RA is taking hydroxychloroquine. The nurse should emphasize the importance of regular screening for which adverse effect?
A client on methotrexate develops a mouth ulcer. What advice should the nurse provide?
A client on methotrexate develops a mouth ulcer. What advice should the nurse provide?
A client taking methotrexate reports increased fatigue, chills, and fever. What is the priority nursing action?
A client taking methotrexate reports increased fatigue, chills, and fever. What is the priority nursing action?
Flashcards
csDMARD Action
csDMARD Action
Nonbiologic DMARDs suppress the immune system by disrupting B and T lymphocyte activity.
Prototype csDMARD
Prototype csDMARD
Methotrexate is the prototype medication for nonbiologic DMARDs.
DMARD Purpose
DMARD Purpose
These medications suppress the immune response to slow or stop RA progression.
csDMARD Adverse Effects
csDMARD Adverse Effects
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Monitoring Bone Marrow
Monitoring Bone Marrow
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Monitoring Liver Function
Monitoring Liver Function
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Monitoring Specific Risks
Monitoring Specific Risks
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Methotrexate Frequency
Methotrexate Frequency
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Nonbiologic DMARDs
Nonbiologic DMARDs
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Methotrexate Administration
Methotrexate Administration
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Methotrexate and Pregnancy
Methotrexate and Pregnancy
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DMARDs and Alcohol
DMARDs and Alcohol
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DMARD Contraindications
DMARD Contraindications
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DMARDs and Teratogenicity
DMARDs and Teratogenicity
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Methotrexate Interactions
Methotrexate Interactions
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Methotrexate Toxicity Reduction
Methotrexate Toxicity Reduction
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Methotrexate Adverse Effects
Methotrexate Adverse Effects
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Study Notes
- Nonbiologic conventional synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs) are antimetabolites, suppressing the immune system by affecting B and T lymphocyte activity.
- The prototype csDMARD is methotrexate.
- Other csDMARDs include leflunomide, hydroxychloroquine, and sulfasalazine.
- DMARDs are administered to suppress the immune response in autoimmune disorders like Rheumatoid Arthritis (RA).
Pharmacologic Action
- Nonbiologic DMARDs primarily act through immunosuppression.
- These medications can slow or halt RA progression because of their immunosuppressive effects.
- Some DMARDs also treat cancer, but at higher doses.
Adverse Reactions
- csDMARDs can cause dizziness, headache, blurred vision, as well as nausea and vomiting.
- These drugs are hepatotoxic, potentially causing liver damage.
- Bone marrow suppression can occur, reducing platelet, red blood cell, and white blood cell counts.
- Due to immunosuppression, individuals on DMARDs are at higher risk of infection.
- Gastrointestinal ulceration and pulmonary fibrosis are other possible adverse effects.
- Methotrexate and leflunomide are teratogenic and contraindicated in pregnancy.
Interventions
- Monitor RBC, WBC, and platelet levels due to the risk of bone marrow suppression.
- Assess for infection, even with normal red and white blood cell counts.
- Conduct liver function tests and monitor for jaundice to detect liver damage early.
- Observe for gastrointestinal bleeding in patients on methotrexate.
- Monitor for respiratory distress and decreased oxygenation, which indicate pulmonary fibrosis.
- Watch for abdominal pain and diarrhea and assess nutritional status.
Safety Alert
- Monitor lab values for critical decreases in platelets, red and white blood cell counts caused by bone marrow suppression.
- Early treatment for bleeding, anemia, and infections can be facilitated by identifying lab values below the expected reference range.
Administration
- Administer methotrexate once a week for RA treatment.
- Methotrexate can be administered orally, subcutaneously, or intramuscularly.
- Auto-injectors are available.
- Start at a low dose and increase as needed for maximum response.
- Folic acid supplements may be prescribed to lower toxicity risk.
Safety Alert
- Daily methotrexate administration can cause severe side effects, including significant immunosuppression and life-threatening infections.
- Verify the dose and frequency for RA treatment to ensure correct administration.
Client Instructions
- Maintain hydration (2 L per day) to help the kidneys excrete the medication.
- Report yellowing of skin or eyes.
- Report manifestations of infection like fatigue, chills, and fever.
- Report ulcerations of the mucous membranes of the mouth and tongue.
- Report any abnormal bleeding, bruising, or petechiae.
- Report blood in vomitus or stools, which indicates decreased platelets.
- Report difficulty breathing or shortness of breath, which indicates pulmonary involvement.
- Clients of childbearing age should use contraception while taking methotrexate due to its teratogenic effects and should avoid breastfeeding.
- Be aware of potential fertility issues related to this medication.
- Avoid alcohol ingestion.
Safety Alert
- Methotrexate and leflunomide are toxic to the liver, and alcohol increases the risk of liver damage.
Contraindications and Precautions
- Use caution in clients with active bacterial or viral infections due to immunosuppressive action.
- Monitor clients with peptic ulcer disease or ulcerative colitis closely for gastrointestinal bleeding and pain.
- DMARDs are contraindicated for clients with liver insufficiency, hepatitis, renal insufficiency, alcohol use disorder, and immunosuppression.
- Methotrexate and leflunomide are contraindicated in pregnancy and breastfeeding due to teratogenic effects.
- Use sulfasalazine with caution during lactation because it can cause jaundice in infants.
- Hydroxychloroquine is considered safe during pregnancy.
Safety Alert
- Nonbiologic DMARDs are teratogenic.
- Clients of childbearing age should use contraception while taking the medication and should avoid breastfeeding.
Interactions
- Concurrent use of methotrexate and digoxin may reduce serum digoxin levels.
- Concurrent use of methotrexate with NSAIDs, salicylates, and/or sulfonamides may cause toxicity.
- If a client is taking methotrexate and NSAIDs concurrently, the methotrexate dosage may need adjustment.
- Caffeine may reduce methotrexate's effectiveness.
- Concurrent use of nonbiologic DMARDs with warfarin may increase bleeding risk.
- Alcohol ingestion with nonbiologic DMARDs may increase the risk of hepatotoxicity.
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