Methotrexate



Methotrexate
QUESTION
The purpose of the presentation is for you to educate your colleagues on the drug “Methotrexate”. The presentation must include information about the:

-Drug pharmacology, pharmacokinetics
-Brand name
-Generic name
-Dosing
-Indications for use
-Side effects
-Contraindications
-Pregnancy class
-You must also perform a cost analysis of the drug.
-Provide a patient case study on a patient in which you would utilize the drug you have selected and include at least two peer-reviewed evidence-based studies related to the drug.
-Describe the appropriate patient education.
-What is your role as a Nurse Practitioner for prescribing this medication to this patient on your case study presentation?
-Describe the monitoring and follow-up.
Methotrexate

ANSWER
Methotrexate has a unique mode of action for each of its applications, including chemotherapy and immunosuppression in autoimmune diseases. Methotrexate works as an antifolate antimetabolite in cancer treatment (Levêque et al., 2017). Human decreased folate carriers (SLC19A1) transport methotrexate into the cell, where it interacts with glutamate to form methotrexate-polyglutamate. Methotrexate and methotrexate-polyglutamate can both block the enzyme dihydrofolate reductase. This enzyme is in charge of catalyzing the conversion of dihydrofolate into tetrahydrofolate, the active form of folic acid () Tetrahydrofolate is required for the synthesis of nucleotides, which are the building blocks of both DNA and RNA. The interaction of methotrexate-polyglutamate with purine and thymidylate synthase results in the inhibition of de novo purine synthesis, which inhibits DNA synthesis. This method is used in cancer treatment because of its cytotoxic effect.Multiple mechanisms contribute to the decision to utilize methotrexate as the primary therapeutic option in the context of autoimmune diseases. Because of its anti-inflammatory properties, adenosine inhibits T-cell activation, down-regulates B-cells, increases the sensitivity of activated CD-95 T cells, and inhibits the binding of beta-1 interleukin to its cell surface receptor. It accomplishes this by blocking the enzyme AICAR transformylase, hence impeding adenosine metabolism.Interactions with other medications Because methotrexate is so strongly bound to proteins in the plasma, any medication that can displace it from proteins and elevate blood levels is likely to have this effect.

Methotrexate is marketed under a variety of brand names, including Reditrex, Trexall, Xatmep, Otrexup, and Rasuvo, among others.Both Otrexup and Rasuvo can be administered through the use of an auto-injector pen (Hannoodee & Mittal, 2022). However, you can only purchase these medications under their respective brand names. Therefore, there is not currently a generic methotrexate injectable pen that can be purchased.A generic drug is an exact replica of the active ingredient found in a medication with a brand name. It is generally agreed that the generic version is just as safe and effective as the original medication. In addition, the price of generic pharmaceuticals is typically lower than that of brand-name medications. Talk to your healthcare practitioner, pharmacist, or insurance company about the differences in price between the brand-name and generic versions of methotrexate. This will allow you to determine which option is more affordable for you.

After being administered, the folate analog methotrexate tends to transport itself to the body’s non-fatty tissues rather than its fatty tissues. A medicine used in the chemotherapy process is called methotrexate. Plasma concentrations larger than 1 M occur on a time scale that is compatible with the limits of plasma flow as a result of the rapid passage of MTX through the capillaries and cell membranes of the liver, kidney, and skin (Hannoodee & Mittal, 2022). This ratio is created fast as well, despite the fact that there is no movement of information between the muscle cells themselves. When compared to the rates seen in the other organs, the pace at which MTX is transported through the cell membranes of cells in the gastrointestinal (GI) tract, spleen, and bone marrow is significantly slower. As a consequence of this, the initial distribution of MTX to these organs is restricted not by the volume of blood that is able to flow to them, but rather by the membrane transport that occurs within these organs.

Before beginning medical treatment with methotrexate, a patient is required to undergo a pre-methotrexate evaluation. This evaluation entails a series of blood tests, some of which are as follows: a complete blood count with differential; renal function tests, which include the serum creatinine, blood urea nitrogen, and urinalysis; and liver function tests, which include serum bilirubin, AST, ALT, serum albumin, and hepatitis (Levêque et al., 2017). Testing for HIV is also required, and the practitioner should additionally acquire a chest radiograph if one is warranted by the patient’s condition. It is possible to take methotrexate in pill form orally, or it can be injected intramuscularly, intravenously.When taken orally, the typical dosage is a “pulse” once per week, which can be given as a single dose or as three divided doses spread out over eight hours in a period of twenty-four every week. To avoid a suppression of bone marrow, it is recommended that all patients take a folic acid supplement of either 1 milligram per day or 5 to 7 milligrams once every seven days. Oral absorption in humans is proportional to the amount of medication consumed. Within one to two hours, maximum concentrations in the serum can be reached.Injection: Single-dose auto-injector may give MTX in certain amounts such as: 7.5 mg, 10 mg, 12.5 mg, 15 mg, 17.5 mg, 20 mg, 22.5 mg, 25 mg, 27.5 mg, and 30 mg (). Following the beginning of medical treatment with methotrexate, suggested follow-up tests include monitoring of complete blood count, renal function test, and liver function test results every week for the first four weeks, and then at least once every two months after that ().

Methotrexate is a folic acid antagonist that has been licensed by the FDA for use in the treatment of rheumatoid arthritis due to its high potency and efficacy in these patients. It may also be therapeutic for persons who suffer from juvenile idiopathic arthritis. It was recommended that methotrexate be used in rheumatoid arthritis patients following the completion of a clinical trial that compared the effectiveness of methotrexate to that of a placebo that was administered in a double-blind fashion (Hannoodee & Mittal, 2022). When methotrexate was first introduced as an effective treatment for pediatric leukemia, it was once believed that aminoopterin was the parent molecule for methotrexate.In the modern world, one of the most important chemotherapeutic options for treating a wide variety of malignancies is methotrexate. Psoriasis patients, patients suffering from systemic lupus erythematosus, patients suffering from inflammatory bowel disease, patients suffering from vasculitis, and patients suffering from a range of other connective tissue illnesses may also benefit from the medicine. However, the medication’s efficacy and safety in patients with blood dyscrasia have not been demonstrated, and it should not be taken by pregnant women under any circumstances. The medication is particularly helpful for those who have received organ transplants because of its ability to reduce inflammation and modulate the immune system. It has been shown that the combination of methotrexate and anti-TNF drugs is effective in the treatment of ulcerative colitis, non-lymphoma, Hodgkin’s carcinoma of the breast, small-cell carcinoma of the lung, epidermal malignancies of the head and neck, and ovarian cancer. Methotrexate can also be used alone to treat ulcerative colitis. The drug has the same effects that cyclosporin does for patients who are suffering from graft-versus-host disease. Mycosis fungoides, dermatomyositis, pityriasis rubra pilaris, eczema, sarcoidosis, non-lymphoma Hodgkin’s (advanced stage), and non-metastatic osteosarcoma are some of the conditions that can be treated with methotrexate.

Methotrexate


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