folic acid analogs (antimetabolites)

main folic acid analog

methotrexate

what types of cancer does methotrexate treat

• acute leukemia

• lymphoma

• cancer in the neck, head, and pelvs

• choricocarcinoma - associated w/ pregnany

• rheumatoid arthritis

• psoriasis

adverse effects of methotrexate

• GI and oral ulcerations

• bone marrow suppression

• pulmonary fibrosis

• liver damage

interventions when using methotrxate

• monitor cbc count

• monitor fever

• monitor bleeding; gums,GI, blood in stool or urine

• administer colony-stimulating meds: fligrastim - prevent neutropenia

• monitor respiratory distress and give o2 if needed

• monitor liver function tests

• avoid brusing

administration of methrotrexate

• given orally, IM, IV, preservation free intrathecal.

• high dose of methrotrexate, give LEUCOVORIN - a reduced form of folic acid. antidote for bone supression

• given in varied intervals

• can be given w/ or w/o food orally

• incompatible with other medications when given IV

client instructions

• report fever, sore throat, bruising, unusual fatigue

• scrupulous handwashing, limit visitation from the ill

• oral care to prevent stomatitis

• use electric razor, soft bristle toothbrush

• prevent bruising

• report pain, oral ulcerations, blood in stool or urine, yellowing of skin and eyes, difficulty breathing

• use contraceptions during and after treatment

contraindications of methotrexate

• tetraogenic

• liver insuffiency, hepatitis

• renal insuffiency

precautions of methotrexate

methotrexate is a immunosupression

• risk of active or viral infections

interations with other substances/food

• concurrent methotrexate + digoxin = ↓ digoxin - treats heart failure and afib

• concurrent methotrexate + nsaids, salicylates, sulfomaides = toxicity

• + alcohol, ↑ risk of hepatoxicity

• taking folic acid changes pt. response to methotrexate