Oncology+Meds;Antimetabolites Folic Acid Analog: methotrexate (PO, IV, IM, intrathecal)

mechanism of action for antimetabolites methorexate

• Stops cell reproduction needed for the synthesis of DNA by inhibiting folic acid conversion

therapeutic use

• Choriocarcinoma

• Solid tumors (ie. breast and lung)

• Head & Neck sarcomas

• Osteogenic sarcoma

• Acute lymphocytic leukemia

• Non-Hodgkin’s lymphoma

• T-cell lymphoma

complications

• Bone marrow suppression

• GI issues

• Mucositis, gastric ulcers, perforation

• Renal Damage

• Reproductive toxicity (congenital abnormalities)

contraindications

• Pregnancy and lactation

• Renal or hepatic failure, blood dyscrasias

• Caution with liver/kidney dysfunction, myelosuppression, leukopenia, older clients 

drug to drug interactions

• Salicylates, NSAIDs, sulfonamides, PCN, tetracycline

• Proton pump inhibitors

• Echinacea

nursing administration

Reduce dosage with renal disease

Administered with leucovorin rescue to reduce toxicity to healthy cells

Give with sodium bicarb to alkalize urine

Monitor for bleeding  & infection

Monitor CBC, BUN, creatinine, liver enzymes

Give an antiemetic for n/v

Monitor I&O

Monitor for jaundice

Monitor for gout

Nursing education

Practice good oral hygiene

Avoid alcohol-based mouthwashes 

Protect the skin from sunlight

Female clients need to use birth control & for 6 months post tx

Encourage 2-3 L daily fluid intake from food & beverages