Question

1. Mary has been taking methotrexate for about 4 months (along with naproxen as needed). She is currently taking 15mg weekly but her RA is not under control yet and she been feeling really rough the past few days with a sore throat and a cough developing. It’s the weekend and she can’t reach her rheumatologist so she stops at your pharmacy. Should she stop taking MTX?

2. Mary (above) is taking irregular doses of naproxen with her methotrexate. Is that a problem? If so, how should it be managed?

3. You have a patient in the pharmacy who just began her first prescription for a biologic (Actemra). She asks how quickly it will work. She is also very worried about the risks of medication itself, whether she will run out of options to control her disease, and if she must be on medication for life. Please describe the information you will give to counsel her, both to make her well informed and to calm her fears.

4. Assume you have a patient who originally had mild RA for two years. She has taken methotrexate and etanercept for one year and been in full remission now for 6 months. Should we stop her drug treatment? What exactly should you recommend?

5. Another patient was on methotrexate orally, but now her doctor wants to switch to the injection form and the patient is upset about it. What are the possible advantages to sc. injection?

Answer 1

1.Yes, she should stop taking medicines. It is advised to visit the doctor if the patient experience any of the symptoms such as sore throat, cough, chills, fever or other signs of infections.

2Concomitant use of naproxen does not abruptly alter the disposition of low-dose methotrexate in patients with rheumatoid arthritis who have normal renal function.

3it is a biologic medication currently approved to treat adults with moderately to severely active rheumatoid arthritis .Treatment with Actemra is associated with a higher incidence of neutropenia, thrombocytopenia and elevated liver enzymes. Though it has risks patient should consult doctor immediately if the above said complications occur.