Question

4.         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?

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

                                   

6.         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.

7.         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?

8.         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

Answer: Mary should stop the methotrexate because she is now having side effects of this drug as she is using it for long term i.e. since 4 months. So, the throat soreness, development of cough etc are the side effects of long term use of methotrexate.

Any dose should not be missed because the action of the drug decreases as compared to regular or the particular time prescribed for. The side effects of naoroxna causes irregular heartbeat.

Actemra is mainly used in rheumatoid arthritis and it is immunosuppressive. It doesn't have any serious side effects but if consumed for long period of time it may cause in some people headache, fatigue, nausea etc.

She should stop the medication for a month and then restart the intake of the same dose.

The advantages of methotrexate injection is that the body absorbs the drug more quickly and hence causes relief in pain and decreases the effect slowly.