Question

Case Study 3 Glucocorticoid Agents A 40-year-old woman has had rheumatoid arthritis for 5 years. She has been on multiple NSAIDS with some symptomatic relief. On a few occasions she has taken corticosteroids for severe exacerbations. She feels that her disease is getting worse. She has more stiffness and swelling in her hands and wrists. She is currently taking the recommended maximum dosage of ibuprofen, but admits to taking more than she should on bad days. On examination, the nurse notes active synovitis of both wrists and all of her metacarpal joints. There is a subtle ulnar deviation of all of her fingers. The Physician assesses her as having an acute exacerbation of rheumatoid arthritis, prescribes a short course of corticosteroids and starts her on methotrexate . What is the mechanism of the immune response mediated by glucocorticoids? (25 pts.) 2. What is the mechanism of action of methotrexate (25pts.) 3. Why is methotrexate helpful in this situation? (25pts.) What would the nurse teach this woman regarding glucocorticoid drugs? (25pts.)

Answer 1

Q. No. 1. Answer :

Mechanism of the immune response mediated by glucocorticoids, is the glucocorticoids act upon the various effector cells of the immune system.

So that these glucocorticoids may decreases the immune system, by decreasing humoral immunity, these glucocorticoids cause B cells to express smaller amounts of IL - 2 and of IL2 receptors.

So that the inflammatory responses may decreases.

Q. No. 2. Answer :

Mechanism of action of methotexate :

It is mainly used in cancer and Rheumatoid arthritis, in the twoways those are it inhibit the dehydrofolate reductase, which is use full in the tetrahydrofolate synthesis, so that inhibits the synthesis of DNA, RNA, thymidylates, and proteins, which are in the abnormal cell growth.

Q. No. 3. Answer :

The corticosteroids are decreases or supress the immune system so that there is a complications to the patients, due to excessive usage of corticosteroids.

so by using methotrexate, it will be works like more anti-inflammatory drug rather than immunisuppressive drug.

So it is beneficial to the client.

Q. No. 4. Answer :

Regarding glucocorticoid drugs nurse should be teach to the client like

* these drugs are causes side effects like high blood pressure, diabetes, more vulnerablity to get infections, thinning of the skin, weight gain.ect.

* and also before giving these drugs to the patient we need to ask if you are taking or using medications for hypertension, diabetes, viral infection, ect because these medications are increases these problems again.

* educate regarding osteoporosis because due to this osteoporosis is one of the side-effect ,so they have to get easily fractures, and also clients has to take high potassium diet.

* educate regarding avoidance of alcohol talking.