Author Question: A patient is beginning therapy with oral methotrexate (Rheumatrex) for rheumatoid arthritis. The ... (Read 33 times)

karen · **on:** Jul 23, 2018

A patient is beginning therapy with oral methotrexate (Rheumatrex) for rheumatoid arthritis. The nurse will teach this patient about the importance of:

a. having routine renal and hepatic function tests.
b. limiting folic acid consumption.
c. reporting alopecia and rash.
d. taking the medication on a daily basis.

Question 2

A patient with rheumatoid arthritis is taking leflunomide (Arava) and an oral contraceptive. She tells the nurse she would like to get pregnant. What will the nurse tell her?

a. That leflunomide is not dangerous during the first trimester of pregnancy
b. That plasma levels of leflunomide will drop rapidly when she stops taking it
c. To ask her provider about an 11-day course of cholestyramine
d. To stop taking leflunomide when she stops using contraception

sultansheikh · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: A
Periodic tests of renal and liver function are mandatory for patients taking methotrexate. Patients taking methotrexate should take folic acid supplements. Alopecia and rash are not worrisome side effects. Methotrexate is taken once weekly.

Answer to Question 2

ANS: C
Leflunomide is contraindicated during pregnancy. Patients desiring pregnancy must follow a three-step protocol that includes stopping the drug, taking cholestyramine to chelate the leflunomide, and ensuring that leflunomide drug levels are below 20 mcg/L before getting pregnant. Leflunomide is teratogenic and is not safe during pregnancy. Plasma levels of leflunomide may take 2 years to drop without using cholestyramine. It is not correct to stop taking leflunomide without following the protocol.