Methotrexate (DMARDs) Prednisone (Glucocorticoids) Hydrocortisone (corticosteroid
MOA: folate antagonist, resulting in MOA: mimic cortisol à anti-inflammatory and immunosuppression help or glucocorticoid)
immunosuppression regulate carbohydrate, fat, and protein metabolism and manage the MOA: mimic effect of natural
Therapeutic use: body’s stress response. steroid hormones (cortisol) à
• Decrease inflammation of joint and Therapeutic use: anti-inflammatory and
subsequently joint damage. • Relief of pain and inflammation immunosuppression help
• Delay RA progression • Delay autoimmune disorder progression regulate carbohydrate, fat, and
• Treat cancer in much larger dose • Prevent organ rejection and is adjunctive therapy for some cancer protein metabolism and manage
• Management of skin disorders/allergic reactions the body’s stress response.
Bone suppression, infections Therapeutic use:
o monitor CBC and report decreased RBC, Adrenal suppression: N/V, hypotension, confusion • First-line cortisol
WBC, platelets o don’t stop med abruptly, notify manifestations if occurs, carry medic replacement therapy for
o monitor and report fatigue, chills, fevers, alert ID to ensure proper dose during pregnancy adrenocortical insufficiency
sore throat + initiate appropriate o Report any physical and emotional stress à may increase dosages (Addison’s disease)
antimicrobial therapy o administer IV normal saline + hydrocortisone • Oral for chronic and IV
Hepatotoxicity: jaundice, abdominal pain, infections: sore throat, fever, tachycardia hydrocortisone for acute or
N/V, fatigue, anorexia, dark urine o Report s/x of infection emergency adrenal crisis
o monitor liver function (AST&ALT blood test) o Initiate appropriate antimicrobial therapy • Nonendocrine disorders:
and report manifestation of hepatotoxicity GI discomfort/bleeding: N/V/D, abdominal pain, bleeding gum, cancer, inflammation,
o Hold med if occurs bruising, petechiae, dark stool or vomitus allergic reaction
o Advise patient not to drink alcohol o Observe manifestation of GI bleeding à Obtain occult blood test
Pulmonary fibrosis (respiratory depression o Take med with foods to minimize GI discomfort Same complication,
and decreased oxygen) o Advise patient to take acetaminophen for pain and avoid NSAIDs intervention, and client
o Watch and report for SOB or difficulty Osteoporosis education as prednisone
breathing, dry cough o Monitor bone density studies and watch for any fractures
GI discomfort/bleeding: N/V/D, abdominal o Perform weight-bearing exercise daily, take calcium and vitamin D Administration:
pain, bleeding gum, bruising, petechiae, dark supplement, and/or bisphosphonate (etidronate) • Give PO with food reduce
stool or vomitus fluid retention GI discomfort (take entire
o Watch and report GI upset and GI bleeding o Monitor I&O and watch for manifestation of excessive fluid (edema, dose right in the morning or
manifestation à Obtain occult blood test crackle lung sound, weight gain) take split dose if evening
Ulceration in the mouth and tongue Electrolyte imbalance: fatigue occurs à 2/3AM and
(stomatitis) o Watch for edema and unexpected weight gain à hypernatremia 1/3 early PM)
o Watch gum, mouth, tongue, and throat for o Watch for generalized weakness à hypokalemia, so monitor K level • Discuss the need to take
ulceration and take K supplement or K-rich foods med life-time and report
Teratogenic Hyperglycemia stress à higher dose may
o Do not use if pregnant or breastfeeding o Monitor blood glucose be prescribed
o Instruct child-bearing age patient to follow o Watch for manifestation (3P) à polyuria, polyphagia, polydipsia • Contra with live vaccine,
advice regarding effective contraceptive o May increase insulin or oral hypoglycemics severe infection, cataract
Minor side effects: Dizziness, headache, N/V Myopathy
o Monitor and report muscle weakness
Additional knowledge to know: Long-term causes Cushing-like effects
• Med is administered once a week (oral, SQ, o Watch for fat deposit, truncal obesity, moon-shaped face, hump on
IM) the upper part of the neck
• Dosages start from low and gradually Long-term causes cataracts
increase. o Watch for blurred vision and loss of color acuity
• Folic acid supplement: reduce toxicity o Protect eye from sunlight, wear sunglasses, obtain regular eye
• Patient on methotrexate must drink a lot of examination, decrease to lowest effective dose.
water (2L/day) to flush out med
• Closely monitor if patient has peptic ulcer, Additional knowledge to know:
ulceration colitis, active infection • ANY ROUTES
• Contra with renal/liver problem, pregnant, • Recommend largest to the lowest possible effective dose for short-
breastfeeding, live vaccines term oral use
• NSAIDs d/c when methotrexate develop • Recommend alternate-day dosing for long-term oral use (more than
therapeutic effect 10 days)
• Give supplement doses (increase dosages) in the time of stress
• Closely monitor if patient has HF, peptic ulcers, DM, HTN, kidney
dysfunction, myasthenia gravis, osteoporosis
• Contra with live vaccine, systemic fungal infection, cataract
Commented [SR1]: Good luck
MOA: folate antagonist, resulting in MOA: mimic cortisol à anti-inflammatory and immunosuppression help or glucocorticoid)
immunosuppression regulate carbohydrate, fat, and protein metabolism and manage the MOA: mimic effect of natural
Therapeutic use: body’s stress response. steroid hormones (cortisol) à
• Decrease inflammation of joint and Therapeutic use: anti-inflammatory and
subsequently joint damage. • Relief of pain and inflammation immunosuppression help
• Delay RA progression • Delay autoimmune disorder progression regulate carbohydrate, fat, and
• Treat cancer in much larger dose • Prevent organ rejection and is adjunctive therapy for some cancer protein metabolism and manage
• Management of skin disorders/allergic reactions the body’s stress response.
Bone suppression, infections Therapeutic use:
o monitor CBC and report decreased RBC, Adrenal suppression: N/V, hypotension, confusion • First-line cortisol
WBC, platelets o don’t stop med abruptly, notify manifestations if occurs, carry medic replacement therapy for
o monitor and report fatigue, chills, fevers, alert ID to ensure proper dose during pregnancy adrenocortical insufficiency
sore throat + initiate appropriate o Report any physical and emotional stress à may increase dosages (Addison’s disease)
antimicrobial therapy o administer IV normal saline + hydrocortisone • Oral for chronic and IV
Hepatotoxicity: jaundice, abdominal pain, infections: sore throat, fever, tachycardia hydrocortisone for acute or
N/V, fatigue, anorexia, dark urine o Report s/x of infection emergency adrenal crisis
o monitor liver function (AST&ALT blood test) o Initiate appropriate antimicrobial therapy • Nonendocrine disorders:
and report manifestation of hepatotoxicity GI discomfort/bleeding: N/V/D, abdominal pain, bleeding gum, cancer, inflammation,
o Hold med if occurs bruising, petechiae, dark stool or vomitus allergic reaction
o Advise patient not to drink alcohol o Observe manifestation of GI bleeding à Obtain occult blood test
Pulmonary fibrosis (respiratory depression o Take med with foods to minimize GI discomfort Same complication,
and decreased oxygen) o Advise patient to take acetaminophen for pain and avoid NSAIDs intervention, and client
o Watch and report for SOB or difficulty Osteoporosis education as prednisone
breathing, dry cough o Monitor bone density studies and watch for any fractures
GI discomfort/bleeding: N/V/D, abdominal o Perform weight-bearing exercise daily, take calcium and vitamin D Administration:
pain, bleeding gum, bruising, petechiae, dark supplement, and/or bisphosphonate (etidronate) • Give PO with food reduce
stool or vomitus fluid retention GI discomfort (take entire
o Watch and report GI upset and GI bleeding o Monitor I&O and watch for manifestation of excessive fluid (edema, dose right in the morning or
manifestation à Obtain occult blood test crackle lung sound, weight gain) take split dose if evening
Ulceration in the mouth and tongue Electrolyte imbalance: fatigue occurs à 2/3AM and
(stomatitis) o Watch for edema and unexpected weight gain à hypernatremia 1/3 early PM)
o Watch gum, mouth, tongue, and throat for o Watch for generalized weakness à hypokalemia, so monitor K level • Discuss the need to take
ulceration and take K supplement or K-rich foods med life-time and report
Teratogenic Hyperglycemia stress à higher dose may
o Do not use if pregnant or breastfeeding o Monitor blood glucose be prescribed
o Instruct child-bearing age patient to follow o Watch for manifestation (3P) à polyuria, polyphagia, polydipsia • Contra with live vaccine,
advice regarding effective contraceptive o May increase insulin or oral hypoglycemics severe infection, cataract
Minor side effects: Dizziness, headache, N/V Myopathy
o Monitor and report muscle weakness
Additional knowledge to know: Long-term causes Cushing-like effects
• Med is administered once a week (oral, SQ, o Watch for fat deposit, truncal obesity, moon-shaped face, hump on
IM) the upper part of the neck
• Dosages start from low and gradually Long-term causes cataracts
increase. o Watch for blurred vision and loss of color acuity
• Folic acid supplement: reduce toxicity o Protect eye from sunlight, wear sunglasses, obtain regular eye
• Patient on methotrexate must drink a lot of examination, decrease to lowest effective dose.
water (2L/day) to flush out med
• Closely monitor if patient has peptic ulcer, Additional knowledge to know:
ulceration colitis, active infection • ANY ROUTES
• Contra with renal/liver problem, pregnant, • Recommend largest to the lowest possible effective dose for short-
breastfeeding, live vaccines term oral use
• NSAIDs d/c when methotrexate develop • Recommend alternate-day dosing for long-term oral use (more than
therapeutic effect 10 days)
• Give supplement doses (increase dosages) in the time of stress
• Closely monitor if patient has HF, peptic ulcers, DM, HTN, kidney
dysfunction, myasthenia gravis, osteoporosis
• Contra with live vaccine, systemic fungal infection, cataract
Commented [SR1]: Good luck
