Rx Note

Indications Unlike its use for treatment of cancer, methotrexate is administered as long-term, low-dose therapy, usually 7.5 to 25 mg weekly in rheumatoid arthritis and other disorders. Sometimes, it might be a good idea to have a discussion with patients to select a day for them to take this medication. It could be a Monday, since methotrexate starts with a "M", or it could be a Sunday, since patient is going to church in the morning. Method of Administration In terms of prandial advice , methotrexate should be taken with an empty stomach. Milk-rich foods may decrease its absorption. However, under management, Lexicomp did suggest to administer without regards to food , which is interesting to be take note of. Being an antineoplastic agent, methotrexate is listed in  NIOSH List of Hazardous Drugs in Healthcare Settings, 2024 . The 2.5 mg methotrexate tablet should not be cut or crushed in an unprotected environment. If a weekly dose is missed , it can be taken as soon as ...

Introduction Atopic dermatitis (eczema) is a chronic, pruritic, inflammatory skin disease that occurs most frequently in children but also affects many adults. The lifetime prevalence of atopic eczema is 20%; begins in 90% between 3 months and 5 years of age. It persists into adult life in at least one quarter of cases. Clinical features of atopic dermatitis include Skin dryness Erythema Oozing and crusting Lichenification Affected individuals often have a family history of asthma , hay fever and/or type 1 food allergy (anaphylactoid reactions). Management Identify and, if possible, avoid possible triggers including Irritants, e.g. abrasive clothing, soaps/detergents (including bubble bath), raised temperatures, sweating, heavily chlorinated pools or spas Allergens, e.g. preservatives, fragrances, lanolin, nickel, aeroallergens (e.g. house dust mites, animal dander), foods (only avoid if confirmed by testing) The goals of treatment are to reduce symptoms (pruritus and dermatitis ),...

Introduction Rheumatoid arthritis is a chronic autoimmune disease characterized by persistent synovitis, systemic inflammation and the presence of autoantibodies. Persistent joint inflammation can lead to the development of bony erosions, cartilage and tendon degradation and joint deformity. It usually affects the small joints of hands, wrists and feet, but can also occurs at other sites. It is more common in females than males, with onset between the ages of 30 and 60 years. Features suggesting rheumatoid arthritis Family history of inflammatory arthritis Early morning stiffness lasting longer than 1 hour and is usually relieved with activity and warmth Swelling in five or more joints Symmetry of the areas affected Bilateral compression tenderness of the metatarsophalangeal joints Rheumatoid factor positivity anti-cyclic citrullinated peptide antibody test positivity Symptoms present for longer than 6 weeks Bony erosions evident on X-rays of the wrists, hands or feet (uncommon in...

Introduction The vast majority of patients occasionally miss a dose of their medication. Hence, it seems logical to counsel patients on what to do about a missed dose at the time of dispensing. General Advice In general, always look first in the manufacturer's Patient Information Leaflet (PI) or Consumer Medicine Information (CMI) . They may have a section entitled "What to do if you miss a dose". If the information is not available, you may then follow: If the dose is less than 2 hours late, take the missed dose as soon as they remember, and resume the next dose at usual time. If the dose is more than 2 hours late, the advice depends on how often the medicine is taken. If taken once or twice a day, patient should usually take the dose as soon as they remember as long as the next dose is not due within a few hours. Patients should then continue taking the medicine at the usual times. If taken more often than twice a day, it is usually safer to omit the missed dose, and...