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Methotrexate counselling — GPhC CRA MCQ

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ModeratePatient Counselling and Pharmaceutical CareMethotrexate counsellingGPhC CRA

A 48-year-old woman collects methotrexate 2.5mg tablets for rheumatoid arthritis. The prescription is for 15mg once weekly on Mondays with folic acid 5mg on Fridays. She asks what symptoms should prompt urgent advice. What would you advise the patient?

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Correct answer: C — report sore throat, mouth ulcers, unexplained bruising or breathlessness urgently

Methotrexate can cause bone marrow suppression, mucosal toxicity and pulmonary toxicity. Sore throat, mouth ulcers, bruising or breathlessness require urgent advice and blood-test review. Weekly dosing must be reinforced to prevent fatal medication errors. Trimethoprim should not be started without checking because of serious interaction risk.

Reference: BNF; NICE CKS: DMARDs