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Difficulty: EasyMonitoring and Treatment Evaluation

A 48-year-old woman is newly diagnosed with moderate, seropositive rheumatoid arthritis. Her physician decides to initiate disease-modifying therapy with oral methotrexate along with daily folic acid supplementation. Her past medical history is otherwise unremarkable, and baseline laboratory investigations are within normal limits. Which of the following parameters are essential to monitor routinely to detect common adverse effects of this pharmacological therapy? (Select all that apply)

  1. Complete blood countAnswer
  2. Hepatic aminotransferasesAnswer
  3. C
    Prothrombin time and activated partial thromboplastin time
  4. D
    Transthoracic echocardiogram
  5. E
    Fasting lipid panel

Answer

The essential parameters to monitor routinely in this patient are a complete blood count and hepatic aminotransferases.
Methotrexate is an antimetabolite that acts by inhibiting dihydrofolate reductase. Its most common and potentially severe adverse effects include bone marrow suppression (which can present as macrocytic anemia, leukopenia, or thrombocytopenia) and hepatotoxicity. Therefore, standard of care requires routine monitoring with a complete blood count and liver function tests (including hepatic aminotransferases) at baseline and periodically throughout the duration of treatment.

Step-by-Step Solution

1
Identify the prescribed medication and its established side effect profile.
The medication is methotrexate, an antimetabolite whose major toxicities include myelosuppression, hepatotoxicity, and pulmonary toxicity.
Understanding the drug's specific toxicity profile dictates the appropriate clinical monitoring strategy.
2
Select the laboratory tests that correspond directly to the identified risks.
A complete blood count is necessary to monitor for bone marrow suppression, and hepatic aminotransferases are necessary to monitor for hepatotoxicity.
Routine surveillance with these specific tests allows for early detection of adverse effects before they become clinically severe or irreversible.

Key Concept

Routine monitoring for methotrexate therapy requires regular assessment of a complete blood count, liver function tests (including aminotransferases), and renal function due to the risks of myelosuppression, hepatotoxicity, and delayed renal clearance.
Estimated Time:45s
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Monitoring and Treatment Evaluation

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