A client with a organ transplant has been placed on methotrexate (Rheumatrex). Which of the following mechanism of actions below describes this medication?

Inhibits helper T Cells

Inhibits replication by blocking folic acid synthesis

Prevents DNA and RNA synthesis

Estrogen blocker

Answer and Explanation

The Correct Answer is B

A) Inhibits helper T Cells:
While methotrexate does have an immunosuppressive effect, it does not directly inhibit helper T cells. Instead, it primarily acts by inhibiting the folic acid pathway, which is necessary for DNA and RNA synthesis. This action affects rapidly dividing cells, including those in the immune system, but its mechanism is not specifically focused on inhibiting T cells. Therefore, this is not the most accurate description of methotrexate’s action.

B) Inhibits replication by blocking folic acid synthesis:
Methotrexate is a folic acid antagonist that works by inhibiting the enzyme dihydrofolate reductase (DHFR). This inhibition disrupts the conversion of folic acid into its active form (tetrahydrofolate), which is crucial for purine and pyrimidine synthesis necessary for DNA and RNA replication. This action limits the replication of cells, including immune cells, which is beneficial in conditions such as organ transplantation, where immune suppression is necessary to prevent rejection. This mechanism is central to methotrexate's use in both cancer treatment and immunosuppressive therapy for organ transplants.

C) Prevents DNA and RNA synthesis:
While it is true that methotrexate affects DNA and RNA synthesis, this statement is too broad and not as specific as the correct answer. The drug works by blocking folic acid metabolism, which in turn affects the synthesis of DNA and RNA, but it is the inhibition of folic acid synthesis (as described in option B) that is the most accurate mechanism of action. Other drugs, such as antimetabolites, may also prevent DNA and RNA synthesis through different mechanisms.

D) Estrogen blocker:
Methotrexate is not an estrogen blocker. It has no direct effect on estrogen receptors or the endocrine system in a way that would block estrogen action. Estrogen blockers (e.g., tamoxifen) are used in the treatment of hormone receptor-positive breast cancer, but methotrexate is an immunosuppressant and antimetabolite with no significant role in estrogen receptor modulation. Therefore, this is an incorrect description of methotrexate’s mechanism.

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Correct Answer is ["A","B","D","F"]

Explanation

A. Nausea:
Nausea is one of the most common and well-known side effects of chemotherapy. Chemotherapy drugs target rapidly dividing cells, and the gastrointestinal tract is one of the areas with high cell turnover, making it susceptible to the effects of chemotherapy. Nausea can be severe, but it can usually be managed with antiemetic medications. Educating the client about potential nausea and how to manage it is important for preparing them for the treatment experience.

B. Bleeding:
Chemotherapy can lead to a reduction in the number of platelets in the blood, a condition known as thrombocytopenia. This decreases the blood's ability to clot, increasing the risk of bleeding and bruising. Clients should be educated to watch for signs of bleeding, such as unusual bruising, blood in urine or stool, or prolonged bleeding from cuts. It is crucial to monitor platelet counts during chemotherapy.

C. Urinary Frequency:
Urinary frequency is not a common or typical side effect of chemotherapy in general. While certain chemotherapy drugs (e.g., cyclophosphamide) may cause bladder irritation or hematuria, increased urinary frequency is not a widespread concern for most chemotherapy regimens. If a client experiences urinary symptoms, they should be evaluated for other causes, but this is not a primary side effect of chemotherapy.

D. Bone marrow suppression:
Bone marrow suppression is a significant and well-documented adverse effect of chemotherapy. Chemotherapy targets all rapidly dividing cells, including those in the bone marrow, leading to decreased production of red blood cells (anemia), white blood cells (neutropenia), and platelets (thrombocytopenia). This increases the risk of infection, anemia, and bleeding. It is essential to educate clients on the potential for bone marrow suppression and the need for regular blood count monitoring during treatment.

E. Extrapyramidal symptoms:
Extrapyramidal symptoms (EPS), such as tremors, rigidity, and bradykinesia, are typically associated with certain medications, especially antipsychotic drugs, and are not a common side effect of chemotherapy. While some chemotherapy drugs can cause central nervous system effects, EPS is not generally a concern with the majority of chemotherapy regimens. Therefore, this is not a primary focus of client education for chemotherapy.

F. Alopecia:
Alopecia (hair loss) is a well-known side effect of many chemotherapy drugs. Because chemotherapy targets rapidly dividing cells, hair follicles are often affected, leading to hair loss, which can be distressing for patients. Clients should be educated that hair loss is temporary in most cases, and hair typically regrows after the completion of chemotherapy. Managing expectations and providing emotional support regarding hair loss is an important part of chemotherapy education.

A. ALT & AST B. leukocyte count C. hemoglobin & hematocrit D. Clotting Factors

Correct Answer is C

Explanation

A. ALT & AST:
ALT (alanine aminotransferase) and AST (aspartate aminotransferase) are liver enzymes that are typically used to assess liver function and detect liver damage. Epoetin alfa (Epogen) is a medication used to stimulate red blood cell production in patients with anemia, particularly in those with chronic renal disease. While liver function may be important in overall health monitoring, ALT and AST levels are not directly relevant to evaluating the effectiveness of epoetin alfa therapy.

B. Leukocyte count:
Leukocyte count measures the number of white blood cells and is used to assess immune function or detect infections. Epoetin alfa does not have a direct effect on white blood cell production, and therefore, monitoring the leukocyte count is not the best indicator for determining the effectiveness of epoetin alfa therapy, which is primarily concerned with red blood cell production.

C. Hemoglobin & hematocrit:
Epoetin alfa (Epogen) is used to stimulate the production of red blood cells and treat anemia, particularly in patients with chronic kidney disease or those undergoing chemotherapy. The therapeutic effectiveness of epoetin alfa is most commonly assessed by monitoring the hemoglobin and hematocrit levels, as these are direct indicators of red blood cell count and oxygen-carrying capacity. An increase in these values suggests that the medication is effective in treating anemia.

D. Clotting Factors:
Clotting factors are proteins in the blood that help control bleeding. While epoetin alfa can increase red blood cell production, it is not directly associated with changes in clotting factors. In fact, there is a potential risk of increased thromboembolic events (e.g., blood clots) with epoetin alfa, particularly if hemoglobin levels rise too rapidly, but monitoring clotting factors is not the primary way to assess the drug's effectiveness. Monitoring hemoglobin and hematocrit levels is the more appropriate strategy.

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A client with a organ transplant has been placed on methotrexate (Rheumatrex). Which of the following mechanism of actions below describes this medication?

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Correct Answer is ["A","B","D","F"]

Explanation

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Explanation

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