OBGYN Chemo: Methotrexate
I am an OBGYN resident, and this video is intended to briefly review the chemotherapeutic agent, Methotrexate. This video is intended for medical students, residents, and fellows. Please enjoy!
Methotrexate is a versatile medication that finds applications in various medical specialties, including obstetrics and gynecology. As an OBGYN resident, it is essential to have a comprehensive understanding of methotrexate, its indications, mechanism of action, administration, potential side effects, and monitoring.
Mechanism of Action:
Methotrexate is a folate antagonist that works by inhibiting the enzyme dihydrofolate reductase, which is essential for the synthesis of DNA, RNA, and proteins. By interfering with folate metabolism, methotrexate suppresses cell division and proliferation, leading to the cessation of abnormal tissue growth.
Administration:
Methotrexate can be administered via multiple routes, including intramuscular, intravenous, oral, and intrathecal (rarely used in obstetrics and gynecology). The route of administration depends on the specific indication, patient's condition, and clinician's preference.
Side Effects and Monitoring:
Gastrointestinal Disturbances: Methotrexate can cause nausea, vomiting, diarrhea, and stomatitis. Patients are often prescribed folic acid supplementation to mitigate these side effects.
Hematological Effects: Methotrexate may induce bone marrow suppression, leading to anemia, leukopenia, and thrombocytopenia. Regular blood counts are necessary to monitor for any significant changes.
Hepatotoxicity: Liver function tests should be monitored as methotrexate can cause liver damage, particularly at higher doses or with prolonged use.
Renal Toxicity: Methotrexate can affect renal function, and monitoring of renal parameters is important, especially in patients with pre-existing renal impairment.
Immunologic Effects: Methotrexate can modulate the immune system and increase the risk of infections. Clinicians should be cautious when using methotrexate in patients with active infections or immunodeficiency.