Case study 5 RR, aged 42 years, with rheumatoid arthritis, visits.

Case study 5

RR, aged 42 years, with rheumatoid arthritis, visits her general practitioner complaining of nausea and gastric irritation. She has been taking oral methotrexate every Friday in an effort to control her symptoms of pain relating to rheumatoid arthritis. RR visited her general practitioner about a month ago, reporting nausea, and was prescribed prochlorperazine 5 mg twice daily to be taken on Fridays. However, this antiemetic regimen does not seem to have helped. She is also taking slow-release naproxen tablets to help with the symptoms of pain.

Questions

How can the methotrexate dose be altered in an attempt to assist with RR’s nausea? (0.5 point; 30 words)

What is the mechanism by which methotrexate exerts its therapeutic effects in rheumatoid arthritis? (1 point; you must understand it and then you can explain it in about 60 words)

Should folic acid be added to RR’s treatment regimen? Provide a rationale for your answer. (1 point; about 40 words)

Note: References should not be 5 years old.