Methotrexate

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    Working in the ED and a 24 year old female comes in with known ectopic pregnancy. I wasn't familiar with the drug except in cancer pts. I was just wondering if any nurses would have an issue administering it, even with an ectopic pregnancy?

    I gave it, after trying to get the doc to do it (who wouldn't) but made the doctor explain it IN DETAIL to the patient and boyfriend.

    Patient was also already miscarrying.
  2. 9 Comments so far...

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    The only thing I would add is that you should use chemo gloves when administering it, and have a nurse double check it with you, since it is a high-risk med.

    When I worked in Day Surgery, we used to give this drug for the same reason. We also used to give it where I work in oncology, but now the OB department gives it.
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    Quote from BellaInBlueScrubsRN
    Working in the ED and a 24 year old female comes in with known ectopic pregnancy. I wasn't familiar with the drug except in cancer pts. I was just wondering if any nurses would have an issue administering it, even with an ectopic pregnancy?

    I gave it, after trying to get the doc to do it (who wouldn't) but made the doctor explain it IN DETAIL to the patient and boyfriend.

    Patient was also already miscarrying.
    Methrotrexate is a drug given for ectopic/interstitial pregnancy's with a specificic criteria to be followed.

    Never give a drug until you have looked it up and know how to administer it. Also know the policy at your facility for the administration of methotrexate for ectopic pregnancy. The MD SHOULD BE explaining the procedure IN DETAIL....prior to administering the drug to anyone. Jeezy (smacking forehead here) what was he thinking. What did you charge nurse have to say? Let your charge nurse know of your discomfort.

    Methotrexate in ectopic Pregnancy
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    Methotrexate has many uses. Its primarily use is as chemotherapy but it is also used in the treatment of autoimmune diseases (I have a friend who was on it for Crohn's disease and I currently have a home care patient who gets it weekly for JRA) and it is a common treatment for ectopic pregnancies. I'm not sure what you mean when you ask if nurses would "have an issue" giving it. I am chemo certified so no problem there but I believe that when I worked in the hospital, if it was low dose subq methotrexate, they probably gave it on non-oncology floors for autoimmune patients and the nurses on those floors were not chemo certified. In the hospital, it's a drug that should be double-checked and, as OCNRN said, you should wear chemo gloves when administering it. It should also be disposed of properly. If your hospital has an oncology floor, you could always call them to ask about it since it's likely something they give regularly.
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    By "issue" I meant giving it knowing that it would continue/cause miscarriage. I did speak with pharmacy, MD, and charge nurse. I didn't use chemo gloves :/ Pharmacy just said not to handle it if I was pregnant.

    However, I meant more in the idea that it would cause miscarriage. One of the aides that overheard me speaking to pharmacy made a side comment about killing the baby. The doctor put it more like saving a life, as ectopic pregnancy can't survive anyway and put the mother at risk. It was just strange to know that once I gave it, she'd miscarry. It was a weird feeling.

    The doctor went in there again, and did explain in detail. She had seemed fine during the whole ER stay. When I went in to give it, she said that her partner had stepped out and could I wait until he got back. She got tearful when I gave it.
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    I thought that's what you meant. No, I would not have an issue giving it even if its intended purpose was to terminate the pregnancy. An ectopic pregnancy is not a viable pregnancy and if the pregnancy isn't terminated, the fallopian tube can rupture and cause serious damage to your patient. If an aide made a comment like that, it was ignorant.

    I would also not have an issue giving RU486 or misoprostol to a woman who was choosing to terminate her pregnancy, nor would I have an issue transferring a patient to surgery for an elective D&C.
    fromtheseaRN, KittyBinimi, and Luckyyou like this.
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    I think it would have been more appropriate given in an OB's office though, as her OB told her it was ectopic.
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    Ok, that's probably true. Did the OB send the patient to the ER because of the ectopic or did the woman come in because of worsening symptoms? It does seem odd that an OB wouldn't initiate the treatment for an ectopic pregnancy. I don't work in OB, so I don't know what the protocol for that is. I'd be happy if an ectopic pregnancy was all that was wrong with my patient I was giving methotrexate to though... I gave it to a 20 month old with ALL today and am going out to give it to a 4 yo with JRA tomorrow.
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    Worsening symptoms. Actually, she said she has 2 uteruses! Uteri?
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    We have given MTX on several occasions for confirmed ectopic pregnancies. If you're talking moral issue, no, I have no moral issue with giving it, since an ectopic is a life-threatening situation for the woman. The only issue I'd have with giving it, like someone else said, is if I were pregnant myself.

    We ran it by the chemo nurses at the hospital and they said you should also wear chemo gloves if handling the pt's urine for 48 hours after the last dose....just an FYI.


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