Pharmacology Immune Drugs #4

Question

A client with rheumatoid arthritis taking methotrexate requires a flu vaccination. She asks the nurse why she was denied the nasal spray vaccination by her provider. Which response from the nurse is best?

Answers

  1. "You should not be vaccinated against the flu due to the risk of catching the flu from the vaccine."
    • Rationale:

      This answer is not correct because you cannot get the flu from the flu vaccine. Flu vaccines are made with inactivated viruses.

  2. "You should not be vaccinated against the flu, so that you can catch the infection and build antibodies against it."
    • Rationale:

      This answer is not correct because the flu can be a serious infection in otherwise healthy clients. The client taking methotrexate is immunosuppressed and is at risk for more serious complications due to the client’s weakened immune system.

  3. "Getting the flu vaccination makes you more suspceptial to getting other respiratory illnesses."
    • Rationale:

      This answer is not correct because the flu vaccination does not make it easier to get other respiratory illnesses. There are no studies to date that support this claim.

  4. "The nasal spray vaccination is a live vaccine, whereas the flu vaccination by injection does not contact a live virus."
    • Rationale:

      This answer is correct because methotrexate suppresses the immune system. Live vaccines contain weakened viruses, but are still dangerous to those with compromised immunity. Immunocompromised clients should avoid live vaccines due to the risk of a serious infection.

Overview

Methotrexate is a chemotherapy and immunosuppressive drug. Immunocompromised clients should avoid live vaccines due to the risk of a serious infection.

Explanation

Learning Outcomes

Methotrexate is in the class of immunosuppressants. Because of its dangerous adverse effects and potential for toxicity, it is usually used as a last resort when other treatments or medications have failed. It reduces inflammation and also weakens the immune system in clients with autoimmune diseases whose immune systems are attacking their own bodies. This results in the client’s body not being able to fight infection. Therefore, the client is instructed to not take vaccinations containing live viruses. The utilization of methotrexate is usually a last-ditch effort due to its negative effects on the kidneys and liver. As a result, methotrexate toxicity is common due to the buildup of the drug in the system. It also is known to cause lung lesions and fatal skin infections. Studies show it also raises the risk of malignant lymphoma.

Test Taking Tip

Knowing the classification of this medication will help the student ascertain why a live virus is not advised.

Video Rationale