A 52-year-old Caucasian woman comes to the office for a routine follow-up visit. She complains of weakness and fatigue for the past two weeks. She 'feels tired' even while doing minor household chores. She denies fever or any changes in appetite or weight. Three months ago, she underwent surgery for carcinoma of the breast and has been on chemotherapy ever since. She is a retired nurse and lives at home with her husband. She was diagnosed with hypertension twenty years ago. Her current therapy includes cyclophosphamide, methotrexate, 5-flurouracil, ondansetron, atenolol and famotidine. Her vital signs are within normal limits. Examination is unremarkable, except for moderate pallor. Rectal examination shows no abnormalities. Her lab results reveal the following: Which of the following is the most appropriate pharmacotherapy for this patient?

Question

A 52-year-old Caucasian woman comes to the office for a routine follow-up visit.  She complains of weakness and fatigue for the past two weeks.  She 'feels tired' even while doing minor household chores.  She denies fever or any changes in appetite or weight.  Three months ago, she underwent surgery for carcinoma of the breast and has been on chemotherapy ever since.  She is a retired nurse and lives at home with her husband.  She was diagnosed with hypertension twenty years ago.  Her current therapy includes cyclophosphamide, methotrexate, 5-flurouracil, ondansetron, atenolol and famotidine.  Her vital signs are within normal limits.  Examination is unremarkable, except for moderate pallor.  Rectal examination shows no abnormalities.  Her lab results reveal the following:  Which of the following is the most appropriate pharmacotherapy for this patient?

Quizplus · Accepted Answer

Explanation: Folinic acid is more potent than folic acid in 'rescuing' red blood cells from the deficiency by bypassing the block on DHFR. It is therefore the drug of choice for folate deficiency anemia induced by chronic, high dose methotrexate therapy. (Choice D)Folic acid may be used as a supplement to prevent or treat the folate deficiency seen with chronic use of methotrexate. It is not the drug of choice. (Choice A)Vitamin B12 therapy is inappropriate since this patient is most likely deficient in folic acid. (Choices B and C)Ferrous sulphate treatment is also inappropriate since the patient does not have iron deficiency. Educational objective: Chronic methotrexate therapy results in folate depletion and produces a macrocytic anemia. It is best treated with folinic acid (Leucovorin).

A 52-Year-Old Caucasian Woman Comes to the Office for a Routine