Methotrexate for Ectopic Pregnancy

Medication Administration

1.Take a thorough history, including last menstrual period and symptoms of pregnancy.
2.Perform hand hygiene and apply gloves.
3.Verify patient's identity according to institutional protocol.
4.Obtain a baseline βhCG, liver and kidney function tests, and a complete blood count.
5.Assist with any other diagnostic procedure, such as an abdominal or vaginal ultrasound.
6.Offer bereavement counseling or support.
7.Remove gloves and perform hand hygiene.
8.Apply nitrile gloves and protective gown.
  • Prepare the single-dose methotrexate, as prescribed. The intramuscular dosage is 50 mg/m2 of body surface area.
Giving The Medication
 
The physician or advanced practice nurse calculates the patient's body surface area using the following formula:BSA (m2) = ([Height(cm) × Weight(kg)] / 3600)½An alternate, multiple-dose regimen may be used and consists of methotrexate (1mg/kg of body weight) alternating with leucovorin (0.1 mg/kg of body weight) for up to four doses of each agent.
 
1.Administer medication intramuscularly.
2.Follow the facility's protocols for handling and disposing of methotrexate.
3.Remove gown and gloves and perform hand hygiene.
4.Document the procedure in the patient's record.
5.Obtain and assess serial β measurements daily or weekly until no longer detectable.
6.If β levels do not decrease, a second course of methotrexate may be given, as prescribed.
7.Obtain laboratory assessment of liver function tests, blood counts, and creatinine to monitor any untoward effects of the medication.
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