Methotrexate - You will never look at Methotrexate the same

Methotrexate (MTX) blocks DNA synthesis by inhibiting dyhydrofolate reductase (DHFR), via the pyrimidine synthesis pathway, shown as the pyramids. You can see it is a competitive inhibitor (stopping people running) of the enzyme dy-hydro-foal-ate reductase – the two hydrants with the foal eating the reducing sign.

It can be used for Crohn’s disease as you can see by the old Crone. The saw shows that it’s effective in Psoriasis, and the room in the background indicates that you can also use it for rheumatoid arthritis. The lady having her abdomen sawn in half depicts it’s indication for unwanted pregnancies, with the eggs showing its use for ectopic pregnancies. The cans represent utilisation in various kinds of cancer, with the vase representing many types of vasculidities.

The SIDE EFFECTS are shown by the plant, because the mnemonic is "Plant my Horrible Mucositis". PL stands for Pulmonary Fibrosis – causing damaged lungs. ‘A’ is for Anaemia i.e. low blood levels. N is for nephrotoxicity - the damaged kidney. T is for teratogen, so you can’t have it whilst pregnant or you can harm the baby. MY stands for myelo suppression, the tin beneath the pony. Horrible H, indicates that it is hepatotoxic, causing damage to the liver. And finally it can cause mucositis i.e.,  inflamed mucus membranes, such as these revolting swollen lips on the plant. 

Now if you have it in too high of a level, you can get electrolyte imbalances. Up in the top left corner the hippo shaking the salt which indicates that you can get Hyponatremia. Hippo -hypo, natraemia – salt.

Finally, methotrexate is excreted via the urinary system, as you can see by the pony urinating.