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46 Cards in this Set
- Front
- Back
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majority of juvenile patients suffer from what type of arthritis
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oligoarticular
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what subtype of arthritis occurs equally in females and males
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systemic
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what age does systemic occur in
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age < 17 years
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what age does oligoarticular peak in
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2-3 years
rare > 10 years |
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what age does polyarticular peak in
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2-5 years
10 - 14 years |
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what joints do oligoarticular present in
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large joints
rarely hips |
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what joints do systemic and polyarticular joints present in
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any
polyarticular rarely seen in hip |
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which type of arthritis presents with a fever, rash, etc
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systemic
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uveitis is likely to occur in what type of arthritis
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oligoarticular
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destructive arthritis is likely to occur in what arthritis
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systemic
polyarticular |
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increased risk of uveitis in children with what type of arthritis
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oligoarticular
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macrophage activation syndrome is seen in what arthritis
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systemic JIA
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what can be done to manage juvenile arthritis
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exercise
cold and or hot compress adequate calcium/vit d intake |
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what are the pharmacologic options to treat juvenile arthritis
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NSAIDs
corticosteroids DMARDS |
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what agent for JIA does not affect progression
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NSAIDs
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what are NSAIDs effective at treating in JIA
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pain associated with inflammation
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how long should patients be on NSAIDs
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4 - 6 weeks
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what is the max dose of Naproxen and Ibuprofen
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Naproxen 1.2 g/day max
Ibuprofen 2.4 g/day max |
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how old must a patient be to use celecoxib
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>= 2 years due to concern of heart disease with use
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what are the doses of Celecoxib given
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>= 10 kg to <= 25 kg 50 mg PO BID
> 25 kg 100 mg PO BID |
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what is used to control the symptoms of active arthritis or until a DMARD takes effect
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corticosteroids
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what are the corticosteroids used in JIA
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triamcinolone (intra-articular injection)
prednisone (PO) |
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what corticosteroid is only used in Systemic arthritis
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prednisone
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what are the DMARDs used to slow progression of JIA
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methotrexate
sulfasalazine |
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what is the dosing for:
methotrexate sulfasalazine |
methotrexate 10 mg/m2/week
sulfasalazine 10 mg/kg PO daily |
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Jain has JIA and has already received traimcinolone and methotrexate yet her oligoarticular arthritis is still progressing, what can you give her?
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TNF inhibitors
patients who received glucocorticoid joint injections and methotrexate/sulfasalazine therapy >>>> give TNF INHIBITOR |
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what do TNF inhibitors do
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reduce pain
reduce morning stiffness reduce swollen joints |
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what must you do before initiating therapy with TNF inhibitors
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TB test before initiation of therapy
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what are the TNF inhibitors
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infliximab
adalimumab etanercept |
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what labs must be monitored for when treating patients with JIA
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CBC
LFT SCr |
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if a patient has oligoarticular arthritis what is the order of drug treatment
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NSAIDS
INTRA-ARTICULAR TRIAMCINILONE METHOTREXATE TNF INHIBITOR |
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if a patient has polyarticular arthritis (5+ joints) what is the order of drug treatment
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METHOTREXATE
TNF INHIBITOR 2ND TNF INHIBITOR OR ABATACEPT |
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if a patient has systemic arthiritis what is the order of drug treatment
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NSAID
PREDNISONE ANAKINRA |
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when treating patients with JIA how long must ou continue therapy before tapering
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6-12 months
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what is the clinical presentation of Type 1 DM
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polydypsia
polyuria weight loss glucosuria +/- ketonuria hyperglycemia |
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what glucose values would diagnose a patient as having type 1 DM
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FPG > 126
random plasma glucose or 2 hr plasma glucose > 200 A1C > 6.5% |
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what is the total insulin dose usually used for newly diagnosed children
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0.5 - 1 unit/kg/day
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what are the rapid acting insulins
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lispro
aspart glulisine |
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what are the long acting insulins
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glargine
detemir |
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how do you calculat sensitivity factor and what does it tell you
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1500 DIVIDED BY total daily insulin dose
this tells you the decrease in blood glucose from 1 unit of rapid acting insulin |
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what are the criteria for use of Continuous SQ insulin infusion
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wide fluctuations in blood glucose level (regardless of A1C)
failure to achieve A1C goal frequent hypoglycemic episodes family and patient interested |
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what are the risk factors for type 2 DM
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Obesity: BMI > 95th percentile for age
positive family history African America, Native American, Hispanic, Asian-Pacific Islander female gender conditions of insulin resistance (PCOS/PUBERTY) |
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what is done for management of type 2 DM
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weight loss
low fat diet exercise avoidance of smoking |
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type 2 DM patients with normal glucose levels (70-100) what agent should they use
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wean off insulin start metformin
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for patients who are uncontrolled on metformin and lifestyle modifications what therapy should be given
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daily insulin therapy (long acting insulin eg insulin glargine)
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what is the dose of metformin
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500 mg PO BID
OR 850 mg PO QD |
