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Thera XI > 01 Lab Values Park > Flashcards

01 Lab Values Park Flashcards

1
Q

When getting a blood chemistry panel, what is included in an SMA-7?

A

Na, K, Cl, CO2, BUN, SCr, Glucose

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2
Q

What are the extra labs obtained in an SMA-12?

A

Albumin, Protein, Bilirubin, Alk Phos, Ca, Creatinine. This is also known as a CMP (complete metabolic panel)

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3
Q

What is the normal SCr range?

A

0.6-1.2 mg/dL. A GFR decrease by 50% will double Cr level

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4
Q

What is the normal BUN (blood urea nitrogen) range?

A

8-18 mg/dL. Increases in renal dysfunction, pancreatitis. Decreases in hepatic failure, pregnancy

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5
Q

What is a normal CrCl?

A

75-125 mL/min. Reflects GFR

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6
Q

What is the normal Albumin range?

A

4-6 g/dL. Reflects livers synthetic ability

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7
Q

What are some situations when the Albumin concentration can be decreased?

A

Overhydration. Malnutrition. Cancer. Severe burns. Pregnancy. Cirrhosis. Hepatitis. Liver failure (< 2.5 g/dL is a poor prognosis in liver disease)

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8
Q

What are some common drugs to consider that are highly protein-bound?

A

Phenytoin, Digoxin, Calcium

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9
Q

What is Phenytoin used for?

A

Epilepsy. Arrhythmia’s

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10
Q

What routes of administration are there for Phenytoin?

A

PO. IV

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11
Q

What is the formula for adjusted concentration with a protein bound drug?

A

[Measured total Concentration] / [(0.2 x albumin) + 0.1]

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12
Q

What is the normal Prothrombin Time (PT)?

A

10-13 seconds

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13
Q

What are the coagulation factors synthesized by the liver?

A

I, II (prothrombin), V, VII, IX, X. Vitamin K catalyzes the synthesis of clotting factors: II, VII, IX, X4

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14
Q

What is Warfarins main CYP enzyme?

A

2C9

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15
Q

What is the normal AST range?

A

0-40 U/L. Released into blood during acute cellular injury to hear or liver. Abnormal if > 4x ULN in liver disease

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16
Q

What is the normal ALT range?

A

0-40 U/L. ALT is more liver-specific. An increase in ALT means an increase in AST

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17
Q

What is Bilirubin?

A

A breakdown product of hemoglobin

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18
Q

What is the normal Total Bilirubin range?

A

0.1-1 mg/dL. Increases when liver is unable to conjugate bilirubin. Jaundice: > 2.5-3 mg/dL

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19
Q

What is the normal Alkaline Phosphate range?

A

30-120 U/L. Increased in Cirrhosis, Hepatitis, Pancreatitis, Bone disease, CHF

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20
Q

What can levels of Alpha-Fetoprotein (AFP) > 500 ng/mL indicate in adults?

A

May be indicative of Hepatocellular Carcinoma

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21
Q

What is the normal Amylase range?

A

40-120 U/L. Breaks down complex CHO into similar sugars. Produced in pancreas, increased in pancreatitis

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22
Q

What is the normal Lipase range?

A

0-160 U/L. Breaks down triglycerides into fatty acids. Produced in pancreas, increases in pancreatitis

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23
Q

What are some agents associated with causing pancreatitis?

A

Exenatide (Byetta). Januvia (Sitagliptin). Valproic acid. Didanosine (Videx). Lamivudine (Epivir). Sulindac (Clinoril). Statins; most ACE-I

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24
Q

What is the normal Creatinine Kinase (CK) range?

A

0-150 U/L, formerly known as CPK

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25
Q

What is the normal range for CK-MB (myocardium)?

A

0-12 U/L. > 25 U/L defects an MI (peak 12-24 hrs post-MI)

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26
Q

What are some other causes of increased Creatine Kinase?

A

Rhabdomyolysis. Shock. Infection. Seizures, etc.

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27
Q

What is the normal Troponin range?

A

0-0.5 ng/mL. A more specific and sensitive indicator of myocardial damage than CK-MB

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28
Q

What are the Troponin levels like with an MI?

A

Increases in 2-4 hours post-MI. > 2 ng/mL detects acute MI. Remains elevated 10-14 days (compared to 2-3 days elevation of CK-MB)

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29
Q

What are the normal TSH levels?

A

0.5-5 U/L. Causes the thyroid gland to produce two hormones; T3 and T4 (Thyroxine)

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30
Q

What are the levels like in Hypothyroidism?

A

TSH > 5; low T4. “Subclinical”: High TSH + Normal T4

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31
Q

What are the symptoms of Hypothyroidism?

A

Weight gain, fatigue, depression, dry skin, cold intolerance, constipation, bradycardia, peripheral edema

32
Q

What are the levels like in Hyperthyroidism?

A

TSH < 0.5; High T4. “Subclinical”: Low TSH + Normal T4

33
Q

What are the symptoms of Hyperthyroidism?

A

Weight loss, nervousness, heat intolerance, diarrhea, diaphoresis, irritability, tachycardia, tremor, hair thinning

34
Q

What is the normal Total T4 range?

A

5-12 ug/dL

35
Q

What is the normal Free T4 range?

A

0.8-2.2 ng/dL

36
Q

What is the normal Triiodothyronine (T3) range?

A

75-200 ng/dL

37
Q

What blood dyscrasia is Ribavirin associated with causing?

A

Hemolytic anemia is the primary clinical toxicity

38
Q

What blood dyscrasia’s are Interferon-Alphas associated with causing?

A

Neutropenia, Leukopenia, Anemia, Thrombocytopenia

39
Q

What measurements are taken in a CBC?

A

RBCs, Hgb, Hct, WBCs, MCV, MCHC

40
Q

What is the normal RBC (Erythrocyte) range?

A

Males: 4.3-5.9x10^6. Females: 3.5-5x10^6

41
Q

What is the normal Hemoglobin (Hgb) range?

A

M: 14-18. F: 12-16

42
Q

What is the normal Hematocrit (Hct) range?

A

M: 40-50%. F: 34-47%. Its a percentage of red cells to the blood volume

43
Q

What is the normal MCV range?

A

75-100. Useful in Anemia classification. Detects changes in cell size

44
Q

What are the MCV ranges in Micro- and Macrocytosis?

A

Micro: < 75 (iron deficiency). Macro: > 100 (B-12 or folic acid deficiency)

45
Q

What is the normal MCHC range?

A

33-37 g/dL. Measures concentration of hemoglobin. Changes in the Hgb content of red cells alter the cell color

46
Q

What is Hypochromic?

A

Decreased about of Hgb in cells. Characteristic of iron deficiency anemia

47
Q

What is the normal range for Total Iron Binding Capacity (TIBC)?

A

220-420

48
Q

What is the normal WBC range?

A

3.5-10x10^3

49
Q

What is Leukocytosis?

A

High WBCs

50
Q

What is Leukopenia?

A

Low WBCs

51
Q

What is considered Neutropenia?

A

ANC < 2,000

52
Q

What is considered Agranulocytosis?

A

ANC < 500 (risk of infection significantly increases)

53
Q

What is the normal Platelet range?

A

150-400x10^3. Thrombocytopenia (low platelet level). Thrombocytosis (high platelet level)

54
Q

What medications are used for Thrombocytopenia?

A

Eltromopag (Promacta; oral tab). Romiplostim (Nplate; SubQ)

55
Q

What agents are used for Low WBC (Neutropenia)?

A

G-CSFs: Filgastrim (Neupogen), Pegfilgastrim (Neulasta)

56
Q

What agents are used for Low RBCs (Anemia)?

A

ESAs: Epoetin alfa (Epogen, Procrit), Darbepoetin (Aranesp)

57
Q

What is the Rapid Plasma Reagin (RPR) used for?

A

Test for Syphilis

58
Q

What is the abnormal range for QTc?

A

Males: > 470. Females: > 480msec. Increased risk of QT prolongation when > 500msec or > 60msec increase from baseline

59
Q

What is the clinical presentation of Anemia?

A

Weakness. SOB. Dizziness. Chest pain. TACHYcardia. “Roaring in the ears”. HA. Impaired mentation. Cold hands or feet. Pale skin

60
Q

What are some common drugs that can induce Anemia?

A

Bactrim. Cephs. Interferons. Levodopa. NSAIDs. Rifampin. Linezolid. Ribavirin, etc.

61
Q

What is needed for RBC formation?

A

Need Iron, Folate, B12, and enough BM and Epo as well

62
Q

How can renal failure lead to anemia?

A

Renal dysfunction –> Decreased erythropoietin synthesis –> Decreased RBC formation –> Anemia

63
Q

What are some of the approved indications for Epoetin alpha?

A

Anemia d/t CKD. Anemia d/t concurrent myelosuppressive chemotherapy. Anemia associated with HIV (zidovudine) therapy

64
Q

What laboratory parameters need to be monitored for Epoetin alfa?

A

Transferrin saturation and serum ferritin; hemoglobin

65
Q

At what Hgb level should epoetin dose reduction or treatment interruption be considered?

A

Target hemoglobin levels >11. On HD: if Hgb approaches or > 11

66
Q

What black box warnings are associated with Epoetin alfa?

A

Increased risk of death, serious cardiovascular events, and stroke was reported in CKD patients. MI and stroke if levels > 11

67
Q

What is the reason for monitoring BP with Epoetin alfa?

A

Caution in patients with a history of HTN (contraindicated in uncontrolled HTN)

68
Q

What laboratory parameter is used to calculate corrected calcium?

A

Albumin

69
Q

How is corrected calcium calculated?

A

Corrected Ca = Measured Ca + 0.8 (4-alb)

70
Q

What electrolyte abnormality may be corrected by Kayexalate?

A

Hyper K, given PO or PR

71
Q

What is the MOA of Kayexalate?

A

Removes potassium by exchanging sodium ions for potassium ions in the intestine (especially the large intestine) before the resin is passed from the body (caution in bowel obstruction)

72
Q

What are the BUN:SCr ratios used to assess for causes of acute kidney injury?

A

> 20:1 Prerenal, 10-20:1 Normal or Postrenal, < 10:1 intrarenal

73
Q

What laboratory parameters should be monitored for lisinopril?

A

BUN, Serum creatinine, renal function, WBC, and potassium

74
Q

What laboratory parameters need to be monitored for patients on heparin treatment?

A

Hgb, Hct, signs of bleeding; fecal occult blood test; aPTT, anti-Xa (shows efficacy)

75
Q

Ampicillin requires dose adjustment for what organ functions?

A

Renal

76
Q

What are the major toxicities associated with aminoglycoside therapy?

A

Nephrotoxicity, Ototoxicity

Thera XI (16 decks)

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