Case study Cram (-; Flashcards
1
Q
WBC
A
4-10.5
2
Q
RBC
A
3.8-5.2
3
Q
HgB
A
120-150
4
Q
HCT
A
0.38-0.48
5
Q
PT-INR
A
0.9-1.1
6
Q
platelet
A
150-400
7
Q
Neutrophil
A
2-6
8
Q
Na
A
135-145
9
Q
K
A
3.5-5
10
Q
glucose
A
3.9-11
11
Q
creatinine
A
50-90
12
Q
GFR
A
> 60
13
Q
PTT
A
23-32
14
Q
what could polycythemia mean
A
increased RBC so hypoxia, tumour, dehydration, kidney tutor
15
Q
what could anemia mean
A
bleed, renal failure, malnutrition, iron deficiency, over hydration
16
Q
why do we get HgB
A
CBC (complete blood count) bleeding, surgery, kidney disease, cancer treatment
17
Q
what would low HgB mean
A
anemia, bleeding, chronic kidney disease, cancer treatment, rheumatoid arthritis
18
Q
what would hi HgB mean
A
COPD, lung scaring, HF d/t chronic hypoxia
19
Q
what is HCT
A
%RBC in blood
20
Q
what is low HCT
A
anemia, nutritional deficiency, CKD, leukaemia
21
Q
what would hi HCT mean
A
dehydration, lung disease, CAD
22
Q
what does neutrophilia mean
A
acute bacterial infection, inflammation (RA_, tissue death (sx, MI, Burn) stess
23
Q
what does neutropenia mean
A
sepsis, reaction to drugs, autoimmune
24
Q
hat does lymphocytosis mean
A
viral infection, lymphocytic leukaemia
25
what doe lympopenia mean
autoimmune (RA) infection, bone marrow dmg, immune disease
26
why test NA
general malaise, dehydration, vomiting, monitor in (HTN, HF, Chronic liver disease & kidney disease)
27
what would cause hyponatremia
diarrhea, vom, diuretics, increased H2O, chronic kidney disease, malnutrition, heart failure
28
what would cause hyper natremia
usually dehydration
29
why is K+ tested
kidney disease, weak muscles, arrhythmia, diuretics, HTN med
30
what would cause hyperkelemia
kidney disease, tissue dmg, infection, diabetes, dehydration, drugs
31
what would cause hypokalemia
diuretics, diarrhea, vomiting, diabetes
32
what is creatinine
waste product removed by kidneys
33
what does high creatinine mean
kidney disease, UTI, infection, decreased blood flout kidneys
34
what does thrombocytopenia mean
not enough made or there has been distruction
cancer treatment, drugs, autoimmunity
bleeding risk
35
what does thrombocytosis mean
hemolytic anemai, iron deficiency, surgery, trauma, infection, medication, spleen removal, blood clots
36
what does troponin elevation mean
even slight increase means Heart damage
| may also be d/t medical procedure, cardiomyopathy of HF
37
when would you test BNP
symptoms of HF (SOB, EDEMA)
38
what does it mean when BNP is high
heart cannot pump the way it should
most likely HF or (KF, PE, Pulm HTN, sepsis, lung problems)
it is a hormone secreted by cardiomyocytes in the ventricles in response to increased streching cause by increased blood volume
39
what is PTT
partial thromboplastin time - measures time it takes for a clot to form - an tell if clotting factors are working
40
why would you test PTT:
unexplained bleeding, bruising, clouting, liver disease, surgery, HEPARIN
LOOKING AT EXTRINTRINSIC & COMMON PATH
41
why would PTT be longer than normal
bleeding disorder, liver disease, lupus, vitamin K deficiency
42
why is PT INR tested
detect blleeed/ clot disorder - INR to determine how well anticoagulant warfarin is working (INTRINSIC PATHAY)
43
what should you INR be if you're taking warfarin
2-3
44
what does a prolonged PT mean with normal PTT
liver disease, vitamin K insufiecnecy, defective clouting factors or WARFARIN
45
what does normal pt with prolonged put mean
defect clot factors, lupus anticoag, von will, autoimmune
46
what does prolonged PT & PTT-INR mean
defective factors, severe liver disease, warfarin over dose
47
what does D-Dimer test
rule out clotting (thrombotic episodes) (DVT, PE)
| D-Dimer is one of the protein fragments produced when a blood clot gets dissolved in the body -> usually undetected
48
when is D-Dimer ordered
```
DVT symptoms (leg pain, edema, discolour)
PE symtoms (SOB, cough, chest pain, rapid HR)
```
49
what does a negative D-Dimer test mean
person doesn't have acute clot formation of breakdown
50
what does a positive D-Dimer mean
abnormally high fibrin degradation products, doesn't tell us location or cause
elevated levels also after Sx, trauma, infection, MI, cancer or liver disease
*used to rule out, not confirm diagnosis
51
what is you HgB A1C if you don't have diabetes vs. if you do
No diabetes <5.7%
| Diabetes 6.5% or higher
52
what are the signs of hyperglycemia
increased thirst, frequent urination, blurry vision, slow healing
53
what are the signs of hypoglycaemia
sweat, hunger, tremble, anxiety, confusion, blurred vision
54
what id normal FBG
3.9-5.5
55
what is normal OGTT after 2 hr
<7.8 = norm
56
what are normal BG numbers
fasting: 4-7
Post-prandial (2 hr after meal): 5-10
random: <7
57
what does the oral glucose tolerance test determine
measures bodes ability to use glucose
58
what is the normal results of OGTT
fast: <7
1 Hr: <10.2
2 hr <7.7
59
what are the prediabetic response for OGTT
2 hr: 7.8-11.0
60
normal vs prediabetic vs diabetic HbA1C
```
Normal = <6
pre = 6.0-6.4
dia= 6.5+
```
61
what are the neurogenic/autonomic hypoglycaemia symptoms
Tremble, hunger, palpitations, nausea, sweating, tingle, anxiety
62
what are the neurglycopenic symptoms of hypoglycaemia
difficulty concentration ,vision changes, difficulty speaking, confusion, headache, weak, dizzy, drowsy, tired
63
what is mild-mod hypoglycemia
2.8-3.9mmol/L with autonomic symptoms
64
what do you do with mild-mod hypoglycaemia
1) 16g glucose or 4 tabs
2) repeat BG in 15 minutes
3) repeat until BG >4.0
4) give meal or snack
5) inform physician if happens 3+ times
6) document
65
what is severe-conscious hypoglycaemia
autonomic & neuroglycopenic symptoms & <2.8mmol
66
what do you do with severe conscious
1) 20g carbs
2) bg again 15 mins repeat until >4.0
3) meal or snack
4) physician
5) document
67
what is severe uncontious
same as severe continous except they not conscious
68
what do you do in severe uncontious
1) IV glucose, 25g as 50ml D50W over 1-3 minutes or 1mg glycogen SC
2) 10 min retest (redo step one title <4)
(max one glycogen shot)
3) ASAP inform doctor
4)Document
69
explain morphine
Reduces pain
opiod analgesic
side effects are Resp depress & conspitation
mechanism is it binds to opiod receptors in cans, alters perception & response to painful stimuli with generalized CNS depression
Assess: rr, bp, pain, narcan is less than 8 is less than 12 hold, urinary retention, cranial pressure, tolerance & physical dependence
70
what class of drug is lipitor / atorvastatin
lip lowering agent -> HMG-CoA reductase inhibitors
71
what is the indication for a atorvastatin
hypercholestemia. Prevent CAD. Lower LDL (2 weeks) must be taken life long
increases HDL & decreases Tg
72
what are the non lipid benefits of atorvastatin/lipitor
```
stability of atherosclerotic plaques
decreases inflamation
slows calcification
improves abnormal endothelial function
increases dilation
decreases AFIB
suppreses thrombin
```
73
what are the worst outcome for atorvastatin
LIVER DISFUNCTION CAN OCCUR (LFT tests prior & 3 months post) (ALT, AST)
Muscle pain, tenderness or weakness -> CHECK CPK (INDICATES MUSCLE INJURY)
n/v, heart burn, cramping, diarrhea, memory loss
can cause overweight fetus
CANNOT BE GIVEN WITTH LIVER DISEASE
74
what is the mechanism of atorvastatin action
increased LDL receptors on hepatocytes
| inhibits HMG cos-reductase (rate limiting enzyme in cholesterol biosynthesis) = hepatocytes better able to remove LDLS
75
what is the therapeutic use of atorvastatin
```
hypercholesterolemia
prevent CV
primary prevention with normal LDD
post MI therapy
diabetes
influenza
```
76
what class is metoprolol
beta blockers (Anti-anginas & anti-HTN)
77
what is the mechanism of metoprolol
blocks beta 1 receptors ( myocardial) adrenergic receptors (doesn't usually affect beta 2)
78
what is the indication for metoprolol
HTN, angina, prevent MI . decrease mortality, management of HF
Unlabled for: ventricular arrhythmia, tremor, anxiety & migraine
79
what does metoprolol do?
blocks action of NE & E so it decreases HR & BP
80
what are the adverse effects of metoprolol
low bp, low hr, pulmonary edema, HF
81
when is metoprolol contraindicated
decreased hr or bp, pulmonary edema, heart block, cariogenic shock, signs of HF
CANT GIVE WHEN BPM UNDER 50
82
teaching about metoprolol
abrupt withdrawal can lead to arrhythmia, HTN, ischemia
| may cause drowsiness & orthostatic HTN
83
when is hydrochlorthizide in effective
with a low GFR
84
what class is hydrochlorothiazide
antiHTN, thiazide diuretics
85
when is hydrochlorothiazide indicated
HTN, edema
86
what is hydrochlorothiazide mechanism
increased urine production via block or reabsorption of Na+ & chloride in early DCT (smaller amt than loop)
Dependent on kidney function - INEFFECTIVE WITH A LOW GFR 15-20
Diuresis within 2 hours, 4-6 hr peak, duration 10 hour
87
what are the adverse effects of hydrochlorothiazide
hyponatremia, hypochloremia, dehydration, hypokalemia
hyper uricemia
increased LDL
increased excreted MG
88
what kind of drug is furosemide
loop diuretic
89
what is the mechanism of furosemide
acts on henley loop to block reab or Na & CL-
prevent passive reabsorption of H20
oral onset is 60 minutes for 8 hours
IV onset is 5 min for 2 hours
90
what are indications for furosemide
pulmonary edema, edema, HTN
91
what are the adverse effects of furosemide
```
hyponatremia
hypochloremia
dehydration
hypotension
hypokalemia
ototoxicity
hyperglycaemia
hyperuricemia
reduces LDL, raises HDL
NOT SAFE FOR PREG
```
92
what type of insulin is lispro/humalog
RAPID ACTING ANALOG of regular insulin
93
when would lispro/humalog be given
food must be in front of them -> immediately b4 meals
94
what is the onset of lispro/humalog
10-15 minutes
95
what is the peak of lispro/humalog
60-90 minutes
96
what is the duration of lispro/humalog
3-5 hr
97
what is the color of lispro/humalog
clear
98
can you mix lispro/humalog
yes with NPH
99
why does lispro/humalog work faster than regular
aggregates less than normal insulin b/c of a changed animo acid so is absorbed pasted
usually SC
100
what type of insulin is glargine/lantus
long acting basal insulin analogue
101
what is the onset of glargine/lantus
90 mins
102
what is the peak of glargine/lantus
non
103
what is the duration of glargine/lantus
24 hours
104
what are some special considerations of glargine/lantus
```
DO NOT GIVE IV
DO NOT MIX WITH OTHER INSULIN
DOSING CAN OCCUR AT ANY TIME
LOW SOLUBILITY SO EXTENDED RELEASE
is clear
```
105
what is warfarin
vitamin K antagonist
106
what does warfarin do
prevents thrombosis
delayed onset -> inappropriate for emergencies
LT prophylaxis
poses a huge hermorage risk
107
what is the mechanism of warfarin
decreased clotting factor production (by inhibiting enzyme needed to convert vitamin K to active form)
* no effect on clotting factors already in circulation
108
when does warfarin start to work
Onset: 8-12 hours
peak: 72-96 hours
Direction 2-5 days
109
what is the therapeutic use of warfarin
prevent VT
| prevent PE, thromboembolism with prosthetic valve, thrombosis from AFIB, decreases TIA & MI risk
110
what do u need to monitor for warfarin
PT-INR 2-3 for most
| daily for first 5 days
111
what are side effects of warfarin
hemorrhage, skin necrosis, weak bones, fever, GI disturb
112
when is warfarin contraindicated
thrombocytopenia. Lumbar puncture. Recent CNS surgery. Hi risk bleeders (Hemophilia, aneurysm, GI ulcer, HTN, abortion)
vitamin K deficiency, Liver disease, alchoholism
pregnancy & lactation
*KEEP VIT K INTAKE STABLE
113
what kind of drug is ramipril
Ace inhibitor
114
what does ramipril do
lowers bp b/c not angio 2 which causes there to be vasodilation & decreased heart workload
115
what are the indications for ramipril
treats HTN, HF, MI (prevent)
116
what are the side effects of ramipril
hypotension, Increasd K, cough, kidneys disease need reduced dosage, fetal death
117
what do assess for ramipril
Bp (HR not most important) electrolytes, K+, dry cough
118
what is digoxin
Cardiac glycoside - effects both mechanical & electrical
119
what does if the effect of digoxin
increases myocardial contractility & effects on neural hormonal
CAN CAUSE DANGEROUS DYSRYTHMIAS EVEN WITHIN THERAPEUTIC DOAGE
DOESNT PROLONG LIFE - SYMPTOM RELIEF ONLY. Increases exercise tolerance & decreases hospital stay
120
what are the indications for digoxin
HF, dysrhythmias
121
what is mechanism of digoxin
IT IS A POSITIVE INOTROPE -> increases the force of ventricular contraction -> increased CO
- Inhibits na+/K+ATPASE -> which promotes Calcium accumulation in the myocytes ->augments contractile force
- K+ IONS COMPETE TO BIND Na+/K+ATPASE so when K+ is low, excessive inhibition occurs -> toxicity
* K+ MUST BE MONITORED
122
what are the benefits of digoxin
increased CO
| Decreased sympathetic tone. increased urine, decreased renin, decreased heart size & fatigue reduced.
123
what are the side effects of digoxin
Dysrythmias b/c hypokalemia or OD (0.5-0.8 ideal)
| anorexia, N/v, fatigue, visual distrubance,
124
when do hold Digoxin
if HR <60
125
what class is hydralazine
direct action vasodilator
126
what is the effect of hydralazine
direct relaxation of arteriolar smooth muscle
(no effect on veins)
(BP falls)
(HR & myocardial contraction increases)
127
what is onset & duration for hydralazine
PO 45 minutes for 6 hr
| IV: 10 minutes for 2-4 hours
128
what is the therpeatuic use for Hydralazine
essential HTN with a beta blocker
HTN crisis ( 220/130)
HF
129
what are the side effects of hydralazine
reflex tachycardia, increased blood volume, systemic lupus erythmatosis
130
what should you monitor for HYDRALAZINE
BP, ECG, O2, RR.
| hold if BP LOW
