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Ultimate Sadness > Chapter 4: Lab Values and Drug Monitoring > Flashcards

Chapter 4: Lab Values and Drug Monitoring Flashcards

1
Q

Definition: point of care testing

A

provides rapid results at the site of patient care

home test kits

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2
Q

Definition: complete blood count

A
  • WBC
  • RBC
  • plts
  • Hgb: O2 carrying protein in RBC
  • Hct: level of RBC in the fluid component of lood or plasma

cbc with differential looks at types of wbc

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3
Q

Definition: basic metabolic panel

A

looks at electrolytes, glucose, renal function and acid/base (HCO3/bicarb)

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4
Q

\ X /
X ——- X
/ X \

A

\ hgb /
wbc ——- plt
/ hct \

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5
Q

x | x | x /
—————- x
x | x | x \

A

Na | Cl | BUN /
—————————————– glucose
K | HCO3 | SCr \

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6
Q

Definition: leukocytosis

A

increase in WBC

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7
Q

Definition: thrombocytosis

A

increased platelets

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8
Q

Definition: leukopenia

A

low WBC

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9
Q

Definition: thrombocytopenia

A

low platelets

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10
Q

Definition: myelosuppression

A

decreased WBC, RBC, plts

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11
Q

Definition: agranulocytosis

A

decreased in granulocytes (WBC that have secretory granules in cytoplasm): neutrophils, basophils, eosinophils

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12
Q

drugs that can cause agranulocytosis

A
  • clozapine
  • popylthiouracil
  • methimazole
  • procainamide
  • CBZ
  • isoniazid
  • TMP/SMX
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13
Q

Definition: critical lab value

A

life threatening unless corrective action is quickly taken

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14
Q

drugs that cause hypercalcemia

A
  • vit D
  • thiazide diuretics
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15
Q

drugs that cause hypocalcemia

A
  • long term heparin
  • loop diuretics
  • bisphosphonates
  • cinacalcet
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16
Q

drugs that can cause hypoMg

A
  • PPI
  • diuretics
  • amphotericin B
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17
Q

Phosphate (PO4) is increased in what disease state

A

CKD

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18
Q

drugs that can cause hyperkalemia

A
  • ACE/ARB
  • aldosterone receptor antags
  • alkiskiren
  • canagliflozin
  • CNIs
  • K supplements
  • SMP/TMX
  • dospirenone
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19
Q

drugs that can cause hypokalemia

A
  • beta-2 agonist
  • diuretics
  • insulin
  • SPS
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20
Q

drugs that can cause hypernatremia

A
  • hypertonic saline
  • tolvaptan
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21
Q

drugs that can cause hyponatremia

A
  • CBZ (OxCBZ)
  • SSRI
  • diuretics
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22
Q

drugs that can decrease HCO3 (bicarb)

A

topiramate

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23
Q

BUN is elevated in waht disease state

A

renal impairment and dehydration

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24
Q
A
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25
drugs that can impair renal function | increase SCr
- AG - amphoteriicn B - cisplatin - colistimethate - CNI - loop diuretics - polymyxin - NSAIDs - vanco - radiocontrast dye
26
a high anion gap suggests _
metabolic acidosis
27
what drugs can increase WBC
systemic steroids
28
what drugs can decrease WBC
- clozapine - chemo - CBZ - immunosuppresants
29
Definition: "left shift"
large percents of bands (immature neutrophils) which are released to fight an infection
30
Definition: neutrophils
aka polymorphonuclear cells (PMNs or polys); segmanted neutrophils (segs)
31
elevated eosinophils are present in what disease state
- asthma - inflammation - parasitic infection
32
elevated basophils are present in what disease state
hypersensitivyt reactions
33
elevated lymphocytes are present in what dsease state
- viral infections - lymphoma
34
decreased lymphocytes are present in waht disease state
- boe marrow suppression - HIV | also systemic steroids
35
What drugs can increase RBCs
erythropoeisis stimulating agents (ESAs)
35
what drugs can decrease RBC
chemo
36
what drug can increase Hgb
erythropoeisis stimulating agent (ESA)
37
hgb is decreased in what disease state
certain anemias
38
Definition: mean corpuscular volume (MCV)
average size and volume of RBC ## Footnote - macrocytic anemia: dt B12 or folate deficiency - microcytic anemia: dt iron definciency
39
40
drugs that can decrease folic acid (folate)
- (fos) phenytoin - phenobarbital - primidone - methotrexate
41
drugs that can decrease B12
- PPI - metformin
42
reticulocyte count is low in what disease state
- untreated anemia - bone marrow suppression
43
Coombs test
used to dx immune-mediated hemolytic anemia
44
drugs that can cause immune-mediated hemolytic anemia
- penicillins (prolonged use, high [ ]) - cephalosporins (prolonged use, high [ ]) - isoniazid - levodopa - methyldopa - quinidine - quinine - rifampin - sulfonamides ## Footnote dc if it does cause it
45
what drugs can cause glucose-6-phosphate dehydrogenase (G6PD)
- dapsone - methylene blue - nitrofurantoin - pegloticase - primaquine - rasburicase - quinidine - quinine - sulfonamides | fava beans
46
when to draw anti-Xa levels
- LMWH: 4 hrs after inj, can draw a peak - unfractionated heaprin: obtain 6 hrs after IV infuson starts and then Q6H
47
what drugs can cause a falsely elevated INR
- daptomycin - oritavancin - telavancin | liver disease can also elevate INR in the absence of warfarin
48
what drugs can falsely elevated aPTT
oritavancin, telavancin
48
when to draw aPTT (PTT)
6 hours after start of IV heparin and then Q6
49
average lifespan of plts
7-10 days
50
drugs that can decrease plts
- heparin and LMWH - fondaparinux - lineazolid - VPA
51
albumin can be low in what disease states
cirrhosis adn malnutrition
52
drugs that are hgihly protein bound and impacted by albumin
- warfarin - Ca (lab value, not drug) - pheytoin ## Footnote correct for low albumin when looking at Ca (you want the ionized) and when looking at phenytoin (you want free level, not total)
53
AST and ALT come from _
injured hepatocyctes
54
what does the bilirubin lab tell you
used along other liver tests to see if the case of liver damage comes from bile duct
55
drugs taht can elevate ammonia
- VPA - topiramate
56
drugs that can lower ammonia
lactulose
57
amylase and lipase are elevated in waht disease state (and what drugs can cause that)
pancreatitis ## Footnote - didanosine - stavudine - GLP-1 agonists - DDP-4i - VPA - hypertriglyeridemia (not a drug)
58
59
creatine kinase (or creatine phosphokinase) are used to determine what
muscle inflammation or damage
60
what drugs can elevate CK (creatine kinase)
- daptomycin - statins - tenofovir - raltegravir - dolutegravir
61
which cardiac enzymes are used to diagnosis MI
- TnT (troponin T) - TNI (troponin I) - CK-MB
62
markers of cardiac stress
- BNP and NT-proBNP - if elevated indicate higher likelihood of HF
63
how long to fast before lipid draw
9-12 hrs
64
how to calculate non-HDL
TC-HDL
65
goal LDL
< 100
66
goal non HDL
< 130
67
elevated CRP is indicative of what
inflammation
68
fasting plasma glucose lab value
- > 126 is postive for diabetes - 100-125 is normal | fast for 8+ hrs
69
A1C lab value goals
< 7% for ADA, < 6.5% for AACE | average glucose over past 3 months
70
Definition: estimated average glucose
used to corrlate a finger stick with an A1C ## Footnote eAG of 126 corresponds to A1C of 6%
71
what lab value distinguishes T1DM from T2DM
C-peptide, absent or low in T1DM
72
TSH is (high/low) i hypothyroidism
TSH is HIGH in HYPOthyroidism | low in hyper
73
drugs that can affect TSH levels
- amiodarone and interferons can raise OR lower - raise: tyrosine kinase inhibitors, Li, CBZ
74
drugs that can increase uric acid levels
- diuretics - niacin - low dose asa - pyrazinamide - cyclosporine - select pancreatic enzyme products - select chemo
75
drugs that can cause DILE
- ant-TNF agents - hydralazine - isoniazid - methimazole - methyldopa - minocycline - procainamide - propylthiouracil - quinidine - terbinafine
76
what CD4 count is indicative of an immunosuppresed state
< 200
77
a positive result of _ in a urine test indicates pregnancy
hCG
78
Definition: LH
rises mid cycle causing eggs to release from ovaries (ovulation)
79
drugs that can elevate lactic acid
- NRTIs - metformin
80
Rapid Pasma Reagin (RPR) or Venereal Diseases Research Laboratory (VDRL) is used to screen for _
syphilis
81
patients with _ genetic deficiency may require lower doses of azathioprine and mercaptopurine
TPMT, they are at increased risk for myelosuppression
82
usual therapeutic range of CBZ
4-12 mcg/mL
83
usual therapeutic range of digoxin
0.8-2 ng/mL (AF) 1.0.5-0.9 ng/mL (HF)
84
usual therapeutic range of gentamicin (traditional dosing)
- peak: 5-10 mcg/mL - trough: < 2 mcg/mL
85
usual therapeutic range of Li
0.6-1.2 mEq/L - drawn as a trough | can have up to 1.5 to treat acute symptoms
86
(fos) phenytoin
- 10-20 mcg/mL - correct if albumin is low - free phenytoin: 1-2 mcg/mL
87
usual therapeutic range of procainamide
- 4-10 mcg/mL - active metabolite (NAPA): 15-25 mcg/mL - combined: 10-30 mcg/mL
88
usual therapeutic range of theophylline
5-15 mcg/mL
89
usual therapeutic range of tobramycin
- peak: 5-10 mcg/mL - trough: < 2 mcg/mL
90
usual therapeutic range of VPA
50-100 mcg/mL | up to 150 in some patients
91
usual therapeutic range of vancomycin
- AUC/MIC: 400-600 - trough in serious infections: 15-20 mcg/mL - trough in less serious infections: 10-15 mcg/mL

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