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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
Q

drugs that can impair renal function

increase SCr

A
  • AG
  • amphoteriicn B
  • cisplatin
  • colistimethate
  • CNI
  • loop diuretics
  • polymyxin
  • NSAIDs
  • vanco
  • radiocontrast dye
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26
Q

a high anion gap suggests _

A

metabolic acidosis

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27
Q

what drugs can increase WBC

A

systemic steroids

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28
Q

what drugs can decrease WBC

A
  • clozapine
  • chemo
  • CBZ
  • immunosuppresants
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29
Q

Definition: “left shift”

A

large percents of bands (immature neutrophils) which are released to fight an infection

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30
Q

Definition: neutrophils

A

aka polymorphonuclear cells (PMNs or polys); segmanted neutrophils (segs)

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31
Q

elevated eosinophils are present in what disease state

A
  • asthma
  • inflammation
  • parasitic infection
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32
Q

elevated basophils are present in what disease state

A

hypersensitivyt reactions

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33
Q

elevated lymphocytes are present in what dsease state

A
  • viral infections
  • lymphoma
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34
Q

decreased lymphocytes are present in waht disease state

A
  • boe marrow suppression
  • HIV

also systemic steroids

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35
Q

What drugs can increase RBCs

A

erythropoeisis stimulating agents (ESAs)

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35
Q

what drugs can decrease RBC

A

chemo

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36
Q

what drug can increase Hgb

A

erythropoeisis stimulating agent (ESA)

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37
Q

hgb is decreased in what disease state

A

certain anemias

38
Q

Definition: mean corpuscular volume (MCV)

A

average size and volume of RBC

  • macrocytic anemia: dt B12 or folate deficiency
  • microcytic anemia: dt iron definciency
40
Q

drugs that can decrease folic acid (folate)

A
  • (fos) phenytoin
  • phenobarbital
  • primidone
  • methotrexate
41
Q

drugs that can decrease B12

A
  • PPI
  • metformin
42
Q

reticulocyte count is low in what disease state

A
  • untreated anemia
  • bone marrow suppression
43
Q

Coombs test

A

used to dx immune-mediated hemolytic anemia

44
Q

drugs that can cause immune-mediated hemolytic anemia

A
  • penicillins (prolonged use, high [ ])
  • cephalosporins (prolonged use, high [ ])
  • isoniazid
  • levodopa
  • methyldopa
  • quinidine
  • quinine
  • rifampin
  • sulfonamides

dc if it does cause it

45
Q

what drugs can cause glucose-6-phosphate dehydrogenase (G6PD)

A
  • dapsone
  • methylene blue
  • nitrofurantoin
  • pegloticase
  • primaquine
  • rasburicase
  • quinidine
  • quinine
  • sulfonamides

fava beans

46
Q

when to draw anti-Xa levels

A
  • LMWH: 4 hrs after inj, can draw a peak
  • unfractionated heaprin: obtain 6 hrs after IV infuson starts and then Q6H
47
Q

what drugs can cause a falsely elevated INR

A
  • daptomycin
  • oritavancin
  • telavancin

liver disease can also elevate INR in the absence of warfarin

48
Q

what drugs can falsely elevated aPTT

A

oritavancin, telavancin

48
Q

when to draw aPTT (PTT)

A

6 hours after start of IV heparin and then Q6

49
Q

average lifespan of plts

50
Q

drugs that can decrease plts

A
  • heparin and LMWH
  • fondaparinux
  • lineazolid
  • VPA
51
Q

albumin can be low in what disease states

A

cirrhosis adn malnutrition

52
Q

drugs that are hgihly protein bound and impacted by albumin

A
  • warfarin
  • Ca (lab value, not drug)
  • pheytoin

correct for low albumin when looking at Ca (you want the ionized) and when looking at phenytoin (you want free level, not total)

53
Q

AST and ALT come from _

A

injured hepatocyctes

54
Q

what does the bilirubin lab tell you

A

used along other liver tests to see if the case of liver damage comes from bile duct

55
Q

drugs taht can elevate ammonia

A
  • VPA
  • topiramate
56
Q

drugs that can lower ammonia

57
Q

amylase and lipase are elevated in waht disease state (and what drugs can cause that)

A

pancreatitis

  • didanosine
  • stavudine
  • GLP-1 agonists
  • DDP-4i
  • VPA
  • hypertriglyeridemia (not a drug)
59
Q

creatine kinase (or creatine phosphokinase) are used to determine what

A

muscle inflammation or damage

60
Q

what drugs can elevate CK (creatine kinase)

A
  • daptomycin
  • statins
  • tenofovir
  • raltegravir
  • dolutegravir
61
Q

which cardiac enzymes are used to diagnosis MI

A
  • TnT (troponin T)
  • TNI (troponin I)
  • CK-MB
62
Q

markers of cardiac stress

A
  • BNP and NT-proBNP
  • if elevated indicate higher likelihood of HF
63
Q

how long to fast before lipid draw

64
Q

how to calculate non-HDL

65
Q

goal LDL

66
Q

goal non HDL

67
Q

elevated CRP is indicative of what

A

inflammation

68
Q

fasting plasma glucose lab value

A
  • > 126 is postive for diabetes
  • 100-125 is normal

fast for 8+ hrs

69
Q

A1C lab value goals

A

< 7% for ADA, < 6.5% for AACE

average glucose over past 3 months

70
Q

Definition: estimated average glucose

A

used to corrlate a finger stick with an A1C

eAG of 126 corresponds to A1C of 6%

71
Q

what lab value distinguishes T1DM from T2DM

A

C-peptide, absent or low in T1DM

72
Q

TSH is (high/low) i hypothyroidism

A

TSH is HIGH in HYPOthyroidism

low in hyper

73
Q

drugs that can affect TSH levels

A
  • amiodarone and interferons can raise OR lower
  • raise: tyrosine kinase inhibitors, Li, CBZ
74
Q

drugs that can increase uric acid levels

A
  • diuretics
  • niacin
  • low dose asa
  • pyrazinamide
  • cyclosporine
  • select pancreatic enzyme products
  • select chemo
75
Q

drugs that can cause DILE

A
  • ant-TNF agents
  • hydralazine
  • isoniazid
  • methimazole
  • methyldopa
  • minocycline
  • procainamide
  • propylthiouracil
  • quinidine
  • terbinafine
76
Q

what CD4 count is indicative of an immunosuppresed state

77
Q

a positive result of _ in a urine test indicates pregnancy

78
Q

Definition: LH

A

rises mid cycle causing eggs to release from ovaries (ovulation)

79
Q

drugs that can elevate lactic acid

A
  • NRTIs
  • metformin
80
Q

Rapid Pasma Reagin (RPR) or Venereal Diseases Research Laboratory (VDRL) is used to screen for _

81
Q

patients with _ genetic deficiency may require lower doses of azathioprine and mercaptopurine

A

TPMT, they are at increased risk for myelosuppression

82
Q

usual therapeutic range of CBZ

A

4-12 mcg/mL

83
Q

usual therapeutic range of digoxin

A

0.8-2 ng/mL (AF)
1.0.5-0.9 ng/mL (HF)

84
Q

usual therapeutic range of gentamicin (traditional dosing)

A
  • peak: 5-10 mcg/mL
  • trough: < 2 mcg/mL
85
Q

usual therapeutic range of Li

A

0.6-1.2 mEq/L - drawn as a trough

can have up to 1.5 to treat acute symptoms

86
Q

(fos) phenytoin

A
  • 10-20 mcg/mL - correct if albumin is low
  • free phenytoin: 1-2 mcg/mL
87
Q

usual therapeutic range of procainamide

A
  • 4-10 mcg/mL
  • active metabolite (NAPA): 15-25 mcg/mL
  • combined: 10-30 mcg/mL
88
Q

usual therapeutic range of theophylline

A

5-15 mcg/mL

89
Q

usual therapeutic range of tobramycin

A
  • peak: 5-10 mcg/mL
  • trough: < 2 mcg/mL
90
Q

usual therapeutic range of VPA

A

50-100 mcg/mL

up to 150 in some patients

91
Q

usual therapeutic range of vancomycin

A
  • AUC/MIC: 400-600
  • trough in serious infections: 15-20 mcg/mL
  • trough in less serious infections: 10-15 mcg/mL

Ultimate Sadness (9 decks)

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