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Naplex 2023 > Lab Values and Drug Monitoring > Flashcards

Lab Values and Drug Monitoring Flashcards

1
Q

CBC components

A

WBC
RBC
PLT

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2
Q

CBC with differential components

A

WBC
RBC
PLT with types of neutrophils analyzed

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3
Q

components of BMP

A

electrolytes
glucose
renal function
acid/base (bicarbonate)

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4
Q

circle stick diagram starting at left and going clockwise - 4 components

A

WBC
Hgb
PLT
Hct

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5
Q

long stick diagram starting at top left and going clockwise - 7 components

A

Na
Cl
BUN
Glucose
SCr
HCO3
K

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6
Q

leukocytosis

A

inc WBC

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7
Q

thrombocytosis

A

inc platelets

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8
Q

leukopenia

A

dec WBC

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9
Q

thrombocytopenia

A

dec platelets

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10
Q

myelosuppression

A

dec WBC, RBC, platelets

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11
Q

agranulocytosis

A

dec granulocytes - neutrophils, basophils, eosinophils

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12
Q

drug causes of agranulocytosis

A

clozapine
propylthiouracil
methimazole
procainamide
carbamazepine
bactrim
isoniazid

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13
Q

calcium

A

calcium corrected calcium if albumin is low

inc from vit d and thiazide diuretics

dec from long-term heparin, loop diuretics, bisphosphonates, and cinacalcet

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14
Q

magnesium

A

dec due to PPIs, diuretics, and amphotericin B

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15
Q

phosphate

A

inc in CKD

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16
Q

potassium

A

inc from ACEi, ARBS, aldosterone antagonists, aliskiren, canagliflozin, cyclosporine, tacrolimus, potassium supplements, bactrim, drospirenone

dec from beta-2 agonists, diuretics, and insulin

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17
Q

sodium

A

inc due to hypertonic saline, tolvaptan

dec from carbamazepine, oxcarbazepine, SSRIs, diuretics

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18
Q

bicarbonate

A

dec from topiramate

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19
Q

BUN

A

inc in renal impairment and dehydration

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20
Q

SCr

A

inc from aminoglucosides, amphotericin B, cisplatin, colistimethate, cyclosporine, loop diuretics, polymyxin, NSAIDs, radiocontrast dye, tacrolimus, vancomycin

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21
Q

anion gap

A

inc in metabolic acidosis

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22
Q

WBC

A

inc from systemid steroids

dec from clozapine, chemoo, carbamazepine, immunosuppressants

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23
Q

neutrophils

A

aka polymorphonuclear cells (PMNs/polys)
aka segmented neutrophils (segs)

bands = immature neutrophils; fight infection (“left shift” when inc)

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24
Q

eosinophils

A

inc in asthma, inflammation, parasitic infection

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25
Q

basophils

A

inc in hypersensitivity reactions

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26
Q

lymphocytes

A

inc in viral infections, lymphoma

dec in bone marrow suppression, HIV, systemic steroids

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27
Q

RBC

A

inc from erythropoiesis-stimulating agents

dec from chemo, deficiency anemias (B12, folate), hemolytic anemia, sickle cell anemia

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28
Q

hemoglobin

A

inc from ESA

dec in anemias

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29
Q

MCV

A

inc (macrocytic anemia) from B12 or folate deficiency

dec (microcytic anemia) from iron deficiency

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30
Q

folic acid

A

part of macrocytic anemia workup

dec from phenytoin/fosphenytoin, phenobarbital, primidone, methotrexate, bactrim

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31
Q

vitamin B12

A

dec from PPIs and metformin

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32
Q

reticulocyte count

A

dec in untreated anemia and bone marrow suppression

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33
Q

Coombs test, direct

A

used in diagnosis of hemolytic anemia when cause is unclear

hemolytic anemia caused by penicillins and cephalosporins (prolonged use/high concentrations), dapsone, isoniazid, levodopa, methyldopa, methylene blue, nitrofurantoin, pegloticase, primaquine, quinidine, quinine, rasburicase, rifampin, and sulfonamides

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34
Q

G6PD

A

determines if hemolytic anemia is from G6PD deficiency

RBC destruction with G6PD deficiency from fava beans, dapson, methylene blue, nitrofurantoin, pegloticase, primaquine, rasburicase, and sulfonamides

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35
Q

Anti-Xa

A

used to monitor LMWH therapeutic dose: take peak 4 hrs after SC LMWH dose

UFH: take level 6 hrs after IV starts and every 6 hours until therapeutic

36
Q

PT/INR

A

monitors warfarin
inc w/o warfarin from liver disease
false inc from daptomycin, oritavancin, telavancin

37
Q

activated partial thromboplastin time

A

UFH: obtain 6 hrs after IV start and every 6 hrs until therapeutic

false inc from oritavancin, telavancin

38
Q

platelets

A

life of 7-10 days

dec from LMWH, fondaparinux, linezolid, and valproic acid

39
Q

heparin-induced platelet antibodies

A

if HIT is suspected - ELISA first, then SRA to confirm

40
Q

albumin

A

dec from cirrhosis and malnutrition

dec will impact highly protein-bound drugs: warfarin, calcium, phenytoin

correct phenytoin and calcium concentrations for low albumin

41
Q

ALT and AST

A

inc from injured hepatocytes

42
Q

bilirubin

A

used to determine causes of liver damage and detect bile duct blockage

43
Q

ammonia

A

measured in suspected hepatic encephalopathy

inc from valproic acid, topiramate

dec from lactulose

44
Q

liver/hepatic panel

A

AST, ALT, Tbili, albumin, Alk phos

assess acute and chronic liver inflammation/disease and baseline and routine monitoring of hepatotoxic drugs

45
Q

amylase and lipase

A

inc in pancreatitis

pancreatitis can be from didanosine, GLP-1s, DPP-4is, valproic acid, hypertriglyceridemia

46
Q

CK or CPK

A

assesses muscle inflammation or muscle damage

inc from daptomycin, statins, tenofovir, raltegravir, dolutegravir

47
Q

troponin

A

used in diagnosis of MI

48
Q

BNP and NT-proBNP

A

markers of cardiac stress

high = higher likelihood of HF with symptoms

49
Q

LDL

A

<100 desirable

fast 9-12 hrs before blood draw

50
Q

non-HDL

A

<130 desirable

non-HDL=TC-HDL

51
Q

lipid panel components

A

TC
HDL
LDL
TG

52
Q

CRP

A

inc indicates inflammation

53
Q

FPG

A

> 126 = diabetes

100-125 = pre-diabetes

fast 8 hours or more

54
Q

A1C

A

<7% normal

average BG over past 3 months

55
Q

eAG

A

<154 normal

126 = A1C of 6%

56
Q

preprandial BG

A

80-130 normal

57
Q

postprandial BG

A

<180 normal

58
Q

c-peptide (fasting)

A

absent/low in T1DM bc from insulin breakdown

59
Q

TSH

A

inc = hypothyroidism

dec = hyperthyroidism

inc or dec from amiodarone, interferons

inc from TKI, lithium, carbamazepine causing hypothyroidism

60
Q

uric acid

A

inc from diuretics, niacin, low dose ASA, pyrazinamide, cyclosporine, tacrolimus, some pancreatic enzymes, some chemo (tumor lysis syndrome)

61
Q

CRP
RF
ESR
ANA

A

nonspecific for autoimmune disorders, inflammation

Drug-induced lupus erythematosus: more likely with anti-TNF agents, hydralazine, isoniazid, methimazole, methyldopa, minocycline, procainamide, propylthiouracil, quinidine, terbinafine; d/c causative drug

62
Q

CD4 T-lymphocyte count

A

<200 = immunocompromised

assess HIV and monitor treatment

63
Q

HIV RNA viral load

A

used to assess HIV and monitor treatment

64
Q

pH
pCO2
pO2
HCO3
O2 sat

A

make up arterial blood gas
pH/pCO2/pO2/HCO3/O2 sat

65
Q

PSA

A

used in detecting prostate cancer and BPH

66
Q

hCG

A

positive = pregnancy

67
Q

LH

A

rises = ovulation

68
Q

lactic acid

A

inc from NRTIs and metformin

69
Q

prolactine

A

inc with haloperidol, risperidone, and paliperidone

70
Q

PPD/TST

A

TB skin test

71
Q

rapid plasma reagin (RPR) or venereal diseases research laboratory

A

used to screen for syphilis

72
Q

thiopurine methyltransferase (TMPT)

A

lower dose of azathioprine and mercaptopurine if genetic deficiency in TMPT

73
Q

vitamin d, serum 25(OH)

A

dec levels inc risk of osteoporosis, osteomalacia (rickets)

74
Q

carbamazepine therapeutic range

A

4-12

75
Q

digoxin therapeutic range

A

0.8-2 (AF)
0.5-0.9 (HF)

76
Q

gentamin therapeutic range

A

peak: 5-10
trough: <2

77
Q

lithium therapeutic range

A

0.6-1.2 (up to 1.5 for acute symptoms), drawn as trough

78
Q

phenytoin/fosphenytoin therapeutic range

A

10-20 (if albumin is low, calculate corrected level)

79
Q

free phenytoin therapeutic range

A

1-2.5

80
Q

procainamide therapeutic range

A

4-10

81
Q

NAPA therapeutic range

A

15-25

82
Q

combined procainamide + NAPA therapeutic range

A

10-30

83
Q

theophylline therapeutic range

A

5-15

84
Q

tobramycin therapeutic range

A

peak: 5-10
trough: <2

85
Q

valproic acid therapeutic range

A

50-100 (up to 150 in some)

86
Q

vancomycin therapeutic range

A

trough: 15-20 for most serious infections
trough: 10-15 for others

87
Q

warfarin therapeutic range

A

goal INR 2-3 for most
high 2.5-3.5 for high risk (mechanical mitral valve)

Naplex 2023 (21 decks)

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