Lab values and Drug Monitoring Flashcards
increase in platelets
Thrombocytosis
Increase in WBC
leukocytosis
decrease in WBC
leukopenia
decrease in platelets
Thrombocytopenia
Myelosuppression
decrease in RBCs, WBCs, and platelets
Agranulocytosis
-decrease in granulocytes (WBCs that have secretory granules in the cytoplasm) -this will decrease neutrophils, basophils and eosinophils
causes: clozapine, propylthiouracil, methimazole,
procainamide, carbamazepine, isoniazid, TMP/SMP
Calcium
-8.5 to 10.5 mg/dl
-must be corrected if albumin is low
-vitamin D and thiazides increase it
-long term heparin, loops, bisphosphonates, and cinacalcet decrease it
magnesium
1.3-2.1 mEq/L
-decreases due to PPIs, diuretics, amphotericin B
Phosphate (PO4)
2.3-4.7 mg/dL
-increases in chronic kidney disease
Potassium
3.5 - 5 mEq/L
Increases due to:
-ACE-I and ARBs and ARAs
-aliskiren
-canagliflozin
-cyclosporine
-tacrolimus
-potassium supplements
-TMP/SMP
-drosperinone containing contraceptives
Decreases due to:
-beta-2 agonists
-diuretics
-insulin
-sodium polystyrene sulfonate
Sodium
135 - 145 mEq/L
increases due to:
-hypertonic saline
-tolvaptan (anti-diuretic hormone)
decreases due to:
-carbamazepine
-oxcarbazepine
-SSRIs
-diuretics
Bicarbonate (HCO3)
Venous: 24 - 30 mEq/L
Arterial: 22 - 26 mEq/L
-used to assess acid-base status
Increases:
-loop diuretics
-systemic steroids
Decreases:
-topiramate
-salicylate overdose
Blood Urea Nitrogen
7-20 mg/dL
increases:
-renal impairment and dehydration
Serum Creatinine
0.6 - 1.3 mg/dl
Drugs that cause increase:
-aminoglycosides
-amphotericin B
-cisplastin
-colestimethate
-cyclosporine
-loop diuretics
-polymyxin
-NSAIDs
-radiocontrast dye
-tacrolimus
-vancomycin
Glucose
70-110 mg/dL
Anion Gap
5 - 12 mEq/L
High gap = metabolic acidosis
WBCs
4,000 - 11,000
Increases:
-systemic steroids
Decreases:
-clozapine
-chemotherapy
-carbamazepine
-immunosuppressants
Neutrophils
45 - 73%
-polymorphonuclear cells (PMNs or polys
-also called segmented neutrophils (segs)
Calculations: absolute neutrophil count (ANC)
Bands
3 -5 %
-immature neutrophils
-released from bone marrow to fight infection (left shift)
Eosinophils
0 - 5%
-asthma, inflammation, parasitic infection
Basophils
0-1%
-hypersensitivity reaction
lymphocytes
20 - 40%
-increases in viral infections and lymphoma
-decreases in bone marrow suppression, HIV or systemic steroid use
Red Blood Cells
Males: 4.5 -5.5 x 10^6
Females: 4.1 - 4.9 x 10^6
-average life span of 120 days
increases:
-erythropoiesis-stimulating agents (ESAs), smoking and polycythemia
Decreases:
-chemotherapy
-deficiency anemias
-hemolytic anemia
-sickle cell anemia
Hemoglobin
Males: 13.5 - 18
Females: 12 - 16
Mean Corpuscular Volume (MCV)
80 - 100 fL
-reflects the size and average volume of RBCs
Increases:
-macrocytic anemia due to B12 and folate deficiency
Decreases:
-microcytic anemia due to iron deficiency
Folic acid (folate)
5 - 25 mcg/L
-further work-up of macrocytic anemia
Decreases:
-phenytoin/fosphenytoin
-phenobarbital
-primidone
-methotrexate
-TMP/SMP
Vitamin B12
Greater than 200 pg/ml
-decreases due to PPIs and metformin
Reticulocyte Count
0.5 - 2.5 %
-measures the amount of immature RBCs being made in the bone marrow
Decreased in untreated anemia or bone marrow suppression
Coombs test (DAT)
NEGATIVE
-used in diagnosis of immune-mediated hemolytic anemia
Drugs that can cause this:
-penicillin and cephalosporins
-isoniazid
-levodopa
-methyldopa
-quinidine
-quinine
-rifampin
-sulfonamide
Glucose-6-Phosphate Dehydrogenase (G6PD)
5 - 14 units/ gram
used to determine if hemolytic anemia is due to G6PD deficiency
Triggers:
-fava beans
-dapsone
-methylene blue
-nitrofurantoin
-pegloticase
-primaquine
-rasburicase
-quinidine
-quinine
-sulfonamides
Anti-factor Xa activity (Anti-Xa)
LMWH: 4 hours after SC dose: 1-2 IU/mL
UFH: 6 hours after IV: 0.3 - 0.7 IU/mL
Prothrombin Time/INR
PT: 10 - 13 seconds
INR: less than 1.2 (if not on warfarin)
increase in INR w/out warfarin due to liver disease
False increase:
-daptomycin
-oritavancin
-telavancin
Activated Partial Thromboplastin Time (aPTT or PTT)
22 - 38 seconds (control)
GOAL for UFH: 1.5 - 2.5 x control
-used to monitor UFH and direct thrombin inhibitors
-False increase can occur from oritavancin and telavancin
Platelets
150,000 - 450,000 cells/mm^3
-average life span of 7 - 10 days
-spontaneous bleeding can occur when platelets are below 20,000
Decreases:
-heparin, LMWH, fonaparinux, linezolid, valproic acid
Albumin
3.5 - 5 g/dL
Decreases:
-cirrhosis
-malnutrition
Highly protein bound drugs =
-warfarin
-calcium
-phenytoin
(all impacted by low albumin)
Phenytoin and calcium require correction for low albumin
AST and ALT
(Aspartate and Alanine Aminotransferase)
10 - 40 units/L
-enzymes released from injured hepatocytes
Bilirubin
0.1 - 1.2 mg/dL
-determine liver damage and detect bile duct blockage
Amylase and Lipase
60 - 180 units
5 - 160 units/L
increases in pancreatitis
Causes:
-didanosine
-stavudine
-GLP-1 agonists
-DPP-4 inhibitors
-valproic acid
-hypertriglyceridemia
Troponin
0-0.1 ng/mL
-diagnosis of MI
BNP
less than 100 ng/mL
-marker of cardiac stress
-higher markers indicate higher likelihood of Heart failure
LDL
less than 100 mg/dL desirable
HDL
less than 40 is low in males
60 or more is desirable
Triglycerides
less than 150 mg/dl
C-reactive protein (CRP)
0 - 0.5 mg/dL
-indicates inflammation
-high sensitivity CRP is more sensitive to CVD
fasting plasma glucose
greater than 126 is positive for diabetes
100 - 125 = pre-diabetes
hemoglobin A1c
less than 7% (ADA)
less than 6.5% (AACE)
C peptide
0.78 - 1.89 ng/mL
-distinguishes type 1 from type 2 diabetes
(this is a insulin breakdown product used to evaluate beta-cell function)
-low to absent in a type 1 diabetic
Thyroid stimulating hormone (TSH)
0.3 - 3 mIU/L
increases: hypothyroidism
Low: hyperthyroidism
*Amiodarone may increase/decrease
increases (meaning hypothyroidism);
-tyrosine kinase inhibitors
-lithium
-carbamazepine
Uric Acid
Males: 3.5 - 7.2 mg/dL
Females: 2 - 6.5 mg/dL
Increases due to:
-diuretics
-niacin
-low doses of aspirin
-pyrazinamide
-cyclosporine
-tacrolimus
-select pancreatic enzyme products
-select chemotherapy
CD4 T Lymphocyte Count
immunocompromised state = less than 200 cells/mm^3
-diagnosis of HIV
HIV RNA Concentration (Viral Load)
undetectable
pH
7.35 - 7.45
pH/pCO2/pO2/HCO3/O2 sat
Lactic Acid
0.5 - 2.2 mEq/L
-indicates anaerobic metabolism
Increases due to:
-NRTIs (HIV)
-metformin
Vitamin D serum 25(OH)
greater than 30 ng/mL
decreased levels increase the risk of osteoporosis, osteomalacia (rickets)
Carbamazepine
4 - 12 mcg/mL
Digoxin
0.8 - 2 ng/mL (AF)
0.5 - 0.9 ng/mL (HF)
Gentamicin
peak: 5 - 10 mcg/mL
trough: <2 mcg/mL
Lithium
0.6 - 1.2 mEq/L
(up to 1.5 mEq/L for acute symptoms)
Phenytoin/ Free phenytoin
10 - 20 mcg/mL
1 - 2.5 mEq/L
Procainamide
NAPA
Combined
4 - 10 mcg/mL
15 - 25 mcg/mL
10 - 30 mcg/mL
Theophylline
5 - 15 mcg/mL
Tobramycin
peak: 5 - 10 mcg/mL
trough: < 2 mcg/mL
Same as gentamicin
Valproic Acid
50 -100 mcg/mL
Vancomycin
trough: 15 - 20 mcg/mL
*10 - 15 for non-serious infections
Warfarin
INR: 2-3
*2.5 to 3.5 for mechanical heart valves
