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NAPLEX > Lab values and Drug Monitoring > Flashcards

Lab values and Drug Monitoring Flashcards

1
Q

increase in platelets

A

Thrombocytosis

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1
Q

Increase in WBC

A

leukocytosis

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2
Q

decrease in WBC

A

leukopenia

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3
Q

decrease in platelets

A

Thrombocytopenia

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4
Q

Myelosuppression

A

decrease in RBCs, WBCs, and platelets

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5
Q

Agranulocytosis

A

-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

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6
Q

Calcium

A

-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

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7
Q

magnesium

A

1.3-2.1 mEq/L
-decreases due to PPIs, diuretics, amphotericin B

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8
Q

Phosphate (PO4)

A

2.3-4.7 mg/dL
-increases in chronic kidney disease

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9
Q

Potassium

A

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

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10
Q

Sodium

A

135 - 145 mEq/L
increases due to:
-hypertonic saline
-tolvaptan (anti-diuretic hormone)

decreases due to:
-carbamazepine
-oxcarbazepine
-SSRIs
-diuretics

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11
Q

Bicarbonate (HCO3)

A

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

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12
Q

Blood Urea Nitrogen

A

7-20 mg/dL

increases:
-renal impairment and dehydration

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13
Q

Serum Creatinine

A

0.6 - 1.3 mg/dl

Drugs that cause increase:
-aminoglycosides
-amphotericin B
-cisplastin
-colestimethate
-cyclosporine
-loop diuretics
-polymyxin
-NSAIDs
-radiocontrast dye
-tacrolimus
-vancomycin

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14
Q

Glucose

A

70-110 mg/dL

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15
Q

Anion Gap

A

5 - 12 mEq/L

High gap = metabolic acidosis

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16
Q

WBCs

A

4,000 - 11,000

Increases:
-systemic steroids

Decreases:
-clozapine
-chemotherapy
-carbamazepine
-immunosuppressants

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17
Q

Neutrophils

A

45 - 73%
-polymorphonuclear cells (PMNs or polys
-also called segmented neutrophils (segs)
Calculations: absolute neutrophil count (ANC)

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18
Q

Bands

A

3 -5 %
-immature neutrophils
-released from bone marrow to fight infection (left shift)

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19
Q

Eosinophils

A

0 - 5%
-asthma, inflammation, parasitic infection

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20
Q

Basophils

A

0-1%
-hypersensitivity reaction

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21
Q

lymphocytes

A

20 - 40%
-increases in viral infections and lymphoma
-decreases in bone marrow suppression, HIV or systemic steroid use

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22
Q

Red Blood Cells

A

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

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23
Q

Hemoglobin

A

Males: 13.5 - 18
Females: 12 - 16

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24
Q

Mean Corpuscular Volume (MCV)

A

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

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25
Q

Folic acid (folate)

A

5 - 25 mcg/L
-further work-up of macrocytic anemia

Decreases:
-phenytoin/fosphenytoin
-phenobarbital
-primidone
-methotrexate
-TMP/SMP

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26
Q

Vitamin B12

A

Greater than 200 pg/ml
-decreases due to PPIs and metformin

27
Q

Reticulocyte Count

A

0.5 - 2.5 %
-measures the amount of immature RBCs being made in the bone marrow

Decreased in untreated anemia or bone marrow suppression

28
Q

Coombs test (DAT)

A

NEGATIVE
-used in diagnosis of immune-mediated hemolytic anemia

Drugs that can cause this:
-penicillin and cephalosporins
-isoniazid
-levodopa
-methyldopa
-quinidine
-quinine
-rifampin
-sulfonamide

29
Q

Glucose-6-Phosphate Dehydrogenase (G6PD)

A

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

30
Q

Anti-factor Xa activity (Anti-Xa)

A

LMWH: 4 hours after SC dose: 1-2 IU/mL

UFH: 6 hours after IV: 0.3 - 0.7 IU/mL

31
Q

Prothrombin Time/INR

A

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

32
Q

Activated Partial Thromboplastin Time (aPTT or PTT)

A

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

33
Q

Platelets

A

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

34
Q

Albumin

A

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

35
Q

AST and ALT
(Aspartate and Alanine Aminotransferase)

A

10 - 40 units/L
-enzymes released from injured hepatocytes

36
Q

Bilirubin

A

0.1 - 1.2 mg/dL
-determine liver damage and detect bile duct blockage

37
Q

Amylase and Lipase

A

60 - 180 units
5 - 160 units/L

increases in pancreatitis
Causes:
-didanosine
-stavudine
-GLP-1 agonists
-DPP-4 inhibitors
-valproic acid
-hypertriglyceridemia

38
Q

Troponin

A

0-0.1 ng/mL
-diagnosis of MI

39
Q

BNP

A

less than 100 ng/mL
-marker of cardiac stress
-higher markers indicate higher likelihood of Heart failure

40
Q

LDL

A

less than 100 mg/dL desirable

41
Q

HDL

A

less than 40 is low in males
60 or more is desirable

42
Q

Triglycerides

A

less than 150 mg/dl

43
Q

C-reactive protein (CRP)

A

0 - 0.5 mg/dL
-indicates inflammation
-high sensitivity CRP is more sensitive to CVD

44
Q

fasting plasma glucose

A

greater than 126 is positive for diabetes
100 - 125 = pre-diabetes

45
Q

hemoglobin A1c

A

less than 7% (ADA)
less than 6.5% (AACE)

46
Q

C peptide

A

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

47
Q

Thyroid stimulating hormone (TSH)

A

0.3 - 3 mIU/L

increases: hypothyroidism
Low: hyperthyroidism

*Amiodarone may increase/decrease

increases (meaning hypothyroidism);
-tyrosine kinase inhibitors
-lithium
-carbamazepine

48
Q

Uric Acid

A

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

49
Q

CD4 T Lymphocyte Count

A

immunocompromised state = less than 200 cells/mm^3

-diagnosis of HIV

50
Q

HIV RNA Concentration (Viral Load)

A

undetectable

51
Q

pH

A

7.35 - 7.45

pH/pCO2/pO2/HCO3/O2 sat

52
Q

Lactic Acid

A

0.5 - 2.2 mEq/L

-indicates anaerobic metabolism

Increases due to:
-NRTIs (HIV)
-metformin

53
Q

Vitamin D serum 25(OH)

A

greater than 30 ng/mL

decreased levels increase the risk of osteoporosis, osteomalacia (rickets)

54
Q

Carbamazepine

A

4 - 12 mcg/mL

55
Q

Digoxin

A

0.8 - 2 ng/mL (AF)
0.5 - 0.9 ng/mL (HF)

56
Q

Gentamicin

A

peak: 5 - 10 mcg/mL
trough: <2 mcg/mL

57
Q

Lithium

A

0.6 - 1.2 mEq/L
(up to 1.5 mEq/L for acute symptoms)

58
Q

Phenytoin/ Free phenytoin

A

10 - 20 mcg/mL
1 - 2.5 mEq/L

59
Q

Procainamide
NAPA
Combined

A

4 - 10 mcg/mL
15 - 25 mcg/mL
10 - 30 mcg/mL

60
Q

Theophylline

A

5 - 15 mcg/mL

61
Q

Tobramycin

A

peak: 5 - 10 mcg/mL
trough: < 2 mcg/mL
Same as gentamicin

62
Q

Valproic Acid

A

50 -100 mcg/mL

63
Q

Vancomycin

A

trough: 15 - 20 mcg/mL
*10 - 15 for non-serious infections

64
Q

Warfarin

A

INR: 2-3
*2.5 to 3.5 for mechanical heart valves

NAPLEX (7 decks)

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