Lab Values and Drug Monitoring Flashcards
From left to right, top to bottom, what are the lab values in the fish bone diagram?
Na | Cl | BUN < Glucose
K | HCO3 | SCr
What values do we see in a CBC stick diagram from left to right?
WBC -> Hgb -> Plt -> Hct
Calcium - When do we need to calculate corrected calcium? What are 3 drugs that increase calcium? What are 4 drugs that decrease calcium?
Calculate corrected calcium when albumin is low
Increase Ca:
- calcium supplementation
- vitamin D
- thiazide diuretics
Decrease Ca:
- long-term heparin
- loop diuretics
- bisphosphonates
- cinacalcet
Magnesium - What are 3 drugs that decrease magnesium?
Decrease Mg:
- PPIs
- Diuretics
- Amphotericin B
Phosphate - What disease can increase phosphate?
CKD can increase PO4
Potassium - What are 9 meds that can increase potassium?
Increase K:
- ACEi
- ARB
- aldosterone receptor antagonists (ARAs/MRAs)
- aliskiren
- canagliflozin
- cyclosporine
- tacrolimus
- sulfamethoxazole/trimethoprim
- drospirenone containing oral contraceptives
Sodium - What are 4 meds that can decrease sodium?
Decrease Na:
- carbamazepine
- oxcarbezepine
- SSRIs
- diuretics
Bicarbonate - What is a med that can decrease bicarb?
Decrease HCO3:
- topiramate
What does it mean if bands are increased? What if lymphocytes are increased?
Bands are immature neutrophils that are increased to fight infection.
Lymphocytes are increased in viral infection and lymphoma
What does the Coombs test help us differentiate?
A Coombs test is used when trying to determine if hemolytic anemia is auto immune or drug induced. If we suspect it may be drug induced and theres a positive Coombs test, we need to discontinue the offending drug.
What is a G6PD test used for? What are some drugs that may trigger G6PD?
Used to determine if hemolytic anemia is due to G6PD deficiency.
G6PD deficiency could be triggered by
- dapsone
- methylene blue
- nitrofurantoin
- pegloticase
- primaquine
- rasburicase
- quinidine
- quinine
- sulfonamides
What is the usual therapeutic range for carbamazepine?
carbamezepine: 4-12 mcg/mL
What is the usual therapeutic range for digoxin for AF and HF?
AF: 0.8-2ng/mL
HF: 0.5-0.9ng/mL
What is the desired peak and trough for gentamicin and tobramycin (traditional dosing)?
Peak: 5-10mcg/mL
Trough: <2mcg/mL
What is the usual therapeutic range for lithium? Is it drawn as a peak or trough?
0.6-1.2 mEq/L (up to 1.5mEq/L for acute symptoms)
drawn as trough
What is the usual therapeutic range for phenytoin/fosphenytoin? What about for free phenytoin?
phenytoin/fosphenytoin: 10-20mcg/mL (remember corrected phenytoin equation if albumin is low)
free phenytoin: 1-2mcg/mL
What is the usual range for procainamide? What about NAPA (procainamide active metabolite)? What about combined?
procainamide: 4-10mcg/mL
NAPA: 15-25mcg/mL
combined: 10-30mcg/mL
What is the usual range for theophylline?
5-15mcg/mL
What is the usual range for valproic acid?
50-100mcg/mL (up to 150mcg/mL in some patients)
