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NAPLEX Prep > Lab Values/Drug Monitoring > Flashcards

Lab Values/Drug Monitoring Flashcards

1
Q

CBC lab check will include

A

WBCs, RBCs, PLTs

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2
Q

CBC with differential will include _______ compared to just CBC

A

differential = diff types of neutrophils

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3
Q

RBCs have average life span of _______

A

120 days

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4
Q

Platelets have average life span of ______

A

7 - 10 days

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5
Q

BMP/CMP will have what in results?

A

Na/Cl/K
BUN/SCr
HCO3
Glucose

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6
Q

Normal Calcium Levels?
Total:
Ionized:

A

Total: 8.5 - 10.5 mg/dL
Ionized: 4.5 - 5.1 mg/dL

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7
Q

Calcium:

Calculate “corrected” calcium if _____ is low

A

albumin

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8
Q

What things can increase calcium levels?

A

vitamin D

thiazide diuretics

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9
Q

What things can decrease calcium levels

A

long term heparin
loop diuretics
bisphosphonates
cinacalcet

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10
Q

Normal Magnesium Levels?

A

1.3 - 2.1 mEq/L

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11
Q

what drugs can decrease magnesium levels?

A

PPIs

diuretics

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12
Q

Normal Phosphate Levels?

A

2.3 - 4.7 mg/dL

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13
Q

Normal Potassium Levels?

A

3.5 - 5 mEq/L

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14
Q

what drugs can increase potassium levels?

A 
ACEIs/ARBs
ARAs (aldosterone receptor antagonists)
tacrolimus
K+ supplements...
drospirenone BCs
canagliflozin
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15
Q

what drugs can decrease potassium levels?

A

beta 2 agonists
diuretics
insulin

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16
Q

What drugs can decrease sodium levels?

A

carbamazepine
oxcarbazepine
SSRIs
diuretics

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17
Q

what drugs can decrease bicarbonate levels?

A

topiramate

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18
Q

what are some drugs that can increase SCr

A 
aminoglycosides
vancomyocin
amphotericin B
cisplatin
cyclosporine/tacrolimus
loop diuretics
NSAIDs
radiocontrast dye
colistimethate
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19
Q

WBCs:

can be increased due to surgery/inflammation/infections but what drug notably increase WBCs?

A

systemic steroids

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20
Q

WBCs:

what drugs can notably cause low WBC counts?

A

chemo
Clozapine
Carbamazepine

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21
Q

_____ are immature neutrophils;
they get released from bone marrow to fight an infection

called a _____ shift

A

bands;

left

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22
Q

Increased _______ can mean drug allergy, asthma, parasitic infection

A

eosinophils

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23
Q

Increased _______ can mean viral infections, lymphoma

A

lymphocytes…

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24
Q

what lab value helps determine if an anemia is B12/folate or iron deficient

A

MCV - mean corpuscular volume

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25
Q

If MCV is high —- it means it could be a ______ deficient anemia

A

B12 or folate

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26
Q

If MCV is low —- it means it could be a ______ deficient anemia

A

iron

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27
Q

Hgb can be high due to _______

A

ESAs (erythropoiesis stimulating agents)

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28
Q

what drugs can decrease folic acid levels?

A

sulfa drugs (bactrim)
phenytoin/fosphenytoin
methotrexate

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29
Q

what drugs can decrease B12 levels

A

PPIs

metformin

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30
Q

what test can be used to see if hemolytic anemia is autoimmune or drug induced

A

Coombs test

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31
Q

A coombs test will be positive or negative if it is drug induce hemolytic anemia

A

positive

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32
Q

what drugs can cause a positive coombs test?

A 
PCNs/cephalosporins
isoniazid
levodopa
methyldopa
nitrofurantoin
quinidine/quinine
rifampin
sulfonamides
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33
Q

what is the G6PD test used for? (related to anemia)

A

test to see if the hemolytic anemia is related to due a G6PD deficiency (result will be low if it is)

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34
Q

RBC destruction with G6PD destruction is triggered by what food?

A

fava beans

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35
Q

RBC destruction with G6PD destruction is triggered by what drugs?

A 
chlorquine
dapsone
methylene blue
nitrofurantoin
primaquine
probenecid
quinine/quinidine
rasburicase
sulfonamides
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36
Q

Antifactor Xa activity (Anti-Xa) is used to monitor what drugs?

A

LMWH

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37
Q

Antifactor Xa will (increase or decrease) due to heperain/LWMH

A

will increase

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38
Q

what patient population is Antifactor Xa monitoring highly recommended?

A

pregnancy

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39
Q

Obtain an Antifactor Xa level how long after a dose?

A

4 hours after dose

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40
Q

Pt/INR is used to monitor what drug…..

A

warfarin

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41
Q

Activated partial thromboplastin time (aPTT or PTT) is used to monitor what drug?

A

unfractionated heparin

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42
Q

platelet counts can decrease due to what drugs?

A

heparin/LMWH
fondaparinux
valproic acid

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43
Q

When albumin levels change – highly protein drugs can be affected (example of a highly protein drug that the book points out…)

44
Q

what drugs require correction when albumin is low?

A

phenytoin
valproic acid
calcium serum concentrations

45
Q

normal albumin levels?

A

3.5 - 5 g/dL

46
Q

what monitoring levels can be drawn that are enzymes related to injured hepatocytes?

A

AST and ALT
(aspartate aminotransferase)
(alanine aminotransferase)

47
Q

what enzyme levels will increase if pancreatitis is present?

A

amylase and lipase

48
Q

what drugs can increase pancreatitis risk?

A

GLP-1 agonists
hypertriglyceridemia
didanosine (is an antiviral)

49
Q

albumin levels can decrease because what organ is having dysfunction?

A

liver (cirrhosis)

50
Q

what monitoring level will alter when muscle inflammation is present – can be used to diagnose some cardiac conditions

A

CPK/CK - creatine phosphokinase/creatine kinase

51
Q

what drugs can increase CPK levels

A

daptomyacin
statins
tenofovir
raltegravir/dolutegravir

52
Q

what enzymes are used to diagnose an MI?

A

CK-MB enzymes
Troponin
BNP
NT-proBNP

53
Q

_______ and _____ are markers for cardiac stress

A

BNP and NT-proBNP

are NOT HF or heart disease specific – but probs HF when there are HF symptoms present too

54
Q

Normal BNP levels?

A

< 100 pg/mL or ng/L

55
Q

Normal TC (total cholesterol) levels ?

A

< 200 mg/dL

56
Q

Normal HDL (high density lipoprotein) levels?

A

> 60 - is desirable

< 40 - low

57
Q

Normal TG (triglyceride) levels?

A

< 150 mg/dL

58
Q

CRP levels indicate _______

A

inflammation

c-Reactive protein

59
Q

TSH levels — will be increased or decrease in HYPOthyroidism

60
Q

what drugs can increase TSH levels

A

lithium

and amiodarone and interferons – these can also decrease TSH levels

61
Q

what drugs can increase uric acid levels?

A

diuretics
niacin
pyrazinamide (drug used for tuberculosis)

62
Q

what are some nonspecific tests used in autoimmune disorders, inflammation, infection?

A

CRP (c-reactive protein)
RF (rheumatoid factor)
ESR (erythrocyte sedimentation rate)
ANA (antinuclear antibodies)

63
Q

what drugs can cause DILE (drug induced lupus erythematosus)

A 
anti-TNF agents
hydralazine
isoniazid
methimazole
methyldopa
minocycline
procainamide
propylthiouracil
quinidine
terbinafine
64
Q

what are the 2 main monitoring things looked at for HIV management

A

CD4+ t lymphocyte count

HIV RNA concentration = viral load

65
Q

what lab values consist of an ABG sample?

A

ABG = arterial blood gas

pH, pCO2, pO2, HCO3, O2 sat

66
Q

Lactic acidosis = ______ metabolism

67
Q

what drugs can increase lactic acid levels?

A

NRTIs

metformin

68
Q

Prolactin (secretions related to dopamine)

what drugs can increase prolactin levels?

A

haloperidol
risperidone
paliperidone

69
Q

what drug can decrease prolactin levels

A

bromocriptine

70
Q

what specific item is used/injected for the TB skin test?

A

PPD - purified protein derivative aka Mantoux test

71
Q

what does RPR stand for and what is it used to screen for?

A

RPR = rapid plasma reagin

screens for syphillis

72
Q

A genetic deficiency that leads to a low TPMT levels will affect what drug?

A

azathiopurine (use lower doses of this drug)

73
Q

If you see the following labs: elevated BNP/NTproBNP - what diagnosis could this mean?

A

Heart failure

74
Q

If you see the following labs: low Hgb/Hct/RBC with symptoms of SOB, fatigue, weakness, pallor, exercise intolerance
- what diagnosis could this mean?

A

anemia

or blood loss – blood loss might have chest pain/tachycardia too

75
Q

If you see the following labs: increased AST/ALT and symptoms of N/V, jaundice, abdominal pain
- what could the diagnosis be?

A

ACUTE liver injury

76
Q

If you see the following labs: increased INR, low albumin, low platelets and symptoms of N/V, jaundice, abdominal pain plus ascites, edema, drowsiness, confusion
- what could the diagnosis be?

A

CHRONIC liver disease

77
Q

If you see the following labs: increased amylase/lipase and symptoms of N/V, jaundice, abdominal pain (worse after eating usually)?

A

pancreatitis

78
Q

If you see the following labs: increased Alk Phos/T bili/GGT and slightly increased AST/ALT and symptoms of pruritis, light colored stools, jaundice, N/V
- what could the diagnosis be?

A

cholestasis

79
Q

If you see the following labs: increased BUN/SCr and maybe high K+ and asymptomatic - what could the diagnosis be?

A

AKI

(if not caused by dehydration the BUN:SCr ratio is probably < 20:1

80
Q

If you see the following labs: increased BUN/SCr and maybe high K+ and dry mouth, headache symptoms - what could the diagnosis be?

A

dehydration

probably will have BUN:SCr ratio of > 20:1

81
Q

If you see the following labs: High BUN, SCr, K, PO4, PTH and low Ca and Hgb;
symptoms make be edema, weight loss, fatigue, pruritis
what could the diagnosis be?

A

CKD (untreated)

82
Q

If you see the following labs: increase WBCs and neutrophils/bands and symptoms of increased temp and many other symptoms -
what could the diagnosis be?

A

infection - bacterial

83
Q

If you see the following labs: increased/normal WBCs and normal neutrophils/bands and a variety of other symptoms -
what could the diagnosis be?

A

infection - viral

84
Q

if you see increased eosinophils what could the diagnosis be?

A

infection - parasitic

85
Q

If you see the following labs: increased ESR/CRP/ANA and symptoms of achy joints, butterfly rash, fatigue -
what could the diagnosis be?

A

SLE - systemic lupus erythemous

86
Q

If you see the following labs: increased ESR/CRP/ANA and symptoms of joint stiffness/swollen joints -
what could the diagnosis be?

A

Rheumatoid arthritis

87
Q

If you see the following labs: increased CPK and SCr and symptoms of muscle pain, N/V, dark urine -
what could the diagnosis be?

A

Rhabdomyolsis

88
Q

what symptoms will somebody with lactic acidosis present with?

A

decreased blood pressure
deep/sighing respirations
confusion

89
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Amikacin (traditional dosing)
peak?
trough?

A

P: 20 - 30 mcg/mL
T: < 5

90
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Carbamazepine

A

4 - 12 mcg/mL

91
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Digoxin

A

for Afib: 0.8 - 2 ng/mL

for HF: 0.5 - 0.9 ng/mL

92
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Gentamicin (traditional dosing)
peak?
trough?

A

P: 5 - 10 mcg/mL
T: < 2 mcg/mL

93
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Lithium

A

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

94
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Phenobarbitol/Primidone

A

20 - 40 mcg/mL (adults)

95
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Enoxaparin - VTE tx - DAILY therapy:

A

AntiXa: 1 - 2 units/mL

96
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Enoxaparin - VTE tx - Q12H therapy:

A

AntiXa: 0.6 - 1 units/mL

97
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Enoxaparin - recurrent VTE prophylaxis in pregnancy:

A

AntiXa: 0.2 - 0.6 units/mL

98
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Phenytoin/fosphenytoin

A

10 - 20 mcg/mL — do correction if albumin is low

99
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Free phenytoin

A

1 - 2.5 mcg/mL

100
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Theophylline

A

5 - 15 mcg/mL

5 - 10 mcg/mL (neonates)

101
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range? (below is antiarrhythmic drugs)
Procainamide?
NAPA?
Combined?

A

P: 4 - 10 mcg/mL
NAPA: 15 - 25 mcg/mL
Combined: 10 - 30 mcg/mL

102
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Tobramycin (traditional dosing)
peak?
trough?

A

P: 5 - 10 mcg/mL
T: < 2 mcg/mL

103
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Valproic acid

A

50 - 100 mcg/mL (can go up to 150 in some patients)

adjust if low albumin

104
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Vancomyocin
trough?

A

T: 15 - 20 mcg/mL (for very serious conditions)
T: 10 - 15 mcg/mL (for others)

105
Q

Therapeutic Drug Monitoring: what is the usual therapeutic range?
Warfarin

A

INR: 2 - 3 for most disease states

2.5 - 3.5 if mechanical mitral valve

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