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Labs Flashcards

1
Q

What do the following labs order:
-Complete Blood Count (CBC)
-CBC with differential

A

CBC:
-White blood cells (WBCs) = leukocytes
-Red blood cells (RBCs) = erythrocytes
-Platelets (PLTs)

CBC w/ differential: CBC labs + types of WBCs ordered

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2
Q

What do the following labs order:
-Basic metabolic panel (BMP)
-Comprehensive metabolic panel (CMP)

A

BMP: electrolytes, glucose, renal function, and acid/base tests
-Some calculate anion gap

CMP: BMP labs + albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, total protein
-Addition tests for liver function

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3
Q

Calcium (Ca++):
-Common Reference Range (likely provided on NAPLEX)
-Interpretation of values/drugs that can cause imbalances
-When supplementation is indicated

A

Ranges:
-Ca, total: 8.5-10.5 mg/dL
-Ca, ionized: 4.5-5.1 mg/dL

Interpretation:
-FIRST: is albumin low? yes –> calculate corrected Ca++
-High Ca: could be Ca supplementation, vitamin D, or thiazide diuretics
-Low Ca: long-term HEPARIN, LOOP DIURETICS, BISPHOSPONATES, cinacalcet, systemic steroids, calcitonin, foscarnet, topiramate

Supplementation: in pregnancy, osteoporosis/osteopenia, certain medications

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4
Q

Magnesium (Mg):
-Common Reference Range (likely provided on NAPLEX)
-Drugs that can cause imbalances
-When supplementation is indicated

A

Range: 1.3-2.1 mEq/L

Drug-induced:
-High: magnesium-containing antacids and laxatives –> risk of renal impairment
-Low: PPIs, DIURETICS, AMPHOTERICIN B, foscarnet, echinocandins, diarrhea, chronic alcohol intake

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5
Q

Phosphate (PO4):
-Common Reference Range (likely provided on NAPLEX)
-Interpretation of values/causes of imbalances

A

Range: 2.3-4.7 mg/dL

Interpretation:
-High: CHRONIC KIDNEY DISEASE
-Low: phosphate binders, foscarnet, oral Ca+ intake

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6
Q

Potassium (K+):
-Common Reference Range (likely provided on NAPLEX)
-Drug causes of imbalances

A

Range: 3.5-5 mEq/L

Drug-induced:
-RAAS Inhibitors: ACEIs, ARBs, aliskiren
-K+-sparing diuretics
-Others: CANAGLIFLOZIN, CYCOSPORINE, TACROLIMUS, K+-SPARING DIURETICS, K+ SUPPLEMENTS, SMX/TMP, DROSPIRENONE, oral contraceptives, chronic heparin use NSAIDs, pentamidine

Low levels: BETA-2 AGONISTS, DIURETICS (not-K sparing), INSULIN, SODIUM POLYSTYRENE SULFONATE, steroids, conivaptan

Mycophenolate: can increase and decrease K+

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7
Q

Sodium (Na):
-Common Reference Range (likely provided on NAPLEX)
-Drug causes of imbalances

A

Range: 135-145 mEq/L

Drug-induced:
-High: HYPERTONIC SALINE, TOLVAPTAN, conivaptan
-Low: CARBAMAZEPINE, OXCARBAZEPINE, SSRIs, DIURETICS, desmopressin

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8
Q

Bicarbonate (HCO3):
-Common Reference Range (likely provided on NAPLEX)
-Interpretation/Drug causes of imbalances

A

Range:
-Venous: 24-30 mEq/L
-Arterial: 22-26 mEq/L

Interpretation: used to assess acid-balance status

Drug-induced:
-High: loop diuretics, systemic steroids
-Low: TOPIRAMATE, zonisamide, salicyclate overdose

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9
Q

Blood Urea Nitrogen (BUN):
-Common Reference Range (likely provided on NAPLEX)
-Interpretation

A

Range: 7-20 mg/dL

Interpretation: used with SCr to assess fluid status and renal function - high levels/ratios between BUN:SCr suggests renal impairment and dehydration

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10
Q

Serum Creatinine (SCr):
-Common Reference Range (likely provided on NAPLEX)
-Drugs that increase SCr
-Drugs that falsely increase SCr
-Causes of low SCr

A

Range: 0.6-1.3 mg/dL

Drug-induced Increased SCr (KNOW ALL):
-Antimicrobials: aminoglycosides, Amphotericin B, polymixin, colistimethate, vancomycin
-Oncology, immune modulators: cyclosporine, tacrolimus, cisplatin
-Others: NSAIDs, loop diuretics, radiocontrast dye

False increased SCr: SMX/TMP, H2RAs, cobicistat

Low SCr: decreased muscle mass, amputation, hemodilution

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11
Q

Anion Gap (AG):
-Common Reference Range (likely provided on NAPLEX)
-Interpretation

A

Range: 5-12 mEq/L

Interpretation: calculated value that when increased, suggests metabolic acidosis

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12
Q

White Blood Cells (WBCs):
-Common Reference Range (likely provided on NAPLEX)
-Interpretation
-Drug causes of imbalances

A

Range: 4,000-11,000 cells/mm3

Interpretation: used to diagnose/monitor infections or inflammation
-Increases can be acute phase reactant from stress (ex. surgery)

Drug-induced:
-High: SYSTEMIC STEROIDS, colony stimulating factors, epinephrine
-Low: CLOZAPINE, CARBAMAZEPINE, CHEMOTHERAPY, IMMUNOSUPPRESSANTS (DMARDs, biologics), cephalosporins, procainamide, vancomycin

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13
Q

Neutrophils (segmented and bands):
-Common Reference Range (likely provided on NAPLEX)
-Interpretation

A

Range:
-Neutrophils, segmented (polymorphonuculear segmented) 43-75%
-Bands (immature neutrophils): 3-5%

Interpretation: used to assess likelihood of acute infection
-Can be used with WBCs for absolute neutrophil count (ANC) calculation
-Bands specifically are released from bone marrow to fight infections (“left shift” when elevated)

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14
Q

Eosinophils:
-Common Reference Range (likely provided on NAPLEX)
-Interpretation

A

Range: 0-5%

Interpretation: increased during drug allergy, asthma, inflammation, and parasitic infections

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15
Q

Basophils:
-Common Reference Range (likely provided on NAPLEX)
-Interpretation

A

Range: 0-1%

Interpretation: increased from inflammation, HYPERSENSITIVITY RXNS, and leukemia

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16
Q

Lymphocytes:
-Common Reference Range (likely provided on NAPLEX)
-Interpretation

A

Range: 20-40%

Interpretation:
-High: viral infections, lymphoma
-Low: bone marrow suppression, HIV, systemic steroids

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17
Q

Red Blood Cells (RBCs):
-Common Reference Range (likely provided on NAPLEX)
-Interpretation

A

Range:
-Males: 4.5-5.5 x10^6 cells/uL
-Females: 4.1-4.9 x10^6 cells/uL

Interpretation:
-RBCs have an average lifespan of 120 days
-High: erythropoesis-stimulating agents (ESAs), smoking, polycythemia (condition that increases RBCs)
-Low: chemotherapy, low production, blood loss, deficiency anemia, hemolytic anemia, sickle cell anemia

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18
Q

Hemoglobin (Hgb, Hb):
-Common Reference Range (likely provided on NAPLEX)
-Interpretation

A

Range:
-Males: 13.5-19 g/dL
-Females: 12-16 g/dL

Interpretation: iron-containing protein that carries oxygen in RBCs
-High: erythropoesis-stimulating agents (ESAs)
-Low: anemias, bleeding, drug-induced (anticoagulatns, antiplatelets, anti-fibrinolytics)

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19
Q

Mean Corpuscular Volume (MCV):
-Common Reference Range (likely provided on NAPLEX)
-Interpretation

A

Range: 80-100 fL

Interpretation: reflects size and average volume of RBCs
-High: macrocytic anemia due to B12 or folate deficiency
-Low: microcytic anemia due to iron deficiency

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20
Q

Folic Acid (folate):
-Common Reference Range (likely provided on NAPLEX)
-Interpretation
-Drugs that can cause high folate
-When to supplement folate

A

Range: 5-25 mcg/L

Interpretation: deficiency suggests macrocytic anemia

Drug-induced:
-High: PHENYTOIN (fosphenytoin), PHENOBARBITAL, PRIMIDONE, METHOTREXATE, SMX/TMP, sulfasalazine

Supplementation: consider in women of child-bearing age and alcohol use disorder

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21
Q

Vitamin B12:
-Common Reference Range (likely provided on NAPLEX)
-Drugs that can cause low B12

A

Range: >200 pg/mL

Drug-induced B12 deficiency: METFORMIN, PROTON PUMP INHIBITORS, colchicine, chloramphenicol

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22
Q

Reticulocyte Count:
-Common Reference Range (likely provided on NAPLEX)
-Interpretation

A

Range: 0.2-0.5%

Interpretation: the amount of reticulocytes (immature RBCs) made by bone marrow
-High: blood loss, hemolysis
-Low: untreated anemia (iron, folate, or B12 deficiency), bone marrow suppression

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23
Q

Coombs Test, Direct (“Direct Antiglobulin Test = DAT”)
-Test is used for the diagnosis of _____________
-What are drugs that can cause this?

A

Positive: immune-mediated hemolytic anemia

Drug-induced: penicillins, cephalosporins, isoniazid, levodopa, methyldopa, quinidine, quinine, rifampin, sulfonamides

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24
Q

Glucose-6-Phosphate Dehydrogenase (G6PD):
-Common Reference Range (likely provided on NAPLEX)
-Interpretation

A

Range: 5-14 units/g

Interpretation: RBC destruction can be triggered with deficiency caused by stress, food (fava beans), or drugs (dapsone, methylene blue, nitrofurantoin, pegloticase, primaquine, rasburicase, quinidine, quinine, and sulfonamides)

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25
Anti-Factor Xa Activity (Anti-Xa): -Activity should be monitored _____ hours after administration of low molecular weight heparin (LMWH) is given as peak dose, and ______ hours after heparin. -What are the typical ranges? -Who is specifically indicated for LMWH monitoring?
Range: -LMWH: monitor 4 hours afters; range: 1.0-2.0 IU/mL -Heparin: monitor 6 hours after; range: 0.3-0.7 IU/mL LMWH Monitoring: pregnancy -May be used in obesity, low body weight, pediatrics, elderly, renal insufficiency
26
Prothrombin Time (PT) / International Normalized Ratio (INR) -Common Reference Range (likely provided on NAPLEX) -Purpose of INR -What disease state increases INR? -What drugs falsely evelate INR?
Range: -PT: 10-13 seconds (can vary) -INR: <1.2 (if NOT on warfarin) Purpose: used to monitor warfarin -Increased INR (w/o being on warfarin): liver disease -False increased INR from drugs: daptomycin, ortivancin, televancin
27
Activated Partial Thromboplastin Time (aPTT or PTT): -Common Reference Range (likely provided on NAPLEX) -Monitor ______ hours after administering heparin. What is the goal when on heparin? -What drugs can cause false increases in aPTT?
Range: 22-38 seconds (can Unfractionated heparin (UFH): take 6 hours after infusion starts and Q6 hours until therapeutic - goal is to be 1.5-2.5x the control False increases: ortivancin, telavancin
28
Platelets (PLTs): -Common Reference Range (likely provided on NAPLEX) -Interpretation -Drugs that lower PLTs
Range: 150,000-450,000 cells/mm3 Interpretation: PLTs have average lifespan of 7-10 days, and spontaneous bleeding can occur when <20,000 cells/mm3 Drugs that lower PLTs: HEPARIN, LMWHs, FONDAPARINUX, LINEZOLID, VALPROIC ACID, glycoprotein IIb/IIIa receptor antagonists, chemotherapy
29
Albumin: -Common Reference Range (likely provided on NAPLEX) -What can cause low albumin? -What highly protein-bound drugs will be affected by low albumin?
Range: 3.5-5 g/dL Low albumin: cirrhosis, malnutrition Highly-protein bound drugs: warfarin, calcium, phenytoin -Phenytoin and serum calcium levels require correction for low albumin
30
Aspartate Aminotransferase (AST) / Alanine Aminotransferase (ALT): -Common Reference Range (likely provided on NAPLEX) -Interpretation
Range: -AST: 10-40 units/L -ALT: 10-40 units/L Interpretation: enzymes that are released from injured hepatocytes
31
Billirubin, total (Tbili): -Common Reference Range (likely provided on NAPLEX) -Interpretation
Range: 0.1-1.2 mg/dL Interpretation: used along with other liver tests to determine causes of liver damage and detect bile duct blockage
32
Amylase and Lipase: -Common Reference Range (likely provided on NAPLEX) -Interpretation/drug causes
Range: -Amylase: 60-180 units/L -Lipase: 5-160 units/L Interpretation: increased in pancreatitis, which can be caused by didanosine, stavudine, GLP-1 agonists, DPP-4 inhibitors, valproid acid, hypertriglyceridemia
33
Creatine Kinase (CK) / Creatine Phosphokinase (CPK): -Common Reference Range (likely provided on NAPLEX) -Interpretation -What drugs increase these levels
Range: -Males: 55-170 IU/L -Females: 5-160 IU/L Interpretation: used to assess muscle inflammation (myositis) or more serious muscle damage; for diagnosis of cardiac conditions Increased from: DAPTOMYCIN, STATINS, TENOFOVIR, RALTEGRAVIR, DOLUTEGRAVIR, emtricitabine, fibrates (especially when given w/ statin), tipranavir
34
Cardiovascular Markers: Explain what each of the following indicates if elevated: -CK-MB Isoenzymes -Troponin T (TnT) -Troponin I (TnI) -B-Type Natriuretic Peptide (BNP) -N-Terminal-ProBNP (NT-proBNP)
CK-MB, TnT, TnI: diagnosis of MI -Troponins can be elevated in sepsis, PE, or CKD BNP and NT-proBNP: markers of cardiac stress with likelihood of HF when consistent WITH SYMPTOMS -Second common reason for elevation is renal failure Myoglobin and CK-MB are NOT interchangeable -Myoglobin: sensitive marker for muscle injury, but relatively low specificity for acute MI
35
Lipid Panel: Typical values for for -Total Cholesterol (TC) -High Density Lipoprotein (HDL) -Low Density Lipoprotein (LDL) -Trigylcerides (TG) Fasting should occur ____-____ hours before blood draw
TC: <200mg/dL HDL: ideally >/= 60 mg/dL (men low: <40; women low <50) LDL: <100mg/dL (hx of ASCVD: <70 mg/dL) TG: <150 mg/dL (>500: increased risk for pancreatitis) Fasting: 9-12 hours before blood draw
36
C-reactive protein (CRP): -Common Reference Range (likely provided on NAPLEX) -Interpretation
Range: 0-0.5 mg/dL Interpretation: increased levels indicate inflammation (infection, trauma, malginancy) -High-sensitivity CRP (hs-CRP) more sensitive for CVD
37
Fasting Plasma Glucose (FPG): -Common Reference Range (likely provided on NAPLEX) -Fasting should occur at least ____ hours before blood draw
Range: -Prediabetes: 100-125mg/dL -Diabetes: >/=126 mg/dL Fasting: at least 8 hours before blood draw
38
Hemoglobin A1c (A1c): -Common Reference Range (likely provided on NAPLEX) -Interpretation
Range: -ADA: <7% -AACE:
39
C-Peptide (fasting): -Common Reference Range (likely provided on NAPLEX) -Interpretation
Range: 0.78-1.89 ng/mL Interpretation: insulin breakdown product used to evaluate beta-cell function (distinguishes T1DM from T2DM) -Decreased or absent in T1DM
40
Urinary Albumin Excretion (UAE): -Common Reference Range (likely provided on NAPLEX)
Range: <30 mg/24 hours
41
Thyroid Stimulating Hormone (TSH): -Common Reference Range (likely provided on NAPLEX) -Interpretation -Drugs that can change TSH levels
Range: 0.3-3 mIU/L Interpretation: used with T4 to diagnose hypo- or hyperthyroidism and monitoring -High TSH = hypothyroidism (TSH produced in higher amounts to signal to thyroid to make hormones) -Low TSH = hyperthyroidism (TSH produced in lower amounts for less thyroid production) Drugs: -Decreased TSH: amiodarone, interferons -Increased TSH: amiodarone, inteferons, tyrosine kinase inhibitors, lithium, carbamazepine
42
Uric Acid: -Common Reference Range (likely provided on NAPLEX) -Interpretation -Drugs that increase uric acid
Range: -Male: 3.5-7.2mg/dL -Females: 2-6.5mg/dL Interpretation: used in diagnosis/TX of gout Drugs that increase uric acid: diuretics, niacin, low doses of ASA, pyrazinamide, cyclosporine, select pancreatic enzyme products, select chemotherapy from tumor lysis syndrome
43
Inflammation / Autoimmune Disease Markers: Explain the interpretation of the following -C-Reactive Protein (CRP) -Rheumatoid Factor (RF) -Erythrocyte Sedimentation Rate (ESR) -Antinuclear Antibodies (ANA)
ALL are NON-specific tests CRP: high risk >3 mg/dL (normal: 0-0.5mg/dL) RF: usually negative or less than upper limit, usually <20 IU/mL ESR: -Males:
44
HIV Measures: Explain the interpretation of the following: -CD4 T Lymphocyte Count -HIV RNA Concentration ("Viral Load")
Used to diagnose HIV and monitor TX -CD4 count used to indicate immune function and establish need for opportunistic infection prophylaxis
45
Prostate-Specific Antigen (PSA): -Common Reference Range (likely provided on NAPLEX) -Interpretation
Range: <4 ng/mL Interpretation: can be used to detect BPH and prostate cancer -Increased with testosterone supplementation
46
Human Chorionic Gonadotropin (hCG): -Interpretation
Interpretation: positive result from blood or urine indicates preganancy
47
Luteinizing Hormone (LH): -Interpretation
Interpretation: rises mid-cycle, causing an egg to release from the ovaries (ovulation)
48
Lactic Acid (Lactate): -Common Reference Range (likely provided on NAPLEX) -Interpretation -Drugs that can increase lactate
Range: 0.5-2.2 mEq/L Interpretation: lactic acidosis indicates anaerobic metabolism, which occurs in long-distance running or certain medical conditions (ex. sepsis) Drugs that increase: NRTIs, metformin (low risk mostly with renal disease and HF), alcohol, cyanide
49
Purified Protein Derivative (PPD) or Tuberculin Skin Test (TST): -Test results for negative -Interpretation
Negative result: no induration (raised area) Interpretation: induration indicates Mycobacterium tuberculosis (latent TB)
50
Interferon-Gamma Release Assay (IGRA): -Common Reference Range (likely provided on NAPLEX) -Interpretation
Range: negative Interpretation: non-treponemal antibody test to screen for syphilis -If these results are positive, test for treponemal assay to confirm
51
Thiopurine Methyltransferase (TPMT): -Common Reference Range (likely provided on NAPLEX) -Interpretation
Range: >/= 15 units/mL Interpretation: genetic deficiency increases risk for myleosuppression potentially requiring lower doses for azathioprine and mercaptopurine
52
25-(OH)-Vitamin D: -Common Reference Range (likely provided on NAPLEX) -Interpretation
Range: >30 ng/mL Interpretation: decreased levels increase risk of osteoporosis, osteomalacia (rickets), CVD, DM, HTN, infectious diseases, and other conditions
53
Usual therapeutic range of: Carbamazepine
4-12 mcg/mL
54
Usual therapeutic range of: Digoxin
Afib: 0.8-2 ng/mL HF: 0.5-0.9 ng/mL
55
Usual therapeutic range of: Gentamicin (traditional dosing)
Peak: 5-10 mcg/mL Trough: <2 mcg/mL
56
Usual therapeutic range of: Lithium
Trough: 0.6-1.2 mEq/L (up to 1.5 mEq/L for acute symptoms)
57
Usual therapeutic range of: -Phenytoin / fosphenytoin -Free Phenytoin
Phenytoin / Fosphenytoin: 10-20 mcg/mL (consider if albumin is low and adjust) Free Phenytoin: 1-2 mcg/mL
58
Usual therapeutic range of: -Procainamide -NAPA (Procainamide active metabolite) -Combined
Procainamide: 4-10 mcg/mL NAPA: 15-25 mcg/mL Combined: 10-30 mcg/mL
59
Usual therapeutic range of: Theophylline
5-15 mcg/mL
60
Usual therapeutic range of: Tobramycin (traditional dosing)
Peak: 5-10 mcg/mL Trough: <2 mcg/mL
61
Usual therapeutic range of: Valproic acid
50-100 mcg/mL
62
Usual therapeutic range of: Vancomycin
Serious infections: AUC/MIC ratio of 400-600 recommended (associated w/ improved outcomes and less toxicity) -Alternatively, trough: 15-20 mcg/mL Other infections, trough: 10-15 mcg/mL
63
Usual therapeutic range of: Warfarin (INR)
Goal INR: 2-3 -2.5-3.5 if higher risk condition

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