Monitoring drug therapy PART 2

Question 1

Renal function is calculated by working out the clearance of what product? Give the equation for this

Ranges:
M - 90-140ml/min
F - 80-125ml/min

Answer 1

Creatinine

CrCl= Urine x flow rate (V) / Plasma conc

Question 2

Cockcroft & Gault equation calculates creatinine clearance. What is the equation?

What are the values of F for male and female?

Answer 2

CrCl= F(140-age) x weight/ plasma Cr

F = 1.04 in females
F = 1.23 in males

Question 3

Creatinine is a by-product of normal muscle metabolism and is eliminated by the kidney

Creatinine plasma concentration depends on what 2 (or 3) things?

Answer 3

Muscle mass and break down

Ability of the kidney

Question 4

Rapid fall in creatinine indicates what?

Answer 4

acute renal failure

Question 5

What causes an increase in Urea? (4)
What causes a decrease in urea? (2)

hint: something about hydration in both

Answer 5

Increase in urea:
Renal failure, increase catabolism, GI bleeding, dehydration

Decrease in urea: low protein diet and water retention

Question 6

What is the normal range for Urea?

Answer 6

2.5 - 7.8 mmol/L

Question 7

Comparing serum creatinine with urea conc is an indicator of hydration
What does a serum creatinine: urea ration indicate when:
Above 15
Below 15

Answer 7

Above 15: renal impairment

Below 15: dehydration

Question 8

What does an increase in white blood cells indicate?

What does LOW red blood cells indicate?

What is C-reactive protein an indicator for?

Answer 8

a) high WBC- inflammation
b) low RBC- blood loss or decreased production

c) C-reactive protein is an indicator for inflammation or infection
So an increase suggests bac inf, auto-immune disease, acute phase response, inflam

Question 9

Prothrombin time (PT) is usually 10-14 seconds, why would liver impairment cause an increase in PT?

Answer 9

• clotting factor dependent on Vitamin K
• Vit K needed to activate clotting factors
• Liver impairment: Vit K absorption reduced, increases PT

Question 10

What can cause Liver cell destruction? 4

Answer 10

Alcohol, hepatitis, drugs, biliary destruction

Question 11

Cause of Cholestasis:

Answer 11

Failure of bile to reach duodenum

Question 12

Bilirubin is excreted in bile, where is it processed before hand?

Answer 12

Liver

Question 13

What is the cause of pre-hepatic (haemolytic) jaundice?

And what kind of bilirubin is produced

Answer 13

Production of bilirubin exceeds capacity to process

Unconjugated bilirubin in blood

Question 14

What is the cause of Intra-hepatic (hepatocellular) jaundice?

What kind of bilirubin is produced?

Answer 14

Liver unable to utilise bilirubin

caused by liver disease

Conjugated and unconjugated bilirubin in blood

Question 15

What is the cause of post-hepatic (obstructive) jaundice?

What kind of bilirubin is produced?

Answer 15

Obstruction of bile duct

caused by gall stones or drugs

Conjugated bilirubin in blood

Question 16

Target BP?

Question 17

Normal pulse:

Answer 17

60-70 bpm

Question 18

Causes of pyrexia?

Answer 18

infection

Question 19

Normal respiratory rate

Answer 19

12-16 bpm, increases with exacerbation of asthma and COPD