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NAPLEX topics > Reference Ranges > Flashcards

Reference Ranges Flashcards

1
Q

calcium

A

8.5-10.5 mg/dl

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2
Q

calculate corrected calcium if

A

albumin is low

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3
Q

increased Ca due to

A

calcium supplementation, thiazide diuretics, vitamin D

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4
Q

decreased Ca due to

A

long-term heparin, loop diuretics, bisphosphonates, cinacalcet

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5
Q

chloride (Cl)

A

95-106 mEq/L

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6
Q

magnesium (Mg)

A

1.3-2.1 mEq/L

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7
Q

decrease Mg due to

A

PPIs, diuretics, amphotericin B

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8
Q

phosphate (PO4)

A

2.3-4.7 mEq/L

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9
Q

increased PO4 due to

A

CKD

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10
Q

potassium (K)

A

3.5-5 mEq/L

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11
Q

increased K due to

A

ACEi, ARB, aldosterone receptor antagonists (ARAs), aliskiren, canagliflozin, cyclosporine, tacrolimus, potassium supplements, SMX/TMP, drospirenone-containing oral contraceptives

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12
Q

decreased K due to

A

beta-2 agonists, diuretics, insulin, sodium polystyrene sulfonate

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13
Q

sodium (Na)

A

135-145 mEq/L

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14
Q

decreased Na due to

A

hypertonic saline, tolvaptan

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15
Q

decreased Na due to

A

carbamazepine, oxcarbazepine, SSRIs, diuretics

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16
Q

bicarb (HCO3)

A

venous: 24-30 mEq/L
arterial: 22-26 mEq/L

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17
Q

increased bicarb due to

A

loop diuretics, systemic steroids

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18
Q

decreased bicarb due to

A

topiramate, zonisamide, salicylate overdose

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19
Q

BUN

A

7-20 mg/dl

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20
Q

increased BUN due to

A

renal impairment and dehydration

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21
Q

SCr

A

0.6-1.3 mg/dl

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22
Q

increased SCr due to

A

drugs that impair renal function: aminoglycosides, amphotericin B, cisplatin, colistimethate, cyclosporine, loop diuretics, polymixin, NSAIDs, radiocontrast dye, tacrolimus, vancomycin

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23
Q

glucose

A

70-110 mg/dl

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24
Q

anion gap (AG)

A

5-12 mEq/L

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25
Q

increased AG suggests

A

metabolic acidosis (increased acidity in the blood)

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26
Q

WBCs

A

4,000-11,000 cells/mm3

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27
Q

WBC count can increase due to

A

systemic steroids

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28
Q

WBC count can decrease due to

A

clozapine, chemotherapy that targets the blood marrow, carbamazepine, immunosuppressants (DMARDs, biologics)

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29
Q

neutrophils

A

45-73%

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30
Q

neutrophils are also called

A

PMNs, polys, segs

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31
Q

bands

A

3-5% (left shift when elevated)

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32
Q

what are bands?

A

immature neutrophils released from the bone marrow to fight infection

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33
Q

eosinophils

A

0-5%

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34
Q

basophils

A

0-1%

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35
Q

lymphocytes

A

20-40%

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36
Q

lymphocytes decrease due to

A

bone marrow suppression, HIV, or due to systemic steroids

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37
Q

RBCs in females

A

4.1-4.9 x10^6 cells/microliters

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38
Q

RBCs in males

A

4.5-5.5 x10^6 cells/microliters

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39
Q

average lifespan of RBCs

A

120 days

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40
Q

RBCs increase due to

A

erythropoiesis-stimulating agents (ESAs)

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41
Q

RBCs decrease due to

A

chemotherapy that targets the bone marrow, low production, blood loss, deficiency anemia (B12, folate), hemolytic anemia, sickle cell anemia

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42
Q

Hgb in males

A

13.5-18 g/dL

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43
Q

Hgh in females

A

12-16 g/dL

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44
Q

Hgb increase due to

A

ESAs

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45
Q

Hgb decrease due to

A

anemias and bleeding (drug-induced causes include anticoagulants, antiplatelets, fibrinolytics)

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46
Q

mean corpuscular volume (MCV)

A

80-100 fL

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47
Q

what does the MCV reflect

A

size and average volume of RBCs

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48
Q

increased MCV (macrocytic anemia)

A

due to B12 or folate deficiency

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49
Q

decreased MCV (microcytic anemia)

A

due to iron deficiency

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50
Q

folic acid (folate)

A

5-25 mcg/L

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51
Q

folic acid decrease due to

A

phenytoin/fosphenytoin, phenobarbital, primidone, methotrexate

52
Q

who should take folate supplements

A

women of childbearing age and alcohol use disorder

53
Q

reticulocyte count

A

0.5-2.5%

54
Q

reticulocyte count decrease due to

A

untreated anemia, bone marrow suppression

55
Q

Coombs Test, Direct (direct antiglobulin test)

A

negative

56
Q

Coombs Test is used for the diagnosis of

A

immune-mediated hemolytic anemia

57
Q

which drugs can cause immune-mediated hemolytic anemia

A

penicillins, cephalosporins, isoniazid, levodopa, methyldopa, quinidine, rifampin, sulfonamides

58
Q

glucose-6-phosphate dehydrogenase (G6PD)

A

5-14 units/gram

59
Q

when do we look at G6PD?

A

when determining if hemolytic anemia is due to G6PD deficiency

60
Q

G6PD deficiency causes

A

RBC destruction with G6PD deficiency is triggered by stress, foods (fava beans), or drugs (dapsone, methylene blue, nitrofurantoin, pegloticase, primaquine, rasburicase, quinidine, quinine, sulfonamides

61
Q

Anti-Xa

A

used to monitor low molecular weight heparins (LMWH) and unfractionated heparin (UFH)

62
Q

when to obtain anti-Xa level in LMWH therapy

A

obtain peak anti-Xa level 4 hours after SC LMWH dose of 1.0-2.0 IU/mL

63
Q

when to obtain anti-Xa level in unfractionated heparin therapy

A

obtain 6 hours after IV infusion starts and every 6 hours until therapeutic (0.3-0.7 IU/mL)

64
Q

Prothrombin Time/International Normalized Ratio (PT/INR)

A

PT: 10-13 seconds (varies)
INR: <1.2 (if not on warfarin)

65
Q

what is PT/INR used for

A

to monitor warfarin

66
Q

why would INR increase

A

without taking warfarin, increased INR is typically due to liver disease

67
Q

false increases in PT/INR can occur with

A

daptomycin, oritavancin, televancin

68
Q

what is aPTT used for?

A

used to monitor unfractionated heparin (UFH)

69
Q

false increase in aPTT can occur with

A

oritavancin, televancin

70
Q

aPTT

A

22-38 seconds (“control”)

71
Q

when to obtain aPTT in UFH therapy

A

obtain 6 hours after IV infusion starts and every 6 hours until therapeutic

72
Q

what is aPTT goal on UFH therapy

A

1.5-2.5x control

73
Q

PLTs

A

150,000-450,000 cells/mm^3

74
Q

what is the avg life span of PLTs?

A

7-10 days

75
Q

PLTs are required for

A

clot formation, spontaneous bleeding can occur when PLTs are <20,000 cells/mm^3

76
Q

when would PLTs decrease

A

heparin, LMWH, fondaparinux, linezolid, valproic acid

77
Q

albumin

A

3.5-5 g/dL

78
Q

albumin decrease due to

A

cirrhosis, malnutrition

79
Q

impact of low albumin

A

serum levels of highly protein-bound drugs (warfarin, calcium, phenytoin)

80
Q

which drugs require correction of low albumin

A

phenytoin and calcium (a “free” phenytoin or ionized calcium does not require adjustment)

81
Q

AST/ALT

A

10-40 units/L

82
Q

what is AST and ALT

A

enzymes released from injured hepatocytes (liver cells)

83
Q

bilirubin

A

0.1-1.2 mg/dL

84
Q

why do we look at bilirubin?

A

used along with other liver tests to determine causes of liver damage and detect bile duct blockage

85
Q

ammonia

A

though not diagnostic, often measured in suspected hepatic encephalopathy (HE)

86
Q

increased ammonia due to

A

valproic acid, topiramate

87
Q

decreased ammonia due to

A

lactulose

88
Q

amylase

A

60-180 units/L

89
Q

lipase

A

5-160 units/L

90
Q

when would amylase and lipase increase?

A

increased in pancreatitis which can be caused by didanosine, stavudine, GLP-1 agonists, DPP-4 inhibitors, VPA, hypertriglyceridemia

91
Q

CK or CPK

A

males: 55-170 IU/L
females: 30-135 IU/L

92
Q

what is CK used for

A

used to assess muscle inflammation (myositis) or more serious muscle damage, and to diagnose cardiac conditions

93
Q

increased CK can be due to

A

daptomycin, statins, tenofovir, raltegravir, dolutegravir

94
Q

BNP and NT-proBNP

A

markers of cardiac stress (higher values indicate a higher likelihood of HF); renal failure is the second most common cause of increased BNP and NT-proBNP

95
Q

LDL

A

<100 mg/dl is desirable

96
Q

total cholesterol

A

<200 mg/dL

97
Q

non-HDL

A

<130 mg/dL is desirable

98
Q

triglycerides

A

<150 mg/dL

99
Q

TC, HDL, LDL, TG

A

lipid panel which is ordered to assess the major cholesterol types and determine CV risk

100
Q

C-reactive protein (CRP)

A

0-0.5 mg/dl

101
Q

increased CRP

A

indicates inflammation (infection, trauma, malignancy)

102
Q

fasting plasma glucose (FPG) in diabetes

A

> 126 mg/dL (diagnostic)

103
Q

FPG diagnostic for pre-diabetes

A

100-125 mg/dL

104
Q

hemoglobin A1c

A

<7% (ADA)
=< 6.5% (AACE)

105
Q

what is A1c?

A

inc glucose -> inc BG attached to Hgb -> inc A1c

106
Q

ADA goals

A

FBG: 80-130 mg/dL
PPG: <180 mg/dL
A1c: <7%

107
Q

AACE goals

A

FBG: <110 mg/dL
PPG: <140 mg/dL
A1c: <6.5%

108
Q

C-peptide

A

insulin breakdown product; absent or low in T1DM (dysfunctional beta cells)

109
Q

T1DM

A

-autoimmune
-immune system attack and destroy insulin-producing beta cells in the pancreas

110
Q

T2DM

A

-insulin resistance
-our body’s cells do not respond effectively to insulin

111
Q

urinary albumin excretion (UAE)

A

<30 mg/24 hours

112
Q

normal albumin excretion

A

-healthy kidneys have intact glomeruli (filtering units) and tubules that prevent significant protein leakage
-normal albumin excretion in urine is minimal

113
Q

abnormal albumin excretion

A

when glomeruli is damaged, they become “leaky” allowing albumin to enter the urine

114
Q

TSH

A

0.3-3 mIU/L

115
Q

increased TSH

A

hypothyroidism

116
Q

decreased TSH

A

hyperthyroidism

117
Q

which drugs effect TSH levels

A

amiodarone, interferons

118
Q

which drugs can cause increased TSH (hypothyroidism)

A

tyrosine kinase inhibitors, lithium, carbamazepine

119
Q

uric acid in males

A

3.5-7.2 mg/dl

120
Q

uric acid in females

A

2-6.5 mg/dl

121
Q

uric acid can increase due to

A

diuretics, niacin, low doses of aspirin, pyrazinamide, cyclosporine, select pancreatic enzyme products, select chemotherapy (due to TLS)

122
Q

drug induced lupus erythrematous (DILF)

A

anti-TNF agents, hydralazine, isoniazid, methimazole, methyldopa, minocyclcine, procainamide, propylthiouracil, quinidine, terbinafine

123
Q

CD4 T lymphocyte count

A

immunocompromised state: <200 cells/mm3

124
Q

pH

A

7.35-7.45

125
Q

prostate-specific antigen (PSA)

A

<4 ng/mL

126
Q

lactic acid (lactate)

A

0.5-2.2 mEq/L

127
Q
A

NAPLEX topics (2 decks)

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