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Naplex 2023 > Lab Values and Drug Monitoring > Flashcards

Lab Values and Drug Monitoring Flashcards

1
Q

CBC components

A

WBC
RBC
PLT

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2
Q

CBC with differential components

A

WBC
RBC
PLT with types of neutrophils analyzed

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3
Q

components of BMP

A

electrolytes
glucose
renal function
acid/base (bicarbonate)

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4
Q

circle stick diagram starting at left and going clockwise - 4 components

A

WBC
Hgb
PLT
Hct

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5
Q

long stick diagram starting at top left and going clockwise - 7 components

A

Na
Cl
BUN
Glucose
SCr
HCO3
K

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6
Q

leukocytosis

A

inc WBC

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7
Q

thrombocytosis

A

inc platelets

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8
Q

leukopenia

A

dec WBC

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9
Q

thrombocytopenia

A

dec platelets

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10
Q

myelosuppression

A

dec WBC, RBC, platelets

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11
Q

agranulocytosis

A

dec granulocytes - neutrophils, basophils, eosinophils

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12
Q

drug causes of agranulocytosis

A

clozapine
propylthiouracil
methimazole
procainamide
carbamazepine
bactrim
isoniazid

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13
Q

calcium

A

calcium corrected calcium if albumin is low

inc from vit d and thiazide diuretics

dec from long-term heparin, loop diuretics, bisphosphonates, and cinacalcet

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14
Q

magnesium

A

dec due to PPIs, diuretics, and amphotericin B

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15
Q

phosphate

A

inc in CKD

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16
Q

potassium

A

inc from ACEi, ARBS, aldosterone antagonists, aliskiren, canagliflozin, cyclosporine, tacrolimus, potassium supplements, bactrim, drospirenone

dec from beta-2 agonists, diuretics, and insulin

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17
Q

sodium

A

inc due to hypertonic saline, tolvaptan

dec from carbamazepine, oxcarbazepine, SSRIs, diuretics

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18
Q

bicarbonate

A

dec from topiramate

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19
Q

BUN

A

inc in renal impairment and dehydration

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20
Q

SCr

A

inc from aminoglucosides, amphotericin B, cisplatin, colistimethate, cyclosporine, loop diuretics, polymyxin, NSAIDs, radiocontrast dye, tacrolimus, vancomycin

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21
Q

anion gap

A

inc in metabolic acidosis

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22
Q

WBC

A

inc from systemid steroids

dec from clozapine, chemoo, carbamazepine, immunosuppressants

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23
Q

neutrophils

A

aka polymorphonuclear cells (PMNs/polys)
aka segmented neutrophils (segs)

bands = immature neutrophils; fight infection (“left shift” when inc)

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24
Q

eosinophils

A

inc in asthma, inflammation, parasitic infection

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25
basophils
inc in hypersensitivity reactions
26
lymphocytes
inc in viral infections, lymphoma dec in bone marrow suppression, HIV, systemic steroids
27
RBC
inc from erythropoiesis-stimulating agents dec from chemo, deficiency anemias (B12, folate), hemolytic anemia, sickle cell anemia
28
hemoglobin
inc from ESA dec in anemias
29
MCV
inc (macrocytic anemia) from B12 or folate deficiency dec (microcytic anemia) from iron deficiency
30
folic acid
part of macrocytic anemia workup dec from phenytoin/fosphenytoin, phenobarbital, primidone, methotrexate, bactrim
31
vitamin B12
dec from PPIs and metformin
32
reticulocyte count
dec in untreated anemia and bone marrow suppression
33
Coombs test, direct
used in diagnosis of hemolytic anemia when cause is unclear hemolytic anemia caused by penicillins and cephalosporins (prolonged use/high concentrations), dapsone, isoniazid, levodopa, methyldopa, methylene blue, nitrofurantoin, pegloticase, primaquine, quinidine, quinine, rasburicase, rifampin, and sulfonamides
34
G6PD
determines if hemolytic anemia is from G6PD deficiency RBC destruction with G6PD deficiency from fava beans, dapson, methylene blue, nitrofurantoin, pegloticase, primaquine, rasburicase, and sulfonamides
35
Anti-Xa
used to monitor LMWH therapeutic dose: take peak 4 hrs after SC LMWH dose UFH: take level 6 hrs after IV starts and every 6 hours until therapeutic
36
PT/INR
monitors warfarin inc w/o warfarin from liver disease false inc from daptomycin, oritavancin, telavancin
37
activated partial thromboplastin time
UFH: obtain 6 hrs after IV start and every 6 hrs until therapeutic false inc from oritavancin, telavancin
38
platelets
life of 7-10 days dec from LMWH, fondaparinux, linezolid, and valproic acid
39
heparin-induced platelet antibodies
if HIT is suspected - ELISA first, then SRA to confirm
40
albumin
dec from cirrhosis and malnutrition dec will impact highly protein-bound drugs: warfarin, calcium, phenytoin correct phenytoin and calcium concentrations for low albumin
41
ALT and AST
inc from injured hepatocytes
42
bilirubin
used to determine causes of liver damage and detect bile duct blockage
43
ammonia
measured in suspected hepatic encephalopathy inc from valproic acid, topiramate dec from lactulose
44
liver/hepatic panel
AST, ALT, Tbili, albumin, Alk phos assess acute and chronic liver inflammation/disease and baseline and routine monitoring of hepatotoxic drugs
45
amylase and lipase
inc in pancreatitis pancreatitis can be from didanosine, GLP-1s, DPP-4is, valproic acid, hypertriglyceridemia
46
CK or CPK
assesses muscle inflammation or muscle damage inc from daptomycin, statins, tenofovir, raltegravir, dolutegravir
47
troponin
used in diagnosis of MI
48
BNP and NT-proBNP
markers of cardiac stress high = higher likelihood of HF with symptoms
49
LDL
<100 desirable fast 9-12 hrs before blood draw
50
non-HDL
<130 desirable non-HDL=TC-HDL
51
lipid panel components
TC HDL LDL TG
52
CRP
inc indicates inflammation
53
FPG
>126 = diabetes 100-125 = pre-diabetes fast 8 hours or more
54
A1C
<7% normal average BG over past 3 months
55
eAG
<154 normal 126 = A1C of 6%
56
preprandial BG
80-130 normal
57
postprandial BG
<180 normal
58
c-peptide (fasting)
absent/low in T1DM bc from insulin breakdown
59
TSH
inc = hypothyroidism dec = hyperthyroidism inc or dec from amiodarone, interferons inc from TKI, lithium, carbamazepine causing hypothyroidism
60
uric acid
inc from diuretics, niacin, low dose ASA, pyrazinamide, cyclosporine, tacrolimus, some pancreatic enzymes, some chemo (tumor lysis syndrome)
61
CRP RF ESR ANA
nonspecific for autoimmune disorders, inflammation Drug-induced lupus erythematosus: more likely with anti-TNF agents, hydralazine, isoniazid, methimazole, methyldopa, minocycline, procainamide, propylthiouracil, quinidine, terbinafine; d/c causative drug
62
CD4 T-lymphocyte count
<200 = immunocompromised assess HIV and monitor treatment
63
HIV RNA viral load
used to assess HIV and monitor treatment
64
pH pCO2 pO2 HCO3 O2 sat
make up arterial blood gas pH/pCO2/pO2/HCO3/O2 sat
65
PSA
used in detecting prostate cancer and BPH
66
hCG
positive = pregnancy
67
LH
rises = ovulation
68
lactic acid
inc from NRTIs and metformin
69
prolactine
inc with haloperidol, risperidone, and paliperidone
70
PPD/TST
TB skin test
71
rapid plasma reagin (RPR) or venereal diseases research laboratory
used to screen for syphilis
72
thiopurine methyltransferase (TMPT)
lower dose of azathioprine and mercaptopurine if genetic deficiency in TMPT
73
vitamin d, serum 25(OH)
dec levels inc risk of osteoporosis, osteomalacia (rickets)
74
carbamazepine therapeutic range
4-12
75
digoxin therapeutic range
0.8-2 (AF) 0.5-0.9 (HF)
76
gentamin therapeutic range
peak: 5-10 trough: <2
77
lithium therapeutic range
0.6-1.2 (up to 1.5 for acute symptoms), drawn as trough
78
phenytoin/fosphenytoin therapeutic range
10-20 (if albumin is low, calculate corrected level)
79
free phenytoin therapeutic range
1-2.5
80
procainamide therapeutic range
4-10
81
NAPA therapeutic range
15-25
82
combined procainamide + NAPA therapeutic range
10-30
83
theophylline therapeutic range
5-15
84
tobramycin therapeutic range
peak: 5-10 trough: <2
85
valproic acid therapeutic range
50-100 (up to 150 in some)
86
vancomycin therapeutic range
trough: 15-20 for most serious infections trough: 10-15 for others
87
warfarin therapeutic range
goal INR 2-3 for most high 2.5-3.5 for high risk (mechanical mitral valve)

Naplex 2023 (21 decks)

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