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NAPLEX > Lab values and Drug Monitoring > Flashcards

Lab values and Drug Monitoring Flashcards

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1
Q

increase in platelets

A

Thrombocytosis

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1
Q

Increase in WBC

A

leukocytosis

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2
Q

decrease in WBC

A

leukopenia

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3
Q

decrease in platelets

A

Thrombocytopenia

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4
Q

Myelosuppression

A

decrease in RBCs, WBCs, and platelets

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5
Q

Agranulocytosis

A

-decrease in granulocytes (WBCs that have secretory granules in the cytoplasm) -this will decrease neutrophils, basophils and eosinophils
causes: clozapine, propylthiouracil, methimazole,
procainamide, carbamazepine, isoniazid, TMP/SMP

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6
Q

Calcium

A

-8.5 to 10.5 mg/dl
-must be corrected if albumin is low
-vitamin D and thiazides increase it
-long term heparin, loops, bisphosphonates, and cinacalcet decrease it

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7
Q

magnesium

A

1.3-2.1 mEq/L
-decreases due to PPIs, diuretics, amphotericin B

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8
Q

Phosphate (PO4)

A

2.3-4.7 mg/dL
-increases in chronic kidney disease

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9
Q

Potassium

A

3.5 - 5 mEq/L
Increases due to:
-ACE-I and ARBs and ARAs
-aliskiren
-canagliflozin
-cyclosporine
-tacrolimus
-potassium supplements
-TMP/SMP
-drosperinone containing contraceptives

Decreases due to:
-beta-2 agonists
-diuretics
-insulin
-sodium polystyrene sulfonate

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10
Q

Sodium

A

135 - 145 mEq/L
increases due to:
-hypertonic saline
-tolvaptan (anti-diuretic hormone)

decreases due to:
-carbamazepine
-oxcarbazepine
-SSRIs
-diuretics

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11
Q

Bicarbonate (HCO3)

A

Venous: 24 - 30 mEq/L
Arterial: 22 - 26 mEq/L
-used to assess acid-base status

Increases:
-loop diuretics
-systemic steroids

Decreases:
-topiramate
-salicylate overdose

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12
Q

Blood Urea Nitrogen

A

7-20 mg/dL

increases:
-renal impairment and dehydration

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13
Q

Serum Creatinine

A

0.6 - 1.3 mg/dl

Drugs that cause increase:
-aminoglycosides
-amphotericin B
-cisplastin
-colestimethate
-cyclosporine
-loop diuretics
-polymyxin
-NSAIDs
-radiocontrast dye
-tacrolimus
-vancomycin

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14
Q

Glucose

A

70-110 mg/dL

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15
Q

Anion Gap

A

5 - 12 mEq/L

High gap = metabolic acidosis

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16
Q

WBCs

A

4,000 - 11,000

Increases:
-systemic steroids

Decreases:
-clozapine
-chemotherapy
-carbamazepine
-immunosuppressants

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17
Q

Neutrophils

A

45 - 73%
-polymorphonuclear cells (PMNs or polys
-also called segmented neutrophils (segs)
Calculations: absolute neutrophil count (ANC)

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18
Q

Bands

A

3 -5 %
-immature neutrophils
-released from bone marrow to fight infection (left shift)

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19
Q

Eosinophils

A

0 - 5%
-asthma, inflammation, parasitic infection

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20
Q

Basophils

A

0-1%
-hypersensitivity reaction

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21
Q

lymphocytes

A

20 - 40%
-increases in viral infections and lymphoma
-decreases in bone marrow suppression, HIV or systemic steroid use

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22
Q

Red Blood Cells

A

Males: 4.5 -5.5 x 10^6
Females: 4.1 - 4.9 x 10^6

-average life span of 120 days

increases:
-erythropoiesis-stimulating agents (ESAs), smoking and polycythemia

Decreases:
-chemotherapy
-deficiency anemias
-hemolytic anemia
-sickle cell anemia

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23
Q

Hemoglobin

A

Males: 13.5 - 18
Females: 12 - 16

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24
Mean Corpuscular Volume (MCV)
80 - 100 fL -reflects the size and average volume of RBCs Increases: -macrocytic anemia due to B12 and folate deficiency Decreases: -microcytic anemia due to iron deficiency
25
Folic acid (folate)
5 - 25 mcg/L -further work-up of macrocytic anemia Decreases: -phenytoin/fosphenytoin -phenobarbital -primidone -methotrexate -TMP/SMP
26
Vitamin B12
Greater than 200 pg/ml -decreases due to PPIs and metformin
27
Reticulocyte Count
0.5 - 2.5 % -measures the amount of immature RBCs being made in the bone marrow Decreased in untreated anemia or bone marrow suppression
28
Coombs test (DAT)
NEGATIVE -used in diagnosis of immune-mediated hemolytic anemia Drugs that can cause this: -penicillin and cephalosporins -isoniazid -levodopa -methyldopa -quinidine -quinine -rifampin -sulfonamide
29
Glucose-6-Phosphate Dehydrogenase (G6PD)
5 - 14 units/ gram used to determine if hemolytic anemia is due to G6PD deficiency Triggers: -fava beans -dapsone -methylene blue -nitrofurantoin -pegloticase -primaquine -rasburicase -quinidine -quinine -sulfonamides
30
Anti-factor Xa activity (Anti-Xa)
LMWH: 4 hours after SC dose: 1-2 IU/mL UFH: 6 hours after IV: 0.3 - 0.7 IU/mL
31
Prothrombin Time/INR
PT: 10 - 13 seconds INR: less than 1.2 (if not on warfarin) increase in INR w/out warfarin due to liver disease False increase: -daptomycin -oritavancin -telavancin
32
Activated Partial Thromboplastin Time (aPTT or PTT)
22 - 38 seconds (control) GOAL for UFH: 1.5 - 2.5 x control -used to monitor UFH and direct thrombin inhibitors -False increase can occur from oritavancin and telavancin
33
Platelets
150,000 - 450,000 cells/mm^3 -average life span of 7 - 10 days -spontaneous bleeding can occur when platelets are below 20,000 Decreases: -heparin, LMWH, fonaparinux, linezolid, valproic acid
34
Albumin
3.5 - 5 g/dL Decreases: -cirrhosis -malnutrition Highly protein bound drugs = -warfarin -calcium -phenytoin (all impacted by low albumin) *Phenytoin and calcium require correction for low albumin*
35
AST and ALT (Aspartate and Alanine Aminotransferase)
10 - 40 units/L -enzymes released from injured hepatocytes
36
Bilirubin
0.1 - 1.2 mg/dL -determine liver damage and detect bile duct blockage
37
Amylase and Lipase
60 - 180 units 5 - 160 units/L increases in pancreatitis Causes: -didanosine -stavudine -GLP-1 agonists -DPP-4 inhibitors -valproic acid -hypertriglyceridemia
38
Troponin
0-0.1 ng/mL -diagnosis of MI
39
BNP
less than 100 ng/mL -marker of cardiac stress -higher markers indicate higher likelihood of Heart failure
40
LDL
less than 100 mg/dL desirable
41
HDL
less than 40 is low in males 60 or more is desirable
42
Triglycerides
less than 150 mg/dl
43
C-reactive protein (CRP)
0 - 0.5 mg/dL -indicates inflammation -high sensitivity CRP is more sensitive to CVD
44
fasting plasma glucose
greater than 126 is positive for diabetes 100 - 125 = pre-diabetes
45
hemoglobin A1c
less than 7% (ADA) less than 6.5% (AACE)
46
C peptide
0.78 - 1.89 ng/mL -distinguishes type 1 from type 2 diabetes (this is a insulin breakdown product used to evaluate beta-cell function) -low to absent in a type 1 diabetic
47
Thyroid stimulating hormone (TSH)
0.3 - 3 mIU/L increases: hypothyroidism Low: hyperthyroidism *Amiodarone may increase/decrease increases (meaning hypothyroidism); -tyrosine kinase inhibitors -lithium -carbamazepine
48
Uric Acid
Males: 3.5 - 7.2 mg/dL Females: 2 - 6.5 mg/dL Increases due to: -diuretics -niacin -low doses of aspirin -pyrazinamide -cyclosporine -tacrolimus -select pancreatic enzyme products -select chemotherapy
49
CD4 T Lymphocyte Count
immunocompromised state = less than 200 cells/mm^3 -diagnosis of HIV
50
HIV RNA Concentration (Viral Load)
undetectable
51
pH
7.35 - 7.45 pH/pCO2/pO2/HCO3/O2 sat
52
Lactic Acid
0.5 - 2.2 mEq/L -indicates anaerobic metabolism Increases due to: -NRTIs (HIV) -metformin
53
Vitamin D serum 25(OH)
greater than 30 ng/mL decreased levels increase the risk of osteoporosis, osteomalacia (rickets)
54
Carbamazepine
4 - 12 mcg/mL
55
Digoxin
0.8 - 2 ng/mL (AF) 0.5 - 0.9 ng/mL (HF)
56
Gentamicin
peak: 5 - 10 mcg/mL trough: <2 mcg/mL
57
Lithium
0.6 - 1.2 mEq/L (up to 1.5 mEq/L for acute symptoms)
58
Phenytoin/ Free phenytoin
10 - 20 mcg/mL 1 - 2.5 mEq/L
59
Procainamide NAPA Combined
4 - 10 mcg/mL 15 - 25 mcg/mL 10 - 30 mcg/mL
60
Theophylline
5 - 15 mcg/mL
61
Tobramycin
peak: 5 - 10 mcg/mL trough: < 2 mcg/mL *Same as gentamicin*
62
Valproic Acid
50 -100 mcg/mL
63
Vancomycin
trough: 15 - 20 mcg/mL *10 - 15 for non-serious infections
64
Warfarin
INR: 2-3 *2.5 to 3.5 for mechanical heart valves

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