Lab Values/Drug Monitoring Flashcards
1
Q
CBC lab check will include
A
WBCs, RBCs, PLTs
2
Q
CBC with differential will include _______ compared to just CBC
A
differential = diff types of neutrophils
3
Q
RBCs have average life span of _______
A
120 days
4
Q
Platelets have average life span of ______
A
7 - 10 days
5
Q
BMP/CMP will have what in results?
A
Na/Cl/K
BUN/SCr
HCO3
Glucose
6
Q
Normal Calcium Levels?
Total:
Ionized:
A
Total: 8.5 - 10.5 mg/dL
Ionized: 4.5 - 5.1 mg/dL
7
Q
Calcium:
Calculate “corrected” calcium if _____ is low
A
albumin
8
Q
What things can increase calcium levels?
A
vitamin D
thiazide diuretics
9
Q
What things can decrease calcium levels
A
long term heparin
loop diuretics
bisphosphonates
cinacalcet
10
Q
Normal Magnesium Levels?
A
1.3 - 2.1 mEq/L
11
Q
what drugs can decrease magnesium levels?
A
PPIs
diuretics
12
Q
Normal Phosphate Levels?
A
2.3 - 4.7 mg/dL
13
Q
Normal Potassium Levels?
A
3.5 - 5 mEq/L
14
Q
what drugs can increase potassium levels?
A
ACEIs/ARBs ARAs (aldosterone receptor antagonists) tacrolimus K+ supplements... drospirenone BCs canagliflozin
15
Q
what drugs can decrease potassium levels?
A
beta 2 agonists
diuretics
insulin
16
Q
What drugs can decrease sodium levels?
A
carbamazepine
oxcarbazepine
SSRIs
diuretics
17
Q
what drugs can decrease bicarbonate levels?
A
topiramate
18
Q
what are some drugs that can increase SCr
A
aminoglycosides vancomyocin amphotericin B cisplatin cyclosporine/tacrolimus loop diuretics NSAIDs radiocontrast dye colistimethate
19
Q
WBCs:
can be increased due to surgery/inflammation/infections but what drug notably increase WBCs?
A
systemic steroids
20
Q
WBCs:
what drugs can notably cause low WBC counts?
A
chemo
Clozapine
Carbamazepine
21
Q
_____ are immature neutrophils;
they get released from bone marrow to fight an infection
called a _____ shift
A
bands;
left
22
Q
Increased _______ can mean drug allergy, asthma, parasitic infection
A
eosinophils
23
Q
Increased _______ can mean viral infections, lymphoma
A
lymphocytes…
24
Q
what lab value helps determine if an anemia is B12/folate or iron deficient
A
MCV - mean corpuscular volume
25
If MCV is high ---- it means it could be a ______ deficient anemia
B12 or folate
26
If MCV is low ---- it means it could be a ______ deficient anemia
iron
27
Hgb can be high due to _______
ESAs (erythropoiesis stimulating agents)
28
what drugs can decrease folic acid levels?
sulfa drugs (bactrim)
phenytoin/fosphenytoin
methotrexate
29
what drugs can decrease B12 levels
PPIs
| metformin
30
what test can be used to see if hemolytic anemia is autoimmune or drug induced
Coombs test
31
A coombs test will be positive or negative if it is drug induce hemolytic anemia
positive
32
what drugs can cause a positive coombs test?
```
PCNs/cephalosporins
isoniazid
levodopa
methyldopa
nitrofurantoin
quinidine/quinine
rifampin
sulfonamides
```
33
what is the G6PD test used for? (related to anemia)
test to see if the hemolytic anemia is related to due a G6PD deficiency (result will be low if it is)
34
RBC destruction with G6PD destruction is triggered by what food?
fava beans
35
RBC destruction with G6PD destruction is triggered by what drugs?
```
chlorquine
dapsone
methylene blue
nitrofurantoin
primaquine
probenecid
quinine/quinidine
rasburicase
sulfonamides
```
36
Antifactor Xa activity (Anti-Xa) is used to monitor what drugs?
LMWH
37
Antifactor Xa will (increase or decrease) due to heperain/LWMH
will increase
38
what patient population is Antifactor Xa monitoring highly recommended?
pregnancy
39
Obtain an Antifactor Xa level how long after a dose?
4 hours after dose
40
Pt/INR is used to monitor what drug.....
warfarin
41
Activated partial thromboplastin time (aPTT or PTT) is used to monitor what drug?
unfractionated heparin
42
platelet counts can decrease due to what drugs?
heparin/LMWH
fondaparinux
valproic acid
43
When albumin levels change -- highly protein drugs can be affected (example of a highly protein drug that the book points out...)
warfarin
44
what drugs require correction when albumin is low?
phenytoin
valproic acid
calcium serum concentrations
45
normal albumin levels?
3.5 - 5 g/dL
46
what monitoring levels can be drawn that are enzymes related to injured hepatocytes?
AST and ALT
(aspartate aminotransferase)
(alanine aminotransferase)
47
what enzyme levels will increase if pancreatitis is present?
amylase and lipase
48
what drugs can increase pancreatitis risk?
GLP-1 agonists
hypertriglyceridemia
didanosine (is an antiviral)
49
albumin levels can decrease because what organ is having dysfunction?
liver (cirrhosis)
50
what monitoring level will alter when muscle inflammation is present -- can be used to diagnose some cardiac conditions
CPK/CK - creatine phosphokinase/creatine kinase
51
what drugs can increase CPK levels
daptomyacin
statins
tenofovir
raltegravir/dolutegravir
52
what enzymes are used to diagnose an MI?
CK-MB enzymes
Troponin
BNP
NT-proBNP
53
_______ and _____ are markers for cardiac stress
BNP and NT-proBNP
| are NOT HF or heart disease specific -- but probs HF when there are HF symptoms present too
54
Normal BNP levels?
< 100 pg/mL or ng/L
55
Normal TC (total cholesterol) levels ?
< 200 mg/dL
56
Normal HDL (high density lipoprotein) levels?
> 60 - is desirable
< 40 - low
57
Normal TG (triglyceride) levels?
< 150 mg/dL
58
CRP levels indicate _______
inflammation
| c-Reactive protein
59
TSH levels --- will be increased or decrease in HYPOthyroidism
increased
60
what drugs can increase TSH levels
lithium
| and amiodarone and interferons -- these can also decrease TSH levels
61
what drugs can increase uric acid levels?
diuretics
niacin
pyrazinamide (drug used for tuberculosis)
62
what are some nonspecific tests used in autoimmune disorders, inflammation, infection?
CRP (c-reactive protein)
RF (rheumatoid factor)
ESR (erythrocyte sedimentation rate)
ANA (antinuclear antibodies)
63
what drugs can cause DILE (drug induced lupus erythematosus)
```
anti-TNF agents
hydralazine
isoniazid
methimazole
methyldopa
minocycline
procainamide
propylthiouracil
quinidine
terbinafine
```
64
what are the 2 main monitoring things looked at for HIV management
CD4+ t lymphocyte count
| HIV RNA concentration = viral load
65
what lab values consist of an ABG sample?
ABG = arterial blood gas
pH, pCO2, pO2, HCO3, O2 sat
66
Lactic acidosis = ______ metabolism
anaerobic
67
what drugs can increase lactic acid levels?
NRTIs
| metformin
68
Prolactin (secretions related to dopamine)
what drugs can increase prolactin levels?
haloperidol
risperidone
paliperidone
69
what drug can decrease prolactin levels
bromocriptine
70
what specific item is used/injected for the TB skin test?
PPD - purified protein derivative aka Mantoux test
71
what does RPR stand for and what is it used to screen for?
RPR = rapid plasma reagin
screens for syphillis
72
A genetic deficiency that leads to a low TPMT levels will affect what drug?
azathiopurine (use lower doses of this drug)
73
If you see the following labs: elevated BNP/NTproBNP - what diagnosis could this mean?
Heart failure
74
If you see the following labs: low Hgb/Hct/RBC with symptoms of SOB, fatigue, weakness, pallor, exercise intolerance
- what diagnosis could this mean?
anemia
| or blood loss -- blood loss might have chest pain/tachycardia too
75
If you see the following labs: increased AST/ALT and symptoms of N/V, jaundice, abdominal pain
- what could the diagnosis be?
ACUTE liver injury
76
If you see the following labs: increased INR, low albumin, low platelets and symptoms of N/V, jaundice, abdominal pain plus ascites, edema, drowsiness, confusion
- what could the diagnosis be?
CHRONIC liver disease
77
If you see the following labs: increased amylase/lipase and symptoms of N/V, jaundice, abdominal pain (worse after eating usually)?
pancreatitis
78
If you see the following labs: increased Alk Phos/T bili/GGT and slightly increased AST/ALT and symptoms of pruritis, light colored stools, jaundice, N/V
- what could the diagnosis be?
cholestasis
79
If you see the following labs: increased BUN/SCr and maybe high K+ and asymptomatic - what could the diagnosis be?
AKI
| (if not caused by dehydration the BUN:SCr ratio is probably < 20:1
80
If you see the following labs: increased BUN/SCr and maybe high K+ and dry mouth, headache symptoms - what could the diagnosis be?
dehydration
| probably will have BUN:SCr ratio of > 20:1
81
If you see the following labs: High BUN, SCr, K, PO4, PTH and low Ca and Hgb;
symptoms make be edema, weight loss, fatigue, pruritis
what could the diagnosis be?
CKD (untreated)
82
If you see the following labs: increase WBCs and neutrophils/bands and symptoms of increased temp and many other symptoms -
what could the diagnosis be?
infection - bacterial
83
If you see the following labs: increased/normal WBCs and normal neutrophils/bands and a variety of other symptoms -
what could the diagnosis be?
infection - viral
84
if you see increased eosinophils what could the diagnosis be?
infection - parasitic
85
If you see the following labs: increased ESR/CRP/ANA and symptoms of achy joints, butterfly rash, fatigue -
what could the diagnosis be?
SLE - systemic lupus erythemous
86
If you see the following labs: increased ESR/CRP/ANA and symptoms of joint stiffness/swollen joints -
what could the diagnosis be?
Rheumatoid arthritis
87
If you see the following labs: increased CPK and SCr and symptoms of muscle pain, N/V, dark urine -
what could the diagnosis be?
Rhabdomyolsis
88
what symptoms will somebody with lactic acidosis present with?
decreased blood pressure
deep/sighing respirations
confusion
89
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Amikacin (traditional dosing)
peak?
trough?
P: 20 - 30 mcg/mL
T: < 5
90
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Carbamazepine
4 - 12 mcg/mL
91
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Digoxin
for Afib: 0.8 - 2 ng/mL
| for HF: 0.5 - 0.9 ng/mL
92
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Gentamicin (traditional dosing)
peak?
trough?
P: 5 - 10 mcg/mL
T: < 2 mcg/mL
93
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Lithium
0.6 - 1.2 mEq/L (can go up to 1.5 for acute symptoms)
94
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Phenobarbitol/Primidone
20 - 40 mcg/mL (adults)
95
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Enoxaparin - VTE tx - DAILY therapy:
AntiXa: 1 - 2 units/mL
96
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Enoxaparin - VTE tx - Q12H therapy:
AntiXa: 0.6 - 1 units/mL
97
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Enoxaparin - recurrent VTE prophylaxis in pregnancy:
AntiXa: 0.2 - 0.6 units/mL
98
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Phenytoin/fosphenytoin
10 - 20 mcg/mL --- do correction if albumin is low
99
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Free phenytoin
1 - 2.5 mcg/mL
100
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Theophylline
5 - 15 mcg/mL
| 5 - 10 mcg/mL (neonates)
101
Therapeutic Drug Monitoring: what is the usual therapeutic range? (below is antiarrhythmic drugs)
Procainamide?
NAPA?
Combined?
P: 4 - 10 mcg/mL
NAPA: 15 - 25 mcg/mL
Combined: 10 - 30 mcg/mL
102
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Tobramycin (traditional dosing)
peak?
trough?
P: 5 - 10 mcg/mL
T: < 2 mcg/mL
103
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Valproic acid
50 - 100 mcg/mL (can go up to 150 in some patients)
| *adjust if low albumin*
104
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Vancomyocin
trough?
T: 15 - 20 mcg/mL (for very serious conditions)
T: 10 - 15 mcg/mL (for others)
105
Therapeutic Drug Monitoring: what is the usual therapeutic range?
Warfarin
INR: 2 - 3 for most disease states
| 2.5 - 3.5 if mechanical mitral valve
