MSOP Pharmacotherapy 1 test 1

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alpharmgirl
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237610
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MSOP Pharmacotherapy 1 test 1
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2013-09-29 17:29:38
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MSOP pharmacotherapy1
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therapeutic applications of test questions; DLE review
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  1. Sodium
    Low: usually due to excess water / high ADH

    High: severe dehydration, diabetes insipidus, significant renal and GI losses
  2. Potassium
    Low: diuretics, alkalosis, severe v/d, heavy NG suctioning

    High: renal dysfxn, acidosis, K-sparing diuretics, hemolysis, burns, crush injuries
  3. CO2
    • the sum of HCO3 & dissolved CO2
    • reflects acid-base balance
    • compensatory pulm (CO2) & renal (HCO3-)
  4. Chloride
    ***Important for acid-base balance

    Low: due to GI loss (v/d, intestinal fistulas, overdiuresis)
  5. BUN
    • End product of metablolism.
    • Produced by liver.
    • Transported in Blood.
    • Excreted renally.

    High: renal dysfxn, high protein intake, upper GI bleed, volume contraction
  6. Creatinine
    • Major constituent of muscle.
    • Rate of formation=constant
    • Renally excreted.
    • ***Affected by muscle mass.
    • Primary marker for renal fxn (GFR)
    • High: renal dysfunction
  7. Glucose (fasting)
    High: diabetes or adrenal corticosteroids
  8. Total Calcium
    • Regulated by bone redistribution, PTH, Vit D, Calcitonin.
    • **Affected by change in albumin
    • Low: hypothyroidism, Loops, low Vit D
    • High: malignancy & hyperthyroidism
  9. Magnesium
    Low: malabsorption, severe diarrhea, alcoholsim, pancreatitis, diuretics, hyperaldost (weakness, depression, agitation, seizure, hypokal, arrhytmia)

    High: renal fail, hypothyroid, ANTACIDS
  10. Phosphate
    Low: excess aluminum antacids, malabsorption, renal losses, hypercalcemia, refeeding syndrome

    High:renal dysfunction, hypervit D, hypokalemia, hypoparathyroid
  11. Albumin
    • Produced in liver; **PROTEIN BOUND DRUGS!
    • Vital for intravascular osmotic pressure

    Low:liver disease, malnutrition, ascites, hemorrhage, nephropathy

    *Takes 8 days to see 25% chg after sig liver damage (avg. 2 wks b/t draws)
  12. AST
    Used in the monitoring of drug fxn on liver

    • Found in high amts: liver and heart
    • Found in mod amts: muscle, kidney, pancreas

    High: MI & liver injury
  13. ALT
    More liver specificity than AST, but less used in stand alone diagnostics
  14. Total Bilirubin
    • Breakdown product of Hgb
    • Bound to ALBUMIN
    • Conjugated in liver

    High: hemolysis, cholestasis, liver injury
  15. CK-MB
    High energy tissues

    High CK: IM injury, MI, acute psychotic episodes
  16. Troponin (cTnI)
    More specific than CK-MB for myocardial damage (elevated sooner and lasts longer)

    >2.0=injury
  17. Hct
    Low: anemias, bleeding, hemolysis

    High: polycythemia, chronic hypoxia
  18. WBC
    neutrophils+lymphocytes+monocytes+eosinophils+basophils

    High: infection & stress
  19. neutrophils
    High: bacterial/fungal infection
  20. Bands
    High: bacterial infection
  21. Platelets
    • <100 x 10^3 / microL= thrombocytopenia
    • <20 x 10^3 / microL= High risk for severe bleeding
  22. Arterial pH
    Low: acidosis

    High: alkalosis
  23. Blood Anion Gap outside normal range 5-12
    Blood: metabolic acid/base

    Urine: diag of Renal Tubular Acidosis

    ***This level should NOT include K+
  24. Absolute Neutrophil Count (ANC)
    Necessary to determine safety of giving live vaccines (chemo)

    • caution 500-1000 / mm^3
    • Risk <500/mm^3
  25. Reasons to Use
    Corrected Total Calcium
    Low ALBUMIN= Low Complex Ca=Low Total Ca with NORMAL LEVELS OF FREE CA

    *If symptomatic= always request free levels!
  26. Causes of Low Albumin (& corrections needed due to this)
    • 1. Burn victims
    • 2. liver probs
    • 3. malnutrition
    • 4. CHF
    • *calcium adjustments
    • *dilantin adjustments
  27. Reasons for False High K+ results
    • lab error
    • hemolysis of RBC (tourniquet)

    *request lab smear or restick @diff. location!
  28. CBC vs. CBC diff
    • CBC: RBC, WBC, Hgb, Hct, RBC indicators, reticulocyte count, PLT
    • CBC diff: all this, plus- neutro,eosin,baso,mono,lymphocyte counts
  29. What do the elements of CBC diff indicate?
    • 1. neutrophils- High: infection/inflamm
    • 2. eosinophils- parasitic infection/allergy
    • 3. basophilia- chronic inflamm
    • 4. monocytosis- recovery stat of bact inf/TB
    • 5. lymphocytosis- viral infections/lymphoma
  30. Child-Pugh Classification elements and ranges
    • Elements: albumin, total bili, prothrombin/INR
    •     WITH ascites & encephalopathy

    Ranges: A=minimal (5-6), B=Mod (7-9), C=severe (10+)

    This helps us in DOSING MEDS
  31. MELD Score
    *Used to ID liver transplant & severity of disease...DIAGNOSTIC (not Dosing)

    • 1. Scr
    • 2. Total Bili
    • 3. INR
    • 4. Serum Na+
  32. Arterial Blood Gases (5)
    • 1. pH (7.35-7.45)
    • 2. pCO2 (35-45 mmHg)
    • 3. pO2 (80-100mmHg)
    • 4. calc. HCO3 (22-26 mEq/L)
    • 5. O2 saturation (>95%)
  33. Uses and normal ranges of INR
    • 1. efficacy and safety of a/coag
    • 2. diag (liver fxn, malnutrition *leafy greens)

    • 0.9-1.0=normal
    • 2.0-3.0=a/coag normal
    • 2.5-3.5=metal valve pts normal

    High=High bleed risk; Low=clotting risk
  34. Major reasons for using lab data in med therapy
    • 1. Diagnosing presence of disease or health issues
    • 2. Determine baseline before therapy
    • 3. Monitor progress toward therapy goal
    • 4. Direct pt. PK parameters to adjust for renal/hepatic impairment
    • 5. Specific drug level monitor for toxic or suptherapeutic
  35. potential factors in lab errors and interpretation
    age, wt, diet, gender, muscle mass, medications

    Improper: handling,reagents, timing of draw
  36. "reference range"
    statistically derived numerical range obtained by testing a healthy individual
  37. "positive vs. negative" test
    Qualitative test that is reported w/o quantifying

    (pregnancy= +/-  yes/no)
  38. "critical value"
    a lab result that is outside of reference range AND indicates high risk mortality
  39. "therapeutic range"
    where desired clinical response is high and probability of toxicity is low
  40. 7 Steps to Approaching a DI question
    • 1. secure demographics (audience)
    • 2. obtain background info (what & why)
    • 3. Determine and categorize the ULTIMATE Q
    • 4. Design a plan & search
    • 5. Evaluate, analyze, synthesize
    • 6. Response
    • 7. Follow up and DOCUMENT
  41. The 4 D's of Problem Solving
    • Define the problem
    • Design a process to solve the problem
    • Do research, analysis, etc
    • Debrief
  42. Study Designs
    • CCT/RCT (prospective)
    • Cross Over (prospective)
    • Cohort (prospective)
    • Cohort (retrospective)
    • Case-Control (retrospective)
    • Cross-Sectional
    • Case Report
  43. The 3 elements to the Null Hypothesis
    • 1. no difference
    • 2. intervention & control
    • 3. a measurable endpoint
  44. AMA journal citation
    * 6+ authors= 1st 3, then 'et al.'

    Hunter DJ, Hankinson SE Jr, Laden F, et al. Plasma organochlorine levels and the risk of breast cancer. N Engl J Med. 1997;337(18):1253-1258.
  45. Power (1-Beta)
    The ability of the study to DETECT A DIFFERENCE IN OUTCOME EFFECT between intervention and control. Increase power by increasing n.

  46. Best use for CCT/RCT
    most accurate estimate of treatment efficacy and safety
  47. Best use for Cross-Sectional study
    accuracy of a diagnostic test
  48. Best use for a Cohort study
    answering questions about prognosis

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