NAPLEX _ Lab Values & Drug Monitoring

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  1. Complete Blood Count (CBC)
    • analyzes:
    • -- WBCs (Neutrophils)
    • -- Hemoglobin and Hematocrit (RBCs)
    • -- Platelets (PLTs)
    • **CBC with Differential == types of neutrophils are analyzed
  2. Basic Metabolic Panel (BMP)
    • 7 or 8 tests ("Fish Diagram"):
    • -- Na | Cl | BUN
    • -- K | HCO3 | SCr
    • -- Glucose
  3. Comprehensive Metabolic Panel (CMP)
    • includes tests from BMP PLUS:
    • -- albumin
    • -- alanine aminotransferase (ALT)
    • -- aspartase aminotransferase (AST)
    • -- total bilirubin
    • -- total protein
  4. High AND Low Terminology
    • HIGH == "cytosis"
    • -- High WBC = leukocytosis
    • -- High Platelets = thrombocytosis
    • LOW == "penia"
    • -- Low WBC = leukopenia
    • -- Low Platelets = thrombocytopenia
  5. Calcium (Ca)
    - Corrected Calcium Equation
    • -- Calculate Corrected Calcium == if albumin is low
    • Ca(corrected) = Ca(reported_serum) + [(4 - albumin) * 0.8]
  6. Calcium (Ca)
    - High [3]
    • Calcium supplementation
    • Vitamin D
    • Thiazide diuretics
  7. Calcium (Ca)
    - LOW [5]
    • Systemic steroids
    • Long-term Heparin
    • Loop diuretics
    • Bisphosphonates
    • Cinacalcet
  8. Magnesium (Mg)
    - LOW [2]
    • PPI's
    • Diuretics
  9. Potassium (K)
    - HIGH [7]
    • ACE inhibitors
    • ARBs
    • Aldosterone receptor antagonist (ARAs)
    • Tacrolimus
    • K supplementation
    • Drosperinone-containing oral contraceptives
    • Canagliflozin
  10. Potassium (K)
    - LOW [3]
    • Beta-2 agonists
    • Diuretics
    • Insulin
  11. Sodium (Na)
    - LOW [4]
    • Carbamazapine
    • Oxcarbazapine
    • SSRIs
    • Diuretics
  12. Bicarbonate (HCO3 or Bicar)
    - LOW [1]
    Lopiramide
  13. Serum Creatinine (SCr)
    - HIGH
    • -- drugs that impair renal function:
    • Aminoglycosides
    • Amphotericin B
    • Cisplatin
    • Colistimethate
    • Cyclosporine
    • Loop Diuretics
    • NSAIDs
    • Radiocontrast dye
    • Tacrolimus
    • Vancomycin
  14. Anion Gap (cells/m^3)
    - Equation
    • -- presence of HIGH anion gap (>12 mEq/L) suggest metabolic acidosis
    • Anion Gap = Na - Cl - HCO3
  15. Absolute Neutrophil Count (ANC) Calculation
    • -- assess likelihood of acute infection (with s/sx)
    • ANC = WBC * [(% segments + % bands) / 100]
    • -- "segments" == "PMNs"
  16. White Blood Cells (WBC)
    - HIGH [1]
    • Systemic Steroids
    • -- can be increased as an acute phase reactant, indicating systemic reaction to INFLAMMATION or STRESS (eg. surgery)
  17. White Blood Cells (WBC)
    - LOW [2]
    • Clozapine
    • Carbamazapine
  18. Neutrophils
    also called Polymorphonuclear cells (PMNs or Polys) and segmented neutrophils (Segs)
  19. Hemoglobin (Hgb | Hb)
    - HIGH [1]
    • Indicates _ Anemia
    • ESAs
    • -- can also be due to Blood Transfusion
    • ** Hematocrit (Hct) = Hgb x 3
  20. Mean Corpuscular Volume (MCV)
    - HIGH [2]
    • Indicates _ Anemia
    • B12 
    • Folate deficiency
  21. Mean Corpuscular Volume (MCV)
    - LOW [1]
    • Indicates _ Anemia
    • Iron deficiency
  22. Coombs Test, Direct
    aka: Direct Antiglobulin Test (DAT)
    • -- used to determine cause of Hemolytic Anemia (autoimmune vs drug-induced)
    • POSITIVE ==> drug-induced hemolysis caused by:
    • -- penicillins and cephalosporins
    • -- isoniazid
    • -- methyldopa
    • -- nitrofurantoin
    • -- quinidine
    • -- quinine
    • -- rifampin
    • -- sulfonamides
    • ** D/C offending Drug
  23. Glucose-6-Phosphate Dehydrogenase (G6PD)
    • -- used to determine if Hemolytic Anemia is due to G6PD deficiency
    • triggered by:
    • -- stress
    • -- food (Fava beans)
    • -- Chloroquine
    • -- Dapsone
    • -- Methylene blue
    • -- Nirtofurantoin
    • -- Primaquine
    • -- Probenacid
    • -- Quinidine
    • -- Quinine
    • -- Rasburicase
    • -- Sulfonamides
  24. Antifactor Xa Activity (Anti-Xa)
    • Anticoagulation
    • Monitors LMWHs (Dalteparin || Enoxaparin || Tinzaparin)
    • -- obtain peak anti-Xa 4 hours after LMWH dose for proper interpretation
    • monitoring is RECOMMENDED in pregnancy
    • INC due to Heparin, LMWHs and fondaparinux
  25. Prothrombin Time / International Normalized Ratio (PT / INR)
    • Anticoagulation
    • Monitors WARFARIN
    • Goal INR == 2 - 3 (most indications)
    • ** 2.5 - 3.5 == Mechanical Mitral Valve -OR- 2 mechanical heart valves
    • -- INR increase (without warfarin) due to liver disease
  26. Activated Partial Thromboplastin Time (aPTT or PTT)
    • Anticoagulation
    • Monitor UNFRACTIONATED HEPARIN (UFH) and direct thrombin inhibitors (Dabigatran || Argatroban || Bivalirudin)
  27. Platelets (PLTs)
    • Anticoagulation
    • == platelets are required for clot formation -- Spontaneous bleeding can occur when platelets are < 20,000 /mm3
    • DEC due to Heparin | LMWH | Fondaparinux | Valproic acid
  28. Albumin
    • Liver and Gatroenterology
    • decrease due to cirrhosis and malnutrition
    • Low Albumin (< 3.5 g/dL) == needs correction
    • -- Phenytoin
    • Phenytoin(corrected) = measured Phenytoin / [(0.2*albumin)+0.1]
    • -- Calcium
    • Ca(corrected) = Ca(serum) + [(4-albumin)*0.8]
    • -- Valproic Acid
  29. Aspartate Aminotransferase (AST)
    Alanine Aminotransferase (ALT)
    • Liver and Gastroenterology
    • == AST and ALT are enzymes released from injured hepatocytes (liver cells)
    • LFT = "liver function test" --> contains AST/ALT values
    • -- mildly increases in people (2x upper normal limit) == not concerning
    • -- WORRY! == AST/ALT is 3-5x UNL == 120 - 150 units/L
  30. Amylase
    Lipase
    • Pancreatitis
    • increase in pancreatitis can be caused by Didanosine, stavudine, GLP-1 agonist (and DPP-4 inhibitors), valproic acid and Hypertriglyceridemia
  31. Creatine Kinase -OR-
    Creatine Phosphokinase
    (CK or CPK)
    • Cardiovascular
    • to assess muscle inflammation (myositis) or more serious muscle damage to diagnose cardiac conditions
    • INC due to Daptomycin || Statins || Tenofovir || Raltegravir || Dolutegravir
  32. B-Type Natriuretic Peptide (BNP)
    N-Terminal-ProBNP (NT-proBNP)
    Troponin (TnT & TnI)
    • Cardiovascular
    • == as a group, called "cardiac enzymes" and are used in the diagnosis of MI
    • BNP and NT-proBNP == are both markers of cardiac stress
    • -- higher values ==> higher likelihood of HF when consistent with HF symptoms
  33. Total Cholesterol (TC)
    High Density Lipoprotein (HDL)
    Low Density Lipoprotein (LDL)
    Triglycerides (TG)
    • Lipids and Cardiovascular Risk
    • Fasting begins 9-12 hours prior to lipid blood draw
    • Supports initiation of a Statin Intensity level
    • TC = HDL + non-HDL
    • HDL -- "good cholesterol"
    • -- < 40 men | < 50 females == Low HDL
    • LDL:
    • -- < 100 = Desirable || >/= 190 = High
    • TG:
    • -- < 150 = Desirable || >/= 500 = High
  34. C-Reactive Protein (CRP)
    • Lipids and Cardiovascular Risk |&| Inflammation/Autoimmune Disease
    • High CRP indicates Inflammation == due to many conditions (infection, trauma, malignancy)
    • Higher levels indicates Increased risk
    • high-sensitive CRP (hs-CRP) is more sensitive to CVD
  35. Hemoglobin A1C (A1C)
    • Diabetes!
    • Average blood glucose over the Past 3 Months
    • -- based on attachment of glucose to hemoglobin: High glucose = High BG attached to Hgb == HIGH A1C
    • Reference Range: < 7% (ADA) | </= 6.5 (AACE)
  36. Thyroid Stimulating Hormone (TSH)
    • Thyroid Function!
    • TSH is used with FT4 to diagnose Hypothyroidism and is used alone (sometimes with FT4) to monitor patients being treated
    • INC or DEC due to Amiodarone || Interferons
    • INC (hypothyroidism) due to Lithium | carbamazepine, oxcarbazepine
    • HIGH TSH == HYPOthyroidism
    • LOW TSH == HYPERthyroidism
  37. Rheumatoid Factor, serum (RF)
    Erythrocyte Sedimentation Rate (ESR)
    Antinuclear Antibodies (ANA)
    • Inflammation / Autoimmune Disease
    • Nonspecific tests used in autoimmune disorders, inflammation and infections
    • Drug-Induced Lupus Erythematosus (DILE) can be used by many drugs. More likely with anti-TNF agents || Hydralazine || Isoniazid || Methimazole || Methyldopa || Minocycline || Procainamide || Propylthiouracil || Quinidine || Terbinafine
    • If ANA is positive, histone anibody and anti-dsDNA tests will help establish diagnosis 
    • == causative drug must be discontinued!
  38. CD4+ T Lymphocyte Count
    HIV RNA Concentration (Viral Load)
    • Used to assess HIV and monitor Treatment
    • CD4+ count <200 cells/mm3 = more susceptible to opportunistic infections (OIs)
    • -- Treatment goal is a normal CD4+ count (800-1200 cells/mm3)
    • -- measured at baseline, then every 3-6 months thereafter
    • HIV Viral Load = quantifies the copies of HIV RNA in the blood -- most important Indicator of response to antiretroviral therapy (ART)
    • -- Treatment goal is to have undetectable HIV viral load
  39. Acid-Base
    pH / pCO2 / pO2 / HCO3 / O2 Sat
    • pCO2 = 35 - 45 mmHg
    • HCO3 = 22 - 26 mEq/L
    • pH = 7.35 - 7.45
    • ** Acidosis == pH < 7.35  
    • -- Respiratory Acidosis = Low pCO2
    • -- Metabolic Acidosis = High HCO3
    • ** Alkalosis == pH > 7.45 
    • -- Respiratory Alkalosis = High pCO2
    • -- Metabolic Alkalosis = Low HCO3
    • ** Anion Gap == calculated in patients with metabolic acidosis (high if > 12 mEq/L --> "anion gap acidosis")
    • -- causes of anion gap: CUTE DIMPLES (cyanide, uremia, toluene, ethanol, diabetic ketoacidosis, isoniazid, methanol, propylene glycol, lactic acidosis, ethylene glycol, salicylates)
    • -- Anion Gap = Na - Cl - HCO3 
  40. Human Chorionic Gonadotropin (hCG)
    • Hormonal
    • -- tested in blood and urine to determine pregnancy
    • hCG + == women is most likely Pregnant
  41. Purified Protein Derivative or Mantoux test (PPD)
    • TB skin test (TST) -- via intradermal injection
    • -- not used alone for diagnosis of active TB
    • -- IF INduration == measured for diagnosis of TB exposure
  42. Rapid Plasma Reagin (RPR)
    • Antibody test used to screen for SYPHILIS
    • RPR + == Syphilis
    • -- If (+), confirmatory test is performed
    • -- titers may be reported and are used to monitor response for therapy
  43. Acute Kidney Injury
    BUN : SCr
    • HIGH BUN / SCr, possibly High K
    • **Dehydration == BUN:SCr ratio > 20:1
    • Often symptomatic. If caused by dehydration _ Dry mouth | Dry skin | Headache
  44. Alcoholic Hepatitis
    • HIGH AST > HIGH ALT / High GGT
    • Jaundice | nausea | vomiting | weakness | abd tenderness | loss of appetite
  45. Anemia
    • LOW Hgb / Hct / RBC
    • abnormal RBC indices will indicate type of anemia
    • SOB | fatigue | weakness | dizziness | pallor | exercise intolerance
  46. Muscle Damage
    Rhabdomyolysis
    • HIGH CPK (and high SCr in Rhabdomyolysis)
    • -- Rhabdomyolysis = muscle pain or weakness | N/D | dark urine | decrease urine output
  47. Pancreatitis
    • HIGH Amylase & Lipase
    • adb pain (feels worse after eating and can radiate to back) | nausea | vomiting
  48. Heart Failure
    • HIGH BNP / NT-proBNP
    • Edema | SOB | cough | fatigue

Card Set Information

Author:
HNguyen0287
ID:
334511
Filename:
NAPLEX _ Lab Values & Drug Monitoring
Updated:
2017-09-26 21:04:37
Tags:
NAPLEX RXPREP LabValues
Folders:
RxPREP
Description:
RxPREP _ NAPLEX Review - Lab Values & Drug Monitoring
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