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136 Cards in this Set
- Front
- Back
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wbc
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4.4-11.3 x 10^3 cells/microL
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RBC females
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4.1-5.1 x 10^6 cells/microL
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RBC males
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4.5-5.9 x 10^6 cells/ microL
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Mean Corpuscular Volume (MCV)
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80-96% fl/cell
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HgB females
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12.3-15.3 g/dl
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HgB males
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14-17.5 g/dl
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Mean corpuscular HgB
(MCH) |
27-33 pg/cell
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Hct female
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36-45%
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Hct male
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42-50%
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platelets
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150,000-450,000/microL
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Iron defict anemia will see dec in
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MCV and MCH
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Vita B or Folate deficit anemia will see inc in
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MCV and MCH
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All anemia will have dec in
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RBC, HgB, Hct
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Neutrophils
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45-73%
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Band neutrophils
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3-5%
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lymphocytes
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20-40%
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monocytes
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2-8%
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eosinophils
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0-4%
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basophils
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0-1%
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Urine protein
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2-8mg/dl
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urobilinogen
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0.1-1 unit/dl
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substances negative /not detected in normal urine
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Glucose, ketones, blood, bilirubin,nitrite, and leukocyte esterase
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Sodium
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135-145 mEq/L. If less than it's indicative of dec kidney function/diarrhea. If inc then it's indicative of fever, TPN, some antibiotics.
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Potassium
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3.5-5 mEq/L. If under 3.5 then diuretics/vomitting.
If over 5 then dec kidney function. |
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carbon dioxide
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24-30mEq/L
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FBS-fasting glucose
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80-110 mg/dl
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Prediabetic FBS
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100-125 mg/dl
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diabetic FBS
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2 values over 126ml/dl
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glucose "spills" from blood to urine when....
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FBS over 180mg/dl
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HgB A1C
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4-6%
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BUN
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8-20mg/dl. IF under 8 then malnourished. If over then high protein diet and inc urea.
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Creatinine
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0.7-1.5mg/dl. If under 0.7 then DKA,liver dx or age. If over 1.5 then dec renal func.
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normal creatinine clearance
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90-140ml/min/1.73m^2
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BMI for underweight
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18.5 or below
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BMI for normal
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18.5-24.9
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overweight BMI
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25-29.9
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obese BMI
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30+
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AST test for liver function
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8-42 iu/L
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ALT test for liver function
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3-30 IU/L
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albumin
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3.5-5 g/dl
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Prothrombin time (PT)
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10-13 sec of INR=1-2
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function of albumin
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maintains osmotic pressure, binds and transports drugs and hormones.
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Bilirubin function
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assist in digesting fats
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liver's functions
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1. prd bilirubin from RBC
2.assist with AA and carb regulation/metabolism 3.prd albumin and proteins 4.cholesterol synthesis 5. drug and hormone metabolism |
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albumin dec with.....
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trauma, malnutrition,alcoholism, and cirrhosis
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complications with obesity
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CV,Diabetes,asthma,gallbladder dx, PCOD,osteoarthritis,sleep apnea,fatty liver and psychological
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Xenical (orlistat)
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inhibits GI lipase. Dec fat absorption by 30%. 120mg b4 meals. Dec absorption of vitamins, diarrhea, gi issues.
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Adipex (phentermine)
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Noradrenergic drugs,suppresses appetite. 15-30mg.
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OTC or herbal products for weight loss
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Alli, fiber, caffeine, green tea, bitter orange, chitosan,chromium,laxatives,diuretics,capsaicin, hoodia goronii, syrup of ipecac.
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side effects of phentermine
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tachycardia and some HTN
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side effects of sibutramine
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HTN and serotonin syndrome in ppl taking ssri's
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Orlistat/Alli side effects
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Vitamine deficit and GI effects
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Novel pharmaceuticals for weight loss
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Lorcaserin, Naltrexone-bupropion, phentermine-topiramate
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Discreditied weight loss meds
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1.Fenfluramine
2.Ephedrine and phenylpropanolamine |
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Drugs that induce weight gain
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1.steriod hormones
2.neurotropic and psychotropic meds 3.Diabetes treatments |
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Neurotropic and psychotropic drugs that cause weight gain
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1.clozapine
2.olanzapine 3.valproic acid 4.lithium 5.phenothiazine 6.anti-depressants/SSRIs/Tricy/MAOI |
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Diagnosis of DM
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1.random bg greater than 200mg/dl
2. symptoms of DM-polyuria,polydipsia, polyphagia. 3.FPG over 126 mg/dl more than twice 4.A1C over 6.5% |
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Pre-diabetic state
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FPG-100-125
2 hr glucose 140-199 A1C 5.7-6.4% |
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Goals for diabetes therapy
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1.pre-prandial glucose 70-130
2.post-prandial glucose under 180 3. A1C over 7% 4.BP 130/80 5. LDL under 100 mg/dl 6.HDL over 40 for males, over 50 for females |
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Drugs that dec hepatic insulin output
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biguanides/inslin
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Drugs that inc peripheral insulin uptake
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biguanides, insulin, TZD's
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Drugs that inc insulin release from beta cells
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sulfonylureas, glinides, insulin
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Drugs that work by preventing carb break down
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alpha-glucosidase inhibitors
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Rapid acting insulin for type 1 DM
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Humalog, novolog, apidra. Short acting insuling include- humulin or novolin R.
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Basal control of type 1 DM
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1.NPH (humulin or novolin N) intermediate insulin
2. Levemir and lantus. Long acting. |
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Pramlintide (symlin)
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used for type 1 dm. analog of amylin that slow gastric emptying, dec postprandial glucagon, inc satiety. Can cause nausea or hypoglycemia.
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sulfonylurea
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Bind to Beta cells to stim insulin release. Reduces A1C 1-2% but stop working over time.
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Biguanide-metformin
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Dec hepatic gluconeogenesis, glucose absorption, and inc insulin activity. Lowers A1C 1-2%.
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Metformin-glucophage
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can prevent type 2 progression but has GI se's and lactic acidosis.
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Glinides
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pre-meal, stims insulin release from beta cells. Needed TID.
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alpha-glucosidase inhibitors
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inc insulin sensitivity but cause adverse effects like edema, bone fractures, and CV.
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incretin hormone
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inc postprandial insulin, dec postprandial glucagon. delays gastric emptying and enhances satiety.
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DPP-4 inhibitors
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inhibits DPP-4 which slows inactivation of inretins, prolongs actions of glucagon.
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Signs of infections
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1. Fever
2.WBC 3.ESR 4.radiographic evidence 5.site analysis 6. organ specific symptoms |
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Fungal infectins lead to inc in
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Lymphocyte
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Parasites lead to inc in
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Eosinophils
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Mycobacterial infections lead to inc in
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monocytes
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colonization
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organisms that naturally occur in body provide benefit by occupying space and competing for nutrients.
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Infection
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organism or pathogen that causes damage to host tissue and leads to infection
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MIC (a susceptibility test)
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lowest concentration of drug needed to inhibit viable growth. Drugs are classified as resistant, sensitive or intermediate.
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Types of infectious fungi
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endemic, opportunistic, subcutaneous, cutaneous
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Adverse Drugs Event (ADE)
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Any injury caused by medication. Includes allergic response, med errors and idiosyncratic response.
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Adverse drug reactions (ADR)
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unexpected, unwanted, excessive response to a medication.
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Medication error
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PREVENTABLE event that led to inappropriate medication use or pt harm.
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Dechallenge a drug
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Drug is discontinued and the pt is monitored to determine whether ADR abates or dec in intensity. Almost always done.
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Rechallenge a drug
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Drug is discontinued and after ADR abates, the drug is readministered in an attempt to elicit the response again.
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Three types of ADRs
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Definite, Conditional, and Doubtful
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idiosncracy drug reaction
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uncharacteristic response to a drug, usually not occuring on administration. Body lacks a certain enzyme.
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Hypersensitivity drug reaction
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an allergic manifestation
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Intolerance to a drug
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characteristic pharmacological effect of a drug produced by an unusually small dose. So normal dose causes massive reaction!
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drug interaction reaction
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caused by interaction between two or more drugs.
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prescribing error
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error in selection, dose, dosage form, route of admin. The most common error is dose.
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Omission error
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pt does not recieve schedule dose
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wrong time error
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drug is not administered in accordance with a predetermined interval.
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Unauthorized error
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pt recieves drugs not authorized by approproate prescriber
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improper dose error
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dose administered different than what was prescribed.
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wrong DF error
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pt recieves dose form that was different from what was prescribed.
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wrong drug prep error
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compounding error
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wrong administration technique
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drug is given inappropriately
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deteriorated drug error
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expired drug administered
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monitoring error
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pt not monitored appropriately
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compliance error
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pt use meds inappropriately
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drugs commonly involved in malpractice
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warfarin, corticosteriods, hypoglycemic agents, digoxin, amox, phenytoin, antibiotics, narcotics.
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Broad categorization of causes of errors
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Performance lapses (slips), lack of knowledge, lack or failure of safety systems.
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preventable ADE errors
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prescribing, dispensing, administering, and monitoring
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Non-preventable ADE
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ADRs
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5 categories of ADEs
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1.ADRs
2.medication errors 3.therapeutic failure 4.Adverse drug withdrawl events 5.overdoses |
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Use SOAP III to id ADRs
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S-side effect
O-overdose A-allergy P-pseudoallergy I-interaction I-intolerance I-idiosyncracy |
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Side effects
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unplanned symptoms that a person may experience when taking a med. Somewhat predictable and manageable with minor intervention.
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ADE from drug
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unplanned symptoms that a person may experience or feel when taking a drug. Can be predictable, causes problems for the pt, and REQUIRES treatment.
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Top drugs associated with inc death
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Avandia, Digoxin,fentanyl, acetaminophen, lortab, oxycodone, boniva
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Drugs that have high risk for ADRs
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Antibiotics, analgesics, anticonvulsants, sedatives, CV drugs, psychotherapy drugs, and anti-coags.
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Type A ADR
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Augementation of a drug's primary or secondary pharmacological effect. 80% of all ADEs. Includes Toxicity/OD, side effects, secondary effects, drugs interactions.
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Type B ADR
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Bizzare or idiosyncractic. Rare occurence. Intolerance, Hypersensitivty or Pseudoallergy. Not dose dependent or related to mechanism of action.
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Type C ADR
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Chronic effect like dependence (xanax, lorazepam)
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Type D ADR
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Delayed Effects. Carinogenic or teratogenic.
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Type E ADR
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End of treatment effect like narcotic withdrawl or beta blocker withdrawl.
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Type F error
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Failure of therapy. Caused by drug interactions or other causes. Example -BC with antbiotics.
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4 classes of ADRs
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1.Predictable/Unpreventable
2.Unpreventable 3.Unpredictable 4. Preventable |
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Transcribing Error (med error)
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failure to transcribe info of the improper entry of an order into the system
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Root Cause Analysis
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systemic approach to identifying the various factors leading to an error or event. An attempt to understand the problem before it's fixed.
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General steps of RCA
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1. define problem
2.gather data.evidence 3.ask questions and attempt to ID relationships associated with problems. 4. ID causes that could prevent a recurrence of the incidence 5.list solutions 6.implement recommendations 7.continue to asses change |
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Example of Glinides
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Prandin and stalix
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Alpha-glucosidase inhibitors examples
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Precose and Glyset
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Thiazolidinediones (TZD) examples
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Actos and Avandia. Ends in -tazones
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Incretin Mimetics
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Byetta and victoza
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DPP-4 inhibitors examples
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Januvia and onglyza. Generics end in -gliptin
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Desired Cholesterol
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less then 200
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Sensitivity of a test
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The ability of a test to detect a particular outcome
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Specficity of a test
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The ability to distinguish between outpoint of outcome.
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Low Sensitivity means
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The test has more potential to get FALSE NEG
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Low specificity means
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The test has a greater chance of getting False POS
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Suscepitbility
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A bacterium would be susceptible to an antibiotic if the MIC is less than or equal to the susceptibility breakpoint.
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Intermediate outcome on susceptibilty test
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the use of an antibiotic that may achieve optimal therapeutic outcomes with maximal doses
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Susceptibile result on a susceptibility test
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refers to the likelihood of achieving optimal therapeutic outcome with usual doses of antibiotics.
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Basophils associated with
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allergic reactions
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