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136 Cards in this Set

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wbc
4.4-11.3 x 10^3 cells/microL
RBC females
4.1-5.1 x 10^6 cells/microL
RBC males
4.5-5.9 x 10^6 cells/ microL
Mean Corpuscular Volume (MCV)
80-96% fl/cell
HgB females
12.3-15.3 g/dl
HgB males
14-17.5 g/dl
Mean corpuscular HgB
(MCH)
27-33 pg/cell
Hct female
36-45%
Hct male
42-50%
platelets
150,000-450,000/microL
Iron defict anemia will see dec in
MCV and MCH
Vita B or Folate deficit anemia will see inc in
MCV and MCH
All anemia will have dec in
RBC, HgB, Hct
Neutrophils
45-73%
Band neutrophils
3-5%
lymphocytes
20-40%
monocytes
2-8%
eosinophils
0-4%
basophils
0-1%
Urine protein
2-8mg/dl
urobilinogen
0.1-1 unit/dl
substances negative /not detected in normal urine
Glucose, ketones, blood, bilirubin,nitrite, and leukocyte esterase
Sodium
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.
Potassium
3.5-5 mEq/L. If under 3.5 then diuretics/vomitting.

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