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PharmD2014
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Hematocrit (Hct) - Females
34-47%
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Hematocrit (Hct) - Males
40-50%
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Hemoglobin (Hgb) - Females
12-16 g/dL
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Hemoglobin (Hgb) - Males
14-18 g/dL
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WBC
3,500-10,000 cells/mm3
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Neutrophils
- 54-62%
- increase in bacterial or fungal infection
- ANC < 2000: Neutropenia
- ANC <1000: Risk of infxn
- ANC < 500: Agranuloctosis; associated w/ high risk of infxn
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Lymphocytes
- 25-33%
- increase in VIRAL infections, syphilis, mono
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Eosinophils
- 1-3%
- increase in allergies or parasitic infections
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Basophils
- <1%
- increase in allergies or inflammation
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What makes up the "Diff"?
- "Nobody Likes My Educational Background"
- - Neutrophils
- - Lymphocytes
- - Monophils
- - Eosinophils
- - Basophils
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Platelets
- 150,000-400,000 cells/mm3
- High (thrombocytosis) - can lead to clot formation
- Low (thrombocytopenia) - excessive bledding; can be drug-induced (i.e. heparin, bactrim, ASA)
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Mean Cell Volume (MCV)
75-100 fL
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Mean Corpuscular Hemoglobin Concentration (MCHC)
33-37 g/dL
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RBC count
- males: 4.3-5.9x 106 cells/mm3
- females: 3.5-5 x106 cells/mm3
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Hypernatremia
- Altered mental state (AMS)
- thirst
- decreased urine output
- lethargy
- seizures
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Hyponatremia
- Altered mental state (AMS)
- seizures
- disorientation
- muscle cramps
- * Trileptal (oxcarbazepime) and Tegretol (carbamazepime) DECREASE Na
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Hyperkalemia
- Cardiac arrhythmia
- Bradycardia
- Hypotension
- *ACE-I/ARBs INCREASE K
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Hypokalemia
- Fatigue
- Cardiac arrhythmias
- muscle weakness/cramps
- *Insulin, loop diuretics DECREASE K
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BUN elevation
- increase = indicates renal dysfunction
- affected by muscle mass
- Hypovolemia, shock, MI, sepsis, renal infection/failure
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Creatinine (SCr)
0.6-1.2 mg/dL
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Creatinine Elevation
- increase = renal dysfunction
- affected by muscle mass
- Metformin is CI:
- - SCr >= 1.5 in males
- - SCr >= 1.4 in females
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Pre-Diabetes glucose level
100-125 mg/dL
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Diabetes glucose level
>= 126 mg/dL
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Diabetic Goals (A1C, FPG, PPG, BP, LDL)
- A1C < 7%
- Fasting glucose = 70 - 130 mg/dL
- Postprandial glucose < 180 mg/dL
- BP < 130/80
- LDL < 100
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Calcium
- 8.6-10.2 mg/dL
- neuromuscular function
- bone formation
- **correct for decrease Albumin levels!!!
- inversely related to phosphate (forms complex)
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Hypercalcemia
- weakness
- anorexia
- constipation
- N/V
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Hypocalcemia
- muscle cramps
- tingling fingers
- tetany
- seizures
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Amylase
- 30-100 IU/L
- helps digest carbohydrates
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Amylase elevation
- Pancreatic injury
- Acute pancreatitis
- Obstruction of pancreatic duct by gallstone or tumor
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Lipase
- 0-160 IU/L
- helps digest fats
- *more specific for pancreatic dz than amylase!!
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Lipase elevation
- Pancreatic injury
- Acute pancreatitis
- Obstruction of pancreatic duct by gallstone or tumor
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AST
- 2-35 IU/L
- Aspartate aminotransferase (AST)
- Found primarily in heart and liver - increase in MI increase
- - in acute hepatic necrosis
- - Concern: 4x the UNL (upper normal limit)
- - levels do not correlate with extent of liver damage
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ALT
- 0-45 IU/L
- Found primarily in liver (more liver specific)
- Released during cell injury
- - concern: 4x the UNL
- - levels do not correlate with extent of liver damage
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Alkaline Phosphatase (Alk Phos)
- 30 - 120 IU/L
- 80% AlkPhos comes from liver and bone
- (also, sm intestine, kidney, placenta)
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AlkPhos Elevation
- Hepatitis
- Liver disease
- Pancreatitis
- Bone disorders (cancer, Paget's disease)
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Gamma-Glutamyl Transpeptidase (GGT)
- Test to differentiate between bone and liver disease
- Increase AlkPhos + increase GGT = Liver dz
- Increase AlkPhos + normal GGT = bone disorder
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Total bilirubin
0.1-1mg/dL
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Albumin
- 4-6 g/dL
- primary plasma protein
- synthesized by liver
- major determinant of colloidal osmotic pressure
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Decreased Albumin
- overhydration
- malnutrition
- cancer
- severe burns
- pregnancy
- cirrhosis
- hepatitis
- liver failure
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Hypoalbuminemia
- leads to Edema Ascites
- - (leaking fluid)
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medications/elements that bind to Albumin
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Liver Dysfunction indicators
- low albumin,
- high AST
- high ALT
- high Alkphos
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T3
- 75 - 200 ng/dL
- Triiodothyronine
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Hypothyroidism
- ELEVATED TSH
- Decrease T3, T4
- Sxs:
- - cOld intolerance
- - Weight GAIN
- - Depression
- - Fatigue
- - Constipation
- - Sluggishness
- - Inc cholesterol
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Subclinical HypOthyroidism
- INCREASE TSH
- Normal T3, T4
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Hyperthyroidism
- Decreased TSH
- INCREASED T3, T4
- Sxs:
- - Tachycardia
- - Heat intolerance
- - Weight loss
- - Nervous, irritable
- - Diarrhea
- - Difficulty sleeping
- - Sweating
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Total Cholesterol (TC)
- <200 = Desireable
- 200 - 239 = Borderline High
- ≥ 240 = High
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LDL
- < 100 = Optimal
- 100 - 129 = Near/above optimal
- 130 - 159 = Borderline high
- 160 - 189 = High
- ≥ 190 = Very High
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HDL
- < 40 = Low
- ≥ 60 = High
- F: >50-55
- M: >40-45
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Triglycerides (TG)
- Normal: < 150
- Borderline High: 150 - 199
- High: 200 - 499
- Very High: ≥ 500 --> increase risk for pancreatitis
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BMI
- eqns
- classifications
- BMI = kg/m2
- BMI = lbs/in2 *703
- - overestimated in muscular pts
- - underestimated in muscle atrophy pts
- < 18.5 = Underweight
- 18.5 - 24.9 = Normal Weight
- 25 - 29.9 = Overweight
- 30 - 34.9 = Obesity Class I
- 35 - 39.9 = Obesity Class II
- ≥ 40 = Extreme Obesity
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Blood Pressure
- Normal: ≤ 120/80 mmHg
- Hypertension: SBP > 140 OR DBP > 90
- Hypertensive Urgency: > 180/20 + NO s/sxs of target organ damage
- Hypertensive Emergency: > 180/20 + s/sxs of target organ damage
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Kidney Dysfucntion
- Stage 1: ≥ 90 mL/min
- Stage 2: 60 - 80
- Stage 3: 30 - 59
- Stage 4: 15 - 29
- Stage 5: < 15 + dialysis [Kidney Failure]
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Magnesium
- 1.5 - 2.3 mEq/L
- excreted renally
- Hyper/Hypo: cardiac arrhythmia
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Target BP in HTN pts
- BP < 140/80
- BP < 130/80 for special populations (DM, CAD, CKD, post MI, HF)
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Vancomycin
Trough: 10 - 20 mcg/mL
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Gentamycin/Tobramycin
- Peak: 5 - 10 mcg/mL
- Trough: < 2 mcg/mL
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Lithium
Maintenance: 0.6 - 1.2 mEq/L
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Valproic Acid
50 - 125 mcg/mL (therapeutic conc.)
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Low Hbg/Hct + _____ MCV:
- Low MCV (<75) = microcytic anemia (iron deficiency or sickle cell anemia)
- High MCV (>100) = macrocytic anemia (folic acid or vit B12 deficiency - pernicious anemia)
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Liver Dysfunction
- Weakness, fatigue
- Loss of appetite
- N/V
- Abdominal swelling/pain
- Jaundice
- Dark urine
- Light colored stool
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