MSOP Pharmacotherapy 1 test 1

Low: usually due to excess water / high ADH

High: severe dehydration, diabetes insipidus, significant renal and GI losses

Low: diuretics, alkalosis, severe v/d, heavy NG suctioning

High: renal dysfxn, acidosis, K-sparing diuretics, hemolysis, burns, crush injuries

• the sum of HCO3 & dissolved CO2
• reflects acid-base balance
• compensatory pulm (CO2) & renal (HCO3-)

***Important for acid-base balance

Low: due to GI loss (v/d, intestinal fistulas, overdiuresis)

• End product of metablolism.
• Produced by liver.
• Transported in Blood.
• Excreted renally.

High: renal dysfxn, high protein intake, upper GI bleed, volume contraction

• Major constituent of muscle.
• Rate of formation=constant
• Renally excreted.
• ***Affected by muscle mass.
• Primary marker for renal fxn (GFR)
• High: renal dysfunction

High: diabetes or adrenal corticosteroids

• Regulated by bone redistribution, PTH, Vit D, Calcitonin.
• **Affected by change in albumin
• Low: hypothyroidism, Loops, low Vit D
• High: malignancy & hyperthyroidism

Low: malabsorption, severe diarrhea, alcoholsim, pancreatitis, diuretics, hyperaldost (weakness, depression, agitation, seizure, hypokal, arrhytmia)

High: renal fail, hypothyroid, ANTACIDS

Low: excess aluminum antacids, malabsorption, renal losses, hypercalcemia, refeeding syndrome

High:renal dysfunction, hypervit D, hypokalemia, hypoparathyroid

• 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)

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

More liver specificity than AST, but less used in stand alone diagnostics

• Breakdown product of Hgb
• Bound to ALBUMIN
• Conjugated in liver

High: hemolysis, cholestasis, liver injury

High energy tissues

High CK: IM injury, MI, acute psychotic episodes

More specific than CK-MB for myocardial damage (elevated sooner and lasts longer)

>2.0=injury

Low: anemias, bleeding, hemolysis

High: polycythemia, chronic hypoxia

neutrophils+lymphocytes+monocytes+eosinophils+basophils

High: infection & stress

High: bacterial/fungal infection

High: bacterial infection

• <100 x 10^3 / microL= thrombocytopenia
• <20 x 10^3 / microL= High risk for severe bleeding

Low: acidosis

High: alkalosis

Blood: metabolic acid/base

Urine: diag of Renal Tubular Acidosis

***This level should NOT include K+

Necessary to determine safety of giving live vaccines (chemo)

• caution 500-1000 / mm^3
• Risk <500/mm^3

Low ALBUMIN= Low Complex Ca=Low Total Ca with NORMAL LEVELS OF FREE CA

*If symptomatic= always request free levels!

• 1. Burn victims
• 2. liver probs
• 3. malnutrition
• 4. CHF
• *calcium adjustments
• *dilantin adjustments

• lab error
• hemolysis of RBC (tourniquet)

*request lab smear or restick @diff. location!

• CBC: RBC, WBC, Hgb, Hct, RBC indicators, reticulocyte count, PLT
• CBC diff: all this, plus- neutro,eosin,baso,mono,lymphocyte counts

• 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

• 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

*Used to ID liver transplant & severity of disease...DIAGNOSTIC (not Dosing)

• 1. Scr
• 2. Total Bili
• 3. INR
• 4. Serum Na+

• 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%)

• 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

• 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

age, wt, diet, gender, muscle mass, medications

Improper: handling,reagents, timing of draw

statistically derived numerical range obtained by testing a healthy individual

Qualitative test that is reported w/o quantifying

(pregnancy= +/-  yes/no)

a lab result that is outside of reference range AND indicates high risk mortality

where desired clinical response is high and probability of toxicity is low

• 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

• Define the problem
• Design a process to solve the problem
• Do research, analysis, etc
• Debrief

• CCT/RCT (prospective)
• Cross Over (prospective)
• Cohort (prospective)
• Cohort (retrospective)
• Case-Control (retrospective)
• Cross-Sectional
• Case Report

• 1. no difference
• 2. intervention & control
• 3. a measurable endpoint

* 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.

The ability of the study to DETECT A DIFFERENCE IN OUTCOME EFFECT between intervention and control. Increase power by increasing n.

most accurate estimate of treatment efficacy and safety

accuracy of a diagnostic test

answering questions about prognosis