Pharm care II test 2
Terms
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- Hgb males=
- 14-18gm/dl
- Hgb females=
- 12-16gm/dl
- Hct males=
- 39-49gm/dl %
- Hct females
- 33-43gm/dl %
- RBC males=
- 4.3 - 5.9 x 10^6 mm^3
- RBC females=
- 3.5 to 5.0 x10^6 mm^3
- Reticulocyte count=
- 0.1-2.4%
- MCV=
- 76-100 um^3
- MCH=
- 27-33pg
- MCHC=
- 33-37gm/dl
- ESR males=
- 0-20mm/hr
- ESR females=
- 0-30mm/hr
- serum iron=
- 60-185ug/dl
- TIBC=
- 250-460ug/dl
- %tranferrin saturation
- 30%
- Serum ferritin=
- 12-200ng/ml
- erythropoietin=
- 2-25IU/L
- Folic acid level
- 1.8-16 ng/ml
- Vitamin B12 level=
- 100-900 pg/ml
- Platelet count=
- 140,000 - 440,000/uL
- Relative thrombocytopenia=
- <150,000mm^3
- Absolute thrombocytopenia=
- <20,000mm^3
- Bleeding time=
- 2.5 to 7 min
- Prothrombin time (abr)
- PT
- PT =
- 12 to 16 sec
- What can prolong PT?
- defeciency in clotting factors II, V, VII, IX, X; low levels of fribrinogen; very high levels of heparin
- What is the goal of anticoagulation therapy for PT?
- maintain the ratio between 1.3-1.5 times the control
- INR stands for...
- International Normalization Ratio
- What is the purpose of the INR system?
- to standardize PT ratio
- An INR of 2-3 is equivalent to what PT ratio?
- 1.3-1.5
- aPTT stands for ...
- Activated Partial Thromboplastin Time
- aPTT=
- 24 - 36 secs
- What is aPTT used for?
- to monitor heparin therapy
- What factor does aPTT not measure?
- factor VII
- What is the goal of anticoagulation therapy for aPTT?
- to maintain a ratio of 1.5 to 2.0
- Fribrinogen levels =
- 200-400mg/dL
- What does decreased circulating levels of fribrinogen suggest?
- a state of active coagulation
- Fribrin Degradation Products=
- <10ug/dL
- An excessive degradation of fibrin and fibrinogen causes an increase in what
- FDP
- Name some risk factors for developing Thromboembolism
- Anti thrombin II deficiency; dysfibrinogenemia; heart disease; immobility; paralysis; obesity; protein C and S deficiency; lupus anticoagulant; trauma; estrgen use; IBD; sickle cell anemia; malignancy; surgery;peripartum period; H/O varicose veins
- What is venous stasis?
- an alteration or decrease in blood flow in the deep veins of the lower extremities that can lead to formation of thrombi
- What is vascular wall injury?
- endothelial damage due to mechanical or chemical trauma
- When does hypercoagulability occur?
- when activation of the coagulation system exceeds the ability of the intrinsic fibrinolytic system to prevent thrombus formation
- DVT stands for...
- Deep Vein Thrombosis
- What are the physical findings of DVT
- pain and tenderness; leg swelling;discoloration; increased skin temp;palpable cord; (+) Homan's sign; leg ulcers/infection
- What are some commonly employed lab studies for DVT?
- doppler ultrasonography; impedance plethysmography; real time ultrasonography; 125I-fibrinogen leg scan; and Venography
- What is doppler ultrasonography?
- a noninvasive test that measures changes in sound waves to detect changes in venous flow
- What is impedance plethysmography?
- a noninvasive test that measures changes in electrical resistance which accompanies changes in blood volume
- What is real time ultrasonography?
- A noninvasive ultrasound which provides a 3-D picture of the deep veins through the use of a transducer
- What is 125I-fibrinogen leg scan?
- a screening tool in high risk patients or as an adjunctive test to impedance plethsymography in patients with suspected DVT
- What is a venography
- the most reliable, radio-opaque contrast dye which is injected into a dorsal foot vein or femoral vein providing an outline of the deep venous system of the lower limbs
- Where do most thromboemboli originate?
- the iliofermoral deep veins
- What are less common sources of thromboemboli?
- vessels below the knee, pelvic veins, upper extremities, mural thrombi arising from the right side of the heart
- What does PE stand for?
- Pulmonary Embolism
- What are the clinical presentations of suspected PE?
- dyspnea, cough, tachypnea, tachycardia, anxiety, sense of impending doom, pleuritic chest pain, hemoptysis, acute right heart failure, cardiovascular collapse, fever
- What techniques are used to confirm or rule out PE?
- ventilation/perfusion scan and pulmonary angiography
- RBC definition is
- an actual count of cell per unit of blood
- Is the rbc elevated or decreased during polycythemia vera?
- elevated
- Hemoglobin is...(def)
- a direct indicator of the oxygen transport capacity of the blood
- Hematocrit is...(def)
- the percentage of blood volume that is occupied by erythrocytes
- Mean Cell Volume is...(def)
- the average volume of the RBC
- Mean Cell Hemoglobin is...(def)
- the average wieght of the hemoglobin in the RBC
- Mean cell hemoglobin concentration is ...(def)
- the percent contribution of hemoglobin volume to the total volume of the cell
- What does the total reticulocyte count represent?
- the total number of circulating immature RBC compared to the RBC
- what does the serum iron represent?
- the conc of the iron bound to transferrin
- What is total iron binding capacity?
- an indirect measurement of the serum transferrin
- What is ferritin?
- the storage form of iron
- What is ESR?
- the rate at which erythrocytes settle to the bottom of a test tube through forces of gravity
- What are some causes of IDA?
- inadequate dietary intake; inadequate absorption; increased demand; excess blood loss or disease induced
- What are some mechanisms of defeciency in meagloblastic anemia
- inadequate intake; malabsorption;inadequate utilization; increased demand
- What is the Schilling's test
- a test used to distinguish pernicious anemia from other causes of Vitamin B12 deficiency anemia
- What is normocytic anemia?
- anemia where iron availability is adequate but there is ineffective utilization
- What is the def. of a normal range?
- where 95% of normal people fall
- What is the critical value?
- a lab result that is far outside the normal range implying morbidity
- Define sensitivity.
- the chances that a person with a particular disease state will have a positive test result
- Define specificity
- the chances that a person without a disease will have a negative test result
- What is megaloblastic anemia?
- Reduced number of cell division with larger then normal RBC
- What is pernicious anemia?
- Sufficient B12 but defects in/or lack of intrinsic factor leads to malabsorption
- What is Romberg's Sign?
- a person can't tell where they are in space when their eyes are closed so they bob around
- What drugs induce Folic Acid Deficiency?
- methotrexate, trimethoprim, triamterene
- How many signs do you need to have to be diagnosed with RA?
- 4 of the 7
- What are the 7 criteria for RA
- morning stiffness, arthritis of 3 or more joints, artritis of hand joints, symmetric arthritis, rheumatoid nodules, serum rheumatoid factor, and radiographic changes
- what is SLE?
- multisystemic, chronic inflammatory disease with a course of attenuating exacerbations and remissions
- What drugs can induce SLE?
- hydralazine, procainamide, isonazid, chlorpropamide, methyldopa, phenytonin, carbamazepine, lithium
- how many criteria must a person have to be diagnosed with SLE?
- 4 of the 10
- what are the 10 criteria for SLE?
- malar rash, discoid rash, oral ulcers, arthritis, serositis, renal disorder, neurologic disorder, hematologic disorder, immunologic disorder, antinuclear antibody
- What does ANA indicate?
- presence of antibodies to nonspecific neuclear material
- How many criteria must a person have to be diagnosed with gout?
- 6 of 11
- What are the 11 criteria for gout?
- exquisite pain involving joint; more then 1 acute attack of arthritis; joint inflammation max w/in 1 day; oligoarthritis; erythrema over involved joint;podagra; tophi; hyperuricemia; complete termination of an acute attack; asymmetrric swelling w/in a joint on radiologic exam