Term
What is the purpose of Lab Testing? |
|
Definition
1. Screen for a disease
2. Diagnose a condition
3. Monitor prior to treatment
4. Plan treatment
5. Monitor prior to treatment |
|
|
Term
What are some types of laboratories? |
|
Definition
1. Institutional (hospital)
2. Commercial (LabCorp)
3. Point of care (Doc Office)
4. Home testing |
|
|
Term
Qualitative is defined as either __________ or __________ and an example would be ___________. |
|
Definition
+ or -
Home pregnancy test |
|
|
Term
Semiquantitative is reported as + or - but with varying degrees. An example would be ______________ |
|
Definition
|
|
Term
Quantitative is reproted as an ______________ and usually in the context of ______________. |
|
Definition
Exact number
Reference range
Example: Serum glucose value |
|
|
Term
Reference ranges are identified as a valuew within ____________ |
|
Definition
|
|
Term
|
Definition
The ability to DETECT the particular outcome if it is present |
|
|
Term
The _________ the sensitivity the greater the chance of getting a _____________. |
|
Definition
|
|
Term
______________ is the ability of DISTINGUISH between 2 pts of outcome. |
|
Definition
|
|
Term
The lower the sensitivity the ______________the chance of getting a ____________. |
|
Definition
|
|
Term
T/F:
WBC| Hb/Ht| Platelets is a commonly used formatting for a patient chart |
|
Definition
|
|
Term
What is the normal value for WBC and RBC for both men and women? |
|
Definition
In Men
WBC = 4.4- 11.3 x 10^3 cells/uL
RBC = 4.5- 5.9 x 10^6 cells/uL
In Women
WBC = 4.4- 11.3 x 10^3 cells/uL
RBC = 4.1 - 5.1 x 10^ 6 cells/uL |
|
|
Term
What is the normal value for both Hgb and Hct in both men and women? |
|
Definition
In Men
Hgb = 14 - 17.5 g/dL
Hct = 42-50 %
In Women
Hgb = 12.3-15.3 g/dL
Hct = 36-45 %
(its a 1:3 ratio of Hgb/Hct) |
|
|
Term
Normal platelet count is _______________ |
|
Definition
|
|
Term
Mean Corpuscular Volume (MCV) is ______________ whereas the Mean Corpuscular HgB(MCH) is _______________. |
|
Definition
80-96 % fl/cell
27-33 pg/cell |
|
|
Term
If your RBC, HgB and Hct are all lowered, but your MCV adn MCH is high then you might have this type of anemia: |
|
Definition
Vitamin B def or Folate def |
|
|
Term
If your RBC, HgB, and Hct are all lowered as well as your MCV and MCH then you may have this type of anemia: |
|
Definition
|
|
Term
If your RBC, Hgb, Hct are all lowered, but your MCV and MCH are unchanged then you have this type of anemia: |
|
Definition
Anemia of a chornic disease |
|
|
Term
List the normal values for
PMNs
Bands
Lymphocytes
Monocytes
Eosinophils
Basophils |
|
Definition
PMNs = 45-73 %
Bands = 3-5 %
Lymphocytes = 20-40 %
Monocytes = 2-8 %
Eosinophils = 0-4 %
Basophils = 0- 1% |
|
|
Term
_____________ has histamine, LK, etc and are associated with allergic responses. |
|
Definition
|
|
Term
Monocytes convert to _____________ in tissues and are ______________. |
|
Definition
Macrophages
Antigen presenting |
|
|
Term
In a urinalysis test there should not be what kinds of things in the urine? |
|
Definition
Nitrite
Blood
Leukocyte esterase
Bilirubin
Ketones
Glucose |
|
|
Term
What are the normal urinalysis values for pH, protein, urobilinogen and specific gravity? |
|
Definition
pH = 6-8
protein = 2-8 mg/dL
Urobilinogen = 0.1-1 unit/dL
specific gravity = 1.010 - 1.025 mg/mL
|
|
|
Term
Na+/K+ | Cl-/CO2 | Bun/Cr \ Glucose
is the ____________ |
|
Definition
BMP
Basic Metabolic Panel |
|
|
Term
What are the normal values for
Na
K
Cl-
CO2
Glucose |
|
Definition
Na = 135 - 145 mEq/L
K = 3.5 - 5 mEq/L
Cl = 96-106 mEq/L
CO2 = 24-30 mEq/L
Glucose = 80-110 mg/dL |
|
|
Term
A decrease in _____________ whereas an increase of _____________ indicates a decrease in kidney function. |
|
Definition
|
|
Term
With a lower CO2 value the pH will ___________ and can lead to ______________ cuz of hyperventilation and also ______________. |
|
Definition
Decrease
Respiratory alkalosis
Metabolic Acidosis |
|
|
Term
With an Increase in CO2 the pH will ___________ and result in _______________ and ______________. |
|
Definition
Increase
Respiratory acidosis
Metabolic alkalosis |
|
|
Term
What things can increase the Cl-? |
|
Definition
|
|
Term
What can decrease the amount of Cl-? |
|
Definition
Severe Diarrhea/Vomitting
BiCarb Steroids |
|
|
Term
If your glucose is lower than 70 then it may be due to _______ or lack of ____________. |
|
Definition
Insulin overdose
Food consumption |
|
|
Term
To be considered pre-diabetic what value do you need? What about diabetic? |
|
Definition
Pre = 100- 125 mg/dL
Diabetic = > 126
|
|
|
Term
If you have a glucose > 180 mg/dL then glucose __________________ from the blood to ____________. |
|
Definition
|
|
Term
What does Hgb A1C measure? |
|
Definition
Glucose levels over the last 2-3 months |
|
|
Term
What is the normal A1C value? |
|
Definition
4-6 % of glycosylated Hgb |
|
|
Term
What is the normal BUN? What are Cr? |
|
Definition
BUN = 8-20 mg/dL
Cr = 0.7 - 1.5 mg/dL |
|
|
Term
A BUN lower than 8 and Cr lower than 0.7 indicates _________. |
|
Definition
|
|
Term
If Cr is higher than 1.5 mg/dL then you have declining ____________. |
|
Definition
|
|
Term
What is the Cockroft and Gault formula? |
|
Definition
(140-age) x Ideal Body Weight in kg x {0.85 if f
/
72 x SCr
Estimates Cr clearance |
|
|
Term
How do you find the Ideal body weight: |
|
Definition
For men:
50 kg + 2.3 kg(for every inch over 5 ft)
For women:
45 kg + 2.3 kg (for every inch over 5 ft) |
|
|
Term
What are some of the livers function? |
|
Definition
1. Make bilirubin from HgG
2. Digest fats
3. A.A. and Carb metabolism/regulation
4. Cholesterol synthesis
5. Drug and hormone metabolism |
|
|
Term
Why does the liver make albumin? |
|
Definition
To maintain the osmotic pressure, bind and tranpsrt durgs, hormones, etc |
|
|
Term
What is the normal value of albumin? |
|
Definition
|
|
Term
If you have a decreased albumin what does it indicate? |
|
Definition
Cirrhosis, alcoholism, trauma, malnutrition |
|
|
Term
The Prothrombin Time shows the clotting time. What is the normal time to clot? |
|
Definition
|
|
Term
To be considered obese you need a BMI over ? |
|
Definition
|
|
Term
How do you determine someones BMI? |
|
Definition
Weight in kg/ Height in m^2 |
|
|
Term
In 2005, the survey of 4 yro kids determined that _____________ had the highest BMI. |
|
Definition
|
|
Term
What is a normal BMI? What about overweight? |
|
Definition
|
|
Term
How are children classified? |
|
Definition
There BMIs are determined and compared other kids in the same age group. > 95% is considered obese. |
|
|
Term
What are some risk factors for being overweight or obese? |
|
Definition
1. Genetic transmissison
2. If parents are overweight |
|
|
Term
What are some contributing factors to obesity? |
|
Definition
1. Energy in> Energy out
2. High Caloric foods
3. Large portion sizes
4. Decreased physical activity |
|
|
Term
How does the diet play a role in constributing to obesity? |
|
Definition
There is an increased in hihg glycemic index carbs that promotes obesity for the simple fact that casues hyperphagia and postprandial hyperinsulinemia.
(insulin spike and still feel hungry = eat more) |
|
|
Term
What are some secondary causes for obesity? |
|
Definition
1. Hypothyroidism
2. Cushings Syndrome
3. Lesions of the hypothalamus
4. Medications like Metformin |
|
|
Term
What are some complications that obesity can lead to? |
|
Definition
1. CV
2. DM
3. PCOD
4. Asthma
5. Gallbladder disease
6. OA
7. Sleep apnea
8, Fatty liver
9. Psychological |
|
|
Term
There is a __________ fold increase incidence of type 2 DM in children. |
|
Definition
10x
(up to 45% of all new cases of diabetes are childs 10-19 yro) |
|
|
Term
What is the first thing we do to treat obesity? |
|
Definition
Lifestyle Modification in all overweight peeps |
|
|
Term
When do you need to seek Rx treatment for obesity? |
|
Definition
When the BMI> 30 or
BMI> 27 + 2 comorbid conditions
If waist circumference in women > 35
in men > 40 |
|
|
Term
What is the goal for treatment of obese peeps? |
|
Definition
A 5- 10 reduction in body weight |
|
|
Term
What are some non-Rx treatment for obesity? |
|
Definition
1. Diet and Exercise
2. Hypnosis
3. Acupuncture
4. Surgery |
|
|
Term
|
Definition
|
|
Term
|
Definition
It inhibits GI lipase thereby decreasing the absorption of dietary fat by 30%. |
|
|
Term
What is the typical dose for Xenical? What about Alli? |
|
Definition
Xenical (prescription) = 120 mg 1hr b4 meal
Alli = 60 mg TID |
|
|
Term
What are some possible drug interactions of Xenical? |
|
Definition
1. Decreases fat soluble vitamins (A, D, E, K)
2. Decrease cyclosporine [M+]
3. Affects warfarin |
|
|
Term
What are some side effects for Xenical? |
|
Definition
1. Oily spotting
2. Liquid stools
3. Flatulence
4. Ab pain
5. Fecal urgency
Treat with low fat meals and psyllium |
|
|
Term
Adipex is aka _____________. |
|
Definition
|
|
Term
Adipex is a _______________ agent that supresses appetite for 12-14 hrs. And is a Scheudle _______ drug. |
|
Definition
|
|
Term
Which drug was just recently pulled from the market for weight loss? |
|
Definition
Meridia or aka Sibutramine |
|
|
Term
What are the 4 stages when treating children? |
|
Definition
Stage 1 = Prevention Plus (healthy eating/activity habits)
Stage 2 = Structural Weight Management (Support and structure)
Stage 3 = Comprehensive Multidisciplinary Intervention (Increased visits and specialists)
Stage 4 = Tertiary Care Intervation (Medications, surgery) |
|
|
Term
Orlistat is approved to be used in kids > __________, whereas Adipex is used in kids > _______. |
|
Definition
|
|
Term
Allis is approved for >________ peeps. |
|
Definition
|
|
Term
What kind of weight loss effects does caffeine have? |
|
Definition
1. Increased lypolysis
2. Increased O2 consumption
3. Circulating fatty acid levels |
|
|
Term
Both ___________and ___________ cause thermogensis of brown adipose tissue. |
|
Definition
|
|
Term
What are some potential effects of continual laxative use? |
|
Definition
Serious dehydration
Electrolyte imbalance
Physical dependance
(Watch teen girls closely) |
|
|
Term
What is a commonly abused product (used to lose weight) that is linked to many fatalities? |
|
Definition
|
|
Term
What is the definition of diabetes? |
|
Definition
A group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. |
|
|
Term
With Type 1 Diabetes there is an absolute ___________ |
|
Definition
Deficiency of insulin (< 10% of cases) |
|
|
Term
With Type 2 Diabetes there is ________________- |
|
Definition
Insulin resistance with inadequate compensatory increase in insulin secretion
(accounts for 85 % of cases) |
|
|
Term
What is glucose intolerance diagnosed during pregnancy? |
|
Definition
|
|
Term
With Type 1 DM there is an autoimmune destruction of ____ cells of the pancreas. |
|
Definition
|
|
Term
With Type 2 DM what things occur in the liver, muscle, and adipocytes? |
|
Definition
Liver = Increased hepatic gluconeogenesis
Muscle = Decreased glucose uptake
Adipocytes = Failure of insulin to supress breakdown of TG |
|
|
Term
Which ethnic groups have a greater risk for Type 2 DM? |
|
Definition
Black
Asian
Hispanic
Native |
|
|
Term
Ketosis is common in Type _____ DM patients. |
|
Definition
|
|
Term
There is a strong family history for DM in this type of DM. |
|
Definition
|
|
Term
What are some ways to diagnose DM? |
|
Definition
Random BG = > 200 mg/dL + Symptoms (Polyuria, Polydipsia, Polyphagia)
Fasting Plasma Gluco (FPG) = > 126 mg/dL
2 hr Blood glucose = > 200 mg/dL
A1C = > 6.5% |
|
|
Term
If you have an increase in blood glucose what happens to your A1C? |
|
Definition
|
|
Term
What equation do you use to estimate the avg. glucose if you know your A1C? |
|
Definition
|
|
Term
What are the criterias for pre-diabetes which increases your risk for DM? |
|
Definition
1. FPG of 100- 125 mg/dL (shows impaired fasting glucose)
2. 2 hr glucose of 140-199 mg/dL (shows impaired glucose tolerance)
3. A1C of 5.7 - 6.4 % |
|
|
Term
What are some of the goals of therapy for DM? |
|
Definition
1. Preprandial glucose of 70-130 (<110)
2. Postprandial glucose of < 180 (< 140)
3. AlC of < 7 % (< 6.5%)
4. B.P. of < 130/80
5. LDL of < 100 mg/dL
6. HDL of > 40 mg/dL
7. TG of < 150 mg/dL |
|
|
Term
What are some Rapid acting Insulin drugs? |
|
Definition
1. Insulin Lispro = Humalog
2. Insulin Aspart = Novolog
3. Insuline Glulisine = Apidra |
|
|
Term
What are some Short acting Insulin drugs used for DM? |
|
Definition
1. Regular Humulin
2. Novolin R |
|
|
Term
What kinds of drugs are used for basal control of DM peeps? |
|
Definition
1. Intermediate insulin
2. Long Acting insulin |
|
|
Term
Give an example of a Intermediate Insulin for DM? |
|
Definition
NPH (Humulin or Novolin N) |
|
|
Term
What are the 2 Long acting Insulin drugs used for basal control of DM peeps? |
|
Definition
1. Lantus (Insulin glargine)
2. Levemir (Insulin detemir) |
|
|
Term
Sulfonylureas bind to B cells and stimules ___________, they reduce the A1C by ______. |
|
Definition
|
|
Term
What are the 3 common Sulfonylureas used to treat DM..Brand and generic. |
|
Definition
Glimepiride = Amaryl
Glipizide = Glucotrol
Glyburide = Diabeta, Glynase |
|
|
Term
___________________ decrease hepatic gluconeogensis and glucose absorption, it increases insulin sensitivity. |
|
Definition
|
|
Term
T/F: Biguanides stimulate insulin secretion and lower the A1C by 1-2%. |
|
Definition
False; They do not stimulate insulin secretion, but they do lower the A1C. |
|
|
Term
What is the preferred therapy for newly diagnosed type 2 DM? |
|
Definition
|
|
Term
What is a serious adverse effect of taking Metformin? |
|
Definition
|
|
Term
What is the contraindication for using Metformin? |
|
Definition
If you have renal dysfunction with a SCr > 1.5 |
|
|
Term
Glinides stimulate insulin release form B cells so they have a ________ onset and ________ duration. |
|
Definition
|
|
Term
T/F: If you skipped a meal then you can still take Glinides. |
|
Definition
False; it is dosed before meals. So if you skip meal then skip dose. |
|
|
Term
Give 2 examples of glinides. |
|
Definition
Repaglinide (Prandin)
Nateglinide (Starlix) |
|
|
Term
_____________ for DM inhibits breakdown of complex CHO and ____________ postprandial glucose. |
|
Definition
alpha-glucosidase inhibitors
Decrease |
|
|
Term
Give 2 examples of an Alpha-glucosidase inhibitor that is used for DM. |
|
Definition
1. Acarbose (Precose)
2. Miglitol (Glyset) |
|
|
Term
Thiazolindinediones used for DM have an increase in _____________ and is contraindicated with _____________. |
|
Definition
Insulin Sensitivity
Heart failure |
|
|
Term
What does incretin hormone do? |
|
Definition
Increase postprandial insulin
Decrease postprandial glucagon
Delay gastric emptying so enhance satiety |
|
|
Term
How do DPP4 Inhibitors work in DM peeps? |
|
Definition
They inhibit the DPP4 enzyme
Slow inactivation of incretins so there is a prolong action of glucagon like peptide (GLP-1) |
|
|
Term
Medical Nutrition Therapy used for DM peeps recommends a diet with protein ________% and fat less than ______%. |
|
Definition
|
|
Term
What are some acute complications from DM if you have too much glucose? |
|
Definition
1. DKA
2. Hyperglycemic Hyperosmolar nonketotic (HHNS) |
|
|
Term
If you have too low glucose under 60 how can you treat it without drugs? |
|
Definition
|
|
Term
Chronic complications of DM peeps affects the ____________ and ___________. |
|
Definition
Microvasculature
Macrovasculature |
|
|
Term
What can occur with chronic complications of DM that affect the microvasculature? |
|
Definition
1. Peripheral neuropathy
2. Autonomic neuropathy
3. Retinopathy
4. Nephorpathy |
|
|
Term
Peripheral neuropathy causes __________. |
|
Definition
Numbness and tingling, pain |
|
|
Term
What is the number one cause of blindness in DM? And how do you treat it? |
|
Definition
Retinopathy
Photocoagulation |
|
|
Term
What is the leading cause of kidney failure and what is it characterized by? |
|
Definition
|
|
Term
What do you use to treat Nephropathy? |
|
Definition
ACE inhibitors and restrict protein intake |
|
|
Term
What is the primary cause of morbidity and mortality in DM patients? |
|
Definition
Macrovascular disease--things that affect the larger vessels. So things like CV events. Like stroke |
|
|
Term
What are some clinical sites for infection? |
|
Definition
1. CNS = meningitis
2. Kidney = Pyelonephritis
3. Bladder = Cystitis
4. Blood = Sepsis
5. Abdomen = Peritonitis
6. Instestines = Gastroenteritis
|
|
|
Term
The top of your body has more gram ________ bacteria whereas the bottom has more ___________. |
|
Definition
|
|
Term
What are some host defenses against an infection? |
|
Definition
1. Humoral immunity - antibody response
2. Cellular immunity - PMNs, Macrophages
3. Physical barrier - skin, mucuous
4. Respiratory tract - coughing, Mucocillary elevator
5. GI - acidic pH and motility
6. GU - urinating/flushing |
|
|
Term
What are some predisposing factors to getting an infection? |
|
Definition
1. Breakdown of normal barrier (cuts, burns, catheters, tobacco use, surgery, bedsores, etc)
2. Alteration of normal gut flora (antibiotics and tobacco use)
3. Extremes of age (neonates and old)
4. Immunosuppression (HIV, drugs)
5. Diseases (DM, Chronic renal/liver failure) |
|
|
Term
What are some signs of infection? |
|
Definition
A fever of a temperature > 100.4 F
And a high WBC |
|
|
Term
With a bacterial infection there is an increase in ____________ whereas in a fungal infection there is an increase in ___________. |
|
Definition
|
|
Term
With a parasite infection there is an increase in _____________ whereas a mycobacterial infection like TB there is an increase in _____________. |
|
Definition
|
|
Term
What specific symptoms would you get with Meningitis? What about sinusitis? |
|
Definition
Headache, neck stiffness
Headache |
|
|
Term
What specific symptoms do you expect to see in Pneumonia? Endocarditis? |
|
Definition
Cough, sputum production, abnormal chest x-ray
A new murmur |
|
|
Term
Skin and soft tissues symptoms of infection include : |
|
Definition
Swelling, erythema, tenderness and oozing |
|
|
Term
|
Definition
Organisms that occur naturally in certain parts of the body. they provide some benefits like suppressing growth of pathogenic bacteria, competing for nutrients, and occupying space. |
|
|
Term
What are 4 ways to ID a pathogen? |
|
Definition
1. Collect the infectious material
2. Direct examination
3. Biochemical/serology testing
4. Susceptibility testing |
|
|
Term
What is the first step in Direct examination of a pathogen? |
|
Definition
Determine the shape of the microorganism via staining or acid fast test. |
|
|
Term
In a gram stain, gram + are ___________ and gram - are ___________. |
|
Definition
|
|
Term
In a TB test, acid fast test, positive stains are ___________ whereas negative stains are ________. |
|
Definition
|
|
Term
A KOH prep is used for __________ infection. |
|
Definition
|
|
Term
What are the steps for gram staining? |
|
Definition
1. Dye with crystal violet
2. Add Iodine (mordant)
3. Decolorize via alcohol
4. Recolorize with saffrin counterstain
5. Rinse and dry |
|
|
Term
|
Definition
Minimum inhibitory concentration
It is the lowest concentration of a drug needed to inhibit visible growth of organism.
For every pathogen a drug is reported as resistant, sensitive or intermediate |
|
|
Term
How are Susceptibility testing performed? |
|
Definition
Broth dilution- Macro and Micro
E-Test
Zone of inhibition - kirby Bauer |
|
|
Term
Describe a Broth Dilution- Macrodilution. |
|
Definition
1. Serial 2 fold dilution of antibiotics in Mueller-Hinton broth
2. Addition of standard inoculum of bacteria
3. Tubes examined for turbidity after 18-24 hr incubation at 35 C. |
|
|
Term
|
Definition
Visible growth of a bacteria |
|
|
Term
|
Definition
Minimum Bactericidal Concentration
The lowest concentration of antibiotic needed to kill an organism |
|
|
Term
What is the Broth dilution- Microdilution? |
|
Definition
Micro titer plate of up to 96 wells that have serial dilutions of multiple antibiotics.
|
|
|
Term
Which organisms would not work with a Microdilution? |
|
Definition
H.influenzae
N.gonorrhea
S. pnuemoniae |
|
|
Term
What are the advantages of using a Microdilution as opposed to a Macrodilution susceptibility test? |
|
Definition
In micro it is automated and less labor intestive and get quicker results. A
A macro is time and labor intensive |
|
|
Term
|
Definition
A predefined, stable gradient of 15 antibiotic concentrations on a plastic strip that is used to determine the on scale MIC of antibiotics, antifungal and anti-Tb agents.
It confirms/detect specific resistance phenotype |
|
|
Term
Zone Inhibition-Kirby Bauer does not work for ___________ and in general a larger inhibition zone correlates with __________. |
|
Definition
|
|
Term
For a drug MIC above the susceptible breakpoint, a _________ dose of the drug should be used to effectively treat an infection. |
|
Definition
|
|
Term
|
Definition
Likely to achieve optimal therapeutic outcome with usual doses of antibiotic |
|
|
Term
What is intermediate MIC? |
|
Definition
May achieve optimal therapeutic outcome with max doses or infections where drug concentrates at that site |
|
|
Term
T/F: With resistance MIC it is likely to achieve optimal therapeutic response. |
|
Definition
|
|
Term
What must you know to compare antibiotics? |
|
Definition
|
|
Term
How do bacteriostatic agents work? |
|
Definition
They limit the growth of bacteria by interfering with its production, DNA replication and other aspects of bacterial metabolism |
|
|
Term
T/F: Bacteriostatic agents kill the bacteria. |
|
Definition
False; they do not kill. Bactericidal agents do kill the bacteria. |
|
|
Term
What are examples of the antibiotic classes that are considered to be bacteriostatic agents? |
|
Definition
1. Tetracyclines = Minocycline (Minocin)
2. Macrolides - Azithromycin (Zithromax)
3. Clindamycin (Cleocin HCl) |
|
|
Term
Bactericidal agents are preferred to be used to treat infections in the ________ and __________. |
|
Definition
|
|
Term
Give examples of bactericidal antibiotics |
|
Definition
1. Aminoglycosides = Tobramycin (Tobi)
2. Quinolones = Ciprofloxacin (Cipro)
3. B-Lactams = Piperacillin (Zosyn)
4. Cephalosporins = Cephalexin (Keflex) |
|
|
Term
What is concentration dependent killing? |
|
Definition
Where you get more kills at a greater rate and to a greater extent with increasing antibiotic concentration. |
|
|
Term
Which kinds of antibiotics are concentration dependent killing? |
|
Definition
Aminoglycosides
Fluoroquinolones
Metronidazole |
|
|
Term
With time dependent killing, it kills at the _______ rate and extent once antibiotic threshold concentration has been reached. |
|
Definition
|
|
Term
What are example of time dependent killing antibiotics? |
|
Definition
B lactams
Cephalosporins
Vancomycin
Clindamycin |
|
|
Term
|
Definition
Post Antibiotic Effect
Persistant suppression of organism growth after exposure and removal of antibiotic |
|
|
Term
What are some acquired antimicrobial resistance? |
|
Definition
1. Drug inactivation
2. Decreased permeability
3. Alterations of binding site
4. Metabolic bypass |
|
|
Term
How long after treatment do you suspect that the treatment has failed for an infection? |
|
Definition
After 3 days
Possibly a fungal/virus infection, a non infectious cause or has acquired antimicrobial resistance
|
|
|
Term
What is the pharmacists role in treatment infections? |
|
Definition
1. Know your bugs and drugs
2. Assist with choice of antibiotic
3. Start with empiric therapy and streamline based on cultre and susceptibility
4. Change from IV to PO
5. Appropriate duration of therapy
6. Monitor for efficacy and toxicity
7. Educate about treatment and outcomes |
|
|
Term
Why use combination regimens? |
|
Definition
To prevent the emergence of resistant strains
To treat empirically when organisms is unknown
To use antibiotic synergism
|
|
|
Term
As a pharmacist, when do you switch from IV to PO? |
|
Definition
When afebrile for 24-48 hrs
Decrease in WBC
and has a working gut |
|
|
Term
What is the 3 conceptual areas which should be considered when assessing an infectious disease? |
|
Definition
1. The bug
2. The drug treatment
3. The patient |
|
|
Term
What are some patient risk factors for an infectious disease? |
|
Definition
1. Age (immune system alterations)
2. Comorbid disease states (HIV, DM)
3. Drugs (Steroids)
4. Social Status (Smoker, ETOH, drugs)
5. Recent Trauma (surgery, accident)
6. Environmental risk (travel) |
|
|
Term
Smells are associated with what type of infection? |
|
Definition
|
|
Term
What things occur with an activated immune system? |
|
Definition
1. fever
2. increased WBC
3. Inflammatory response
4. Discharge
5. Smell |
|
|
Term
What are some questions to ask when trying to determine the "bug" of infection? |
|
Definition
1. What are the likely pathogens for the site/symptoms?
2. What patient risk factors add or take away from the possible list of common pathogens?
Common pathogens include those of normal flora that has been misplaced or opportunistic pathogens. |
|
|
Term
What are some patient pecific treatment questions that one should ask? |
|
Definition
1. Drug allergies?
2. Patient weight?
3. Will dosing adjestments be needed for renal/liver dysfunction?
4. Comorbid diseases?
5. Age?
6. Current drug therapy? |
|
|
Term
After how long on therapy should you expect to see some clinical improvement? |
|
Definition
|
|
Term
|
Definition
An infection of the skin that penetrates into the subcutaneous tissues |
|
|
Term
Diabetics tend to have gram _______ infections. |
|
Definition
|
|
Term
What are some dog normal flora? |
|
Definition
1. Pasturella multocida (gram -)
2. Bacteroides sp (anaerobic)
3. Fusobacterium sp (anaerobic)
4. Capnocytophaga |
|
|
Term
What is IDSA website for? |
|
Definition
www.idsociety.org
Used to help physicans make decisions about specific clinical circumstances. They have clinical practice guidelines that give you quick diagnostic and treatment recommendations. |
|
|
Term
The CDC not only gives you specific immunization criterias but also _____________ |
|
Definition
Vaccine information and Etiology of diseases |
|
|
Term
With the John Hopkins website you can search by diagnosis, drugs, vaccines, and pathogens. What kind of information is on there website? |
|
Definition
Immunization recommendations, indications, administration and contraindications |
|
|
Term
Which organization promotes public health, strengthens healthy systems and fosters health security, and also provides data and statistics all over the world? |
|
Definition
WHO
World health organization |
|
|
Term
Simply put an adverse drug event is |
|
Definition
Any unfavorable event associated with the use a of medication |
|
|
Term
What are the 5 categories of ADEs? |
|
Definition
1. Adverse drug reactions
2. medication erros
3. therapeutic failures
4. adverse drug withdrawal events
5. overdoses
|
|
|
Term
What are some preventable ADEs? |
|
Definition
Medication erros that are involved with these process:
1. Prescribing
2. Dispensing
3. Administering
4. Monitoring |
|
|
Term
An ADR is a _____________ ADE. |
|
Definition
|
|
Term
What is an adverse drug reaction? |
|
Definition
Injury resulting from medical use of a drug with no error involved. |
|
|
Term
One study estimated that nearly _______ of ADEs caused permanent disability. |
|
Definition
|
|
Term
One study estimated that ADEs ________ the risk of patient death. |
|
Definition
|
|
Term
Simply put an ADR is an ADE with _______________. |
|
Definition
|
|
Term
How do you identify ADRs? |
|
Definition
S = Side effect
O = Overdose
A = Allergy
P = Pseudoallergy
I = Interaction
I = Intolerance
I = Idiosyncrasy |
|
|
Term
|
Definition
An undesireable effect at recommended doses |
|
|
Term
|
Definition
A genetically determined abnormal reaction to a drug due to enzyme deficiency |
|
|
Term
Intolerance is a ______________ to the normal action of a drug. |
|
Definition
|
|
Term
|
Definition
Has the same allergic reaction but lacks immunological specificity. |
|
|
Term
An allergy is defined as an ______________ mediated reaction, which is ____________ and reoccurs upon re-exposure. |
|
Definition
|
|
Term
With an ADE symptoms cause problems for the patient and ____________ is required whereas Side effects could be managed by minor intervention like taking with food. |
|
Definition
|
|
Term
What are the risk factors for ADRs? |
|
Definition
1. Advanced age
2. Female gender
3. Nature and degree of illness requiring drug therapy (ex: kidney failure)
4. Type of medication administered |
|
|
Term
How many types of ADRs are there? |
|
Definition
|
|
Term
|
Definition
Augmentation of a drugs primary or secondary pharmacological effect
They are common, predictable and occur in everyone |
|
|
Term
Which type of ADR accounts for 80% of all ADEs? |
|
Definition
|
|
Term
Give some examples of Type A ADRs |
|
Definition
1. Hepatic failure with excess acetaminophen
2. Sedation with antihistamine
3. Diarrhea with antibiotic use |
|
|
Term
|
Definition
Bizzare or idiosyncratic in nature; Reactions are not related to a drugs primary or even secondary pharmacologic effect
They are unpredictable, uncommon
Rare |
|
|
Term
What are some examples of Type B ADRs |
|
Definition
1. Tinnitus with aspirin use
2. Anaphylaxis with penicillin use
3. Pseudoallergic rxn with Radiocontrast dye |
|
|
Term
What is Type C ADR and give an example. |
|
Definition
Chronic effects
Benzodiazepine dependence |
|
|
Term
What is Type D ADR and give an example? |
|
Definition
Delayed effects
Carcinogenic and teratogenic |
|
|
Term
What is Type E ADR and give an example? |
|
Definition
End of Treatment effect
Narcotic or B-blocker withdrawal |
|
|
Term
This type of ADR can be caused by drug interations. An example would be oral contraceptives and anticonvulsants. |
|
Definition
Type F = Failure of Therapy |
|
|
Term
How do you rank the ADRs? |
|
Definition
Minor = No treatment
Moderate = Change in therapy, increased hospital stay
Severe = Potentially life threatening, causes permanent damage, requires intensive care
Lethal = Directly/indirectly causes death |
|
|
Term
What are the 4 classes of ADRs? |
|
Definition
1. Preventable (most important)
2. Predictable/Unpreventable (common)
3. Unpreventable
4. Unpredictable (rare ex: Angioedema with ACE Inhibitors) |
|
|
Term
Why is it important to classify ADRs? |
|
Definition
Aids in developing a monitoring program
Aides in determining where to place health care resources in preventing ADRs
Just one report could lead to further investigation and subsequent withdrawal of a dangerous medication |
|
|
Term
What are the 4 goals of FDA Medwatch? |
|
Definition
1. Increase awareness of medical product/drug induced disease
2. Clarify what should be reported and increase awareness of improtance of reporting
3. Facilitate ease of reporting
4. Provide feedback to health care providers about new safety issues |
|
|
Term
What are some recent examples of Medwatch reports? |
|
Definition
1. Hydrocodone Bitartrate and Acetaminophen Tablets, and Phenobarbital tablets by Qualitest
Avandia = CV events |
|
|
Term
The ADR surveillance program is a system that will ____________ ADRs and allow ____________ and ___________ and ___________ the ADR. |
|
Definition
Identify
Tracking
Trending
Classify |
|
|
Term
What is a JCAHO requirement? |
|
Definition
|
|
Term
|
Definition
Any preventable event that may cause or lead to inappropriate medication use or pateint harm while the medication is in the control of the health care professional, patient or consumer. |
|
|
Term
What are the types of medication errors? |
|
Definition
Prescribing
Transcribing
Dispensing
Administration
Monitoring
Patient Adherence |
|
|
Term
A prescribing error is the inappropriate selection of a drug or drug therapy by the prescriber, or incorrect/inadequate instructions for use. Give some examples. |
|
Definition
Inappropriately selecting a drug
*Indication
*Allergies
*Dose
*Dosage form
*Quantity
*Route of administration
*Concentration
*Contraindication |
|
|
Term
What does a transcribing error entail? |
|
Definition
The failure to transcribe information or the improper entry of an order into an information system. |
|
|
Term
Oral prescription order and confirmation bias occurs in which type of medication error? |
|
Definition
During transcribing error |
|
|
Term
What is confirmation bias? |
|
Definition
You read and dispense what you want, and it is not the actual drug prescribed. |
|
|
Term
The majority of errors that reached the pateint occured during which stage of medication errors? |
|
Definition
|
|
Term
Metformin should not be prescribed to any patient who ahs a SCr > __________ in women or __________ in men. |
|
Definition
|
|
Term
HCTZ is not effective in CrCl < ____________ |
|
Definition
|
|
Term
T/F: A dispensing error can occur at any of stage of the dispensing process. |
|
Definition
|
|
Term
Give examples of dispensing errors |
|
Definition
1. Failure to dispense Rx
2. Dispense wrong Rx, dose or dosage form
3. Failure to dispense right amount
4. Incorrect preparation, packaging, or storage
5. Dispensing expired, or compromised Rx |
|
|
Term
What are some administration errors? |
|
Definition
Timing errors
Omissions
Incorrect drug administration technique
Wrong route of drug administration
Administration of improper dose |
|
|
Term
Monitoring errors occur because of |
|
Definition
Failure to review a prescribed regimen for appropriate treatment
or a
Failure to use appropriate clinical or lab data for adequate assessment of patient response to the prescribed therapy |
|
|
Term
What are some causes that contribute to med errors? |
|
Definition
1. Miscommunication of drug orders
2. Poor technology
3. Poor procedures or techniques
4. Inappropriate labeling when drug is repackaged
5. Poor knowledge of drug therapy
6. Environmental factors and job stress |
|
|
Term
What are some strategies you can use to avoid med errors? |
|
Definition
1. Verify if patients have any allergies/ reactions to the Rx
2. Ask patients about all Rx they are taking including OTC and herbal
3. Compile a list of look alike sound alike (LASA) drugs and High alert Rx
4. Make sure LASA are not close together
5. Make a systematic counseling process
6. Continue to educate yourself on common med. errors and new strategies to decrease these types of errors
7. Verify drug information databases are up to date |
|
|
Term
________________ has a list of high alert medications and improvement strategies to decrease med errors. |
|
Definition
Institute for Safe Medication Practice (ISMP) |
|
|
Term
______________ has patient information on pateint safety including comprehensive handouts |
|
Definition
USP
or aka
US Pharmacopeia |
|
|
Term
|
Definition
It is the only way the health care system will be able to learn how to improve the medication use process.
It allows flaws in the system to be identifed and corrected |
|
|
Term
What is a root cause analysis? |
|
Definition
A systematic approach to identify the various factors leading to an error or event.
It attempts to understand the "true" problem before something is "fixed"
|
|
|
Term
Root cause analysis is an important process for improving ___________ and ___________. |
|
Definition
|
|
Term
T/F: Root cause analysis is a retrospective approach to error analysis used to put blame on an individual. |
|
Definition
False; the first part is correct, but it is not used to put blame, rather avoid blaming peeps. |
|
|
Term
List the general steps to Root cause analysis |
|
Definition
1. Define the problem
2. Gather data on what happened
3. Ask questions to id the causal relationships
4. Id any causes that could prevent a recurrence
5. list possible solutions
6. Implement recommendations
7. Continue to assess changes |
|
|
Term
Who are the last line of defense in medication safety? |
|
Definition
|
|