1. Screen for a disease

2. Diagnose a condition

3. Monitor prior to treatment

4. Plan treatment

5. Monitor prior to treatment

1. Institutional (hospital)

2. Commercial (LabCorp)

3. Point of care (Doc Office)

4. Home testing

+ or -

Home pregnancy test

Exact number

Reference range

Example: Serum glucose value

Lower

False negative

Greater

False positive

T/F:

WBC| Hb/Ht| Platelets is a commonly used formatting for a patient chart

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

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)

80-96 % fl/cell

27-33 pg/cell

List the normal values for

PMNs

Bands

Lymphocytes

Monocytes

Eosinophils

Basophils

PMNs = 45-73 %

Bands = 3-5 %

Lymphocytes = 20-40 %

Monocytes = 2-8 %

Eosinophils = 0-4 %

Basophils = 0- 1%

Macrophages

Antigen presenting

Nitrite

Blood

Leukocyte esterase

Bilirubin

Ketones

Glucose

pH = 6-8

protein = 2-8 mg/dL

Urobilinogen = 0.1-1 unit/dL

specific gravity = 1.010 - 1.025 mg/mL

Na+/K+ | Cl-/CO2 | Bun/Cr \ Glucose

is the ____________

BMP

Basic Metabolic Panel

What are the normal values for

Na

K

Cl-

CO2

Glucose

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

Na

K

Decrease

Respiratory alkalosis

Metabolic Acidosis

Increase

Respiratory acidosis

Metabolic alkalosis

Dehydration

NSAIDs

HCTZ

Severe Diarrhea/Vomitting

BiCarb Steroids

Insulin overdose

Food consumption

Pre = 100- 125 mg/dL

Diabetic = > 126

Spills

Urine

BUN = 8-20 mg/dL

Cr = 0.7 - 1.5 mg/dL

(140-age) x Ideal Body Weight in kg x {0.85 if f

/

72 x SCr

Estimates Cr clearance

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)

1. Make bilirubin from HgG

2. Digest fats

3. A.A. and Carb metabolism/regulation

4. Cholesterol synthesis

5. Drug and hormone metabolism

18.5-24.9

25-29.9

1. Genetic transmissison

2. If parents are overweight

1. Energy in> Energy out

2. High Caloric foods

3. Large portion sizes

4. Decreased physical activity

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)

1. Hypothyroidism

2. Cushings Syndrome

3. Lesions of the hypothalamus

4. Medications like Metformin

1. CV

2. DM

3. PCOD

4. Asthma

5. Gallbladder disease

6. OA

7. Sleep apnea

8, Fatty liver

9. Psychological

10x

(up to 45% of all new cases of diabetes are childs 10-19 yro)

When the BMI> 30 or

BMI> 27 + 2 comorbid conditions

If waist circumference in women > 35

in men > 40

1. Diet and Exercise

2. Hypnosis

3. Acupuncture

4. Surgery

Xenical (prescription) = 120 mg 1hr b4 meal

Alli = 60 mg TID

1. Decreases fat soluble vitamins (A, D, E, K)

2. Decrease cyclosporine [M+]

3. Affects warfarin

1. Oily spotting

2. Liquid stools

3. Flatulence

4. Ab pain

5. Fecal urgency

Treat with low fat meals and psyllium

Sympathomimetic

IV (4)

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)

12 yro

16 yro

1. Increased lypolysis

2. Increased O2 consumption

3. Circulating fatty acid levels

Bitter Orange

Green tea

Serious dehydration

Electrolyte imbalance

Physical dependance

(Watch teen girls closely)

Insulin resistance with inadequate compensatory increase in insulin secretion

(accounts for 85 % of cases)

Liver = Increased hepatic gluconeogenesis

Muscle = Decreased glucose uptake

Adipocytes = Failure of insulin to supress breakdown of TG

Black

Asian

Hispanic

Native

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%

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 %

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

1. Insulin Lispro = Humalog

2. Insulin Aspart = Novolog

3. Insuline Glulisine = Apidra

1. Regular Humulin

2. Novolin R

1. Intermediate insulin

2. Long Acting insulin

1. Lantus (Insulin glargine)

2. Levemir (Insulin detemir)

Insuline release

1-2 %

Glimepiride = Amaryl

Glipizide = Glucotrol

Glyburide = Diabeta, Glynase

Faster

Shorter

Repaglinide (Prandin)

Nateglinide (Starlix)

alpha-glucosidase inhibitors

Decrease

1. Acarbose (Precose)

2. Miglitol (Glyset)

Insulin Sensitivity

Heart failure

Increase postprandial insulin

Decrease postprandial glucagon

Delay gastric emptying so enhance satiety

They inhibit the DPP4 enzyme

Slow inactivation of incretins so there is a prolong action of glucagon like peptide (GLP-1)

10-20

30

1. DKA

2. Hyperglycemic Hyperosmolar nonketotic (HHNS)

Microvasculature

Macrovasculature

1. Peripheral neuropathy

2. Autonomic neuropathy

3. Retinopathy

4. Nephorpathy

Retinopathy

Photocoagulation

Nephropathy

Proteinuria

1. CNS = meningitis

2. Kidney = Pyelonephritis

3. Bladder = Cystitis

4. Blood = Sepsis

5. Abdomen = Peritonitis

6. Instestines = Gastroenteritis

Gram +

Gram -

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

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)

A fever of a temperature > 100.4 F

And a high WBC

Neutrophils

Lymphocytes

Esinophils

Monocytes

Headache, neck stiffness

Headache

Cough, sputum production, abnormal chest x-ray

A new murmur

1. Collect the infectious material

2. Direct examination

3. Biochemical/serology testing

4. Susceptibility testing

Purple

Red

Red

Blue

1. Dye with crystal violet

2. Add Iodine (mordant)

3. Decolorize via alcohol

4. Recolorize with saffrin counterstain

5. Rinse and dry

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

Broth dilution- Macro and Micro

E-Test

Zone of inhibition - kirby Bauer

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. 

Minimum Bactericidal Concentration

The lowest concentration of antibiotic needed to kill an organism

Micro titer plate of up to 96 wells that have serial dilutions of multiple antibiotics.

H.influenzae

N.gonorrhea

S. pnuemoniae

In micro it is automated and less labor intestive and get quicker results. A

A macro is time and labor intensive

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

Viruses

lower MIC

1. Tetracyclines  = Minocycline (Minocin)

2. Macrolides - Azithromycin (Zithromax)

3. Clindamycin (Cleocin HCl)

Endocardium

Meninges

1. Aminoglycosides = Tobramycin (Tobi)

2. Quinolones = Ciprofloxacin (Cipro)

3. B-Lactams = Piperacillin (Zosyn)

4. Cephalosporins = Cephalexin (Keflex)

Aminoglycosides

Fluoroquinolones

Metronidazole

B lactams

Cephalosporins

Vancomycin

Clindamycin

Post Antibiotic Effect

Persistant suppression of organism growth after exposure and removal of antibiotic

1. Drug inactivation

2. Decreased permeability

3. Alterations of binding site

4. Metabolic bypass

After 3 days

Possibly a fungal/virus infection, a non infectious cause or has acquired antimicrobial resistance

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

To prevent the emergence of resistant strains

To treat empirically when organisms is unknown

To use antibiotic synergism

When afebrile for 24-48 hrs

Decrease in WBC

and has a working gut

1. The bug

2. The drug treatment

3. The patient

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)

1. fever

2. increased WBC

3. Inflammatory response

4. Discharge

5. Smell

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.

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?

1. Pasturella multocida (gram -)

2. Bacteroides sp (anaerobic)

3. Fusobacterium sp (anaerobic)

4. Capnocytophaga

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.

WHO

World health organization

1. Adverse drug reactions

2. medication erros

3. therapeutic failures

4. adverse drug withdrawal events

5. overdoses

Medication erros  that are involved with these process:

1. Prescribing

2. Dispensing

3. Administering

4. Monitoring

S = Side effect

O = Overdose

A = Allergy

P = Pseudoallergy

I = Interaction

I = Intolerance

I = Idiosyncrasy

Immunological

Specific

1. Advanced age

2. Female gender

3. Nature and degree of illness requiring drug therapy (ex: kidney failure)

4. Type of medication administered

Augmentation of a drugs primary or secondary pharmacological effect

They are common, predictable and occur in everyone

1. Hepatic failure with excess acetaminophen

2. Sedation with antihistamine

3. Diarrhea with antibiotic use

Bizzare or idiosyncratic in nature; Reactions are not related to a drugs primary or even secondary pharmacologic effect

They are unpredictable, uncommon

Rare

1. Tinnitus with aspirin use

2. Anaphylaxis with penicillin use

3. Pseudoallergic rxn with Radiocontrast dye

Chronic effects

Benzodiazepine dependence

Delayed effects

Carcinogenic and teratogenic

End of Treatment effect

Narcotic or B-blocker withdrawal

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

1. Preventable (most important)

2. Predictable/Unpreventable (common)

3. Unpreventable

4. Unpredictable (rare ex: Angioedema with ACE Inhibitors)

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

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

1. Hydrocodone Bitartrate and Acetaminophen Tablets, and Phenobarbital tablets by Qualitest

Avandia = CV events

Identify

Tracking

Trending

Classify

Prescribing

Transcribing

Dispensing

Administration

Monitoring

Patient Adherence

Inappropriately selecting a drug

*Indication

*Allergies

*Dose

*Dosage form

*Quantity

*Route of administration

*Concentration

*Contraindication

1.4

1.5

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

Timing errors

Omissions

Incorrect drug administration technique

Wrong route of drug administration

Administration of improper dose

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

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

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

USP

or aka

US Pharmacopeia

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

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"

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