PHR 920 Block 3 (Blood Pressures and Lab Values)

Normal BP

less than 120 and less than 80

Elevated BP

120-129 AND less than 80

Stage 1 Hypertension

130-139 OR 80-89

Stage 2 hypertension

140 or higher, OR 90 OR higher

Severe Hypertension

Higher than 180 and/or higher than 120

Hypertensive Emergency

Higher than 180 and/or higher than 120

Goal BP (after medication)

less than 130/80

Blood Pressure consists of

Cardiac Output x Systemic Vascular Resistance (SVR)

1st Korotkoff sound denotes ________ corresponding to arterial pressure during _________

Systolic Blood Pressure, Ventricular Contraction

Last audible Korotkoff sound denotes _______ corresponding to arterial pressure during _______

Diastolic Blood Pressure, Ventricular Relaxation,

How is hypertension diagnosed

Taking an average BP readings on separate occasions

Screening for hypertension

initial visit where BP is taken to identify a high reading

Importance of Blood Pressure Screening

Detecting hypertension, which is the leading cause of heart attacks, strokes, and kidney damage if untreated

Goals of Therapy for Hypertension

BP less than or equal to 130/80, prevent stroke, heart attack, heart failure, improve quality of life, manage risk factors

What are three primary purposes for which pharmacists utilize liver and renal function tests?

1. Assist in dosing medications primarily excreted by the kidney. 2. Monitor patients taking medications with potential hepatotoxic or nephrotoxic effects. 3. Differentiate between adverse medication effects and other causes of hepatic and renal dysfunction.

Why can't liver function tests be used to determine doses of medications metabolized in the liver?

Liver function tests (AST and ALT) are markers for active hepatocyte damage and not a direct measurement of the liver's overall metabolic or clearance capacity.

What are the four categories of laboratory studies of the liver?

1. Synthetic liver function. 2. Excretory liver function and cholestasis. 3. Hepatocellular injury. 4. Detoxifying liver function.

What do liver function tests (LFTs) primarily help clinicians distinguish?

LFTs help distinguish between hepatocellular injury/disease and cholestatic disease.

What are the components typically included in an LFT panel?

Aminotransferases (AST, ALT), alkaline phosphatase (AP), bilirubin (total bilirubin), albumin, and total protein.

What is the normal range for AST and ALT?

Both AST and ALT have a normal range of <35 units/L.

What does an elevation in AST and ALT indicate?

Elevated levels usually indicate active or acute hepatocyte damage such as hepatitis or drug toxicity.

Which aminotransferase is more specific for hepatocytes?

Alanine Aminotransferase (ALT) is more specific for hepatocytes.

What is the normal range for alkaline phosphatase (AP)?

The normal range for alkaline phosphatase is 30-120 units/L.

What does an elevated alkaline phosphatase level indicate?

An elevated AP indicates obstruction of the biliary system (cholestasis).

What is the normal range for total bilirubin?

The normal range for total bilirubin is 0.3-1.0 mg/dL.

What is jaundice and when is it noticeable?

Jaundice is the yellow discoloration of the skin, nail beds, and sclera, noticeable when bilirubin levels are significantly elevated.

What does low albumin levels indicate in the context of hepatic disease?

Low albumin levels indicate chronic hepatocellular damage (cirrhosis) rather than acute damage.

What is the normal range for serum protein (albumin)?

The normal range for serum protein (albumin) is 3.5-5.5 g/dL.

What is the half-life of albumin?

The half-life of albumin is about 20 days.

Why is it important to interpret albumin levels within the context of each patient?

Albumin levels can vary based on individual patient conditions and are a major indicator of the liver's synthetic function.

What are the clinical implications of elevated AST/ALT levels?

Elevations indicate active or acute hepatocyte damage; levels 3-times the upper limit of normal (3x ULN) are considered clinically significant.

What should be done if AST/ALT levels are slightly elevated?

If levels are slightly elevated (<3x ULN), they are typically monitored.

What are non-hepatic causes of elevated alkaline phosphatase?

Bone disorders, hyperthyroidism, hyperparathyroidism, sepsis, diabetes mellitus, renal failure, and neoplasms.

What can be ordered to confirm a hepatic-related disorder in cases of isolated elevations in alkaline phosphatase?

Gamma-glutamyl transpeptidase (GGT) can be ordered to help confirm a hepatic-related disorder.

What is the significance of bilirubin in liver function tests?

Bilirubin is a by-product of hemoglobin breakdown and is a marker of the liver's excretory function.

What does mildly elevated bilirubin suggest in the context of elevated AST and ALT?

Mildly elevated bilirubin suggests hepatobiliary disease.

What is the role of albumin in the body?

Albumin maintains plasma oncotic pressure and binds & transports hormones, anions, drugs, and fatty acids.

What is the relationship between liver function tests and overall liver function?

LFTs alone do not provide a full picture of liver function and must be paired with other tests for comprehensive assessment.

What can cause low albumin levels besides liver dysfunction?

Malnutrition, malabsorption, protein loss from gut, kidney, or skin, systemic inflammation from infection/sepsis or malignancy.

How can IV fluids affect albumin levels?

Administration of IV fluids can dilute albumin, causing falsely low levels.

What effect does dehydration have on albumin levels?

Dehydration can cause falsely increased albumin due to concentrated plasma.

What two additional tests can assess liver synthetic function?

INR and Albumin-to-globulin ratio (A/G ratio).

What is prothrombin?

A clotting agent and protein primarily synthesized by the liver, critical for blood clotting.

What does prothrombin time (PT) measure?

The time (in seconds) it takes for a blood sample to clot.

What is the normal range for INR?

1.

What are typical lab abnormalities in acute hepatocellular disease?

AST/ALT >300; AP <3x increase; Normal Albumin/INR.

What are common signs and symptoms of severe chronic hepatocellular disease?

Ascites, jaundice, spider nevi, gynecomastia, 'liver flap', coma.

Name a common medication that can cause acute hepatotoxicity.

Acetaminophen.

What is a common medication that can cause cholestatic hepatotoxicity?

Anabolic steroids.

Why did the FDA remove the requirement for LFT monitoring in chronic statin users?

True statin-induced hepatotoxicity is considered rare, and serious liver injury is not reliably predicted by periodic monitoring.

What does a Basic Metabolic Panel (BMP) include?

Sodium, potassium, chloride, carbon dioxide, glucose, blood urea nitrogen (BUN), and serum creatinine (SCr).

What does a Comprehensive Metabolic Panel (CMP) include?

All elements of BMP plus albumin, alk phos, AST, ALT, total bilirubin, calcium.

What are serum creatinine (SCr) normal values?

0.7-1.5 mg/dL.

How does muscle mass affect SCr levels?

Differences in muscle mass will affect SCr; women usually have lower values due to less muscle mass.

Why might elderly patients have a normal SCr despite renal impairment?

Decreased muscle mass can lead to a normal SCr even with significant renal impairment.

How quickly does SCr change in acute renal disease?

SCr is slow to change and may take several days to reflect changes in renal function.

What is the normal range for Blood Urea Nitrogen (BUN)?

6-20 mg/dL.

What does BUN measure?

Serum urea, a breakdown product of amino acid metabolism by the liver.

What is a major advantage of using BUN to evaluate renal function?

BUN is sensitive to urine flow and responds quickly to acute changes in glomerular filtration.

What can cause an increased BUN level?

High protein diets and significant upper GI bleeding.

What is a disadvantage of using BUN to evaluate renal function?

Serum levels of urea vary with protein intake, hydration, and GI bleeding.

What is the most accurate way to measure renal function?

A 24-hour creatinine clearance (CrCl) test.

What is the significance of creatinine in muscle metabolism?

Creatinine is a metabolic breakdown product of creatine, synthesized in the liver and taken up by muscle cells.

How can bilirubin levels affect SCr readings?

Increased bilirubin may cause a low SCr due to assay interference.

What condition leads to falsely low BUN levels?

Severe liver damage, such as cirrhosis.

What is the normal BUN/SCr ratio range?

10-20:1

What does a BUN/SCr ratio greater than 20 suggest?

Pre-renal causes of acute renal impairment such as dehydration or shock.

What indicates intrinsic renal damage in terms of BUN/SCr ratio?

A ratio between 10-20 with both elevated SCr and BUN.

What are the three commonly used methods to measure eGFR?

Cockcroft-Gault, MDRD, CKD-EPI.

What is a key characteristic of the Cockcroft-Gault equation?

It tends to overestimate creatinine clearance (CrCl).

What is the normal sodium (Na) range?

135-147 mEq/L

What are the four basic functions regulated by sodium?

Serum osmolality, fluid balance, acid-base balance, and electric potential for nerve impulses.

What is hypernatremia?

Increased serum sodium levels.

What are common clinical conditions that cause hypernatremia?

Gastroenteritis, diabetes insipidus, and hyperaldosteronism.

What is hyponatremia?

Decreased serum sodium levels.

What is the most common cause of hyponatremia?

Excess accumulation of body water (dilutional hyponatremia).

What is the normal potassium (K) range?

3.5-5 mEq/L

What are the three basic functions regulated by potassium?

Nerve excitability, acid-base balance, and muscle function.

What is hyperkalemia?

Increased serum potassium levels.

What clinical conditions can cause hyperkalemia?

Renal failure, metabolic acidosis, and massive cell damage.

What is hypokalemia?

Decreased serum potassium levels.

What are common causes of hypokalemia?

Severe diarrhea, respiratory alkalosis, and hyperaldosteronism.

What is the normal chloride (Cl) range?

95-100 mEq/L

What is hyperchloremia?

Increased serum chloride levels.

What clinical conditions can cause hyperchloremia?

Metabolic acidosis, dehydration, and renal disorders.

What is the normal range for carbon dioxide (CO2, bicarbonate)?

22-28 mEq/L

What does CO2 content on a BMP represent?

The amount of bicarbonate in plasma, which helps regulate physiologic pH.

What is the difference between CO2 content on BMP and pCO2?

CO2 content is measured in plasma, while pCO2 is measured via arterial blood gas.

What can falsely elevate potassium levels in a lab specimen?

Hemolysis of the specimen.

What should be checked if hypokalemia treatment is inadequate?

Magnesium levels, as low magnesium must be treated before potassium normalizes.

What is a common medication that can cause decreased sodium levels?

Diuretics.

What are the signs and symptoms of hypernatremia?

Thirst, restlessness, irritability, muscle twitching, seizures, and coma.

What are the signs and symptoms of hypokalemia?

Cardiac arrhythmias, hypotension, muscle cramps, and death from respiratory paralysis.

What is the normal range of CO2 in mEq/L?

22-28 mEq/L

What does CO2 on a BMP primarily represent?

The amount of bicarbonate (HCO3-) in plasma, which regulates physiologic pH.

How does CO2 content differ from pCO2?

CO2 content is mostly bicarbonate and regulated by the kidneys, while pCO2 is acidic and regulated by the lungs.

What condition is associated with increased CO2 levels?

Metabolic alkalosis.

What are common causes of metabolic alkalosis?

Diuretic therapy and hyperaldosteronism.

What condition is associated with decreased CO2 levels?

Metabolic acidosis.

What are common causes of metabolic acidosis?

Diabetic ketoacidosis, salicylate toxicity, lactic acidosis, and renal failure.