Treatment Planning & Management Flashcards
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Read the first 7 Treatment Planning & Management flashcards as text
A patient with type 2 diabetes has an HbA1c of 9.8%. After 3 months of metformin therapy, repeat HbA1c is 9.1%. This result MOST likely indicates:
Answer: Partial response; consider adding a second agent
A 0.7% reduction with HbA1c still well above the 7% target suggests a partial response, supporting addition of a second antidiabetic agent.
Which laboratory test is used to MONITOR patients receiving thiopurine therapy (azathioprine or 6-mercaptopurine) for inflammatory bowel disease?
Answer: Thiopurine methyltransferase (TPMT) activity and thiopurine metabolite levels
TPMT genotype/phenotype guides dosing, while 6-TGN and 6-MMP metabolite levels help optimize efficacy and identify toxicity or non-adherence.
A post-cardiac surgery patient has a heparin-induced thrombocytopenia (HIT) score of 6 (high probability). The CORRECT immediate management is to:
Answer: Stop all heparin and start a direct thrombin inhibitor
HIT is an immune-mediated thrombotic disorder; all heparin must be discontinued immediately and replaced with a non-heparin anticoagulant such as argatroban or bivalirudin.
A patient's serum lithium level is 2.4 mEq/L. Which clinical scenario would explain why toxicity symptoms are ABSENT despite a supratherapeutic level?
Answer: The sample was drawn in the distribution phase shortly after a dose
Lithium levels drawn within 1–2 hours of a dose reflect the distribution phase and are falsely elevated; trough levels at 12 hours post-dose are standard.
Which platelet function test is used to guide antiplatelet therapy selection (aspirin vs. P2Y12 inhibitor) in high-risk cardiovascular patients?
Answer: Platelet aggregometry (LTA)
Light transmission aggregometry using ADP and arachidonic acid agonists assesses P2Y12 and COX-1 pathway inhibition to evaluate aspirin and P2Y12 inhibitor response.
A patient with B12 deficiency is started on intramuscular cyanocobalamin injections. Which CBC change is expected FIRST after initiating therapy?
Answer: Rise in reticulocyte count at 5–7 days
Reticulocytosis peaks at 5–7 days post-B12 injection, confirming bone marrow response before macrocytosis or hemoglobin normalize.
A neonate with hyperbilirubinemia has a total bilirubin of 22 mg/dL at 72 hours of life. The MOST appropriate laboratory-guided intervention is:
Answer: Initiate phototherapy and obtain DAT and blood type
Total bilirubin at this level in a 3-day-old neonate meets phototherapy threshold; DAT and blood typing identify hemolytic causes requiring escalated management.