Appendices

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193

Interpretation of Clinical Laboratory Tests

The appearance of ketones in urine indicates the severe diabetes mellitus, fevers, CNS

disorders or chronic diarrhoea and vomiting. The urine also manifests the presence of

ketone bodies in case of starvation.

Blood

Usually, blood is not present in urine, but if appears haematuria, injury in urinary tract

system etc. are indicated.

Clinical Importance

Haematuria may signify the presence of UT infection, nephrolithiasis, malignancies,

and benign prostatic hypertrophy (BPH).

Bilirubin

Usually, bilirubin is nil or may appear in trace quantity, which exhibits a dark yellow

or brown colour in urine.

Clinical Importance

Appearance of bilirubin in the urine may be sign of liver disease (e.g. hepatitis),

septicaemia, or obstructive biliary tract disease.

Urobilinogen

The result of urobilinogen is considered along with those for urine bilirubin (as shown

above).

Clinical Importance

Urobilinogen is normally present in urine in trace quantity. Bilirubin generates the

urobilinogen in the intestine from bilirubin; portion of which is absorbed back into the blood.

Appearance of urobilinogen in urine is associated with viral hepatitis, cirrhosis, liver

injury due to drugs or toxic substances, elevated RBC destruction (haemolytic anemia),

etc. There may be possibility of hepatic or biliary obstruction, if urobilinogen is very

low or absent in a urine.

Leukocyte Esterase

This is either absent or present in trace quantity in urine. Presence of leukocyte esterase

gives an indication of presence of WBCs in the urine.

Clinical Importance

Leukocyte esterase in the urine may be associated with UT infections or inflammations.

Nitrites

Gram (-) bacteria are efficient in converting dietary nitrates into nitrites, which is nil

in healthy person.

Clinical Importance

Infection with gram (-) microorganisms is indicated with the appearance of nitrites in

the urine.

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Textbook of Pharmacy Practice

EXERCISE

Multiple ChoiCe Questions

Tick mark the appropriate choice

1. The CBC is an extremely common laboratory test that provides values for __________

(a) Haemoglobin (d) RBCs

(b) Haematocrit (e) All of the above

2. Vitamin B

is important in __________

(a) DNA synthesis (c) Haematopoiesis

(b) Neurologic function (d) All of the above

3. Increase in RBC count beyond 10 million per cu mm is known as _________

(a) Anisocytosis (c) Polycythaemia

(b) Poikilocytosis (d) Leucocytosis

4. Anemia occurs due to ________________

(a) High haematocrit value (c) Low haemoglobin level

(b) Low RBCs count (d) Options ’B’ and ‘C’

5. Clinical hematologic testing of a patient with AlDS shows ____________

(a) Basophilia (c) Eosinophilia

(b) Lymphopenia (d) Thrombocytopenia

short Questions

6. Explain the various components of liver function profile along with their significance.

7. Explain the various components of kidney function test along with their significance.

long Questions

8. Write a descriptive note on urinalysis mentioning the abnormal constituents of urine.

9. Describe the various haematological tests along with their significance.

Answer to MCQs

1. (e) 2. (d) 3. (c) 4. (d) 5. (b)

195

Appendices

APPENDIX 1: NORMAL VALUES SHOWING HAEMATOLOGICAL PARAMETERS

S. No. Types of parameters Men Women Children

1. RBC counts 4.5 to 5.5 million/mm

3.5–5.5 million/mm

4.0 to 5.5 million/mm

2. WBC counts 4000 to 11000 cells/

WBC differential analysis gives the distribution of 5 major leucocytes

WBC % count Actual count

i. Basophils 0–1% 0–100

ii. Eosinophils 1–4% 40–400

iii. Monocytes 4–8% 160–800

iv. Lymphocytes 23–35% 1000–3500

v. Neutrophils 60–70% 2500–7000

3. Thrombocytes (platelets): The normal range of platelets is 1,50,000 to 3,00,000/mm

4. Haemoglobin 13–18 g/dl 11.5–16.5 g/dl 7.5–14.5 g/dl

5. ESR 0–15 mm/1 hr 0–20 mm/1 hr 0–10 mm/1 hr

Clotting time of the blood is 4–9 minutes at 37°C

APPENDIX 2: GLOSSARY OF MEDICATION AND RELATED TERMINOLOGY

Browse these 20 common terms listed below in alphabetical order.

Adverse event: Itisanunexpectedeffectthatmaybecausedbyamedication.Some

adverseeventsaremild,whereasothersmaybesevereorlife-threatening.Forexample,

anallergicreactiontoanantibioticisconsideredanadverseevent.

Agonist: Itisasubstancethatbindstocertaintargetsinthebodytoactivatethem.This

resultsinanumberofactionswithinthebody(e.g.painoranxietyrelief).

Analgesics: These are also known as pain-reliefmedications. Thereare many

kindsof analgesics, andthey work differently inyour body to relieve pain. Some

areavailable over-the-counter(OTC) without a prescription.Some commonOTC

analgesicsincludeacetaminophen(Tylenol)andibuprofen(Motrin,Advil).Analgesics

likecelecoxib(Celebrex)requireaprescription.

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Textbook of Pharmacy Practice

Anaphylaxis: Sometimesallergicreactionscanbecomeverysevereandlife-threatening.

Thisiscalledanaphylaxis,anditcanbecausedbycertainfoods,medications,andother

thingsyou areallergic to. Symptoms canhappen very quickly,includingdifficulty

breathing,swelling ofyour throat,and dizziness.Anaphylaxis isa potentially life-

threateningsituation,sothereisaneedtogetemergencymedicalattentionrightaway.

Antagonist: Itisasubstancethatbindstocertaintargetsinthebodybutdoesnotactivate

them.Itcanalsoblockothersubstancesthatbindtothesametarget.Thispreventsa

numberofactionsfromhappeninginyourbody.Somemedicationsareantagonists.

Thismeanstheyblockcertaintargets,preventingeffectsinthebody.Infact,theyare

sometimesreferredtoas“blockers.”Forexample,metoprolol(Lopressor)blockscertain

targetsintheheart.

Brand medication: Itis usually the first of its kind orthe “original” version of a

medication.Becauseofthis,itisusuallyprotectedbypatents.Thismeansthatnoother

pharmaceuticalcompaniescanmanufactureamedicationlikeitforaperiodoftime.

Onceitspatentexpires,othercompaniescanmakegenericversions.However,brand-

namemedicationsareusuallymoreexpensive.

Contraindications: Therearecertaincircumstanceswhenamedicationshouldnotbe

used.Thisisbecauseitcanbeharmfulwhenusedinthesecircumstances.Thisiscalled

acontraindication.

Therearetwotypesofcontraindications:

• Relative contraindication: If thebenefits outweigh the risks, a medication may

beusedwith caution. Forexample,some medications cancauseliver damage.A

healthcareprovidermaydecidetouseitwithcautionforsomeonewithpre-existing

liverdamage.

• Absolute contraindication: Thiscancausealife-threateningsituation.Anythingthatfalls

underanabsolutecontraindicationshouldbeavoided.Forexample,certainmedications

arecontraindicatedduringpregnancybecausetheycanharmanunbornbaby.

Controlled substance: Thesemedicationsareconsideredtobecontrolledsubstances.

Thisis because they carry a potential risk ofphysical and mental dependence.

Becauseofthisrisk,theyhaverestrictionsonhowtheyareprescribedandfilledata

pharmacy.Controlledsubstancemedicationscanbebrokendownintoseveralcategories

(calledschedules) depending on their risk for misuse.These range from highestto

lowestpotentialriskandincludeSchedulesI,II,III,IV,andV.ScheduleIhasthehighest

potentialriskandScheduleVhasthelowestpotentialrisk.

Dose and dosage: Adoseisaspecificamountofmedicationthatyoutakeatonetime,

suchasa500mgtablet.Adosageincludesthedose,frequency,andhowlongyouare

takingit.

Generic medication: Itismodelledafterabrandnamemedication.Butitcandifferin

shape,colour,andinactiveingredients.For most medications, this should not affect

howitworks.

Interaction

A drug interaction is a reaction between a medication and something else. This can

include:

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Appendices

• Another medication or supplement: Somemedicationsandsupplementscaninterfere

withhowanothermedicationworks.Theseinteractionscanalsoresultinworseside

effectsfromtreatment.

• Food or beverage: Somefoodsandbeveragescanaffecthowyourbodyabsorbsa

medication(e.g.dairyproducts).Theycanalsointerferewithhowyourbodygets

ridofmedication(e.g.grapefruitjuice).

• Health condition: Some medications canworsen certain healthconditions. For

example,peoplewithhighbloodpressureshouldnotusecertainOTCmedications

becausetheycanraisebloodpressure.

Loading dose: Some medications need to reach a certain level inyour body tobe

effective.Thisisespeciallyimportantwhenneedthemtoworkquickly.Aloadingdoseis

whenpatientinitiallytakeahigherdosetostart.Afterthat,patientwillusuallytakea

lowerdosefortheremainderoftreatment.

For example, you may be prescribed azithromycin (Z-Pak) for 5 days when sick. The

first dose is higher than the doses patient will take on the other 4 days. This is to help

the medication reach effective levels faster.

Maintenance dose: Itistheusualdosethatistaken.Itmaybethedosepatienttakeafter

aloadingdose.Oritmaybethedosepatientstayonaftergraduallyraisingyourdose

atthestartoftreatment.Themaintenancedoseensuresthattheamountofmedication

inthebodyconstantlystaysataneffectivelevel.

Maximum dose: Medicationsusuallyhavearecommendedindosagerange.Thisisthe

rangethathasbeendeterminedtobesafeandeffectiveformostpeople.Themaximum

doseistheupperlimitoftherecommendeddosagerange.Dosesabovethemaximum

dosemayresultinmoresideeffectswithoutadditionalbenefits.

Metabolism: When patient takes a medication,it gets processed bythe body. This

processiscalledmetabolism.Medicationsarechemicallychangedduringmetabolism.

Sometimesthisisrequiredforthemtowork.Othertimesthismakesthemeasiertobe

eliminatedfromthebody.

Metabolism usually happens in the liver. But it can also happen in other areas,

including the gastrointestinal (GI) tract (stomach and intestines) and kidneys.

Placebo: When medications are being studied in clinical trials, they aresometimes

comparedtoasubstancethatdoesnotcontainanymedication.Thisiscalledaplacebo.

Somestudiesuseplaceboslikesugartabletsorsaltwater.

Prodrug: Somemedicationsarenotabsorbedverywellbythebody.Andothersmay

workbetteriftheyareabletoreachacertainareainthebody(e.g.,intestines).Scientists

willsometimesformulatemedicationstohelpsolve these issues. These medications

arecalledprodrugs.

Prodrugs are medications that do not have clinical effects on their own. But they turn

into their active form once they enter in body or reach a target area.

Once the prodrug becomes active, it is able to start working. For example, omeprazole

(Prilosec) is a prodrug. It only becomes active once it reaches your gut to relieve

heartburn and treat gastroesophageal reflux disease (GERD).

Prophylaxis: Itisameasuretakentopreventacondition.Itisalsoknownasprevention.

Therearethreetypesofprophylaxis:Primary,secondary,andtertiary:

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Textbook of Pharmacy Practice

• Primary: Preventing a condition beforeit happens.For example,pre-exposure

prophylaxis(PrEP)isrecommendedforpeopleathighriskforHIVinfection.

• Secondary: Preventingarecurrenceorworseningofaconditionyoualreadyhave.

Forexample,dailyexerciseandahealthierdietcanpreventfurtherheartattacksor

strokes.

• Tertiary: Managingaconditiontoeithersloworstopitsprogression.Forexample,

chemotherapycanhelpslowthegrowthofacanceroustumor.

Receptor: Theseareproteinsthatarefoundontheoutsideorinsideofacell.Theyare

responsibleforreceivingandtransmittingsignals,andtheycanbeactivatedorblocked.

Thiscancontroldifferenteffectsinyourbody.Medicationsusuallyworkbybinding

todifferentreceptors.

APPENDIX 3: TYPES OF LICENSE FOR SALE

S. No. Category Sale Type Application Form License Form

1. Drugs other than those specified in

Schedule C&C (1) and X

Wholesale 19 20-B

Retail sale 19 20

Restricted

(General store)

19-A 20-A

2. Drugs specified in Schedule C&C

(1) but excluding those specified in

Schedule ‘X’

Wholesale 19 21-B

Retail sale 19 21

Restricted

(General store)

19-A 21-A

3. Drugs specified in Schedule ‘X’ Wholesale 19-C 20-G

Retail sale 19-C 20-F

4. Sale of drugs from motor vehicles:

(a) Drugs other than those specified in

Schedule C&C (1), (b) Drugs specified

in Schedule C&C (1)

Wholesale 19-AA 20-BB

Wholesale 19-AA 21-BB R-62-D R

5. Homeopathic medicines Wholesale 19-B 20-D

Retail sale 19-B 20-C

2-Hour Postprandial (PP) blood sugar 183

ABC analysis 166

ABC-VED matrix analysis 166

Advantages and disadvantages of the hospital

formulary system 51

Advantages of

implementing the budget 129

primary literature 91

secondary sources 91

tertiary literature 93

Adverse drug–drug interactions 24

Adverse drug reaction monitoring 137

Adverse drug reactions 17

Advisory committee 174

Albumin and total protein 185

Allergic response to drugs 21

ALP or alkaline phosphatase 185

ALT or alanine transaminase 185

Aspartate aminotransferases 190

AST or aspartate transaminase 185

Augmented pharmacological effects 20

Automated medication dispensing method 48

Basic concepts of hospital organization 6

Basic principles of efcient reporting 30

Benecial drug interaction 23

Benets of e-tenders 164

Bilirubin 186

Blood chemistry 176

Blood examination/ hematological test 177

Blood sugar 183

Budget preparation and its implementation 127

BUN/creatinine ratio 187

BUN or blood urea nitrogen 186

Carbon dioxide (CO

) test 187

Case control studies 28

Categories of budgets 127

Categorization of adverse drug events 19

Causes of medication non-adherence 64

Cell counts 178

Centralized unit dose dispensing method 46

Charged oor stock method 44

Chemical examination 191

Chest X-ray 189

Classication based on clinical and non-clinical

basis 4

Classication of adverse events 17

Classication of hospital organizations 3

Classication of investigational drugs 169

Clinical importance 178, 179, 180, 182, 190

Clinical pharmacy 131

Clinical signicance 181

Cl or serum chloride test 187

Closed formulary in contrast 51

Coagulation time/clotting time of blood 182

Code of ethics for community pharmacist 113

Cohort studies 28

Combination of individual prescription and oor

stock method 45

Common serum enzyme test 189

Communication skill 121

Communications with patients, prescribers and

pharmacists 122

Communication with patients 123

Community pharmacy 34

Community pharmacy management 74

Comparison of side effects and adverse effect 17

Computerized drug information services, storage

and retrieval of information 97

Control of investigational use of drugs 170

Creatinine kinase (CK) 189

Daily activities of clinical pharmacists 133

Daily average usage 161

Decentralized unit dose dispensing method 46

Design, layout and specication 153

Design of retail and wholesale drugstore 34

Dialog 98

Difference of re-order level and re-order

quantity 162

Differential leukocyte count (DLC) 181

Disadvantages of

primary literature 91

secondary literature 92

tertiary literature 93

Divisions of budget 128

Doctor reviews 96

Documents required for getting a drug license 37

Index

199

200

Textbook of Pharmacy Practice

Drug and poisons information centre 99

Drug basket methods 45

Drug distribution system in hospitals 43

Drug information services 90

Drug interactions 23

Drugs supply in emergency ward 48

Drugstore management and inventory control 153

ECG 189

Echocardiography 189

Economic order quantity (EOQ) 158

Educational and training programs in hospital 110

Effect of pathological disease on drug therapy 141

Effect of pharmacokinetic prole on drug

therapy 140

Electrolytes and minerals tests 187

Emergency purchases 165

Envelop method 44

Erythrocyte sedimentation rate 182