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Clinical Pharmacy 1 - Term 1 > 11 - Obesity & Bariatric Surgery > Flashcards

11 - Obesity & Bariatric Surgery Flashcards

1
Q

What are some factors that contribute to obesity?

A
  • Environment
  • Hormones
  • Psychology
  • Inactivity
  • Medications
  • Genetics
  • Lack of sleep
  • Emotional stress
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2
Q

What are some reasons for bariatric surgery?

A
  • Co-morbidity resolution
  • Chronic disease and obesity-related condition prevention
  • Improvement in quality of life
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3
Q

With ____, almost any procedure will work

A

Lifestyle changes

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4
Q

What are indications for bariatric surgery?

A
  • BMI over 40
  • BMI over 35 w/ obesity-related co-morbidity
  • Failure of diet and exercise
  • Compliant patient
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5
Q

Diet and exercise is effective in ___% of the population

A

Less than 5%

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6
Q

What are the 2 types of current procedures?

A
  • Restrictive (consume less food)

- Malabsorptive (decreased absorption of calories eaten)

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7
Q

What are the current procedures available?

A
  • Roux-en-Y gastric bypass
  • Sleeve gastrectomy
  • Adjustable gastric band
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8
Q

Which type of procedure is the gastric bypass?

A

Combined restrictive and malabsorptive w/ strong hormonal component

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9
Q

Which type of procedure is the sleeve gastrectomy?

A

Restrictive w/ hormonal component

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10
Q

Which type of procedure is the adjustable gastric band?

A

Restrictive

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11
Q

What are some advantages and disadvantages to the adjustable gastric band?

A
  • Advantages – fewer complications; reversible
  • Disadvantages – higher failure rate; lowest weight loss and disease resolution (about 10-15% total weight loss); can fall off
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12
Q

What occurs in a gastric bypass?

A
  • Small stomach pouch causes restriction

- Food bypasses the distal stomach, duodenum, and portion of jejunum => malabsorption

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13
Q

What are advantages to gastric bypass?

A
  • Results in about 30% total weight loss

- Best resolution of comorbidities, mainly type 2 diabetes

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14
Q

What types of hormonal changes occur from gastric bypass?

A
  • Increased insulin sensitivity and production
  • Increased satiety
  • Decreased hunger
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15
Q

What occurs in sleeve gastrectomy?

A
  • About 80% of stomach is removed, leaving stomach looking like a sleeve or tube
  • Technically not malabsorptive, but b/c of decrease of stomach acid, malabsorption does occur
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16
Q

Sleeve gastrectomy does not cause changes to ____

A

Pyloric sphincter or intestines

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17
Q

What hormonal changes occur from sleeve gastrectomy?

A

Increased satiety and decreased hunger

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18
Q

What is the goal of a pre-op diet?

A

Skin liver to make surgery safer and easier (use up glycogen stores and reduce fatty tissue)

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19
Q

What is the pre-op diet?

A

5 Boost Diabetic bottles per day = 950 kcals, 80g protein, 70g carbs per day

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20
Q

What is the post-op nutrition?

A
  • Minimum 60g protein/day for at least first year
  • About 1200 kcal/day long-term (500-600 kcal/day first weeks, increasing as meal volume/tolerance increases)
  • High protein, high fibre, low-moderate carbs life-long
  • 3 meals + 1-3 snacks; 1-1.5 cups of food per meal
  • Minimum 2 L of fluid/day separate from meals
  • Daily vitamin and mineral supplements
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21
Q

What is the diet for operative day and post-op day 1?

A

Clear fluids and protein supplement

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22
Q

What is the diet for days 1-7 post-op?

A

Clear fluids and meal replacements/protein shakes

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23
Q

What is the diet for 1-4 weeks post-op?

A

Protein-rich pureed foods

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24
Q

What is the diet for 4-8 weeks post-op?

A
  • Soft, minced foods
  • 1/2 cup food per meal, 6-7 small meals per day
  • Begin to separate beverages from meals
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25
Q

What is the diet for 8-12 weeks post-op?

A
  • Regular food

- 3/4 - 1 cup food per meal

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26
Q

What are the required vitamins and minerals post-op?

A
  • Multivitamin 2 times/day (at least 15 mg iron; 2 mg copper, zinc, selenium, vitamins A, E, and K)
  • 500-1000 mcg/day vitamin B12
  • 35 mg ferrous gluconate (at least 2 hours from calcium/thyroid medication)
  • 1200-1500 mg/day calcium in 3 doses
  • 3000 IU/day vitamin D
  • 1 B50 complex/day
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27
Q

Px should take all supplements by __ weeks post-op

A

2

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28
Q

Tablets smaller than an ____ are generally fine to swallow whole

A

M&M

29
Q

What are some potential early complications?

A
  • Staple line leak
  • Bleed
  • Nausea and vomiting
  • Dehydration
30
Q

What are some potential late complications?

A
  • Adhesions/small bowel obstruction
  • Gastric and/or anastomotic ulcers
  • Stomal stenosis
  • Cholelithiasis
  • Nausea, vomiting, diarrhea, constipation
  • Pouch dilation
31
Q

What are some early nutrition complications?

A
  • Food intolerances

- Dumping syndrome

32
Q

What could increasing intolerances signal?

A

Complications (ulcer, stricture)

33
Q

What causes dumping syndrome?

A

Rapid transit of simple/free sugars or greasy foods into lower small intestine

34
Q

What is the tx for dumping syndrome?

A

Avoid suspect foods and beverages (read food labels/ingredients lists carefully)

35
Q

What are late nutrition complications?

A
  • Hair loss
  • Kidney stones
  • Reactive hypoglycemia
  • Lack of appetite
36
Q

When does hair loss typically occur?

A
  • 3-6 months post-op as a stress response

- Over 9 months post-op likely due to nutrient deficiency

37
Q

What causes kidney stones?

A
  • Increased oxalate retention
  • Decreased fat intake
  • Decreased calcium intake
  • Inadequate hydration
  • Other metabolic factors
38
Q

What is the treatment for kidney stones?

A
  • Minimum 2 L of fluid/day
  • At least 1000 mg calcium
  • Low oxalate diet
39
Q

What causes reactive hypoglycemia?

A
  • Inadequate carbohydrates
  • Missed meals
  • Excessive exercise or medication
  • Increased incretin release
40
Q

What is the tx for reactive hypoglycemia?

A
  • Focus on complex/high fibre carbs

- Combine carbs and protein for snacks

41
Q

What are common micronutrient deficiencies in post-op px?

A
  • Iron
  • Zinc
  • Copper
42
Q

What are sx of iron deficiency?

A

Fatigue, headaches, insomnia, hair loss

43
Q

What is the tx for iron deficiency?

A

Up to 300 mg oral elemental iron and 250 mg vitamin C

44
Q

What are sx of copper deficiency?

A

Ataxic gait, extremity numbness, unexplained anemia

45
Q

What is the tx for zinc and copper deficiencies?

A

1 mg copper and 8-15 mg zinc in supplements

46
Q

When do vitamin A deficiencies occur?

A

Poor diet and inadequate supplementation

47
Q

When do thiamine deficiencies occur?

A

Persistent vomiting and reduced food intake

48
Q

When do vitamin B12 deficiencies occur?

A
  • Low acid environment, decreased digestion of vitamin from foods
  • Exclusion of distal stomach, therefore reduced intrinsic factor production
49
Q

When do vitamin D deficiencies occur?

A

Decreased absorption from foods or decreased intake of vitamin D rich foods

50
Q

Which medications should be changed after surgery?

A
  • NSAIDs (avoided or used in small doses)
  • Oral contraceptives
  • Antihyperglycemics (px should stop all SGLT-2 inhibitors before surgery and should never start them after surgery)
  • Psych medications (must be changed to immediate release)
51
Q

What type of medications/supplements should be avoided after bariatric surgery?

A

Extended-release or enteric coated

52
Q

Px should abstain from alcohol for ___ months post-op

A

12

53
Q

Px should wait at least ___ months after bariatric surgery to get pregnant

A

12-18

54
Q

Px are seen at least __ time in the 1st year post-op

A

5

55
Q

What do obesity rates correlate with?

A
  • Increased sitting

- Availability at low/no cost of foods and beverages rich in poorly satiating calories

56
Q

What are some obesity complications?

A
  • Fatigue
  • Depression
  • Clots
  • GERD
  • Gout
  • Various cancers
  • Pancreatitis
  • Diabetes
  • Osteoarthritis
  • Sleep apnea
57
Q

___ percent of loss of initial body weight will provide a substantial improvement in ____

A
  • 5-10%

- Insulin sensitivity, glycemic control, hypertension, dyslipidemia, physical function

58
Q

What are some conditions in which there is evidence that physical activity provides a benefit?

A
  • Osteoarthritis (hip and knee)
  • Type 2 diabetes
  • Heart failure
  • Coronary heart disease
  • COPD
  • Prevention of falls
  • Chronic fatigue syndrome
59
Q

What are the 5 A’s of obesity management?

A

1) ASK for permission to discuss weight and explore readiness
2) ASSESS obesity related risks and causes of obesity
3) ADVISE on health risks and treatment options
4) AGREE on health outcomes and behavioural goals
5) ASSIST in accessing appropriate resources and providers

60
Q

Which drugs are usual suspects of weight gain?

A
  • Antidepressants
  • Atypical antipsychotics
  • Insulin, sulphonylureas
  • Others - valproic acid, lithium
61
Q

How does orlistat work?

A

Prevents body from absorbing fat => fatty diarrhea

62
Q

When is topiramate a reasonable option for weight loss?

A

When indicated for a different reason (ex: migraine prevention) and weight loss is desired

63
Q

What is liraglutide?

A

GLP-1 agonist

64
Q

What are side effects of liraglutide?

A
  • GI (nausea, vomiting, diarrhea)

- Serious adverse events

65
Q

What are the key messages that pharmacists need to give to the public?

A
  • Weight loss pills result in minimal weight loss and their side effects make life difficult
  • Weight loss pills do not improve overall health
66
Q

Being 10 pounds overweight increases the force on the knee by ____ pounds with each step

A

30-60 pounds

67
Q

What effects does weight loss have on osteoarthritis?

A
  • Reduces pain
  • Reduces stiffness
  • Reduce risk of disability
68
Q

What are pharmacist’s roles in obesity?

A
  • Take obesity seriously as a health concern
  • Engage in a caring, sharing conversation
  • Be aware of drug causes
  • Mythbusting
  • Reinforcing
  • Enabling

Clinical Pharmacy 1 - Term 1 (18 decks)

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