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957 Block 2 > 7. Bariatric Surgery > Flashcards

7. Bariatric Surgery Flashcards

1
Q

What BMI is considered overweight?

A

25 - 29.9

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2
Q

What BMI is obesity class 1?

A

30 - 34.9

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3
Q

What BMI is obesity class 2?

A

35 - 39.9

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4
Q

What BMI is obesity class 3?

A

≥ 40

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5
Q

What are the 3 categories of bariatric surgery?

A

restrictive
malabsorptive
combination of restrictive and malabsorptive

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6
Q

What are the specific restrictive procedures?

A
  • vertical banded gastroplasty
  • laparoscopic adjustable gastric band
  • sleeve gastrectomy
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7
Q

What are the specific malabsorptive procedures?

A
  • jejunoileal bypass
  • biliopancreatic diversion
  • biliopancreatic diversion with duodenal switch
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8
Q

What are the specific combination restrictive and malabsorptive procedures?

A

Roux-en-Y gastric bypass

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9
Q

What are the indications for gastric bypass surgery?

A
  • BMI ≥ 40 without comorbidities
  • BMI 35 - 39.9 with at least one severe comorbidity
  • BMI 30 - 34.9 with uncontrolled T2DM or metabolic syndrome
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10
Q

What are contraindications for gastric bypass?

A
  • age 65
  • untreated major depression or psychosis
  • uncontrolled eating disorder
  • alcohol and/or drug abuse
  • severe cardiac disease
  • severe coagulopathy
  • inability to comply with diet
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11
Q

What are some acute complications with bariatric surgery?

A
  • VTE
  • bleeding
  • infection
  • anastomotic leak
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12
Q

What are some chronic complications with bariatric surgery?

A
  • NV
  • diarrhea
  • GERD
  • dumping syndrome
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13
Q

What are some pharmacokinetic complications with patients who have had bariatric surgery?

A
  • decreased surface area
  • enzyme changes (reduced metabolism)
  • faster GI transit time
  • increased pH
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14
Q

What medication formulations are best for patients who have had bariatric surgery?

A
  • liquid
  • crushable
  • non-oral
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15
Q

What medication formulations should you avoid in patients who have had bariatric surgery?

A 
ER and EC formulations
GI irritants (NSAIDS)
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16
Q

Avoid or split pills _____ than a(n) _____.

A

larger

M&M

17
Q

What nutrition deficiencies are common in patients who have had bariatric surgery?

A
  • fat soluble vitamins
  • vitamin B12
  • Ca, Fe, Zn
  • thiamine
18
Q

What diseases should improve/resolve with bariatric surgery?

A
  • Diabetes
  • Hypertension
  • Hyperlipidemia
  • infertility
19
Q

_____ containing medications put BS patients at risk for dumping syndrome.

A

sorbitol

20
Q

What medication class should be avoided in BS patients because it predisposes them to dehydration?

A

diuretics

21
Q

What medication class should be avoided in BS patients because it has questionable risk/benefit?

A

bisphosphonates

22
Q

Oral contraceptions should be avoided in BS patients for what reason(s)?

A

altered enterohepatic recirculation

23
Q

Antidepressants should be avoided in BS patients for what reason?

A

alteration is CYP enzymes

24
Q

What prophylactic medication should be administered to BS patients?

A

PPIs (ulcer prevention)
Ursodiol (gallstone prevention)
nutritional supplementation

25
Q

What are the fat soluble vitamins?

A

A D E K

26
Q

What is the supplementation dose for Vit A?

A

5,000 - 10,000 u/day

27
Q

What is the supplementation dose for Vit D?

A

≥ 3,000 u/day

28
Q

What is the supplementation dose for Vit E?

A

400 u/day

29
Q

What is the supplementation dose for Vit K?

A

1 mg/day

30
Q

What should be supplemented for bone health?

A

Calcium and Vit D

31
Q

Which calcium formulation is superior in BS patients?

A

citrate > carbonate

32
Q

What is the supplementation dose for calcium?

A

1,200 - 1,500 mg/day elemental Ca

33
Q

What should be supplemented for blood health?

A

iron and Vit B12

34
Q

What is the supplementation dose for iron?

A

45 - 60 mg in MVI

add Vit C if no MVI

35
Q

Which of the following pharmacokinetic parameters is MOST affected by bariatric surgery?

a) Absorption
b) Distribution
c) Metabolism
d) Elimination
e) All are equally effected

A

a) Absorption

36
Q

Which of the following bariatric surgical procedures is both restrictive AND malabsorptive?

a) Roux-en-Y
b) Sleeve gastrectomy
c) Gastric band laparoscopy
d) None of the above
e) All of the above

A

a) Roux-en-Y

37
Q

Which of the following medication formulations is the MOST appropriate after bariatric surgery?

a) Extended-release
b) Delayed-release
c) Enteric-coated
d) Immediate release
e) Liquid

A

e) Liquid

38
Q

Which of the following patients would be indicated for bariatric surgery?

a) 35 yo F with SLE and CKD, BMI: 32 kg/m2
b) 28 yo M with OSA, HTN, HLD, T2DM; BMI: 36 kg/m2 c) 39 yo F with no PMH; BMI: 40.0 kg/m2
d) Both B and C
e) All of the above

A

d) Both B and C

39
Q

Which of the following vitamins exhibit reduced absorption after bariatric surgery?

a) Vitamin A
b) Vitamin D
c) Vitamin E
d) Vitamin K
e) All of the above

A

e) All of the above

957 Block 2 (14 decks)

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