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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.

20
Q

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

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
What are the fat soluble vitamins?
A D E K
26
What is the supplementation dose for Vit A?
5,000 - 10,000 u/day
27
What is the supplementation dose for Vit D?
≥ 3,000 u/day
28
What is the supplementation dose for Vit E?
400 u/day
29
What is the supplementation dose for Vit K?
1 mg/day
30
What should be supplemented for bone health?
Calcium and Vit D
31
Which calcium formulation is superior in BS patients?
citrate > carbonate
32
What is the supplementation dose for calcium?
1,200 - 1,500 mg/day elemental Ca
33
What should be supplemented for blood health?
iron and Vit B12
34
What is the supplementation dose for iron?
45 - 60 mg in MVI | add Vit C if no MVI
35
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) Absorption
36
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) Roux-en-Y
37
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
e) Liquid
38
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
d) Both B and C
39
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
e) All of the above

957 Block 2 (14 decks)

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