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Principles 2 > Exam 3 (Obesity) > Flashcards

Exam 3 (Obesity) Flashcards

1
Q
  • How do you calculate BMI?
A

Kg / m²

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2
Q
  • What is android obesity, what about Gynecoid?
A
  • Android is central.
  • Gynecoid is peripheral obesity
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3
Q
  • Android obesity is associated with?
A

Increased O2 consumption & CV disease

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4
Q
  • What clotting factors are increased in obesity?
A
  • Fibrinogen,
  • Factors VII, VIII
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5
Q
  • What happens to the renal system in obesity?
A
  • Glomerular hyperfiltration.
  • Increased renal tubular reabsorption
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6
Q
  • What are the highlights of metabolic syndrome & how many must be present for diagnosis?
A
  • Abdominal obesity,
  • decreased HDL,
  • Hypertriglyceridemia,
  • Glucose intolerance
  • Hypertension.
  • 3 must be present for diagnosis
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7
Q
  • What are the risk factors for metabolic syndrome?
A
  • Increased age
  • Men>women
  • Hispanic & south Asians
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8
Q
  • What drug classes can lead to metabolic syndrome?
A
  • Steroids,
  • antidepressants,
  • antipsychotics,
  • protease inhibitors
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9
Q
  • OSA is defined as?
A
  • Complete breathing cessation.
  • Lasting >10sec.
  • 5x or > each hour.
  • Sats decrease by 4%
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10
Q
  • Hypopnea is defined as?
A
  • 50% or > airflow reduction.
  • Lasting 10sec or >.
  • 15x or > per hour.
  • Sats decrease 4%
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11
Q
  • What AHI score indicates moderate OSAHS, what about severe?
A
  • Moderate: 15 – 30/hr
  • Severe: >30/hr
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12
Q
  • What is Pickwickian syndrome?
A

Long-term OSA d/t obesity

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13
Q
  • What can Pickwickian syndrome result in?
A
  • Pulmonary HTN &
  • Cor pulmonale
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14
Q
  • What is the diagnosis for Pickwickian?
A
  • BMI >30 kg/m² &
  • awake hypercapnia
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15
Q
  • What is Phentermine?
A
  • Sympathomimetic to decrease appetite.
  • Only approved for 3mos.
  • Not in combo w/ Fenfluramine
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16
Q
  • What are the side effects of Phentermine?
A
  • Tachycardia,
  • palpitations,
  • HTN,
  • dependence,
  • abuse
17
Q

How does Orlistat work?

A

Blocks absorption of dietary fat

18
Q

What are the side effects of Orlistat?

A
  • Liquid stool,
  • fecal urgency,
  • flatulence,
  • abdominal cramps,
  • fat-soluble vitamin deficiency,
  • Vit-K deficiency
19
Q

When are GLP-1 agonists stopped before surgery?

A
  • Day before or day of surgery.
  • If on weekly dose then hold for 1 week
20
Q

If Pt took GLP-1 agonist the morning of but has no GI S/S what steps are taken?

A
  • Treat Pt as full stomach.
  • Perform gastric US.
  • Delay Sx if necessary.
21
Q
  • What CPAP setting suggests difficult mask ventilation?
A

Usage of > 10cm H2O

22
Q
  • What home meds are not continued?
A
  • Antihypertensives,
  • insulin,
  • oral hypoglycemics
23
Q
  • What is the airway physiology in obese Pts?
A
  • ↓ vital capacity,
  • ↓ inspiratory capacity,
  • ↓ expiratory reserve volume,
  • ↓ FRC,
  • low compliance,
  • rapid desaturation
24
Q
  • What position is favored in obese Pts, lateral or prone?
A

Lateral decubitus

25
Q
  • What is not needed in lateral decubitus with obese Pts?
A

Axillary rolls

26
Q
  • What is at risk in the supine position in obese Pts?
A

Rhabdomyolysis on gluteal muscles

27
Q
  • What is an ellipse in obese Pts?
A

Short transverse & long AP axis

28
Q
  • What points are aligned in the ramped position for intubation?
A

External auditory meatus & the sternum

29
Q
  • What is the best position for recruitment in an obese Pt & how much PEEP?
A
  • 30° reverse Trendelenburg.
  • PEEP of 10cm
30
Q
  • How are epidural doses adjusted in obese Pts?
A

Smaller doses d/t smaller space.

31
Q
  • What is an issue with epidurals in obese Pts?
A

More hypotension after block d/t IVC/Ao compression

32
Q
  • What meds are favored with obese Pts?
A
  • Short acting
  • Remifentanil & fentanyl favored
33
Q
  • What meds are based on IBW?
A
  • Propofol,
  • Vecuronium,
  • Rocuronium,
  • Remifentanil
34
Q
  • What meds are based on TBW?
A
  • Midazolam,
  • Succinylcholine,
  • Cisatracurium,
  • Fentanyl,
  • Sufentanil
35
Q
  • Do obese Pts loose heat faster or slower than non-obese Pts?
A

Faster d/t bigger surface area

36
Q
  • Is Sugammadex based on IBW or TBW?
A

TBW is better in obese Pts

37
Q
  • What ventilator mode should be considered for obese Pts on emergence?
A

Pressure support

38
Q
  • Which GLP-1 agonists are taken weekly?
A
  • Dulaglutide (Trulicity) &
  • Semaglutide (Ozempic)
39
Q
  • Which GLP-1 agonist is taken BID?
A

Exenatide (Byetta)

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