Exam 3 (Obesity) Flashcards
1
Q
- How do you calculate BMI?
A
Kg / m²
2
Q
- What is android obesity, what about Gynecoid?
A
- Android is central.
- Gynecoid is peripheral obesity
3
Q
- Android obesity is associated with?
A
Increased O2 consumption & CV disease
4
Q
- What clotting factors are increased in obesity?
A
- Fibrinogen,
- Factors VII, VIII
5
Q
- What happens to the renal system in obesity?
A
- Glomerular hyperfiltration.
- Increased renal tubular reabsorption
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
7
Q
- What are the risk factors for metabolic syndrome?
A
- Increased age
- Men>women
- Hispanic & south Asians
8
Q
- What drug classes can lead to metabolic syndrome?
A
- Steroids,
- antidepressants,
- antipsychotics,
- protease inhibitors
9
Q
- OSA is defined as?
A
- Complete breathing cessation.
- Lasting >10sec.
- 5x or > each hour.
- Sats decrease by 4%
10
Q
- Hypopnea is defined as?
A
- 50% or > airflow reduction.
- Lasting 10sec or >.
- 15x or > per hour.
- Sats decrease 4%
11
Q
- What AHI score indicates moderate OSAHS, what about severe?
A
- Moderate: 15 – 30/hr
- Severe: >30/hr
12
Q
- What is Pickwickian syndrome?
A
Long-term OSA d/t obesity
13
Q
- What can Pickwickian syndrome result in?
A
- Pulmonary HTN &
- Cor pulmonale
14
Q
- What is the diagnosis for Pickwickian?
A
- BMI >30 kg/m² &
- awake hypercapnia
15
Q
- What is Phentermine?
A
- Sympathomimetic to decrease appetite.
- Only approved for 3mos.
- Not in combo w/ Fenfluramine
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)
