Obesity (everything but the drugs) Flashcards
restrictive bariatric surgeries
laparoscopic adjustable gastric banding
gastric sleeve surgery (vertical sleeve gastrectomy)
restrictive and malabsorptive surgeries
roux-en-y gastric bypass
biliopancreatic diversion with duodenal switch
describe laparoscopic adjustable gastric banding
an inflatable silicone band around the gastric fungus to make a small pouch which makes the patient feel full after eating a small amount of food. this is reversible and does not cause anatomical gut changes
pros of laparoscopic adjustable gastric banding
no organs are bypassed, delayed gastric emptying, decreases risk of lowered nutritional and drug absorption (but expect delayed drug absorption)
describe vertical sleeve gastrectomy
removes 70% of the stomach, leaving only a banana shaped section– this reduces the amount of food that can fit in the stomach (feel full sooner). removes ghrelin-producing cells
vertical sleeve gastrectomy reduces absorption of ____
products requiring acidic pH
average mean weight loss with vertical sleeve gastrectomy
25%
what is the gold standard of bariatric surgeries
roux-en-y gastric bypass
description of roux-en-y gastric bypass
a small stomach pouch is created, disconnected duodenum. pouch anastomosed to a roux limb of jejunum. duodenum reconnected to start of ileum- Y site.
food bypasses 95% of the stomach, duodenum, most of the jejunum
average weight loss with roux-en-y gastric bypass
30%
what absorption changes happen with the malabsorptive surgeries
decrease absorption for products requiring acidic pH. decreased fat and protein absorption. increased risk of nutritional deficiencies
describe biliopancreatic diversion with duodenal switch
a portion of the stomach is removed vertically creating a small tubular stomach pouch. ileum is connected to beginning of duodenum before the part where bile salts and pancreatic enzymes are secreted. end of jejunum connected to ileum
dumping syndrome
foods rapidly enter GI largely undigested causing n/v, bloating, cramping, diarrhea. avoid foods with high sugar content and eat small meals
fat malabsorption: why does it happen
decreased bile salts and pancreatic enzymes
fat soluble vitamins
ADEK
consequences of fat malabsorption
diarrhea, steatorrhea, bloating, flatus
how to help with fat malabsorption
avoid foods with high fat content
what do micronutrient deficiencies in cyanocobalamin, folate, and iron cause
chronic anemia
what does micronutrient deficiency in calcium cause
osteoporosis
what medication formulations to avoid
ER, DR, enteric coated
what medication formulations to prefer
immediate release
also consider alternative: sublingual, subcutaneous, intravenous, transdermal, rectal, vaginal, intranasal
what pk considerations for bariatric surgery pharmacotherapy
weight based drugs, narrow therapeutic index, drugs dependent on bile salts for solubility
what drugs are dependent on bile salts for solubility
cyclosporine, phenytoin, levothyroxine, tacrolimus
what comorbidities can improve with bariatric surgery
T2DM, HTN, hyperlipidemia
gallstone prophylaxis
ursodiol 300 mg PO daily x 6 months
what med class to avoid with post op bariatric surgery pharmacotherapy
NSAIDs (increased mucosal toxicity)
what diabetes meds cause weight gain
insulin, TZD, sulfonylureas, meglitinides
what depression meds cause weight gain
TCA, paroxetine
what anti-seizure meds cause weight gain
valproic acid, pregabalin, carbamazepine
what antipsychotics cause weight gain
olanzapine
what arthritis meds cause weight gain
steroids
what HIV drugs cause weight gain
protease inhibitors (ritonavir)
what hypertension drugs cause weight gain
beta blockers
BMI criteria for bariatric surgery
≥40
≥37.5 asian
≥35 with comorbidities such as HTN and sleep apnea
≥30 with diabetes or metabolic syndrome
