Obesity (everything but the drugs)

Question 1

restrictive bariatric surgeries

Answer 1

laparoscopic adjustable gastric banding
gastric sleeve surgery (vertical sleeve gastrectomy)

Question 2

restrictive and malabsorptive surgeries

Answer 2

roux-en-y gastric bypass
biliopancreatic diversion with duodenal switch

Question 3

describe laparoscopic adjustable gastric banding

Answer 3

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

Question 4

pros of laparoscopic adjustable gastric banding

Answer 4

no organs are bypassed, delayed gastric emptying, decreases risk of lowered nutritional and drug absorption (but expect delayed drug absorption)

Question 5

describe vertical sleeve gastrectomy

Answer 5

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

Question 6

vertical sleeve gastrectomy reduces absorption of ____

Answer 6

products requiring acidic pH

Question 7

average mean weight loss with vertical sleeve gastrectomy

Answer 7

25%

Question 8

what is the gold standard of bariatric surgeries

Answer 8

roux-en-y gastric bypass

Question 9

description of roux-en-y gastric bypass

Answer 9

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

Question 10

average weight loss with roux-en-y gastric bypass

Answer 10

30%

Question 11

what absorption changes happen with the malabsorptive surgeries

Answer 11

decrease absorption for products requiring acidic pH. decreased fat and protein absorption. increased risk of nutritional deficiencies

Question 12

describe biliopancreatic diversion with duodenal switch

Answer 12

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

Question 13

dumping syndrome

Answer 13

foods rapidly enter GI largely undigested causing n/v, bloating, cramping, diarrhea. avoid foods with high sugar content and eat small meals

Question 14

fat malabsorption: why does it happen

Answer 14

decreased bile salts and pancreatic enzymes

Question 15

fat soluble vitamins

Answer 15

ADEK

Question 16

consequences of fat malabsorption

Answer 16

diarrhea, steatorrhea, bloating, flatus

Question 17

how to help with fat malabsorption

Answer 17

avoid foods with high fat content

Question 18

what do micronutrient deficiencies in cyanocobalamin, folate, and iron cause

Answer 18

chronic anemia

Question 19

what does micronutrient deficiency in calcium cause

Answer 19

osteoporosis

Question 20

what medication formulations to avoid

Answer 20

ER, DR, enteric coated

Question 21

what medication formulations to prefer

Answer 21

immediate release
also consider alternative: sublingual, subcutaneous, intravenous, transdermal, rectal, vaginal, intranasal

Question 22

what pk considerations for bariatric surgery pharmacotherapy

Answer 22

weight based drugs, narrow therapeutic index, drugs dependent on bile salts for solubility

Question 23

what drugs are dependent on bile salts for solubility

Answer 23

cyclosporine, phenytoin, levothyroxine, tacrolimus

Question 24

what comorbidities can improve with bariatric surgery

Answer 24

T2DM, HTN, hyperlipidemia

Question 25

gallstone prophylaxis

Answer 25

ursodiol 300 mg PO daily x 6 months

Question 26

what med class to avoid with post op bariatric surgery pharmacotherapy

Answer 26

NSAIDs (increased mucosal toxicity)

Question 27

what diabetes meds cause weight gain

Answer 27

insulin, TZD, sulfonylureas, meglitinides

Question 28

what depression meds cause weight gain

Answer 28

TCA, paroxetine

Question 29

what anti-seizure meds cause weight gain

Answer 29

valproic acid, pregabalin, carbamazepine

Question 30

what antipsychotics cause weight gain

Answer 30

olanzapine

Question 31

what arthritis meds cause weight gain

Answer 31

steroids

Question 32

what HIV drugs cause weight gain

Answer 32

protease inhibitors (ritonavir)

Question 33

what hypertension drugs cause weight gain

Answer 33

beta blockers

Question 34

BMI criteria for bariatric surgery

Answer 34

≥40
≥37.5 asian
≥35 with comorbidities such as HTN and sleep apnea
≥30 with diabetes or metabolic syndrome