Prodigy- Obesity Flashcards
Which weight calculation is estimated using a formula known as the Broca index?
Ideal body weight
Males = height in cm -100
Females = height in cm - 105
Which body weight measurement estimates the weight of the body minus the apidose tissue?
Lean body weight
Adults - LBW x 1.3
Peds = IBW + 1/3 (TBW-IBW)
Lean body weight is estimated to be what % of TBW for males vs females
Males = 80% of TBW
Females = 75% of TBW
so technically I guess if prop induction should be on LBW - you should calucate what your dose would be for TBW and reduce it 20% for men and 25% for women
what weight caculation is similar to IBW in that it uses gender and height to arrive at it’s estimation
what is it used for?
predicted body weight
caculating appropriate tidal volumes for an obese patient
Men = 50 + 0.91 (height (cm) - 152.4)
Women = 45.4 + 0.91 (height (cm) - 152.4)
Yeah takin an L on that formula
Morbid obesity medications are aimed at decreasing appetite except which two drugs?
- Orlistat
- Liraglutide
- Orlistat- blocks GI absorption of fat (Risk of coagulopathy due to vitamkin K deficiency)
- Liraglutide- decreases reabsorption of glucose in the renal tubules
> Glucagon-Like Peptide 1 Agonist ( -“tide” : liraglutide & exenatide):
> decreases gluccagon release from alpha cells
> increases insulin release from pancreatic beta cells (risk of hypoglycemia)
> prolong gastric emptying
T/F- the difficulty of intubation is directly proportional to BMI
False
*Mallampati, TMJ dysfuncion, male gender, older age, and abdormal upper teeth are most predictive of the difficulty
What is the single most significant predictor of a difficult airway in obese patients?
their neck circumference
If you see someone with a BMI of 40; what do you want to make sure to look at physically?
The size of their neck - single most significant predictor of a difficult airway
-also look at mallampati
-TMJ dysfunction
-upper teeth abnormal
How would you be able to evaluate for the presence of pulmonary hypertension on a 12-lead EKG?
Right axis devation
I -
AVF +
T/F: obesity places patients at increased risk for thromembolic events
True
BMI > 60
evidence of venous stasis (look at their legs)
central obestiy
obesity hypoventilation syndrome (whats their co2 “bicarb” on ther bmp - co2 is carried in blood as bicarb)
osa
Which two lung volumes/capcities abnormalities are most evident in obesity
FRC and ERV
T/F: FRC is the most sensitive indicator of pulmonary function in obesity
False- ERV
(FRC cant be measured [ERV+RV]) & cant measure RV
Obese patients have increased metabolic requirements for excess apidose tissue , resulting in an increase in o2 consumption and carbon dioxide production……what does thsi result in?
increased CO & increased mV to keep up with demand
What are 4 things on the chart you could look at that may indicate the patient has chronic untreated sleep apnea
- What’s their blood pressure
- Right axis devation on EKG? (RV hypertrophy from pulm HTN) (I +, AVF -)
- Co2 on BMP high
T/F: obese pts should follow the same NPO guidelines as individuals who are not obese
True
T/F: fatty infiltration of hte liver is not affected by degree of obesity
True - it’s moreso a reflection of the Length of the time on has been obese
What is the most common LFT abnormality seen in the obese population?
does this effect drug clearance?
alanine aminotransferase (ALT)
no
3 ways obesity affects the kidenys
- increased RBF
- increased GFR
- decreased natriuresis
*renal tubular absoprtion increases and natriuresis is impared due to increased SNS activity and activation of RAAS.
Does obesity make you more likely to bleed or clot?
Clot
Increased: fibrinogen, factor 7, 8, and VWf
*the increased fibrinogen levels are a marker for atherosclerosis
Why would someone have high fibrinogen levels?
atherosclerosis
Are Phase I or Phase II reactions typically more likely to be affected in the obese patients
Phase 2 metabolism (glucuronidation) is often enhanced
fat = increased glucose = increased glucuronidation
How would benzos be affected in the obese patient?
benzo = highly lipophillic
>increased volume of distribution
>longer elmination half-life
*Remi is an exception
If sedation is to be avoided during awake laryngoscopy, how should it be carried out?
Dex and airway blocks
What is the most effective intervention to prevent postop atelectasis in obese patients
PEEP
T/F- obese patients have a decrease in CSF volume
true
bc increased abdominal pressure displaces soft tissue into the intervertebral foramen…. sure
*often require lower voluem of local anesthetic
common postop complications in the obese patients (5)
- atelectasis
- PNA
- DVT
- infection
- dehiscesne
Which of the following body mass index (BMI) values would correspond with the patient as being classed as Overweight?
A. 40
B. 50
C. 31
D. 25
D
If a drug distributes equally to both lean and adipose tissues, then its loading dose should be calculated based on the patient’s
A. lean body weight
B. total body weight
C. predicted body weight
D. ideal body weight
B
if drug tends to distribute into primarily lean (water) tissues- dose should be caclulated on LBW (weight of body tissues minus apidose tissue [IBW x 1.3])
Which of the following would most likely be decreased in a morbidly obese patient?
A. liver enzymes
B. alpha-1 acid glycoprotein level
C. total body water
D. albumin level
C
The initial dose of which of the following drugs should be dosed based on lean body weight?
A. dexmedetomidine
B. rocuronium
C. succinylcholine
D. sugammadex
B
Obesity is most closely associated with
A. eccentric cardiac hypertrophy
B. concentric cardiac hypertrophy
C. increased expiratory reserve volume
D. decreased glomerular filtration rate
A
increased circulating volume , HTN, ECCENTRIC, CC, volume related
