KRISNKY EXAM 2

What type of bariatric procedures are non-surgical?

ENDOSCOPIC BARIATRIC THERAPIES (goal: reduce stomach size)

What are the 2 types of surgical bariatric procedures?

restrictive or malabsorptive

What type of bariatric surgery procedure reduces food intake by REDUCING STOMACH VOLUME?

restrictive

What type of bariatric surgery REDUCES ABSORPTIVE SURFACE of the GI tract?

malabsorptive

List which procedures are restrictive, and which are malabsorptive:

• restrictive:

  • LAGB: laparoscopic adjustable gastric banding

  • LSG: laparoscopic sleeve gastrectomy

  • RYGB: Laparoscopic Roux-en-Y gastric bypass

• malabsorptive:

  • RYGB: Laparoscopic Roux-en-Y gastric bypass

  • BPD: Laparoscopic biliopancreatic diversion

  • BPD-DS: Biliopancreatic diversion/duodenal switch

bariatric surgery may cause altered dissolution of what pH dependent meds?

• ketoconazole

• enalapril

• simvastatin

• tacrolimus, sirolimus

• mycophenolic acid

bariatric surgery may cause reduced absorption for meds with a narrow therapeutic index like…

• cyclosporine

• levothyroxine

• phenytoin

• rifampin

bariatric surgery may cause decreased serum levels of what meds?

antibacterials, psych meds (antipsychotics, antidepressants), tamoxifene

What might a PPI do after bariatric surgery?

• effect bioavailability of some meds

• alter absorption of micronutrients

What is recommended for long-term vitamin supplementation for bariatric surgery?

• multivitamin w/ minerals 2 tabs daily

• calcium citrate (1200-2400mg/day)

• vitamin D (2000-3000 IU/day)

• others: folic acid, iron, vit b-12

This is required on all natural products: “this statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent disease”

Where did it originate?

DSHEA legislation (dietary supplement health and education act of 1994)

What are some factors that determine production issues of natural products?

1. plant species/parts

2. method of prep

3. standardization

Should you use the same natural product manufacturer everytime?

yes

What 4 things are required on natural product/dietary supplement labels?

1. name of the product and the word supplement

2. manufacturer/packer/distributor’s name and address

3. directions for use

4. disclaimer statement

With what 3 supplements normally have a higher risk than benefit?

1. st johns wort for depression

2. ginkgo for memory

3. kava kava for calming

What is the purpose of good manufacturing practices? Does the FDA certify manufacturers/companies to be in compliance with these practices?

purpose: ensure products are manufactured safely and quality is assured

No, the FDA does not certify

What other organizations have cGMPs?

• natural products association (NPA)

• NSF international

• USP

If a supplement has some USP certified ingredients and some non-USP certified ingredients, is it USP certified?

no

What is each of the following supplements commonly used for?

Supplement	Most Common Use
Glucosamine
Alpha Lipoic acid
Melatonin
Ginger
St. John’s Wort
Feverfew
Black Cohosh

Supplement	Most Common Use
Glucosamine	osteoarthritis
Alpha Lipoic acid	diabetes
Melatonin	sleep disorders
Ginger	GI conditions (n/v)
St. John’s Wort	depression
Feverfew	migraines
Black Cohosh	premenstrual syndrome (PMS)

What is each of the following supplements commonly used for?

Supplement	Most Common Use
Garlic
CoQ10
Gingko
Red Yeast Rice Extract
Valerian
Echinacea
Milk Thistle

Supplement	Most Common Use
Garlic	hyperlipidemia
CoQ10	CV conditions
Gingko	memory issues
Red Yeast Rice Extract	hyperlipidemia
Valerian	insomnia
Echinacea	immune support/prevent colds
Milk Thistle	liver conditions

Pharmacists should use the _____________________ process to determine an individual’s candidacy for using natural products.

QuEST/SCHOLAR-MAC