Care and Advocacy with Bariatric Patients Hannah Hemry Connor Hunter Bret Kinne Sonya Thiessen In partial fulfillment of the requirements for PHAR8376 Discovery IV Fall 2018 Why Does Treating Obesity Matter ID: 789262
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Pharmacists Intervention, Care, and Advocacy with Bariatric Patients
Hannah Hemry, Connor Hunter, Bret Kinne, Sonya Thiessen
In partial fulfillment of the requirements for
PHAR:8376 Discovery IV
Fall 2018
Slide2Why Does Treating Obesity Matter?Projected Rates of Obesity
Slide3What is Obesity?"LHI Infographic Gallery | Healthy People 2020". Healthypeople.Gov, 2018, https://www.healthypeople.gov/2020/leading-health-indicators/LHI-Infographic-Gallery#Nov-2017. Accessed 17 Sept 2018.
Slide4StatisticsUSAHistorical timeline
Dramatic increase
Mortality rates
Issues for health care providers
Slide5United States Obesity TrendsCDC.gov. (2018). Adult Obesity Prevalence Maps. [online] Available at: https://www.cdc.gov/obesity/data/trends.HTML [Accessed 7 Sep. 2018].
Slide6USA Obesity Trends (continued)CDC.gov. (2018). Adult Obesity Prevalence Maps. [online] Available at: https://www.cdc.gov/obesity/data/trends.HTML [Accessed 7 Sep. 2018].
Slide7Mortality Risks
Slide8Bariatric Procedure Trends"Bariatric Surgery Trend In Management Of Obesity | © 2018, Medmarket Diligence, LLC -- Advanced Medical TechnologieS:”
Slide9Literature Review“Scoping Review”
Slide10Literature Review Search Strategy
PubMed
Embase
CINAHL
IPA
Scopus
Web of Science
Cochrane Library
Slide11Obesity Treatment OptionsDiet &
Exercise
Surgery
Pharmacotherapy
During and Post-Op
Slide12Diet & ExerciseMany options but balance & moderation are key
Healthy People 2020
Healthypeople.gov, 201
“Healthy People 2020.”
Healthcare-Associated Infections | Healthy People 2020
, www.healthypeople.gov/.
Slide13Surgery ProceduresTypes of surgery
Gastric sleeve
Gastric bypass
Duodenal switch
Lap band
Gastric balloon
vBloc Therapy
AspireAssist
Historical trend/timeline
Slide14Vertical Sleeve Gastrectomy AKA Gastric SleeveLaparoscopic procedure that removes ~80% of the stomachNo rerouting of the intestinesNo foreign devices implantedHunger producing hormone ghrelin is mainly produced in the portion of the stomach removed
“Gastric Sleeve Surgery, Plication, Bypass & Procedures | BeLiteWeight | Beliteweight.”
Responsive Image
, www.beliteweight.com/weight-loss-surgery-procedures/gastric-sleeve-surgery/
“Gastric Sleeve Surgery – The Complete Guide.”
Obesity Coverage
, www.obesitycoverage.com/gastric-sleeve-reference-manual.
Slide15Roux-en-Y Gastric BypassAKA Gastric BypassReduces upper stomach to size of an eggReduces amount of food able to eatThe “Y” shape that is formed bypasses rest of stomach and upper part of small intestines
“Gastric Bypass Surgery - 14 Ways It Will Affect You.”
Bariatric Surgery Source
, Bariatric Surgery Source, www.bariatric-surgery-source.com/laparoscopic-gastric-bypass-surgery.html.
Slide16Biliopancreatic Diversion with Duodenal SwitchAKA Duodenal Switch60-70% of stomach removedLower intestines divided so ⅔ is bypassedIntestinal bypass starts at duodenum Most reliable and longest lasting weight loss procedure
“What Are The Differences Between SADI and DS?”
ObesityHelp
, 26 May 2016, www.obesityhelp.com/articles/what-are-the-differences-between-sadi-and-ds.
Slide17Adjustable Gastric BandAKA LapBandLose weight more naturally over longer period of timeSafest weight loss surgeryCan be adjusted or reversed
“Adjustable, Laparoscopic Gastric Banding | Lap Band Procedures | Beliteweight.”
Responsive Image
, www.beliteweight.com/weight-loss-surgery-procedures/lap-band-gastric-band/.
Slide18Intra-Gastric BalloonAKA Gastric Balloon or Stomach BalloonSaline-filled silicone balloon is placed in stomachFeel fuller faster and limits food intakeLeft in place for up to 6 months
Dailymail.com, Lizzie Parry For. “Gas-Filled Gastric Balloon 'Helps Obese Patients Lose TWICE as Much Weight'.”
Daily Mail Online
, Associated Newspapers, 24 May 2016, www.dailymail.co.uk/health/article-3607101/Gas-filled-gastric-balloon-helps-obese-patients-lose-TWICE-weight-diet-exercise.html
Slide19Emerging TreatmentsvBloc TherapyAspireAssist
"Maestro VBLOC Therapy | UCI Health | Orange County, CA".
Ucihealth.Org
, 2018, http://www.ucihealth.org/medical-services/bariatric-surgery/surgery-options/maestro-vbloc-therapy. Accessed 17 Sept 2018.
"Recently Approved Weight-Loss Device: Aspireassist™ - Obesity Action Coalition".
Obesity Action Coalition
, 2018, https://www.obesityaction.org/community/article-library/recently-approved-weight-loss-device-aspireassist. Accessed 18 Sept 2018.
Slide20Bariatric Procedure Trends"Bariatric Surgery Trend In Management Of Obesity | © 2018, Medmarket Diligence, LLC -- Advanced Medical TechnologieS:”
Slide21A Pharmacist’s ImpactA pharmacist’s role on the care teamPre-surgery/preparation
Recovery
Long-term follow up
Slide22Medications to Avoid Post Surgery Extended-Release formulationsNSAIDsAlka-SeltzerVanquishAspirinBufferin
Cortisone
Pepto-Bismol
Potassium Supplements
Slide23Medications to Monitor Post-OpDigoxinErythromycin base (film tablet)Drugs requiring high levels of fluid to facilitate their actionOthers being studied (Dr. Kauer’s group) Pill size becomes an issue initially
Slide24Post-Op SupplementsTo prevent nutritional problemsDaily multivitaminDaily Ca2+ supplementsVitamin B-12 supplementsOral Vitamin D supplement
Iron supplements
"Life After Bariatric Surgery | American Society For Metabolic And Bariatric Surgery".
Slide25Opportunities for Pharmacist InterventionAsk on intake forms about major surgeriesWork with clinics to gain patient informationCreate handouts to give to patients post-opRemain vigilant regarding patient medication changes
Research post-op pharmacokinetics and pharmacodynamics
Slide26ReferencesRabkin, J. (2018). 7 Types of Weight Loss Surgery - How Each Will Affect You. [online] Bariatric Surgery Source. Available at: https://www.bariatric-surgery-source.com/types-of-bariatric-surgery.html [Accessed 18 Sep. 2018].“Gastric Sleeve Surgery, Plication, Bypass & Procedures |
BeLiteWeight
|
Beliteweight
.”
Responsive Image
, www.beliteweight.com/weight-loss-surgery-procedures/gastric-sleeve-surgery/.
“The History of Sleeve Gastrectomy.”
Bariatric Times
, bariatrictimes.com/the-history-of-sleeve-gastrectomy/.
“Roux-En-Y Gastric Bypass Surgery for Weight Loss.” Is There Really Any Benefit to Multivitamins?, www.hopkinsmedicine.org/healthlibrary/test_procedures/
gastroenterology/roux-en-y_gastric_bypass_weight-loss_surgery_135,65.
“Center for Metabolic and Weight Loss Surgery.” Duodenal Switch (BPD-DS) | Columbia University Department of Surgery, www.columbiasurgery.org/conditions-and-treatments/duodenal-switch-bpd-ds.
Slide27References continued“Weight Loss with Lap Band | UnityPoint Health.” UnityPoint Healt, UnityPoint Health, www.unitypoint.org/desmoines/services-weight-loss-lap-band-surgery.aspx.Belachew, M, Legrand, MJ, Vincent, V. “History of Lap-Band: from dream to reality.” Obesity Surgery 2001 June 11(3):297-302. “Intragastric Balloon.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 13 Jan. 2018, www.mayoclinic.org/tests-procedures/intragastric-balloon/about/pac-20394435.“I Am a Bariatric Surgery Patient. Which Medications Are Recommended and Which Ones Should I Avoid?” Obesity Action Coalition, www.obesityaction.org/community/article-library/i-am-a-bariatric-surgery-patient-which-medications-are-recommende.“Life After Bariatric Surgery.” American Society for Metabolic and Bariatric Surgery, asmbs.org/patients/life-after-bariatric-surgery.