Obesity
suxx cis atracurium midazolam fentanyl
Total body weight drugs for obesity
lean body weight
for the obese patient dosing should be based on what?
50%
general anesthesia causes FRC to fall how many percent in obese patients?
women
gynecoid obesity (pear) is more common in what gender?
joint diseases varicose veins
gynecoid obesity is associated with what 2 health conditions
100ml/min
how much does the cardiac output increase for every extra kilogram of fat?
kg/m2 inch to cm 2.54 / 100
how to calculate for BMI
men = ht (cm) -100 women = ht (cm) - 105
how to calculate ideal body weight
lbw = ibw x 1.3
how to calculate lean body weight
roc remi vec sulfenta
ideal body weight drugs for obesity
b. Obesity hypoventilation syndrome
in the charles dicken novel "the pickwick papers", the errand boy named Joe suffers from what ailment? a. bulimia b. Obesity hypoventilation syndrome c. metabolic syndrome d. virchow's triad
increased in stroke volume
in the obese patient what is responsible for the increased cardiac output?
50%
in the obese patient, how much does FRC decrease in the supine position after induction of anesthesia? 20% 30% 40% 50%
volume distribution of hydrophilic drugs volume distribution of lipophilic drugs
in the obese patient, which of the following are expected to increase? (select 2) volume distribution of hydrophilic drugs MAC volume distribution of lipophilic drugs circulation time
obesity hypoventilation syndrome
is a long term consequence of untreated OSA
succinylcholine midazolam
select the drug whose initial dose should be based on total body weight (select 2) remifentanil suxx midazolam propofol
propofol remifentanil rocuronium vecuronium
select the drug whose initial doses should be based on lean body weight (select 2) remifentanil suxx midazolam propofol
Roux-en-Y gastric bypass
select the most effective weight loss procedure for the patient with morbid obesity a. biliopancreatic diversion with duodenal switch b. Roux-en-Y gastric bypass c. Gastric sleeve d. gastric banding
tidal volume 7ml/kg TOTAL body weight **lean
strategies for mechanical ventilation in the morbidly obese patient include all of the following except: a. CPAP during anesthetic induction b. recruitment maneuver to peak pressure of 40 c H2O c. tidal volume 7ml/kg total body weight d. permissive hypercapnia
true
t/f PaCO2 in obese population is usually normal
false
t/f gynecoid obesity is associated with insulin resistance?
BMI
the incidence of OSA is directly proportional to what?
increased blood volume increased cardiac output altered plasma protein binding lipid solubility of the drug
the volume distribution of a drug in the obese patient is altered by (4 factors)
apple android obesity
which food corresponds with the most pathologic form of fat accumulation?
residual volume
which lung volume in obesity is normal?
vital capacity expiratory reserve volume (total lung capacity)
which of the ff are reduced with obesity? (select 2) a. vital capacity b. expiratory reserve volume c. closing volume d. residual volume
12
which of the following apnea/hypopnea index score is consistent with mild obstructive apnea?
ephedra alkaloid
Ma huang is under what drug class as an appetite supressant?
35-39.9
BMI for Obese Class II
>40
BMI for morbid obesity
30-34.9
BMI for obese class I
25-29.9
BMI for overweight
9
How many calories are required
18.5-24.9
Normal BMI
hypertension cardiovascular morbidity death
OSA is an independent risk factor for the development of what 3 diseases?
apnea or snoring with hypopnea during sleep arousal from sleep daytime somnolence
What is the classic triad of dysfunctional sleep?
ketorolac
a multimodal approach to postoperative pain management in the patient undergoing Roux-en-Y gastric bypass includes all of the following except: a. ketorolac b. acetaminophen c. ketamine d. dexmedetomidine
normal
a patient weighs 176lb and is 74 inches tall. how would you categorize this patient's body habitus? under weight normal overweight obese
second to smoking
according to the national institute of health, adult obesity ranks __ as the leading cause of preventable death?
free fatty acids cytokines
adipose becomes pathologic when it releases significant quantities of what? (2 answers)
decreased blood viscosity
all of the following contribute to hypertension in the obese patient except: decreased blood viscosity angiotensinogen hyperinsulinemia cytokines
thyroarytenoids
all the following muscles dilate the upper aiway except the: a. thyroarytenoid b. genioglossus c. hyoid muscles d. tensor palatine
impending respiratory failure
an elevated PaCO2 in the obese population signifies
ischemic heart disease hypertension dyslipidemia insulin resistance death
android obesity is associated with an increased risk of what 5 health related conditions?
men > 40 inches (>35 for women)
android obesity is more common with what gender?
diastolid dysfunction increased venous return
considerations for the cardiovascular effects of morbid obesity include (select 2) diastolic dysfunction increased venous return increased EKG voltage tachycardia
75%
dosing of epidural anesthetic on obese patients should be reduced to how many percent?
4 calories
each carbohydrate and protein provides how many calories of physiologically available energy
Hypopnea
is defined as a 50% reduction in airflow for 10 seconds, 15 or more times per hour and is linked to snoring and decreased oxygen saturation
obstructive sleep apnea
is defined as the cessation of airflow for at least 10 seconds (apnea) with 5 or more insuccesful efforts to breathe (obstruction) and a greater than 4% reduction in SaO2
bariatric surgery
is the most effective treatment for the reversal of obesity also leads to the resolution of comorbidities such as HTN and DM2
10 seconds
obstructive sleep apnea is associated with cessation of airflow for more than how many seconds?
visceral fat
of all the fat storage sites, which site releases the highest quantities of insulin resistance and inflammation and appears to pose the most significant health risk?
malabsorption restriction combination
waht are the 3 approaches to surgical weight loss?
insulin resistance inflammation
what are (2) terminal consequence of excess adipose tissue throughout the body?
large waist circumference triglycerides >150mg/dL HDL <40 men; <50mg/dL women BP >130/85 fasting glucose > 100mg/dL
what are 5 factors that requires at least 3 signs for the diagnosis of metabolic syndrome (syndrome x)
expansion of intravascular blood volume high cardiac output
what are the 2 key changes that lead to the cardiovascular complications of obesity
BMI> 30 awake PaCO2>45 dysfunctional breathing during sleep
what are the diagnostic criteria for obesity hypoventilation syndrome (OHS)?
cushing's disease hypothyroidism depression eating disorders polycystic ovary syndrome
what are the examples of diseases associated with obesity
prader-willi syndrom bardet-biedl syndrome
what are the examples of genetic conditions associated with obesity
steroids antidepressants
what are the examples of medication side effect associated with obesity
overeating poor access to proper nutrition
what are the examples of social causes of obesity
social medication side effect diseases genetic
what are the medically related etiology associated with obesity?
obesity hypersomnolence during the day hypoxwmia hypercarbia respiratory acidosis compensatory metabolic alkalosis polycythemia pulmonary hypertension right heart failure
what are the signs associated with obesity hypoventilation syndrome?
episodes of apnea during sleep without any respiratory effot
what is the classic presentation of obesity hypoventilation syndrome (OHS)?
polysomnography
what is the definitive test for OSA?
lipase inhibitor
what is the drug class of the appetite suppresant Orlistat
Norepi and serotonin reuptake inhibitor
what is the drug class of the appetite suppressant sibutramine?
Norepi reuptake inhibitor
what is the drug class of the appetite suppresssant phentermine?
50ml/kg (45-55) fluid management should be with lean body weight
what is the estimated blood volume of the patient with class III obesity? a. 40 ml/kg b. 50ml/kg c. 60ml/kg d. 70ml/kg
unexplained tachycardia
what is the most sensitive sign of an anastomotic leak following gastric bypass? a. abdominal pain b. fever c. shoulder pain d. unexplained tachycardia
pickwickian syndrome
what is the old name for obesity hypoventilation syndrome (OHS)?
6-8ml/kg ideal body weight
what is the optimal tidal volume for a patient with class III obesity?
ketorolac
what medications is contraindicated with gastric bypass?
gastric band sleeve gastrectomy
what type of surgeries are considered restrictive for weight loss? (2)
jejunoileal bypass biliopancreatic diversion duodenal switch
what type of surgeries are involved in malabsorption for weight loss? (3)
vit k vit b12 folate depletion
what vit/mineral deficiencies are involved in malabsorption surgery for weight loss? (3)
>30 episodes/ hr
which apnea/hypopnea idex quantify OSA as severe?
Roux-en-Y gastric bypass biliopancreatic diversion
which bariatric procedures are more likely to cause nutritional deficiencies (select 2) gastric sleeve Roux-en-Y gastric bypass biliopancreatic diversion gastric banding
increased renal clearance increased blood volume increased cardiac output
which of the following are associated with obesity (select 3) decreased volume of distribution of lipid soluble drugs increased renal clearance increased blood volume increased cardiac output increased total body water decreased lean body weight
increased risk of preterm labor excessive blood loss during cesarean section
which of the following complications are associated with maternal obesity? (select 2) a. increased risk of preterm labor b. increased incidence of type 1 diabetes c. decreased duration of 1st stage of labor d. excessive blood loss during cesarean section
total body water pulmonary function
which of the following physiologic parameters decreases in the obese patient? cardiac output total body water renal clearance blood volume
