CBN Pharmacology & Medication Management 2 — Questions and Answers
Question 1: Proton pump inhibitors (PPIs) are commonly prescribed after bariatric surgery primarily to:
- Stimulate appetite in the early post-operative phase
- Prevent marginal ulcers at the gastrojejunal anastomosis (Correct answer)
- Enhance absorption of fat-soluble vitamins
- Treat acid reflux caused by post-surgical overeating
Correct answer: Prevent marginal ulcers at the gastrojejunal anastomosis
PPIs suppress gastric acid production and are prescribed after bariatric surgery to prevent the formation of marginal ulcers at the anastomotic site.
Question 2: A post-gastric bypass patient taking levothyroxine develops new hypothyroid symptoms. The bariatric nurse should suspect:
- The patient is taking an excessive levothyroxine dose
- Impaired levothyroxine absorption due to reduced gastric acid and altered GI anatomy (Correct answer)
- A drug interaction between levothyroxine and post-surgical vitamins
- Spontaneous remission of hypothyroidism post-surgery
Correct answer: Impaired levothyroxine absorption due to reduced gastric acid and altered GI anatomy
Levothyroxine absorption depends on gastric acid and intact absorptive surface; both are altered after gastric bypass, potentially reducing drug efficacy.
Question 3: Which pain management option is most appropriate for a post-bariatric patient requiring non-opioid analgesia?
- Ibuprofen 400 mg orally as needed
- Naproxen sodium 220 mg twice daily
- Acetaminophen per protocol (Correct answer)
- Aspirin 325 mg daily
Correct answer: Acetaminophen per protocol
Acetaminophen is the preferred non-opioid analgesic in bariatric patients; NSAIDs (ibuprofen, naproxen, aspirin) are contraindicated due to anastomotic ulcer risk.
Question 4: After Roux-en-Y gastric bypass, alcohol metabolism is altered in which important way?
- Blood alcohol levels rise more slowly due to larger gastric volume
- Patients develop increased alcohol tolerance after surgery
- Peak blood alcohol concentration is higher and reached more quickly (Correct answer)
- Alcohol is significantly less absorbed due to the smaller stomach pouch
Correct answer: Peak blood alcohol concentration is higher and reached more quickly
Reduced gastric alcohol dehydrogenase activity and rapid gastric emptying cause faster and higher peak blood alcohol concentrations after RYGB.
Question 5: What is the minimum recommended daily dose of elemental iron for most bariatric surgical patients to prevent iron deficiency?
- 18 mg/day (standard adult RDA)
- 45–60 mg/day of elemental iron (Correct answer)
- 10 mg/day in divided doses
- 200 mg/day of elemental iron
Correct answer: 45–60 mg/day of elemental iron
Bariatric patients require 45–60 mg/day of elemental iron because reduced gastric acid and bypassed absorptive segments significantly decrease iron absorption efficiency.
Question 6: Bypass of the duodenum and proximal jejunum in RYGB surgery places patients at highest risk for deficiency of which mineral?
- Potassium
- Sodium
- Iron (Correct answer)
- Phosphorus
Correct answer: Iron
The duodenum and proximal jejunum are the primary sites of dietary iron absorption, so bypassing them in RYGB dramatically increases the risk of iron deficiency.
Question 7: A bariatric patient on warfarin therapy requires closer INR monitoring post-surgery because:
- Warfarin is absolutely contraindicated in all post-bariatric patients
- Altered fat and vitamin K absorption can cause unpredictable INR fluctuations (Correct answer)
- The smaller stomach concentrates warfarin to dangerous levels
- Post-surgical liquid diet eliminates all dietary clotting factors
Correct answer: Altered fat and vitamin K absorption can cause unpredictable INR fluctuations
Changes in fat-soluble vitamin K absorption after bariatric surgery cause unpredictable INR changes, requiring more frequent anticoagulation monitoring.
CBN Pharmacology & Medication Management 2
Proton pump inhibitors (PPIs) are commonly prescribed after bariatric surgery primarily to: