Pharmacotherapy – Medication management after bariatric surgery

Link to EAHP Statements

• Section 1 – Introductory Statements and Governance: Statements – 1.1
• Section 4 – Clinical Pharmacy: Statements – 4.1, 4.2, 4.3, 4.4, 4.8
• Section 5 – Patient Safety and Quality Assurance: Statements – 5.1, 5.5

Abstract 

Obesity (defined as a body mass index above 30 kg/m2) is currently a major health issue, with a worldwide prevalence of 13%. It is known that obesity increases the risk of cardiovascular disease, diabetes mellitus, cancer, and many other co-morbidities.

Bariatric surgery is a common applied surgical intervention in patients with obesity to achieve weight-loss. Common techniques for bariatric surgery include the sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). In SG, a smaller stomach is created limiting digestive capacity while with RYGB, a small pouch from the stomach is connected directly to the small intestine. Bariatric surgery techniques are associated with physiological changes in the gastrointestinal tract that may therefore lead to changes in oral drug disposition. Depending on the surgical intervention, gastric changes can occur such as a decreased transit time and increased pH which can influence the pharmacokinetics and – dynamics of drugs.

For hospital pharmacists, it is essential to have general knowledge of the influence of bariatric surgery on the pharmacokinetics of oral drugs.

In this seminar, the consequences of the different surgical interventions are highlighted together with advice on how hospital pharmacists can manage the pharmacotherapy of patients after bariatric surgery.

Learning objectives 

After this session, participants should be able to:

• Know the influence of bariatric surgery on the pharmacokinetics of oral drugs
• Apply guidelines for dosing oral drugs after bariatric surgery
• Apply a medication management strategy for patients after a bariatric surgery

Educational need addressed:

Pharmacists could advise physicians on the right adjustments in pharmacotherapy for bariatric surgery patients. This seminar will focus on the appropriate medication management in patients who had bariatric surgery and give guidance to pharmacists who review these patients’ medication.

Keywords

Bariatric surgery, medication safety, medication therapy management