HEALTH SYSTEMS EDITION stomach, but because bypass patients have reduced acid production, iron must be taken with vitamin C. This acidifies the stomach contents, allowing for better absorption. 43,45 The small stomach pouch created during the bypass procedure produces less gastric acid and hydrochloric acid; this may reduce the absorption of calcium carbonate, but the citrate salt is unaffected. 43 Drugs that may potentially cause decreased absorption in these patients include enalapril and ketoconazole, for which an alternative agent should be prescribed. With ramipril, metoprolol, metformin, olanzapine, quetiapine, ramipril, simvastatin, and zolpidem, the patient should be monitored for reduced drug efficacy. 43 Conclusion and Future Trends The growing epidemic of overweight and obesity is a serious health problem in the U.S., with more than 5 million Americans having a BMI exceeding 35. 46 Severe obesity is a chronic condition that is difficult to treat, and weight loss can be hard to maintain. There are many SURGICAL PROCEDURES FOR WEIGHT LOSS different approaches to weight management; bariatric surgery should be considered only when all other methods have failed. Surgery can result in profound weight loss in adults, which in turn may spur a significant improvement in comorbid conditions. Methods of bariatric surgery have improved over the past 25 years, but questions about safety and efficacy remain. Although concerns exist regarding bariatric procedures in adolescents, surgery is gaining acceptance as a treatment option in this population. Preoperatively, it is essential to stress to the bariatric surgical candidate the importance of healthy eating and exercise behaviors. 47 In 2003, the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH formed a partnership with researchers called the Longitudinal Assessment of Bariatric Surgery. The goal of this consortium is to plan and conduct studies that will lead to a better understanding of bariatric surgery and its impact on the health and well-being of patients with extreme obesity. REFERENCES 1. Schwartz MW, Brunzell JD. Regulation of body adiposity and the problem of obesity. Arterioscler Thromb Vasc Biol. 1997;17:233-238. 2. Centers for Disease Control and Prevention. U.S. obesity trends. www.cdc.gov/nccdphp/ dnpa/obesity/trend/maps/index.htm. Accessed August 14, 2009. 3. U.S. Preventive Services Task Force. Screening for obesity in adults: recommendations and rationale. Ann Intern Med. 2003;139:930-932. 4. Trust for America’s Health. F as in fat 2008: how obesity policies are failing in America. www.healthyamericans.org. Accessed August 14, 2009. 5. Pentin PL, Nashelsky J. What are the indications for bariatric surgery? J Fam Pract. 2005;54:633-634. 6. Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. Int J Obes Relat Metab Disord. 1998;22: 39-47. 7. Wang Y, Beydoun MA. The obesity epidemic in the United States—gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev. 2007;29:6-28. 8. Hedley AA, Ogden CL, Johnson CL, et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA. 2004;291:2847-2850. 9. Allison DB, Fontaine KR, Manson JE, et al. Annual deaths attributable to obesity in the United States. JAMA. 1999;282:1530-1538. 10. Brolin RE. Bariatric surgery and long-term control of morbid obesity. JAMA. 2002;288:2793-2796. 11. Buchwald H. Consensus conference statement. Bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis. 2005;1:371-381. 12. Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240:416-424. 13. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724-1737. 14. Sugerman H, Wolfe LG, Sica DA, Clore JN. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. 2003;237:751-758. 15. Wyles SM, Ahmed AR. Tips and tricks in bariatric surgical procedures: a review article. Minerva Chir. 2009;64:253-264. 16. Duell PB. Bariatric surgery for morbid obesity [letter]. JAMA. 2003;289:1779. 17. Schwartz MW, Woods SC, Porte D, et al. Central nervous system control of food intake. Nature. 2000;404:661-667. 18. Olbers T, Björkman S, Lindroos A, et al. Body composition, dietary intake, and energy expenditure after laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial. Ann Surg. 2006;244:715-722. 19. Santry HP, Lauderdale DS, Cagney KA, et al. Predictors of patient selection in bariatric surgery. Ann Surg. 2007;245:59-67. 20. Puzziferri N, Austrheim-Smith IT, Wolfe BM, et al. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg. 2006;243: 181-188. 21. Johansson H-E, Öhrvall M, Haenni A, et al. Gastric bypass alters the dynamics and metabolic effects of insulin and proinsulin secretion. Diabet Med. 2007;24:1213-1220. 22. Matarasso A, Roslin MS, Kurian M. Bariatric surgery: an overview of obesity surgery. Plast Reconstr Surg. 2007;119:1357-1362. 23. Gong K, Gagner M, Pomp A, et al. Micronutrient deficiencies after laparoscopic gastric bypass: recommendations. Obes Surg. 2008;18:1062-1066. 24. Slater GH, Ren CJ, Siegel N, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004;8:48-55. 25. Favretti F, Ashton D, Busetto L, et al. The gastric band: first-choice procedure for obesity surgery. World J Surg. 2009;33:2039-2048. 26. Zinzindohoue F, Chevallier JM, Douard R, et al. Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients. Ann Surg. 2003;237:1-9. 27. Gentileschi P, Lirosi F, Benavoli D, et al. Laparoscopic reoperative approach after open bariatric surgery. Chir Ital. 2009;61:137-141. 28. Kral JG. ABC of obesity. Management: part III—surgery. BMJ. 2006;333:900-903. 29. NHLBI Obesity Education Initiative. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda, MD: National Heart, Lung, and Blood Institute; 1998. NIH Publication No. 98-4083. 30. Santry HP, Lauderdale DS, Cagney KA, et al. Predictors of patient selection in bariatric surgery. Ann Surg. 2007;245:59-67. 31. Inge TH. Bariatric surgery for morbidly obese adolescents: is there a rationale for early intervention? Growth Horm IGF Res. 2006;(suppl A):S15-S19. 32. Inge TH, Krebs NF, Garcia VF, et al. Bariatric surgery for severely overweight adolescents: concerns and recommendations. Pediatrics. 2004;114:217-223. 33. Sugerman HJ, DeMaria EJ, Kellum JM, et al. Effects of bariatric surgery in older patients. Ann Surg. 2004;240:243-247. 34. Pandolfino JE, Krishnamoorthy B, Lee TJ. Gastrointestinal complications of obesity surgery. MedGenMed. 2004;6:15. 35. Mitka M. Surgery useful for morbid obesity, but safety and efficacy questions linger. JAMA. 2006;296:1575-1577. 36. Encinosa WE, Bernard DM, Chen CC, Steiner CA. Healthcare utilization and outcomes after bariatric surgery. Med Care. 2006;44:706-712. 37. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753-761. 38. Morino M, Toppino M, Forestieri P, et al. Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg. 2007;246:1002-1009. 39. Omalu BI, Buhari AM, Schauer PR, Kuller LH. Death rates and causes of death after bariatric surgery for Pennsylvania residents, 1995 to 2004. Arch Surg. 2007;142:923-928. 40. Zingmond DS, McGory ML, Ko CY. Hospitalization before and after gastric bypass surgery. JAMA. 2005;294;1918-1924. 41. Virji A, Murr MM. Caring for patients after bariatric surgery. Am Fam Physician. 2006;73:1403-1408. 42. Tice JA, Karliner L, Walsh J, et al. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008;1221:885-893. 43. Miller AD, Smith KM. Medication and nutrient administration considerations after bariatric surgery. Am J Health Syst Pharm. 2006;63:1852-1857. 44. Sapala JA, Wood MH, Sapala MA, Flake TM. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg. 1998;8:505-516. 45. Rhode BM, Shustik C, Christou NV, MacLean LD. Iron absorption and therapy after gastric bypass. Obes Surg. 1999;9:17-21. 46. Dalla Vecchia CF, Susin C, Rösing CK, et al. Overweight and obesity as risk indicators for periodontitis in adults. J Periodontol. 2005;76:1721-1728. 47. Balduf LM, Kohn GP, Galanko JA, Farrell TM. The impact of socioeconomic factors on patient preparation for bariatric surgery. Obes Surg. 2009;19:1089-1095. 10 U.S. <strong>Pharmacist</strong> • December 2009 • www.uspharmacist.com
Introducing Teva’s New and Improved Product Labeling NDC#s are prominently placed in top left corner Lot number is imprinted for easier tracking TALLman lettering, used when appropriate, helps reduce dispensing errors Bar Coded with a scannable Standard RSS bar code Strength is highlighted in color for better visibility. Products with multiple strengths are distinguished by different colors. Manufacturing location of product Expiration Date For up-to-date information on all of our products, including many latex-free and preservative-free injectables, visit www.tevausa.com ©2009, Teva Pharmaceuticals USA 8430 A 19 Hughes • Irvine, California 92618 800.729.9991 • www.tevausa.com
Change language