064 Scott Monte, PharmD on Medications Just Before and Just After Bariatric Surgery

by reeger on December 6, 2015

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Scott Monte, PharmD

 

In this episode I bring you my conversation with pharmacist, Scott Monte, PharmD. I met Scott at the 2015 Obesity Week conference in Los Angeles. Since 2009 Scott has worked as a pharmacist with the bariatric surgery program known Synergy Bariatrics in Buffalo, NY. After talking with him at the conference I knew I wanted to bring him on as a guest so that we could have a longer conversation about commonly prescribed medications and issues to consider regarding those medications when getting ready for and recovering from bariatric surgery. This is especially relevant because after bariatric surgery many of the diseases associated with obesity rapidly improve. Which begs the question of what about all the medications used to treat those diseases? I know from my work as a nurse practitioner at Southern Oregon Bariatric Center, this is a very common question people have as they get ready for and recover from bariatric surgery.

IN THIS EPISODE:

  • How Scott became involved in bariatric surgery as a pharmacist
  • His unique role as pharmacist at Synergy Bariatrics

     Just Before Surgery:

  • Medication concerns prior to surgery including NSAIDS, herbal medications, streamlining the number of pills a person is taking prior to surgery.
  • How the pre-surgery “liver shrinking diet” before surgery (often 1-2 weeks) cause blood sugars to improve very quickly which means people who take diabetic medications need to be careful to not take too much medication and risk
  • The importance of improving the A1C level prior to surgery
  • Prevention/treatment of anesthesia-related nausea and vomiting

     Just After Surgery:

  • Type 2 Diabetes management: Metformin, long active insulins, and other diabetes medications
  • Considerations of long-acting medications after gastric bypass
  • Will you be able continue to take your typical handful of pills after surgery?
  • New type 2 diabetes medications
    • GLP-1 Medications are a newer class of medications used to treat Type 2 Diabetes. GLP-1 is a hormone in the body that has three important actions. First GLP-1 helps people feel full after a meal; second, it helps the pancreas produce insulin appropriately; and third, it helps control nighttime blood sugars from going too high. For people with obesity and type 2 diabetes, the GLP-1 hormone may be low. Giving them GLP-1 exogenously (meaning from the outside) has been shown to be very beneficial.
    • The medications in this class are: Exanatides (Bydureon), Dulaglutide (Trulicity), Albiglutide (Tanzeum), Liraglutide (Victoza)
    • SGLT-2 inhibitor medications help the body urinate out more glucose (sugar)
    • The medications in this class are: Canagliflozin (Invokana), Dapagliflozin (Farxiga, pronounced FAR-OX-E-GA), Empagliflozin (Jardiance)
  • Many people believe Type 2 Diabetes is a disease of insulin deficiency. It is in fact NOT a disease of insulin deficiency. It is a disease where a person has an excess of insulin, except during the meal time when they really need it.
  • Metformin’s mechanism of action includes helping the body use insulin more appropriately and it helps reduce the amount of sugar the liver places into the blood stream especially while a person sleeps
  • High blood pressure medications
    • Beta Blockers: Metoprolol, Propranolol, Atenolol, Bisoprolol
    • ACE Inhibitors: Lisinopril, Enalapril, Ramipril
    • Calcium Channel Blockers: Norvasc
  • Water Pills: Lasix and HCTZ
  • Cholesterol Medications including the “statins,” Zetia, and high triglyceride Medications
  • Hormonal Replacement Medications: Estrogen-based birth control medications, Testosterone
  • Considerations for chronic pain medications
  • How taking NSAIDs can result in stomach ulcers
  • Proton Pump Inhibitors: Prilosec, Nexium, Protonix, Dexilant, Aciphex, Zegrid
  • Changes that may occur after surgery regarding thyroid replacement medication
  • The importance of taking bariatric vitamins daily to avoid vitamin deficiencies

 

{ 2 comments… read them below or add one }

Monika Fulton December 6, 2015 at 9:36 pm

I was wondering if Scott could answer a question regarding medication for me. In 2014 – about two years after my lapband surgery – I was diagnosed with hypothyroidism. I had lost 75 lbs and reached my goal weight. After my diagnosis I was prescribed 75 mg of Levothyroxin. Within one month I gained 10 lbs and then slowly another 10 lbs. since then. My doctor says that the medication should have the opposite effect – weight loss rather than weight gain. Online testimonials about the effect of the meds are mixed. Any thoughts?

Reply

reeger December 6, 2015 at 11:06 pm

Hi Monika, Thanks for reaching out. I will forward your question on the Scott and see if he has any thoughts. Reeger

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