CBN Pharmacology & Medication Management 1 — Questions and Answers
Question 1: Which form of vitamin B12 supplementation is most appropriate for patients who have undergone Roux-en-Y gastric bypass due to reduced intrinsic factor availability?
- Oral cyanocobalamin tablet with meals
- Sublingual or injectable B12 (Correct answer)
- B12-fortified solid foods only
- High-dose oral B12 coated tablets
Correct answer: Sublingual or injectable B12
After RYGB, reduced intrinsic factor production impairs oral B12 absorption, making sublingual or injectable routes more reliably effective.
Question 2: After Roux-en-Y gastric bypass, which calcium supplement formulation is preferred over calcium carbonate?
- Calcium phosphate
- Calcium citrate (Correct answer)
- Calcium gluconate
- Calcium lactate
Correct answer: Calcium citrate
Calcium citrate is preferred after RYGB because it does not require gastric acid for absorption, unlike calcium carbonate.
Question 3: Which class of medications should be avoided after bariatric surgery due to significantly increased risk of anastomotic (marginal) ulcers?
- ACE inhibitors
- NSAIDs (Correct answer)
- Beta-blockers
- Calcium channel blockers
Correct answer: NSAIDs
NSAIDs inhibit prostaglandin synthesis and increase the risk of marginal ulcers and GI bleeding at the anastomosis in bariatric patients.
Question 4: Extended-release medication formulations are generally contraindicated after bariatric surgery primarily because:
- They are too costly for post-surgical patients to afford
- Altered GI anatomy and transit time result in unpredictable drug release and absorption (Correct answer)
- They interact with iron and calcium supplements
- They require an intact pyloric sphincter to function correctly
Correct answer: Altered GI anatomy and transit time result in unpredictable drug release and absorption
Extended-release formulations rely on intact GI anatomy for timed drug release; bariatric procedures alter this anatomy, making absorption unpredictable.
Question 5: A patient who underwent sleeve gastrectomy reports decreased effectiveness of her oral contraceptive pills. What is the most appropriate nursing action?
- Advise the patient to double her current oral contraceptive dose
- Counsel the patient to use an alternative or backup contraceptive method (Correct answer)
- Reassure the patient that contraceptive efficacy is unaffected by surgery
- Recommend switching to a higher-estrogen formulation
Correct answer: Counsel the patient to use an alternative or backup contraceptive method
Altered gastric emptying and absorption after bariatric surgery can reduce oral contraceptive reliability, so alternative or backup contraception should be recommended.
Question 6: Which iron supplement formulation is most appropriate for bariatric patients in the post-operative period?
- Ferrous sulfate standard tablet taken with milk
- Enteric-coated ferrous sulfate for GI protection
- Liquid or chewable iron taken with vitamin C (Correct answer)
- Slow-release iron capsule taken at bedtime
Correct answer: Liquid or chewable iron taken with vitamin C
Liquid or chewable iron with vitamin C maximizes bioavailability; enteric-coated and slow-release forms are poorly absorbed after bariatric surgery.
Question 7: How long after bariatric surgery should metformin typically be withheld before safely resuming therapy?
- 24 hours post-operatively
- 48 hours post-operatively
- Until oral intake is adequate, usually one to two weeks (Correct answer)
- Six months post-operatively
Correct answer: Until oral intake is adequate, usually one to two weeks
Metformin is held perioperatively and restarted only when adequate oral intake and hydration are established to minimize the risk of lactic acidosis.
CBN Pharmacology & Medication Management 1
Which form of vitamin B12 supplementation is most appropriate for patients who have undergone Roux-en-Y gastric bypass due to reduced intrinsic factor availability?