27.5 Pharm: Drugs used in obesity

Question 1

What does increased fat do to signalling in the hypothalamus?

Answer 1

Increases leptin, crosses the BBB (transported), binds to a R’ in the hypothalamus which signals to decrease appetite via. peptide manipulation

Question 2

What does CCK signal?

Answer 2

After a fatty meal, CCK signals satiety

Question 3

What does NPY do to signalling/appetite?

Answer 3

Increase feeding

Question 4

What is the rhythm of leptin like?

Answer 4

Circadian rhythm, high at night and decreases at noon

Question 5

What is Phentermine? What does it do? Who/how long can you use it for?

Answer 5

An amphetamine derivative. Increases NA (displaces it from vesicles) in the cleft and supresses appetite.

Use for BMI>30, only for short term use

Question 6

What is Orlistat? How does it work? How long can we use it for?

What are some side effects?

Answer 6

Inhibitor of gastric/pancreatic lipases to decrease dietary fat absorption (by 30%).

Can use longer term.

Side effects are mainly GI and can be controlled by eating low fat diet (this can modify behaviour too)

Question 7

What is Topiramate normally used for? Where/in what form was it approved by the FDA? How does it work in obesity?

Who is it contraindicated in?

Answer 7

Epilepsy/migraine medication

Approved (in combination w/ phentermine) in US

Unknown mechanism, increases energy expenditure/suppresses appetite

Teratogenic

Question 8

How does Glucagon-like peptide 1 agonist work against obesity (brain, stomach, pancreas)?

Answer 8

Brain: Binds directly in hypothalamus to decrease appetite.

Stomach: Also decreases gastric emptying

Pancreas: Increase insulin secretion, decrease glucagon secretion

Question 9

What can be a side effect of GLP-1 R’ agonist in obese people w/o insulin resistance/T2DM?

Answer 9

Hypoglycaemia