39 - 45 yo man who is overweight

Question 1

patients with a BMI over ____ have higher death rates from several types of cancer

Answer 1

40

Question 2

metabolic syndrome: criteria

Answer 2

3/5 of:

• fasting plasma glucose
• BP over 130/85
• Trigs over 150
• HDL under 40 (men) or 50 (women)
• waist circumference over 40” men, 35” women

Question 3

what is believed to be the underlying mechanism of metabolic syndrome?

Answer 3

insulin resistance

Question 4

what is the pooled cohort equation?

Answer 4

predicts atherosclerotic cardiovascular events that are reduced by statin therapy

Question 5

which 4 groups are likely to benefit from statin therapy?

Answer 5

• current ASCVD
• LDL over 190
• DM 1 or 2 age 40-75
• estimated 10 year ASCVD risk by pooled cohort equation over 7.5%

Question 6

bile acid sequestrants such as cholestyramine have a more modest effect on lowering ______ and raising ______ but can cause an increase in _______________

Answer 6

• LDL
• HDL
• trigs

Question 7

what is first line therapy for reducing trigs? what is the downside? what is an added benefit?

Answer 7

• fibric acid derivatives
• modest effect on reducing LDL
• can increase HDL 10-20%

Question 8

what is the MOA of ezetimibe? is there evidence of benefit for ASCVD?

Answer 8

• inhibits absorption of cholesterol at intestinal brush border, increases cholesterol clearance
• no benefit in prevention of ASCVD

Question 9

high intensity statin therapy is reserved for what groups?

Answer 9

• patients under 75 with clinical ASCVD and no safety concerns
• LDL over 190
• diabetics 40-75 with estimated 10 year ASCVD risk over 7.5

Question 10

moderate intensity statin therapy is reserved for what groups?

Answer 10

• patients over 75 with clinical ASCVD

- diabetics 40-75 with estimated 10 year ASCVD risk under 7.5

Question 11

what are the side effects of statins?

Answer 11

• hepatic dysfunction (check LFTs)

- myopathy

Question 12

EQUATION: caloric intake needed to maintain current weight = ?

Answer 12

basal metabolic rate + additional calories for activity

• BMR = body weight (lbs) x 10
• additional calories: body weight (lbs) x _____
• 1.3 if sedentary
• 1.5 for moderate activity
• 1.7 for heavy activity
• 1.9 for intense activity

Question 13

a patient needs to have approximately a ______ calorie DEFICIT in order to lose 1 lb of weight

Answer 13

3500

Question 14

what is the MOA of orlistat?

Answer 14

• lipase inhibitor

- decreases fat absorption

Question 15

what is the MOA of phentermine?

Answer 15

noradrenergic appetite suppressant

Question 16

what is the MOA of lorcaserin?

Answer 16

• highly selective serotonergic receptor agonist

- appetite suppressant

Question 17

what is the major side effect of lorcaserin?

Answer 17

hypoglycemia in diabetic patients

Question 18

qsymia is a combination of _________ and ________

Answer 18

phentermine and topiramate

Question 19

contrave is a combination of _________ and _________

Answer 19

naltrexone and buproprion

Question 20

what are the indications for bariatric surgery?

Answer 20

• BMI over 40

- BMI over 35 with severe health complications who have not succeeded in losing weight with other methods