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Block 10 Week 2 > Burkin: Obesity & Satiety Drugs > Flashcards

Burkin: Obesity & Satiety Drugs Flashcards

1
Q

Over (blank)% of adults are overweight or obese

A

66%

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2
Q

Think about some complications of obesity…

A

sex hormone imbalance
increased free fatty acids –> dyslipidemia, insulin resistance, hypertension
physical stress –> sleep apnea, osteoarthritis, lower back pain, SOB
QOL –> low self esteem, anxiety, disordered eating

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3
Q

Appetite stimulating neurons are called (blank). Here are some examples…

A

orexigenic; Ghrelin, AgRP, NPY, Orexin

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4
Q

Appetite suppressing neurons are called (blank). Here are some examples…

A

anorexigenic; leptin, insulin, CCK, CRH, POMC, CART, PYY

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5
Q

These increase insulin secretion from the pancreas

A

incretins

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6
Q

What is glucostatic hypothesis involving short term hunger regulation

A

blood glucose levels are critical to hunger –> when blood glucose drops, this signals the hypothalamus to generate a “hunger” sensation to trigger eating behavior

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7
Q

In long term hunger regulation, declines in the amount of stored (blank) might function as orexigenic signals. Also the ratio of utilizing (blank):(blank) is involved

A

glycogen; carbohydrate:lipid

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8
Q

(List the hormones) bind receptors on orexigenic or anorexigenic neurons in the arcuate nucleus of the hypothalamus. Ultimately, this sends signals that cause changes in sensations of (blank) or (blank)

A

Ghrelin (stomach), leptin (adipose tissue), insulin (pancreas), PYY (small intestine);
hunger; satiety

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9
Q

In response to hunger, mechanoreceptor responses are transmitted along the (blank) nerve to the dorsal vagal complex in the medulla and terminating in the (NTS)

A

vagus

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10
Q

What is the difference between hunger & appetite

A

hunger = motivation for eating behavior

appetite = desire to eat even if there is no physiological reason

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11
Q

Weight loss is achieved by reducing the size of the stomach

Improvement in short term cardiovascular risk factors and reduction in mortality from 23% to 40%

A

Bariatric surgery

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12
Q

When is bariatric surgery warranted?

A

pts with BMI greater than 40
have tried adequate diet/exercise, but failed
present with obesity related comorbid condition

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13
Q

resecting and re-routing the small intestine to a small stomach pouch

A

gastric bypass

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14
Q

removal of a portion of the stomach

A

sleeve gastrectomy with duodenal switch

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15
Q

device similar to a heart pacemaker is implanted
electrical leads stimulate the external surface of the stomach
interpreted by the brain to give a sense of satiety

A

gastric band

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16
Q

What are some complications of bariatric surgery?

A 
gastric dumping syndrome (20%) --> ingested foods bypass the stomach rapidly & enter the intestine largely undigested
leaks at surgical site (12%)
incisional hernia (7%)
infection
pneumonia
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17
Q

The vagus nerve stimulator is involves wire leads & electrodes that send intermittent electric pulses to the vagus nerve. What are some indications for the vagus nerve stimulator?

A

over 18yo
BMI 35-40
at least one other obesity-related condition

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18
Q

What are some serious adverse events that occur with vagus nerve stimulators?

A 
nausea
pain at neuroregulator site
vomiting
surgical complications
pain
heartburn
problems swallowing
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19
Q

When are weight loss medications indicated?

A

BMI greater than 30 without obesity related risk factors

BMI greater than 27 with obesity related risk factors or disease

20
Q

What was phen-fen & why was it withdrawn?

A

highly effective appetite suppressant, agonist at 5HT2c receptors; withdrawn due to high rates of valvular heart disease and pulmonary hypertension

21
Q

What is phentermine? How does it work?

A

it is an amphetamine derivative - it increases NE, 5HT, and DA levels in the hypothalamus –> increases sympathetic tone

22
Q

When is phentermine used?

A

for short term management of exogenous obesity (few weeks)

Used in conjunction with exercise & caloric restriction

23
Q

Side effects of Phentermine?

A 
dry mouth
insomnia
costipation
headache 
rapid heartbeat
dizziness
24
Q

Adverse effects of Phentermine?

A 
CNS: impaired alertness or physical coordination
Pulmonary HTN
Valvular heart disease
Tolerance may develop w/i a few weeks
Potential for abuse or addiction
25
Q

What are some contraindications to use of Phentermine?

A

Don’t use w/ MAOIs or SSRIs
Don’t use w/ other weight loss drugs
Don’t use during pregnancy or breastfeeding

26
Q

Phentermine can be combined with (blank)

A

extended topiramate

**controlled release phentermine

27
Q

Side effects of phentermine + topiramate?

A 
paresthesia
dry mouth
constipation
dysgeusia
PREGNANCY CATEGORY D --> can cause cleft palate
28
Q

This weight loss drug selectively activates 5HT2C receptors

A

Lorcaserin

29
Q

What is one uncommon but serious/potentially fatal side effect of Lorcaserin?

A

seratonin syndrome –> develops within mins-hrs, mental changes, autonomic instability, neuromuscular hyperactivity

30
Q

Lorcaserin should not be used in these instances…

A 
w/ SSRIs or MAOIs
w/ dopamine antagonists
w/ St. John's Wort
During pregnancy (category X)
During nursing
31
Q

Amphetamine derivative
Associated with weight loss in obese women (level 2, midlevel evidence)
Short term use only
monotherapy only
Orally 3x daily 1 hr before meals or 1x daily (extended release)

A

Diethylpropion

32
Q

What is one major side effect of diethylpropion?

A

pulmonary hypertension!

23x higher risk after 3 mo use with other anorexigenics

33
Q

Contraindications for diethylpropion?

A

HTN, pulmonary hypertension
MAOIs
Other anorexigenic drugs
Pregnancy & lactating

34
Q

Like all amphetamine derivatives, anorexigenic activity likely due to CNS stimulation
Alpha-1 adrenergic receptor agonist
Sodium-dependent noradrenaline transporter antagonist

A

Phendimetrazine

35
Q

Side effects of phendimetrazine?

A

hypertension, pulmonary HTN, advanced arteriosclerosis, hyperthyroidism, glaucoma

36
Q

Brand names Xenical (prescription) and Alli (OTC)
Reversible inhibitor of gastric and pancreatic lipases
Reduces triglyceride hydrolysis & fat absorption
Reduces Moderately effective (mean weight loss 6.4 lbs) in 15 randomized trials
Level 2 (mid-level) evidence
The ONLY FDA-approved treatment for long-term obesity

A

Orlistat

37
Q

What is the MAO of orlistat?

A

inhibits gastric & pancreatic lipases

reduces TAG hydrolysis & fat absorption (at intestinal brush border)

38
Q

ONLY FDA approved treatment for long-term obesity

A

Orlistat

39
Q

Orlistat side effects? How can you reduce these effects?

A

flatus with discharge
oily spotting
fecal urgency & incontinence

**increase fiber & decrease fat intake to reduce these symptoms & supplement with fat soluble vits

40
Q

When should orlistat NOT be used?

A

pregnancy
chronic malabsorption syndrome
w/ cyclosporine

41
Q

Experimental drug in Phase 2 trials for obesity
selective inhibitor of methionine aminopeptidase 2 (MetAP2)
reduce lipid & cholesterol biosynthesis
increased fat oxidation and lipolysis
associated with rapid weight loss
improvement in lipids, C-reactive protein, and adiponectin.

A

Beloranib

42
Q

When given orally, acts specifically on intestinal FXR
Mice on a high fat diet did not gain weight/ body fat
Had better metabolic profiles (glucose, insulin, leptin, cholesterol)
Had higher VO2 consumption but similar respiratory exchange ratios (suggesting enhanced use of sugar & fat)
Increased core body temperature
Induced metabolic responses that promote lipolysis and mobilize fatty acids for oxidation I
“browning” of cells in WAT

A

Fexaramine

**works to increase metabolism

43
Q

What is one med shown to cause modest weight loss at 6-12 months in diabetic pts?

A

Orlistat

44
Q

What is considered successful weight loss maintenance?

A

individuals who have intentionally lost 10% of their body weight & have kept it off for at least one year

45
Q

If individuals can succeed at maintaining their weight loss for (blank) y, they reduce their risk of subsequent regain by nearly 50%

A

2

Block 10 Week 2 (8 decks)

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