Control of Appetite and Weight

Question 1

AMSH useful in

MC4R gene

regulates

AgRP antagonizes

Answer 1

satiety (VM hypothalamus)

transmembrane receptor for AMSH

satiety

AMSH at MC4R

Question 2

Ghrelin

GLP 1

Insulin

Source, stimulus, effect

Answer 2

Stomach, fasting, inc food intake

intestinal EE, intake, inhibits food intake/glucagon/gastric emptying, inc insulin sec

Pancreas, food intake, inhibits food intake

Question 3

Leptin

Peptide YY

Source, stimulus, effect

Answer 3

Adipocytes, basal relase, overeating, inc insulin- inhibits food intake

Ileum/colon ee cells- incom digested nutrients- inhibits food intake/gastric emptying/motility

Question 4

Leptin gene

Leptin receptor

Def of leptin

FTO directs fat cell differentiation

____ genetic signal for determining BMI

Answer 4

adipocyte derived hormone

dec food intake, inc energy expenditure

rare cause of obesity, hyperphagia/low energy expenditure

toward white, away from brown (less thermo)

strongest

Question 5

5HT1 A

5HT2 A

5HT2 C

effect, agonist, antagonist

Answer 5

sleep/feeding/anx
none
Buspirone

Dec anx
LSD
Cloazpine/trazodone

Mood/anx/satiety (AMSH release)
Fenfluramine/Lorcaserin
Mirtazapine

Question 6

SSRIs block _____

SERT moves _____ into presynaptic neurons

SSRIs inc ______

Downregulates 5HT1A ____

Answer 6

serotonin transporter (SERT)

serotonin

serotinin in synapse

presyn receptors

Question 7

Eating disorders

Anorexia nervosa

Bulimia nervosa

Binge eating disorder

Ghrelin, Leptin, Dopaine, Serotonin levels

SSRIs with bulimia: ___ more likely

Binge eating DO ____ more likely

Answer 7

big inc, big decrease, inc, NA

Normal to inc, dec, none, Inc 5HT1A, dec 5HT2A

down, NA, down, down

remission

remission

Question 8

Metabolic syndromes

At least 3 of following

Waist circum m and F

TG

HDL men and women

BP

Fasting glucose

Answer 8

m >102 cm, F>88 cm

> 150

m <40, women <50

> 130/85

> 100

Question 9

Adult pt with BMI between 25-35, measure

measure waist at

measure hips at

Answer 9

waist cirumference

narrowest point

widest point

Question 10

Reduce energency intake

Cal red

Women goals

Men goals

Answer 10

500-750 kcal

1200-1500 kcal

1500-1800

Question 11

7-10% wl associated w

Topiramate targets

Naltrexone is

Phentermine and topirate under

Adv effects

Answer 11

reduced BP, LDL, TG, glucose
inc HDL

GABA receptor

Opiod antagonist

inc control

inc risk of orofacial clefts in 1st trimester
dry mouth
constipation
withdrawal leads to seizures

Question 12

Indications for surgery

Roux en Y bypass

Laparoscopic banding or sleeve gastrectomy

High risk conditions

Usually after

Absent

Answer 12

BMI >40 or 35 w high risk conditions

BMI >40 or 30 w HRC

OSA, cardiomyopathy, severe DM, OA

failed life/pharm therapy

CAD, LD w portal HTN, psych illness

Question 13

Roux en y diet

No more than ____ oz per meal

eat ___ first

eat ____ second

eat ____ third

eat ____ last

Others

Restrict ____ between meals

Answer 13

4

lean protein (2oz)

nonstarchy veggies

small seving of fruit

starches/starchy veggies

drink lots of water, avoid simple carbs

fluids

Question 14

1 pound of fat = ____ kcal

Need deficit of ____ kcal/day to lose 1 lb/wk

Min cals to maintain weight
W
M

More ____ means more cals

_____ fewer cals to maintain weight w recent loss

Answer 14

3500

500

W= 10-11 per pound, 22-24 per kg
M= 12-14 per pound, 26-30 per kg

Muscle mass

10-15%

Question 15

Sleeve gastrectomy downside
upside

Vertical banded gastroplasty
benefit

Answer 15

lose acid/enzymes
pylorus present

very small stomach pouch, band with metal
keep acid/enzymes