CSOWM Deck 2 Flashcards
This drug is a Norepinephrine-releasing agent, approved in the 1960’s, contraindications are anxiety disorders, hx of heart dz, Uncontrolled HTN, siezure, MAO inhibitors, pregnency
Phentermine, resin
This drug is also a Norepinephrine-releasing agent, approved in the 1960’s, similiar to Phentermine resin, contraindications are anxiety disorders, hx of heart dz, Uncontrolled HTN, siezure, MAO inhibitors, pregnency
Diethylpropion
This drug is a pancreatic and gastric lipase inhibitor, approved in 1999 for chronic weight loss, contraindications are Cyclosporin 2 hr before or after, chronic malabsorption, pregnancy and breastfeeding. Decreased absorption of fat soluble vitamins, fecal /anal leakage
Orlistat
This drug is a Serotonin 5HT2C receptor agonist, approved in 2012 for wt. management, contraindications are Pregnancy and breastfeeding, use with caution with SSRI, SNRI/MAOI, etc.
Lorcaserin ( Belviq)
This drug is a combination of Phentermine and Topiramate, a GABA receptor modulation plus a norepinephrine-releasing agent, approved in 2012 for wt. loss, contraindications are pregnancy and breastfeeding, hyperthyroidism, glaucoma, MAO inhibitor
Phentermine + Topiramate (Qsymia)
This medication is a Dopamine and norepinephrine reuptake inhibitor (Bupropion) and a opioid antagonist (Naltrexone)Approved in 2014 for wt management, contraindication with pregnancy and breastfeeding, uncontrolled HTN, seizure do, anorexia nervosa, alcohol withdrawal, MAO inhibitor
Naltrexone/Bupropion (Contrave)
This medication is a GLP-1 agonist, approved in 2014 for wt management, contraindicated with pregnancy and breastfeeding, medullary thyroid, cancer hx, endocrine neoplasia
Liraglutide
Sympathomimetic agents like phentermine and diethylpropion do not use with what type of patients/medical issue?
Uncontrolled HTN
In pt’s with obesity and depression on SSRI or SNRI do not use which wt. loss medication?
Lorcaserin, a better choice will be Phentermine or Qysmia
The AHA/ACC/TOS recommend how many face to face visits /year for treatment of obesity and weight management?
16/year on average.
Weight loss medication is affective if you have lost >5% at 3 months?
True and can be continued.
We loss medication is “ineffective” if you have lost <5% in 3 months?
True and you should switch to a new medication or referral for alternative treatment.
For medications used for wt. loss the recommended doses are?
Orlistat 120 mg tid, Phentermine/Toprimate 7.5mg/46 mg every day; Lorcaserin 10 mg bid; naltrexone/bupropion 8 mg/90 mg bid and Liraglutide 3.0 mg SC QD.
For patient’s who have T2DM and are overweight antidiabetic medications with additional weight loss benefits such as?
GLP-1 or SGLT-2 in addition to the first line Metformin.
Use medications like Lorcarserin and Orlistat for people who have CVD and need to lose weight because they are not?
Sympathomimetics
What medications cause weight gain?
Insulin, sulfonylureas, glitinides and thiazolidinediones, pioglitzaone
Paroxetine/antidepressant; mirtazpine,
Chlorpromazine, clozapine, olanzapine, quetiapine / anti psychotics
Beta blockers, propranolol, metoprolol, atenolol
Hormones: estrogen and steroids
Hypnotics: diphenhydramine/Benadryl
Mood: lithium
Seizure: pregabalin, gabapentin, valproate
SGLT-2 drugs that also cause weight loss, reduce renal glucose absorption
dapagliflozin and canagliflozin
Prioritize the use of Metformin, incretin-based medications and SGLT-2 medications to reduce exercise-related hypoglycemia and increase safety and efficcy of exercise ….in patients with ?
Diabetes
In T2DM with obesity requiring Insulin, what medication should be added to help mitigate weight gain from Insulin?
Metformin, Pramlintide or GLP-1 agonist.
ACE inhibitors, ARB’s, Calcium Channel Blockers are the 1st line obesity /T2DM /HTN treatment rather than which other anti-hypertensive medication?
BETA blockers
Which anti-depressants cause weight gain?
Paroxetine is the SSRI with greatest long term weight gain, amitriptyline, mirtazapine, nortriptyline, venlafaxine, duloxetine.
Antipsychotics drugs that cause weight gain?
olanzapine, quetiapine, risperidone, perphenazine, ziprasidone.
AED’s that cause weight loss?
felbamate, topiramate, zonisamide.
AED’s that cause weight gain?
gabapentin, pregabalin, valproic acid, vegabatrin, carbamazepine
In women with BMI >27 with comorbidites or >30 BMI who are seeking contraception it is suggested that they use?
Oral contraception versus Injectables due to weight gain with injectables.
Weight and waist cm should be monitored when using what other types of medications?
Anti-viral/for immunodeficiency, chronic steroid use/antiinflammatory, some antihistamines
How much protein is considered in a high protein diet?
25% of calories (30% fat, 45% CHO)
Low carbohydrate Diet
<20grams carbohydrate
What is the “typical” protein diet
15% of calories
What is moderate protein diet?
12% calories from protein
BMI cut off points
BMI 25-29.9 overweight; BMI >30 obese
Weight loss of overwt and obese adults at risk for T2DM between 2.5 and 5.5 kg at >/= 2 years ?
reduced the risk of developing type 2 DM by 30 to 60%
In overwt/obese adults with T2DM, 2-5% weight loss achieved in 1-4 years of lifestyle intervention (w/wo orlistat) resulted in?
reduction in HgbA1C by .2 to .3%, FPG
In overwt/obese patients with T2DM who achieve greater weight loss at 1 year with lifestyle intervention have greater improvement of A1C. Wt. Loss of ? % is associated with?
Wt. loss of 5-10% = A1C reductions of .6 to 1.0% and reduction in diabetes medications.
Waist circumference cutoff points for men and women?
> 102 cm for men, >88 for women
With moderate weight loss, lower fat, higher CHO, compared to higher fat, lower CHO diet what are the differences?
reduction in LDL Chol, lesser reductions in TG, Less increase in HDL chol.
There is little difference in weight loss with caloric restriction when protein is ?
Either high at 25% or typical 15%
High protein diet compared to typical protein diets do not?
Result in more beneficial effects on CVD risk factors.
In overwt/obese women the use of meal replacements bars or liquids is associated with?
increased weight loss at up to 6 months, in comparison with balanced deficit diet using conventional food. Long term evidence of continued wt. loss advantage is lacking.
Because Orlistat inhibits fat absorption, what supplements should be considered?
A, D, K, E, and beta carotene
What is the % goal weight loss for Tertiary Prevention for Prediabetes, Metabolic Syndrome?
10%
What is the % goal weight loss for Tertiary Prevention for T2DM, Dyslipidemia, HTN, PCOS?
5-15% or more
What is the % goal weight loss for Tertiary Prevention for Steatosis? Steatohepatitis?
5% or more and 10-40%
What is the %weight loss goal for Tertiary Prevention for Female infertility? male hypogonadism?
10% or more and 5%-10%
What is the % weight loss goal for Tertiary Prevention for OSA?
7-11%
What is the % weight loss goal for tertiary prevention for GERD?
10% or more
With Rou-en-Y and PPD/DS what is the expected weight loss at 1 year and at 10years?
35% initial weight loss then 30% at 10 years.
With a lap band what is the expected weight loss at 1 year and at 10 years?
20% initial weight loss then 15% at 10 years.
Pre Bariatric Surgery what labs should be taken?
Iron, B-12, Vitamin D, folic acid, A, E.
Post Bariatric Surgery what labs and tests should be taken?
B-12, Folic Acid, Vitamin D, Iron, PTH
Bone Dexa
Check Zn, Copper and selenium
Check A initially and every 6-12 months
Thiamine
Management of Oxalosis and calcium oxalate stones in post bariatric surgery includes?
Avoid dehydration
low oxalate diet
Potassium Citrate Therapy
Calcium supplement
What deficiency’s in bariatric surgery might you see?
Zinc: hair loss, PICA, dysgeusia
Copper: anemia, neutropenia, poor wound healing
Thiamine: vomiting, weight loss, increased alcohol
Selenium: fatigue, anemia, diarrhea
Approved weight loss meds for kids?
Orlistat if 12 or older
Sibutramine (Meridia) if 16 or older Meridia was discontinued.
Deficiency seen with Roux-en-Y surgery?
B-12, Iron, Vitamin D, Thiamine
B-12 Deficiency symptoms?
fatigue, pins and needles feeling, loss of appetite,
Deficiencies seen in Obese People?
Iron (inflammation), Vitamin D (hides in adipose tissue), B-12 (if on Metformin), Zinc (hyper insulinemia)
What are healthy pregnancy weights?
BMI of 18-25 you should gain 25-35 lb/
BMI of 25 to 29.9 you should gain 15-25 lbs
BMI of > or = to 30 you should gain 11-20 lbs.
BMI <18.25 you should gain 28 to 40 lbs
Infertility increases or a pregnancy from ART (artificial reproductive technology) as?
BMI increases
Infertility increases or a pregnancy from ART (artificial reproductive technology) as?
BMI increases
Gestational Hypertensionn is (. ) times more likely among those who enter pregnancy with an obese BMI.
6 times
Higher pre pregnancy BMI increases?
Risk of post-partum depression
Supplements possibly effective for weight loss are?
Ephedra, Garcinia,
Caffeine and green tea my increase
Fatty acid oxidation
Medications that are andergenic
Phentermine, Buproprion and Qysmia.
Drugs that are anti-epliletic?
Toperimate, Zonisamide
Drugs that are anti-diabetic
Metformin, Exenatide, Liraglutide, and Pramlintide
MOA drugs
Belviq, Orlistat, Naltrexone, and Contrave
Describe the post WLS diet?
Stage I: clear liquid diet used day 1 and 2 post surgery.
StageII: full liquid diet used 10 to 14 days post surgery.
Stage III: Texture progression
a. Soft and moist foods
B. Small portions
C. Encouraged 60-80 grams of protein/day
How long should women avoid pregnancy after WLS?
12-18 months
A pregnant woman who has had WLS they protein and calorie recommendations are?
1.1 grams protein /kg PRE-Pregnancy IBW; 300-500 calories more than needed for maintenance (at least 1500-1800 calories/day). FAT should include DHA.
Adjustable Gastric Banding has higher -re-operation rate due to
Greater risk of 30 day complications
LGB has?
- At 12 years 1 out of 3 experience band erosion
- 50% band removal
Sleeve Gastrectomy
- First step of a BPD/DS
- Restriction causes some psychological changes and post prandial changes in secretion of gut hormones
- May exacerbate GERD
Gastric Bypass Roux-en-Y
- Changes in gut hormones
- Gherlin is significantly reduced after surgery and remains reduced.
- Partial vagotomy- transaction of the vagus nerve abolishes orexigenic effect
- Accelerated delivery of nutrients into the hindgut increases secretions of hormones that inhibit gastric emptying, inhibit appetite and induce satiety.
- Increase in GLP-1 which inhibits glucagon secretion and augments the insulin response.
Orexigenic Effect
Appetite stimulating, increasing hunger etc.
How is AHI measured for sleep apnea? Apnea Hypopnia Index
Mild: An AHI of at least five events per hour, but fewer than 15.
Moderate: An AHI of at least 15 events per hour, but fewer than 30.
Severe: An AHI of at least 30 events per hour.
Sleep Apnea Measuring AHI
The apnea-hypopnea index (AHI) represents the average number of apneas and hypopneas you experience each hour during sleep. To measure it, doctors divide the total number of apneic and hypopneic events5 by the total number of hours you were asleep. To register as an event, an apnea or hypopnea must last at least 10 seconds or longer.
