Diabetes (exam ?) Flashcards
apple shape
more visceral fat
higher risk of weight related health problems
pear shape
less visceral shape
lower risk of weight related health problems
BMI that classifies overweight
over 25
BMI that classifies obesity
over 30
obesity reduces life expectancy around ___________ and morbid obesity reduces life expectancy around __________
3 years
10 years
abdominal obesity is a major risk factor for
metabolic syndrome
in obesity, there is an accumulation in adipocytes leads to
pro inflammatory factors, adiopocytokines, and lipotoxicity
obesity can lead to
T2DM
HTN
CV diseases
non alcoholic fatty liver disease
cancers
in obesity energy intake _________ energy expenditure
exceeds
key players in control of energy intake
ghrelin (hunger hormone)
leptin (feeling of fullness)
in obesity there is a ________ sensitivity of leptin receptors
decreased
control of energy expenditure is controlled by
basal metabolic rate being lowered/increased
substances that promote weight gain
cannabinoids
orexin
ghrelin
insulin
substances that promote weight loss
histamine
NE
DA
thyroid hormone
leptin
GLP-1
adipose tissue secretes ________________ which can promote ____________________
hormones, inflammatory cytokines, and other substances
inflammation and alter body homeostasis
obesity increases
clotting
insulin resistance
atherosclerosis
blood pressure
cancer risk
insulin binding activates downstream ______________ resulting in the ___________________ to the cell surface
Akt kinase
translocation and exocytosis of intracellular GLUT4 vesicles
what happens during insulin resistance when there is chronic high FA levels?
decreased secretion of insulin from the pancreas
activation of PKC0 which does not form active Akt kinase
GLUT4 vesicles cannot go to the surface
weight loss in indicated in patients with a BMI of
25 to 30 with 1 or more indications of increased CVD risk
or
any patients with a BMI over 30
initial goal of weight loss is _____________ which can significantly improve ______________
5-10%
blood pressure, lipid levels and glucose tolerance
non pharmacological therapy for weight loss
dietary changes
increased physical activity
behavioral modification
when can bariatric surgery be considered?
BMI over 40
BMI over 35 with significant comorbidites
general approach to treatment of obesity
suppress appetite
reduce fat absorption
increase WAT lipolysis and oxidation
pharmacological therapy can be considered as adjunctive treatment for
BMI over 30
BMI 27-29 with at least one weight related comorbidity
use of medication leads to about an ____________ weight loss in the average patient
8-20lb
if ____________ weight loss is not achieved after ______ weeks then the drug should be discontinued
4-5%
12
stimulants/sympathomimetics examples
phentermine (adipex P)
diethylpropion (tenuate)
phendimetrazine (bontril)
stimulant and anticonvulsant examples
phentermine/topiramate ER (qsymia)
NDRI and opioid antagonist example
Bupropion/Naltrexone (contrave)
GLP1 antagonists examples
liraglutide (saxenda)
semaglutide (wegovy)
lipase inhibitor example
orlistat (Xenical - RX or Alli - OTC)
superabsorbent hydrogel example
cellulose/citric acid complex (plenity)
stimulants/sympathomimetics MOA
increase presynaptic release of NE in the brain via reverse transport of NE transporter
increases NE levels and reduces appetite
stimulants/sympathomimetics shouldn’t be taken at night due to
insomnia
stimulants/sympathomimetics are limited to short term treatment due to
CV risk and abuse potential
Phentermine increases ______________ because it blocks ________________
DA and NE in the hypothalamus
NE and DA reuptake transporters
which pathway does stimulants/sympathomimetics affect?
what hormone increases to suppresses appetite partially?
appetite suppressing pathway
alpha-melanocyte stimulating hormone
stimulants/sympathomimetics hepatic metabolism including
3A4
ADRs of stimulants/sympathomimetics
adrenergic effects
decrease the seizure threshold
avoid stimulants/sympathomimetics in patients with
history of seizures
CV disease
hyperthyroidism
history of substance abuse
ADRs of stimulant and anticonvulsant
adrenergic effects
decrease seizure threshold
paresthesia, dizziness, cognitive impairment, kidney stones, alkaline urine
stimulant and anticonvulsant should be
tapered during discontinuation to reduce seizure risk
topiramate is a
teratogen (harmful in pregnancy)
topiramate __________ the actions of phentermine by ________________
potentiates
inhibiting the appetite stimulating pathway
how does topiramate inhibits the appetite stimulating pathway?
reduces excitatory glutamaterigc input by increasing inhibitory GABAergic input
MOA of bupropion in NDRI and opioid antagonist
inhibits presynaptic reuptake of NET and DAT leading to increased NE and DA levels
suppresses appetite
MOA of naltrexone in NDRI and opioid antagonist
reduces food cravings
reduces activation of reward pathways associated with food
naltrexone ______________ the actions of bupropion by __________________
potentiates
blocking the endorphin/endogenous-opioid-mediated negative feedback loop
naltrexone acts on the
appetite suppressing pathway
Bupropion is a ___________ inhibitor
CYP2D6
ADRs of NDRI and opioid antagonist
lowering seizure threshold, insomnia
adrenergic effects
nausea, headache
NDRI and opioid antagonist should not be used in
uncontrolled HTN
seizure disorders
eating disorders
opioid users
GLP1 agonist MOA
peptide agonist at GLP1 receptors which reduces appetite and delays gastric emptying
increases satiety
GLP1 also stimulates _______________ secretion and reduces ________________
glucose dependent insulin secretion
glucagon secretion
mechanisms of potent GLP1 agonists
delayed gastric emptying
increased glucose dependent insulin secretion
reduced glucagon levels
reduced food intake by CNS effects
short acting GLP1 agent exert their effect mostly by
slowing gastric empyting
long acting GLP1 agents exert their effect mostly by
reducing fating glucose levels mediated by their effect on insulin and glucagon release
GLP1 agonists are metabolized by
protease enzymes
half life of liraglutide is
half life of semaglutide is
12 hrs
1 week
ADRs of GLP1 agonsts
nausea
abdominal pain
vomiting
diarrhea
increased HR
hypoglycemia
rare ADR of GLP1 agonists
acute pancreatitis
GLP1 agonists have a black box warning for
risk of thyroid tumors
GLP1 agonists are not recommended for
patients with gastroparesis
Zepbound (tirzepatide) is a
dual GIP and GLP1 receptor agonist
half life of zepbound
5 days
MOA of lipase inhibitor
reversible inhibition of gastric and pancreatic lipases
reduction of fat absorption by GI tract
lipase inhibitors are excreted
through the feces as unchanged drug
ADRs of lipase inhibitors
abdominal cramping
flatulence
fecal incontinence
diarrhea
rare ADRs of lipase inhibitors
liver toxicity
oxalate-induced kidney stones
lipase inhibitors interfere with the absorption of
some medications and fat soluble vitamins (A,D,K,E)
super absorbent hydrogel MOA
small cellulose and citric acid particles released into the stomach and hydrate up to 100x their weight
promotes fullness
hydrogel particles are broken down in the
colon releasing water for reabsorption
super absorbent hydrogel is approved as a ________ by the FDA
device
ADRs of super absorbent hydrogel
abdominal pain
diarrhea
flatulence
abdominal distension
nausea
super absorbent hydrogel is approved for
BMI over 25
super absorbent hydrogel is not recommended in patients with
GI abnormalities or conditions
PK of super absorbent hydrogel
no absorption, distribution and metabolism
excreted through feces
