Exam #3 Flashcards

Question

What do adipokines have to do with anything?

Answer 1

they are expressed by macrophages & by adipocytes play multiple roles, including inflammation, cell to cell signaling, pro-coagulation & traditional hormonal functions MANY of them have to do with inflammation abdominal fat has a much higher metabolic profile - more metabolically active - than subQ fat Leptin hormone regulates feeding/fat balance - mouse with leptin deficiency is obese & hyperphagia (always hungry) - may be key in fighting obesity?

Answer 2

environmental, genetic, physiologic sedentary behavior thrifty gene theory (advantage to store fat efficiently before industrialization) sitting is the new smoking

Answer 3

Lots of different hormones & signaling, reward centers, behaviors - hard to control body likes to maintain homeostasis - so when you lose weight, it's hard to keep it off target 5% weight loss and then stay there for a month or so to help body reset do this over a series of times - evidence shows this is more likely to be successful at long term weight loss than losing a whole bunch at once

Answer 4

3-5% evidence of improved blood pressure improved lipid profile improved insulin sensitivity, glucose tolerance possibly most effective before onset of disease Best programs incorporate: dietary adjustments AND physical activity - raises your metabolic rate +/- pharmacologic therapy

Answer 5

BMI >/= 30 or BMI >/= 27 with comorbidity - pharmacotherapy ***as an adjunct to comprehensive lifestyle intervention*** BMI >/= 40 or BMI >/= 35 with comorbility - bariatric surgery option

Answer 6

20-35% from baseline after 2-3 years 16% after 10 yrs. (drug therapy target is just 5% weight loss)

Answer 7

Gastric banding and Roux-en-Y less common are biliopancreatic diversion and sleeve gastrectomy

Answer 8

Inflatable silicon device placed laparoscopically around top portion of stomach band is adjusted by saline solution via small access point (can take 3-5 adjustments) optimal restriction targeted to allow food to pass slowly while restricting food volume/hunger no bypassing of stomach or intestines ~66 lbs wt loss at 1 yr, 77 lbs @ 3 yrs 30-50% excess weight loss if band is too tight, you throw up all the time. You also throw up if you over-eat

Answer 9

Chronic disease remission: improvements in blood pressure, cholesterol profile, the more weight that is lost, the greater the chances of disease remission risks: 0.4% mortality w/procedure DVT formation & wound infection uncommon Risk of band slipping, eroding, failing $12,000-$36,000 for surgery - not always covered by insurance food intolerance

Answer 10

bypasses most of the stomach & some of the duodenum - reattaching the stomach further down the intestines & making stomach smaller 60-70% excess weight loss small pouch created as stomach unidirectional intestine prevents bile from spilling back into pouch mal absorptive as well as restrictive lose nutrients, too

Answer 11

~$25,000 for procedure not including complications & cost of extended hospital stay cosmetic surgery sometimes needed to remove extra skin T2DM remission occurs before weight loss 30-35% of patients are in remission before hospital discharge. ~83% remission rate overall greatest success in younger, shorter disease duration

Answer 12

- Gallstone formation and cholecystitis (inflammation of the gall bladder) - related to surgery and weight loss present in about 30% of patients at 6 mos. prevented with ursodiol, but poorly tolerated - Food intolerance: significant meat & protein intolerance. Vomiting can occur weekly or even daily - Nutrient deficiency: iron, B12, folate, riboflavin, niacin, thiamin, calcium, vitamin D, zinc, Vitamin A, vitamin C --> absorption enhanced by gastric acid - duodenum essential for nutrient absorption: proteins, fats, carbohydrates, calcium, magnesium, trace vitamins & elements about 30% of patients have nutrient deficiency even when adherent to vitamin regimen

Answer 13

anorexia, forgetting to eat or drink initially struggling to get fluids in mild-moderate nausea finding water "heavy" dysgeusia (funny/metallic taste at first) finding things taste too sweet disliking many protein supplements they previously loved finding vitamins' taste chalky and/or awful these people are often dehydrated

Answer 14

considering expanding coverage to all "at risk" with BMI > 30 kg/m2 ~18 million T2DM patients in US ~50% have a BMI > 30 kg/m2 nutrient replacement is suboptimal 36% non-compliance rate even among those who comply 13% are deficient in folate 30% deficient in B12 and iron --> big role for pharmacists to follow up with 9 million people

Answer 15

lines the upper duodenum blocks all absorption (does the same thing as Roux-en-Y put in through the mouth reversible A1C reduction of > 2.4% at 24 weeks (best drugs drop A1C at around 1.5%)

Answer 16

Mean changes: difference in mean % loss from baseline between active drug & placebo (average % weight loss) Categorical changes: proportion of subjects that lose at least 5% of their body weight between active drug & placebo all pharmacologic obesity drugs are approved as an ADJUNCT to lifestyle changes if no response seen in the first 3 months, discontinue use.

Answer 17

MOA: reduces food intake: sympathomimetic amine Effect on weight: 3-3.6 kg at 6 months SE: HA, insomnia, irritability, palpatations, nervousness

Answer 18

(Xenical, Alli) MOA: prevents dietary fat absorption ~ 30%: reversible GI lipase inhibitor Effect on weight: 2.59 kg at 6 mos. 2.89 kg at 1 yr approved for long term (> 12 mos) obesity mgmt. some evidence of LDL-C, BP & glucose improvements SE: diarrhea, flatulence, bloating, abdominal pain, dyspepsia, oily leaky stools, decreased fat soluble vitamin absorption (ADEK) Rx (120 mg) and OTC (60mg) TID retrains you how to eat

Answer 19

(Belviq) MOA: selective serotonin 2C receptor agonist in the hypothalamus. Decreases food consumption, promotes satiety approved for chronic weight mgmt in adults Effect on weight: 5.6 kg at 1 yr SE: primarily CNS: HA, dizziness, nausea. Dry mouth & constipation less common. Hypoglycemia in diabetes pts, priapism in men Pregnancy category X malignancy in rats at very high doses abuse of drug produces euphoric high similar to zolpidem, ketamine = CIV use with caution : pts with valvular heart disease extensively metabolized by the liver: CYP2D6 inhibitor dosed 10 mg bid discontinue use if 5% wt loss not achieved at 3 mos. $239.40 for 60 tablets

Answer 20

(Qsymia) MOA: reduce food intake, promote satiety, possible increased metabolic rate. Exact moa unknown approved for chronic weight mgmt for adults Effect on weight: 8-10 kg at 1 yr SE: dry mouth, paraesthesia (prickling, tingling, burning in hands, legs, arms or feet), increased resting HR, dizziness, insomnia, constipation, suicidal thoughts/actions, eye/vision problems (decreased vision acuity, increased IOP) dosing: taper both going on & going off 2 week intervals: 3.75mg/23mg --> 7.5/46mg 11.25/69mg --> 15mg/92 mg QD CI: pg - negative pg tests monthly. REMS monitoring due to congenital malformations, glaucoma, hyperthyroidism, concomitant use of MAO inhibitors $239.40 for #30 15mg/92mg tablets

Answer 21

MOA: synergism via POMC activation; appetite suppression and reward center effects Effect on weight: 6.5 kg at 1 yr SE: nausea, vomiting, insomnia, dizziness, increased HR/BP

Answer 22

MOA: GLP-1 central appetite suppression, decreased gastric motility Effect on weight: 5.9 kg at 1 yr SE: nausea, vomiting, diarrhea, constipation, flatulence

Answer 23

MOA: stimulates release of NE in CNS. Differs from amphetamine due to no DA release from synapse Effect on weight: 3.6 kg at 6 months FDA approved for 12 weeks or less (short term use) CI: hyperthyroidism, glaucoma, advanced arteriosclerosis, moderate HTN (no CI if controlled), pulmonary HTN Monitor blood pressure, weight Benefit: cost: $34.99/30 30 mg capsules dosed 18.75-37.5 mg/day