L8 Malabsorption, Weight Loss, and Obesity

Question 1

GLP-1 Agonists Drugs/MOA/Delivery

Side Effects?

Answer 1

(-glutides): Semaglutide and Liraglutide

GLP-1 (glucagon-like peptide) act on the central nervous system to decrease appetite

Subcutaneous injection weekly

Side Effects: GI upset (i.e. nausea)

Question 2

Orlistat MOA/Effectiveness?

Side Effects?

Answer 2

MOA: Inhibitor of fat absorption by inhibiting gastric and pancreatic lipases. ONLY 5% weight loss compared to diet/exercise

Side Effects:

• Steatorrhea, flatulence, and abdominal pain
• Reduced absorption of fat soluble vitamins ( A, D, E, and K)
• Hypoglycemia in type 2 diabetics

Question 3

MOA of Naltrexone/Bupropion in weight loss

Side Effects/Contraindications?

Answer 3

Naltrexone: Opioid receptor antagonist (Suppresses Appetite)

Bupropion: Noradrenaline-dopamine reuptake inhibitor (Acts on hypothalamus to suppress appetite)

Contraindicated in patients with:

• Chronic Kidney Disease
• Cirrhotic liver disease
• Seizures

Side Effects:

• Can increase suicidal behavior
• Seizures
• Hypertension
• Risk of serotonin syndrome

Question 4

_________________ –Anticonvulsant and migraine prophylaxis drug that Inhibits the sodium channel of neurons and increases GABA => Suppresses appetite and increases satiety

Answer 4

Topiramate –Anticonvulsant and migraine prophylaxis drug that Inhibits the sodium channel of neurons and increases GABA => Suppresses appetite and increases satiety

Question 5

_________________ – amphetamine analogue that suppresses appetite (High Risk of Abuse)

Answer 5

Phentermine – amphetamine analogue that suppresses appetite (High Risk of Abuse)

Question 6

Contraindications for Surgical Weight loss?

Answer 6

• Unstable Coronary artery disease
• Advanced liver disease with portal hypertension
• Inflammatory bowel disease
• Malignancy
• Extensive intra-abdominal adhesions

Question 7

Treatment of Malabsorption?

Answer 7

• Treat the underlying disease
• Supplement what is missing: Pancreatin (CREON) – contains Lipase, amylase, and Protease and is given during or immediately after meals

Question 8

Drugs/MOA/Benefits of Bile Acid Sequesterants?

Answer 8

(Cole-): Cholestyramine, colestipol, colesevelam

MOA: Bile sequestrants absorbs and binds to bile acids in the intestine to form insoluble complex improving excretion in the stool =>cholesterol is oxidized into bile salts to replenish levels=> decreased circulating bile acids, decreased cholesterol, and decreased LDL.

Benefits:

• Improves pruritis as bile acids don’t deposit in the skin (reduces itching) and alleviates steatorrhea.
• Improves hyperlipidemia by increasing cholesterol => bile acid formation

Question 9

Fat Soluble Vitamins and consequence of their deficiency?

Answer 9

A – deficiency leads to Night vision disturbance

D - deficiency increases risk of osteoporosis and calcium dysregulation

E – deficiency leads to neurological disruption

K – deficiency leads to increased risk of bleeding

Question 10

Delivery Methods of Vitamin D?

When is Activated Form Preferred?

Answer 10

Oral, Liquid IM injection or spray

Inactivated form: (Cholecalciferol, Ergocalciferol)

Activated form: Calcitriol (given to those w/ kidney failure unable to metabolise inactivated forms)

Question 11

Delivery Methods of Vitamin K?

Answer 11

Can be given oral or intravenously

Given with Prothrombin complex (Octaplex) in Major Bleed if on Warfarin or Vitamin K deficiency

Question 12

Contraindications to Surgical Treatment of Obestiy?

Answer 12

Unstable Coronary artery disease

Advanced liver disease with portal hypertension

Inflammatory bowel disease

Malignancy

Extensive intra-abdominal adhesions - Multiple surgeries

Question 13

Gastric Bypass vs Gastric Sleeve Procedures?

Answer 13

Gastric Sleeve: Portion of stomach is removed

Gastric Bypass: creates small gastric pouch to which a section of jejunum is attached