Lecture 4.1 - Obesity and Metabolic Syndrome Flashcards
BMI > 25 Treatment
Diet, physical activity, behavior therapy w/ comorbidities
BMI > 27 treatment
Diet, physical activity, behavior therapy & Pharmacotherapy w/ comorbidities
BMI > 30 treatment
Diet, physical activity, behavior therapy & Pharmacotherapy
BMI > 35 treatment
Diet, physical activity, behavior therapy & Pharmacotherapy
surgery if have comorbities
BMI > 40 treatment
Diet, physical activity, behavior therapy & Pharmacotherapy + Surgery
Line of treatment for obesity
1st = diet and exercise 2nd = addition of pharmacotherapy + diet/exercise 3rd = surgery
Ranking surgery for % weight loss
Gastric bypass > Gastric sleeve > gastric band
Intensive behavioral therapy
500-1000 kcal deficity
150min of moderate intensity physical activity
Phentermine dose
Cap: 15-30mg QD before breakfast or 10-14hrs b4 bed
Lomaira: 8mg TID: 30min b4 meals
Adipex-P = 37.5mg: before bfast or 1-2hr after
Orlistat dose
rx: 120mg TID before meals
OTC: 60mg TID
Phentermine/Topiramate ER dose
7.5/46mcg or 15/92mcg, req titration
Naltrexone/Bupropion ER dose
32/360mg orally req titration
Liraglutide dose
3mg injection, req titration
Semaglutide dose
2.4mg injection, req titration
Phentermine type
Sympathomimetic
Orlistat Type
pancreatic lipase inhib
Phentermine/topiramate ER type
Gaba receptor modulation, carbonic anhydrase inhib
Naltrexone/bupropion SR type
opioid receptor antagonist, DA/NE reuptake inhib
Drugs associated with weight loss
GLP-1 agonist Metformin Pramlintide SGLT2 inhib Bupropion Topiramate Zonisamide
Drugs associated with weight gain
Glucoccorticoids
1st gen anti-hist
Medroxyprog acetate
Carbs/gaba/pregab/valproic acid
atenolol/metop/nadolol/propo
-ine anti psych
bunch of Anti depressants aside from Fluoxetine/sertraline
Most common drug dosing metric for dosing in obesity
TBW, but can lead to inc exposure and ADE
most metrics have limitations
Most common meds w/ dosing consideration in obesity
Abe anticoag antidiabetic anticancer NMB
Phentermine Clinical use
short term manamgent of exogenous obesity in pts >30->27 in presence of other risk factors
adjust in a regime of weight reduction based on exercise, behavioral changes
Phentermine CI
MAOI Hyperthyroidism CVD GLaucoma Preg/nursing
Phentermine ADE
CNS: insomnia, overstim, resless, etc
CV: tachycardia, HTN, palp, ischemic events
GI: dry mouth, bad tase, D, C,
Endocrine: impotence, change libido
Orlistat advise pt
take multivitamin contains fat-soluble vitamins to ensure adequate nutrition, 2hrs before or after admin orlistat
Orlistat CI
Preg, breastfeeding
Cholestasis
Chronic malabsorption syndrome
Hypersensitivity
Orlistat ADE
most common: oil spotting, farts, fecal urgency, fatty/oily stool, oily pooping, increased poop and cant hold it
Orlistat warnings
dont co-admin cyclosporine
negative effect co-admin w/ antiepileptics and antiretrovirals
Orlistat indication
adults and adolescents with BMI > 30 or > 27 (US) > 28(EU) and with > 1 Comoro and reduce the risk of weight regain after prior weight loss
used in conjunction with a reduced calorie diet
Phen/TPM ER indication
chronic weight management in adults with BMI > 30 or > 27 in presence of atleast 1 weight related Comoro, as adjunct to reduced calorie diet and inc physical activity
When to D/c Phen/TPM
in pt who has not lost > 5% of baseline body weight on 15mg/92mg after 12 weeks
Phen/TPM ADE
most common: paresthesia, dizziness, dysgeusia, insomnia, constipation, dry mouth
Phen/TPM CI
Preg Glaucoma HTN MOAI Hypersensitivity to sympathomimetic drugs
Phen/TPM warning/ precaution
Embryo-fetal toxicity
laundry list of other shit
Phen/TPM ER dosing schedule
Titration, 2 weeks: 3.75/23
Maintenance/ max for renal impair: 7.5/46
if filling to lose >3% BW after 12week, titrate 11.25/69 and then 2 weeks later 15/92
Naltrexone/bupropion Indication
Chronic weight management in adults with BMI > 30 or >27 with >1 weight related comorb, adjunct to reduced calorie diet and inc physical activity
D/x Naltrexone/bupropion if…
pt hasn’t lost >5% baseline BW on max dose after 12 weeks
Naltrexone/bupropion ADE
N,C,HA,V,dizziness, insomnia, dry mouth, diarrhea
Naltrexone/bupropion CI
boat load
MAOI allergy Seizure Unc HTN abrupt stop of booze, bentos, etc
Naltrexone/bupropion warning
D/c w/ suicidal behavior and idea or with neuropsychological AE
Liraglutide 3mg indication
Chronic weight management
Adult BMI > 30/27+ 1 weight related comorbid
Pediatric > 12yrs old and > 60kg and BMI >30 for adults
Liraglutide Dosing
0.6/week for 4 weeks
Week 5 onwards = 3mg/once daily any time
When to D/x Liraglutide
adult, haven’t lost >4% BLBW at 16weeks
peds, haven’t lost > 1% BLBW at 12 weeks
if cant tolerate maintenance dose (or can reduce to 2.4 in peds)
Liraglutide CI
Hypersenstivity
preg
known FMH medullary thyroid cancer or MEN syndrome
Liraglutide ADE
N,D,V,C, injectable site, HA,
bunch of other shit
Semaglutide indication
adult with BMI > 30 or 27 + 1 weight related comorbid
D/x semaglutide if
pts dont tolerate maintenance, can temp decrease for X 4 week then back up.
D/x if pt cant tolerate 2.4mg after 4 weeks
Semaglutide Dosing
Week 1-4 = 0.25mg Week 5-8 = 0.5mg Week 9-12 = 1mg Week 13-16 = 1.7mg Week 17 = 2.4 = maintenance
once weekly, any time of day
Semaglutide ADE
essentially same as Liraglutide
Adjustable Gastric banding info
Advantage:
reversible + adjustable
Lowest rates of early post complication + mortality
Disadvantage:
highest rate of reop
req stric adherence to diet + followups
Sleeve Gastrectomy info
Advantage:
Rapid + sig weight loss
favorable changes in hormones
Disadvantage:
Non-reversible
potential long-term Vit deficiencies
Gastric Bypass info
Advantage:
sig long term weight loss
favorable changes in hormones
Disadvantage:
complex compared to others
req longterm adherence to dietary recommendations
indications for surgery In obesity
BMI > 35 w/ comorbidity
BMI > 40 without comorbidity
