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CDM 2 Exam 3 > Lecture 4.1 - Obesity and Metabolic Syndrome > Flashcards

Lecture 4.1 - Obesity and Metabolic Syndrome Flashcards

1
Q

BMI > 25 Treatment

A

Diet, physical activity, behavior therapy w/ comorbidities

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2
Q

BMI > 27 treatment

A

Diet, physical activity, behavior therapy & Pharmacotherapy w/ comorbidities

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3
Q

BMI > 30 treatment

A

Diet, physical activity, behavior therapy & Pharmacotherapy

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4
Q

BMI > 35 treatment

A

Diet, physical activity, behavior therapy & Pharmacotherapy

surgery if have comorbities

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5
Q

BMI > 40 treatment

A

Diet, physical activity, behavior therapy & Pharmacotherapy + Surgery

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6
Q

Line of treatment for obesity

A 
1st = diet and exercise
2nd = addition of pharmacotherapy + diet/exercise
3rd = surgery
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7
Q

Ranking surgery for % weight loss

A

Gastric bypass > Gastric sleeve > gastric band

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8
Q

Intensive behavioral therapy

A

500-1000 kcal deficity

150min of moderate intensity physical activity

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9
Q

Phentermine dose

A

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

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10
Q

Orlistat dose

A

rx: 120mg TID before meals
OTC: 60mg TID

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11
Q

Phentermine/Topiramate ER dose

A

7.5/46mcg or 15/92mcg, req titration

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12
Q

Naltrexone/Bupropion ER dose

A

32/360mg orally req titration

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13
Q

Liraglutide dose

A

3mg injection, req titration

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14
Q

Semaglutide dose

A

2.4mg injection, req titration

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15
Q

Phentermine type

A

Sympathomimetic

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16
Q

Orlistat Type

A

pancreatic lipase inhib

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17
Q

Phentermine/topiramate ER type

A

Gaba receptor modulation, carbonic anhydrase inhib

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18
Q

Naltrexone/bupropion SR type

A

opioid receptor antagonist, DA/NE reuptake inhib

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19
Q

Drugs associated with weight loss

A 
GLP-1 agonist
Metformin
Pramlintide
SGLT2 inhib
Bupropion
Topiramate
Zonisamide
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20
Q

Drugs associated with weight gain

A

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

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21
Q

Most common drug dosing metric for dosing in obesity

A

TBW, but can lead to inc exposure and ADE

most metrics have limitations

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22
Q

Most common meds w/ dosing consideration in obesity

A 
Abe
anticoag
antidiabetic
anticancer
NMB
23
Q

Phentermine Clinical use

A

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

24
Q

Phentermine CI

A 
MAOI
Hyperthyroidism
CVD
GLaucoma
Preg/nursing
25
Q

Phentermine ADE

A

CNS: insomnia, overstim, resless, etc
CV: tachycardia, HTN, palp, ischemic events
GI: dry mouth, bad tase, D, C,
Endocrine: impotence, change libido

26
Q

Orlistat advise pt

A

take multivitamin contains fat-soluble vitamins to ensure adequate nutrition, 2hrs before or after admin orlistat

27
Q

Orlistat CI

A

Preg, breastfeeding
Cholestasis
Chronic malabsorption syndrome
Hypersensitivity

28
Q

Orlistat ADE

A

most common: oil spotting, farts, fecal urgency, fatty/oily stool, oily pooping, increased poop and cant hold it

29
Q

Orlistat warnings

A

dont co-admin cyclosporine

negative effect co-admin w/ antiepileptics and antiretrovirals

30
Q

Orlistat indication

A

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

31
Q

Phen/TPM ER indication

A

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

32
Q

When to D/c Phen/TPM

A

in pt who has not lost > 5% of baseline body weight on 15mg/92mg after 12 weeks

33
Q

Phen/TPM ADE

A

most common: paresthesia, dizziness, dysgeusia, insomnia, constipation, dry mouth

34
Q

Phen/TPM CI

A 
Preg
Glaucoma
HTN
MOAI
Hypersensitivity to sympathomimetic drugs
35
Q

Phen/TPM warning/ precaution

A

Embryo-fetal toxicity

laundry list of other shit

36
Q

Phen/TPM ER dosing schedule

A

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

37
Q

Naltrexone/bupropion Indication

A

Chronic weight management in adults with BMI > 30 or >27 with >1 weight related comorb, adjunct to reduced calorie diet and inc physical activity

38
Q

D/x Naltrexone/bupropion if…

A

pt hasn’t lost >5% baseline BW on max dose after 12 weeks

39
Q

Naltrexone/bupropion ADE

A

N,C,HA,V,dizziness, insomnia, dry mouth, diarrhea

40
Q

Naltrexone/bupropion CI

A

boat load

MAOI
allergy
Seizure
Unc HTN
abrupt stop of booze, bentos, etc
41
Q

Naltrexone/bupropion warning

A

D/c w/ suicidal behavior and idea or with neuropsychological AE

42
Q

Liraglutide 3mg indication

A

Chronic weight management

Adult BMI > 30/27+ 1 weight related comorbid

Pediatric > 12yrs old and > 60kg and BMI >30 for adults

43
Q

Liraglutide Dosing

A

0.6/week for 4 weeks

Week 5 onwards = 3mg/once daily any time

44
Q

When to D/x Liraglutide

A

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)

45
Q

Liraglutide CI

A

Hypersenstivity
preg
known FMH medullary thyroid cancer or MEN syndrome

46
Q

Liraglutide ADE

A

N,D,V,C, injectable site, HA,

bunch of other shit

47
Q

Semaglutide indication

A

adult with BMI > 30 or 27 + 1 weight related comorbid

48
Q

D/x semaglutide if

A

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

49
Q

Semaglutide Dosing

A 
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

50
Q

Semaglutide ADE

A

essentially same as Liraglutide

51
Q

Adjustable Gastric banding info

A

Advantage:
reversible + adjustable
Lowest rates of early post complication + mortality

Disadvantage:
highest rate of reop
req stric adherence to diet + followups

52
Q

Sleeve Gastrectomy info

A

Advantage:
Rapid + sig weight loss
favorable changes in hormones

Disadvantage:
Non-reversible
potential long-term Vit deficiencies

53
Q

Gastric Bypass info

A

Advantage:
sig long term weight loss
favorable changes in hormones

Disadvantage:
complex compared to others
req longterm adherence to dietary recommendations

54
Q

indications for surgery In obesity

A

BMI > 35 w/ comorbidity

BMI > 40 without comorbidity

CDM 2 Exam 3 (13 decks)

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