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

Lecture 4.1 - Obesity and Metabolic Syndrome Flashcards

(54 cards)

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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

Study These Flashcards
A 
Abe
anticoag
antidiabetic
anticancer
NMB
23
Q

Phentermine Clinical use

Study These Flashcards
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

Study These Flashcards
A 
MAOI
Hyperthyroidism
CVD
GLaucoma
Preg/nursing
25
Phentermine ADE
CNS: insomnia, overstim, resless, etc CV: tachycardia, HTN, palp, ischemic events GI: dry mouth, bad tase, D, C, Endocrine: impotence, change libido
26
Orlistat advise pt
take multivitamin contains fat-soluble vitamins to ensure adequate nutrition, 2hrs before or after admin orlistat
27
Orlistat CI
Preg, breastfeeding Cholestasis Chronic malabsorption syndrome Hypersensitivity
28
Orlistat ADE
most common: oil spotting, farts, fecal urgency, fatty/oily stool, oily pooping, increased poop and cant hold it
29
Orlistat warnings
dont co-admin cyclosporine negative effect co-admin w/ antiepileptics and antiretrovirals
30
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
31
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
32
When to D/c Phen/TPM
in pt who has not lost > 5% of baseline body weight on 15mg/92mg after 12 weeks
33
Phen/TPM ADE
most common: paresthesia, dizziness, dysgeusia, insomnia, constipation, dry mouth
34
Phen/TPM CI
``` Preg Glaucoma HTN MOAI Hypersensitivity to sympathomimetic drugs ```
35
Phen/TPM warning/ precaution
Embryo-fetal toxicity laundry list of other shit
36
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
37
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
38
D/x Naltrexone/bupropion if...
pt hasn't lost >5% baseline BW on max dose after 12 weeks
39
Naltrexone/bupropion ADE
N,C,HA,V,dizziness, insomnia, dry mouth, diarrhea
40
Naltrexone/bupropion CI
boat load ``` MAOI allergy Seizure Unc HTN abrupt stop of booze, bentos, etc ```
41
Naltrexone/bupropion warning
D/c w/ suicidal behavior and idea or with neuropsychological AE
42
Liraglutide 3mg indication
Chronic weight management Adult BMI > 30/27+ 1 weight related comorbid Pediatric > 12yrs old and > 60kg and BMI >30 for adults
43
Liraglutide Dosing
0.6/week for 4 weeks Week 5 onwards = 3mg/once daily any time
44
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)
45
Liraglutide CI
Hypersenstivity preg known FMH medullary thyroid cancer or MEN syndrome
46
Liraglutide ADE
N,D,V,C, injectable site, HA, bunch of other shit
47
Semaglutide indication
adult with BMI > 30 or 27 + 1 weight related comorbid
48
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
49
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
50
Semaglutide ADE
essentially same as Liraglutide
51
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
52
Sleeve Gastrectomy info
Advantage: Rapid + sig weight loss favorable changes in hormones Disadvantage: Non-reversible potential long-term Vit deficiencies
53
Gastric Bypass info
Advantage: sig long term weight loss favorable changes in hormones Disadvantage: complex compared to others req longterm adherence to dietary recommendations
54
indications for surgery In obesity
BMI > 35 w/ comorbidity BMI > 40 without comorbidity

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