Met 2: Obesity Treatments Flashcards
What is the BMI cutoff for recommending lifestyle changes?
Lifestyle changes if
- BMI over 25, with a comorbidity
- or, BMI over 27 (without comorbidity)
What is the BMI cutoff for recommending pharmacotherapy?
Pharmacotherapy if
- BMI over 27, with a comorbidity
- or, BMI over 30 (without comorbidity)
What is the BMI cutoff for recommending weight loss surgery?
Weight loss surgery recommended if
- BMI over 35, with a comorbidity
- or, BMI over 40 (without comorbidity)
Obesity meds cause ____% weight loss
Do they need to be used chronically?
Obesity meds cause 5-12% weight loss
They need to be used chronically
Phentermine MOA
- Increases NE content in brain
- Chemically related to amphetamine (but NOT addictive)
What is the advantage of phentermine?
It’s CHEAPEST
Phentermine ADR (3)
HTN, Headache, anxiety
(expected effects of a sympamimetic agent)
MOA for Orlistat
Pancreatic lipase inhibitor
(inhibits fat absorption)
Orlistat ADR (2)
Oily stools
urgency
Which weight loss medication is the safest?
Orlistat
Orlistat interacts with which two drugs?
Coumadin
Cyclosporin
Lorcaserin MOA
Serotonin 2C agonist
Which weight loss medicine has fewest side effects?
Lorcaserin
(only minimal headache, dizzy)
Phentermine/Topiramate ADR (4)
- Dry mouth
- Parasthesia
- Anxiety, irritability, insomnia
- Decreased attention
Which weight loss drug is teratogenic?
Phentermine/Topiramate
Which weight loss drug also reduces BP/glucose/insulin/TG’s and raises HDL?
Phentermine/topiramate
What is the most effective weight loss medication?
Phentermine/Topiramate
Naltrexone/Bupropion MOA
- Bupropion stimulates hypothalamus to reduce food intake
- Naltrexone blocks u opiod receptors, affecting reward pathways
Naltrexone/Bupropion is ________ in both effectiveness and side effects
Naltrexone/Bupropion is intermediate in both effectiveness and side effects
What are the two worrisome ADR’s with Naltrexone/Bupropion?
Seizures (think bupropion)
Suicidal ideation
Liraglutide MOA
GLP-1 agonist
ADR of liraglutide (1)
nausea
Liraglutide is super expensive. What is one reason to prescribe it as a weight loss med?
It also reduces progression to diabetes and may be protective against CVD
Compare the efficacy of lap band, sleeve gastrectomy, and gastric bypass surgery
- Lap band is least effective
- Sleeve gastrectomy is moderately effective
- Gastric bypass is most effective
Compare the risk associated with lap band, sleeve gastrectomy, and gastric bypass surgery
Lap band is least risk
Sleeve gastrectomy is moderately risky
Gastric bypass is most risky
*Overall, weight loss surgery is still incredibly low risk as far as surgeries go
How do weight loss surgeries cause weight loss?
Decreased ghrelin release (you feel less hungry)
*It’s a neurohormonal treatment
How does weight loss surgery affect diabetes?
Surgical treatment is most effective way to treat T2D
Compared to medical therapy, surgical patients had lower HbA1C without medication and needed fewer meds to control their sugars
Name 4 risks of weight loss surgery besides death
Failure to produce weight loss
Pulmonary Embolus
Sepsis (due to leakage from surgical anastamose)
Vitamin Deficiency
What vitamin deficiency are weight-loss surgery patient susceptible early on (1) and later on (3)?
Early: Thiamin
Late: B12, Iron, Calcium
