Met 2: Obesity Treatments

Question 1

What is the BMI cutoff for recommending lifestyle changes?

Answer 1

Lifestyle changes if

• BMI over 25, with a comorbidity
• or, BMI over 27 (without comorbidity)

Question 2

What is the BMI cutoff for recommending pharmacotherapy?

Answer 2

Pharmacotherapy if

• BMI over 27, with a comorbidity
• or, BMI over 30 (without comorbidity)

Question 3

What is the BMI cutoff for recommending weight loss surgery?

Answer 3

Weight loss surgery recommended if

• BMI over 35, with a comorbidity
• or, BMI over 40 (without comorbidity)

Question 4

Obesity meds cause ____% weight loss

Do they need to be used chronically?

Answer 4

Obesity meds cause 5-12% weight loss

They need to be used chronically

Question 5

Phentermine MOA

Answer 5

• Increases NE content in brain
• Chemically related to amphetamine (but NOT addictive)

Question 6

What is the advantage of phentermine?

Answer 6

It’s CHEAPEST

Question 7

Phentermine ADR (3)

Answer 7

HTN, Headache, anxiety

(expected effects of a sympamimetic agent)

Question 8

MOA for Orlistat

Answer 8

Pancreatic lipase inhibitor

(inhibits fat absorption)

Question 9

Orlistat ADR (2)

Answer 9

Oily stools

urgency

Question 10

Which weight loss medication is the safest?

Answer 10

Orlistat

Question 11

Orlistat interacts with which two drugs?

Answer 11

Coumadin

Cyclosporin

Question 12

Lorcaserin MOA

Answer 12

Serotonin 2C agonist

Question 13

Which weight loss medicine has fewest side effects?

Answer 13

Lorcaserin

(only minimal headache, dizzy)

Question 14

Phentermine/Topiramate ADR (4)

Answer 14

• Dry mouth
• Parasthesia
• Anxiety, irritability, insomnia
• Decreased attention

Question 15

Which weight loss drug is teratogenic?

Answer 15

Phentermine/Topiramate

Question 16

Which weight loss drug also reduces BP/glucose/insulin/TG’s and raises HDL?

Answer 16

Phentermine/topiramate

Question 17

What is the most effective weight loss medication?

Answer 17

Phentermine/Topiramate

Question 18

Naltrexone/Bupropion MOA

Answer 18

• Bupropion stimulates hypothalamus to reduce food intake
• Naltrexone blocks u opiod receptors, affecting reward pathways

Question 19

Naltrexone/Bupropion is ________ in both effectiveness and side effects

Answer 19

Naltrexone/Bupropion is intermediate in both effectiveness and side effects

Question 20

What are the two worrisome ADR’s with Naltrexone/Bupropion?

Answer 20

Seizures (think bupropion)

Suicidal ideation

Question 21

Liraglutide MOA

Answer 21

GLP-1 agonist

Question 22

ADR of liraglutide (1)

Answer 22

nausea

Question 23

Liraglutide is super expensive. What is one reason to prescribe it as a weight loss med?

Answer 23

It also reduces progression to diabetes and may be protective against CVD

Question 24

Compare the efficacy of lap band, sleeve gastrectomy, and gastric bypass surgery

Answer 24

• Lap band is least effective
• Sleeve gastrectomy is moderately effective
• Gastric bypass is most effective

Question 25

Compare the risk associated with lap band, sleeve gastrectomy, and gastric bypass surgery

Answer 25

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

Question 26

How do weight loss surgeries cause weight loss?

Answer 26

Decreased ghrelin release (you feel less hungry)

*It’s a neurohormonal treatment

Question 27

How does weight loss surgery affect diabetes?

Answer 27

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

Question 28

Name 4 risks of weight loss surgery besides death

Answer 28

Failure to produce weight loss

Pulmonary Embolus

Sepsis (due to leakage from surgical anastamose)

Vitamin Deficiency

Question 29

What vitamin deficiency are weight-loss surgery patient susceptible early on (1) and later on (3)?

Answer 29

Early: Thiamin

Late: B12, Iron, Calcium