Obesity Flashcards
what is the medical definition of obesity?
A disease where there is an imbalance between the calories consumed and the energy expended with metabolic parameters and appetite regulation via gastric and the peripheral NS.
name 2 causes of overeating?
- lack of knowledge
- lack of sleep
- snacking
- peer pressure
- medications
name two causes of low energy expenditure?
- lack of motivation
- aging
- sarcopenia
- medication
- neuroendocrine factors
name two causes of low physical activities?
- joint pain
- chronic fatigue
- medications
- emotional barriers
- low fitness levels
what are the hormones involved in gut motility and digestive function and how do they work?
- ghrelin
- anorexigenic intestinal hormones
- lectin
How does ghrelin work and how is it affects obese people?
ghrelin produces gastric fundus and regulates appetite.
Normally after a meal, the hormone ghrelin is suppressed and appetite decreases but its not suppressed in obese people and they remain hungry.
how do the anorexigenic intestinal hormones work and how is it affected in obese people?
GLP1 , CCK and PPY
They are involved in insulin secretion, digestion and post-digestive metabolism.
Obese people have a delayed, reduced or attenuated activity of these hormones.
name the anorexigenic intestinal hormones?
GLP1, PPY ,CCK
How does leptin work and how is it affects obese people?
it is secreted by white adipose tissue and circulating levels correlate with fat mass.
what is an intragastric ballon ?
a balloon is endoscopically inserted and inflated in the patient’s stomach for 6 months. The aim is for the patient to lose weight and is for patients who cannot undergo anesthesia.
what is a gastric band?
it is a band inserted around the stomach which causes gastric restriction
what are 2 gastric surgery operative complications?
thromboembolism bleeding pnemonia ulcers infection stenosis
what are 2 gastric surgery long-term complications?
iron deficiency calcium and vitamin d deficiency b12 deficiency b1 deficiency gallstones
How is adsorption affected in obese people?
its unchanged
How is distribution affected in obese people?
increased body fat mass
decreased body water content
How is metabolism affected in obese people?
increase co
increased hepatic blood flow
How is excretion affected in obese people?
increased eGFR
increased renal blood flow
what changes happen to absorption post-bariatric surgery
ph changes
gt tract motility changes
reduction in gastric volume
Vd changes
What ph changes happen to post-bariatric surgery?
partitioning of the stomach results in decreased HCL being produced so pH increases.
This affects the bioavailability of pH dependant drugs.
What GI tract motility changes happen to post-bariatric surgery?
can increase and decrease
a drug needs enough time at the absorption site to be absorbed.
What Vd changes happen to post-bariatric surgery?
as a patient loses weight the volume of distribution is altered.
increased lipid content and decreased water content.
Monitor lipid-soluble drugs and beta-blockers
What changes happen due to the reduction in gastric volume to post-bariatric surgery?
The patient may develop dumping syndrome. which is cramping one hour after eating due to the rapid emptying of food into the small intestine. therefore absorptioon is affected.
what happens if GI motility is too fast?
drug moves through the GI tract too fast and doesn’t get absorbed.
what happens if GI motility is too slow?
slow drug onset, epithelium lining can be irritated and drug can be degraded.
what drugs should you avoid post-bariatric surgery?
NSAIDs, bisphosphonates and aspirin because there is already increased damage to the mucosa so may cause irritation
Effervescent formulations as they may get stuck
Enteric coating as the patient has created a malabsorptive state for food and oral drugs
what is early dumping?
Due to bariatric surgery
cramping occurs 1 hour after eating due to the rapid emptying of food in to the SI which releases Gi hormones which cause vasomotor symptoms
what is late dumping?
Due to bariatric surgery
cramping 1-3 hours after food due to carbohydrate ingestion.
This is caused by the incretin-driven hyperinsulinemic response leading to hypoglycemia.
what medicine formulations should be avoided post bariatric surgery
sugary formulations
consider liquid formulations instead of oeal
what medicine formulations should be avoided post bariatric surgery
sugary formulations
consider liquid formulations instead of solid
why do lipid-soluble drugs need to be monitored in obese people
lipophilic drugs distribute better in adipose tissue so they have a higher volume of distribution than hydrophilic drugs
do obese people have changes to protein binding to albumin
no
how does obesity affect protein binding?
it does not affect albumin protein binding
it affects the binding of R1-acid glycoprotein( AAG)
An increase in AAG binding increases the free fraction of the drug, so to avoid toxicity give lower doses.
how does renal clearance change in an obese person ?
higher renal blood flow
higher glomerular filtration rate
higher creatin serum concs
how does metabolism change in an obese person ?
higher cardiac output and liver blood flow due to an enlarged liver.
increased metabolic activity due to changes in fatty interfiltration.
Has increased glucuronidation and changes in teh antioxidant system.
