obesity Flashcards
obese waist circumference for M and F
M: >40 in
F >35 in
normal BMI range
18.5-24.9
obese 1 BMI
30-34.9
indication for bariatric surgery w/o comorbities
BMI>40
co moribities that allow for bariatric surgery for BMI 30-34.9
uncontrollable T2DM, metabolic syndrome
how to avoid dumping syndrome post -gastric bypass
avoid simple carbs
indications for pharm treatment of obesity
> 3-6 months of behavior therapy, dietary chagnes, and increased activity AND BMI>30 or >27 w/ other risk factors
Phentermine (Adipex-P), Diethylpropion (Tenuate), Phentermine/Topiramate ER (Qsymia)
Sympathomimetics
Orlistat (Xenical-Rx) or (Alli-OTC)
Gastrointestinal lipase inhibitor
Bupropion/naltrexone (Contrave)
Combination of antidepressant + opioid antagonist
Liraglutide (Saxenda), semaglutide (Trulicity)
Glucagon-like peptide-1 (GLP-1) agonist
Adverse effects:
Cardiovascular: HTN, pulmonary hypertension, tachycardia
CNS: psychosis, seizures, tremor euphoria, drug dependency and addiction
Sympathomimetics
Sympathomimetics contraindications
Avoid in patients w/ history of drug abuse
Pulmonary hypertension, severe atherosclerosis, uncontrolled HTN, glaucoma, hyperthyroidism,pregnancy, breast feeding, CAD, stroke,CHF
Use of an MAOI in the last 14 days
Drug Interactions:Avoid use with SSRIs or TCAs as risk of serotonin syndrome could occur
Sympathomimetics
Pt counseling for Sympathomimetics
monitor HR and BP several times / wk at different times
Sympathomimetics increase what catacholamine
NE
Pt counseling for phentermine/topiramate (Qsymia)
cousnel F on risk of birth defects (oral clefts if during 1st trimester)
SE: dry mouth, altered taste, paresthesia, constipation,dizziness, sedation
topamax
dose considerations w/ topamax
Titrate OFF Qsymia or Topamax gradually as withdrawal from topiramate can cause seizure
MOA: Pancreatic and gastric lipase inhibitor; inhibits triglyceride hydrolysis; blocks the absorption of ingested fat
Orlistat (Xenical Rx) and (Alli OTC)
Pt counseling for orlistat
Must take within 1 hour of consuming high fat meal. low fat diet. supplement w/ fat soluble vitamins. back up BC if diarrhea
orlistat can improve which biomarkers
decrease LDL and improve glucose control
SE: Flatulence w/ discharge, oily or loose stool, fecal urgency/incontinence, and steatorrhea. Reduced absorption of fat-soluble vitamins (A,D,E,K) with a potential for malnutrition; reduced absorption of oral contraceptives and other drugs. hepatoxicity
Minimized by maintaining a strict low fat diet (<30% of diet)
orlistat
Adverse effects: suicidal ideation and seizures (bupropion), Nausea!/V, headache, constipation, dizziness, ↑ BP/HR, and dry mouth
Bupropion/naltrexone (Contrave)
