Obesity

Question 1

Central body weight regulation

————of the hypothalamus, Regulates appetite, feeding behavior and energy status

Answer 1

Arcuate nucleus (ARC)

Question 2

The Arcuate Nucleus (ARC) Receives afferent inputs originating from the ———

Answer 2

GI tract

Question 3

Arcuate nucleus (ARC) Contains receptors for ——- and other hormones

Answer 3

Leptin

fxn: inhibits hunger and regulates energy balance (so that the body doesn’t trigger a hunger response when it doesn’t need energy -calories)

Question 4

In the ARC, there are two groups of functionally distinct neurons that exert opposite effects on appetite
1) ——— (appetite supressing)
2) ——– (appetite promoting)

Answer 4

1) Anorexigenic (appetite supressing)
2) Orexigenic neurons (appetite promoting)

Question 5

Anorexigenic nerurons (appetite supressing)
activate what to supress appetite?

Answer 5

1) Pro-opiomelanocortin (POMC)-derived peptides (such as αmelanocyte-stimulating hormone; α-MSH)
2) Cocaine- and amphetamine-regulated transcript (CART)-derived peptides

Question 6

Orexigenic neurons (appetite promoting), activate what to trigger hunger ?

Answer 6

1) Neuropeptide Y (NPY)
2) Agouti-related peptide (AgRP)

Question 7

Energy homeostasis depends on the balance between
the actions of —— and ——– in the Arcuate nucleus

Answer 7

Energy homeostasis depends on the balance between
the actions of Anorexigenic neurons and Orexigenic neurons in the Arcuate nucleus

Question 8

1st line tx for Obesity

Answer 8

GLP1-mimetics (Liraglutide)

Question 9

2nd line tx for Obesity

Answer 9

Orlistate (when GLP-1 mimetic are not effective/well-tolerated)

Question 10

3rd line tx for Obesity

Answer 10

Phentermine (Centrally acting drug)

Question 11

Centrally acting drugs

Answer 11

Phentermine
topiramate
Naltrexon
Bupropion

Question 12

MoA of Phentermine

Answer 12

Sympathomimetic amine
anorectic effects in hypothalamus and limbic areas of the brain
–> Increases the release of norepinephrine and dopamine (DA) -> increased POMC/CART neuron activity

        SOOO, SUPRESES APPETITE

Question 13

MoA of Topiramate

Answer 13

Anti-epileptic drug that possibly suppresses appetite and enhances satiety

Question 14

MoA of Bupropion

Answer 14

Increases DA activity in the brain –>reduction in appetite and increase in energy expenditure by increased POMC neuron activity

Question 15

MoA of Naltrexon

Answer 15

Blocks opioid receptors on POMC neurons–> preventing feedback inhibition of these neurons with
increased POMC activity

Question 16

GLP-1 mimetics used in the tx of Obesity

Answer 16

liraglutide,
semaglutide

Question 17

GLP-1 is a regulator of ——– and —–

Answer 17

GLP-1 is a regulator of appetite and calorie intake

Question 18

[TRUE/FALSE]
GLP-1 mimetics (liraglutide, semaglutide) promote weight loss in patients with or without T2D

Answer 18

TRUE

Question 19

MoA of Orlistat

Answer 19

Peripherally-acting drug
* Inhibits irreversibly gastric and pancreatic lipases
* Prevents the breakdown of dietary fat to fatty acids and glycerols
* Decreases fat absorption
* Effective in T2D
* Reduces blood pressure
* Delays gastric emptying and gastric secretion
* Does not induce changes in energy expenditure

Question 20

AE of Orlistat

Answer 20

1) Abdominal cramps,
2) flatus with discharge,
3) faecal incontinence,
4) intestinal borborygmi (rumbling),
5) oily spotting

Question 21

which drug requires Supplementary therapy with fat-soluble vitamins

Answer 21

Orlistat

Question 22

Orlistat affects the absoprtion of what drugs?

Answer 22

1) Oral contraceptives
2) Ciclosporin

Question 23

Drugs that may cause weight gain

Answer 23

1) Anti-diabetics (insulin, sulfonylureas, thiazos)
2) α-blockers
3) β-blockers
4) Steroids
5) TCAs
6) MAOIs
7) Anti-psychotics
8) SNRIs
9) Anti-convulsants (phenytoin, carbamazepine)

Question 24

drugs that may case weight loss

Answer 24

1) Anti-infective agents
2) Anti-cancer drugs
3) Salbutamol
4) Theophylline
5) Amiodarone
6) Hydralazine
7) Methylphenidate
8) Fluoxetine
9) Galantamine
10) Rivastigmine
11) Sulfasalazine
12) Topiramate
13) Metformin