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PHRM 852 > Obesity > Flashcards

Obesity Flashcards

1
Q

what % of adults in US are overweight

A

31.1%

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2
Q

what % of adults in US are obese

A

42.5%

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3
Q

what % of adults in US are severely obese

A

9%

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4
Q

what is the mortality of obesity in US

A

300,000 deaths/year

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5
Q

extra weight decreases:

A
  1. qol
  2. energy and vitality
  3. mental outlook and happiness
  4. work performance
  5. sleep time and quality
  6. proper breathing
  7. fertility
  8. asthma control
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6
Q

extra weight increases:

A
  1. aging process
  2. premature death
  3. BP, cholesterol, blood glucose
  4. risk of MI and stroke
  5. insulin resistance
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7
Q

what BMI is considered underweight

A

18.5 or less

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8
Q

what BMI is considered normal weight

A

18.6 to 24.9

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9
Q

what BMI is considered overweight

A

25 to 29.9

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10
Q

what BMI is considered obese

A

30 and above

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11
Q

what is ideal waist measurement for men

A

<40 in

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12
Q

what is ideal waist measurement for women

A

<35 in

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13
Q

what type of body fat is most harmful

A

visceral fat

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14
Q

what is excess fat in abdomen linked to

A

htn, dm, early heart disease, certain cancers

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15
Q

what does code E66.9 mean

A

obesity, unspecified

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16
Q

what does code E66.01 mean

A

morbid obesity due to excess calories

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17
Q

what does code E66.09 mean

A

other obesity due to excess calories

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18
Q

what does code E66.1 mean

A

drug induced obesity

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19
Q

what does code E66.8 mean

A

other obesity

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20
Q

what is adipocytokines

A

pro-inflammatory and anti-inflammatory factors secreted by adipocytes

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21
Q

what is silent inflammation associated with

A

excessive visceral fat

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22
Q

what is cck peripheral effect on food intake

A

decrease

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23
Q

what is ghrelin peripheral effect on food intake

A

increase

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24
Q

what is pp peripheral effect on food intake

A

decrease

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25
Q

what is pyy peripheral effect on food intake

A

decrease

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26
Q

what is glp-1 peripheral effect on food intake

A

decrease

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27
Q

what is oxm peripheral effect on food intake

A

decrease

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28
Q

what is obesity’s #1 contributing behavioral factor

A

genetics

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29
Q

what are other obesity contributing factors

A

no breakfast
high glycemic index carbs
refined/added sugars

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30
Q

what are the basic principles of weight loss

A

nutrition, movement, behavioral therapy

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31
Q

how many calories/gram are in protein

A

4

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32
Q

how many calories/gram are in fat

A

9

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33
Q

how many calories/gram are in carbs

A

4

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34
Q

what does glycemic index measure

A

measure of how quickly blood sugar levels rise after eating a particular type of food

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35
Q

what is glucose’s glycemic index

A

100

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36
Q

what is empty calories

A

calories from solid fats and/or added sugars

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37
Q

what is solid fats

A

fats that are solid from room temperature

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38
Q

what is added sugars

A

sugars and syrups that are added when foods or beverages are processed or prepared

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39
Q

what is physical activity goal

A

be gradually increased to a goal of 30min/day of moderate intensity activity

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40
Q

what are healthy benefits of regular physical activity

A

reduces body fat and increases muscle
lowers bp
lowers blood glucose
lowers ldl, hdl

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41
Q

what % of adults do not meet the guidelines for both aerobic and muscle strengthening activities

A

80%

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42
Q

what % of adolescents do not meet the aerobic physical activity to meet guidelines

A

80%

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43
Q

what is OARS motivational interviewing

A

open ended questions, affirmations, reflections, summaries

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44
Q

what is the indication for med therapy

A

BMI >=30 or >=27 with other risk factors like htn, dm, dyslipidemia AND did not lose weight or maintain weight loss with lifestyle intervention

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45
Q

what cns stimulants are available for weight loss

A

phentermine, phendimetrazine, benphetamine, diethylpropion

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46
Q

what lipase inhibitor are available for weight loss

A

orlistat

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47
Q

what sympathomimetic and anticonvulsant are available for weight loss

A

phentermine and topiramate

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48
Q

what opioid antagonist and dopamine/norepinephrine reuptake inhibitor are available for weight loss

A

naltrexone and bupropion extended release

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49
Q

what glp-1 agonist are available for weight loss

A

liraglutide, semaglutide

50
Q

how much does gastric bypass procedure reduce gastric volume

A

15-30 ml

51
Q

what does gastric bypass procedure do

A

restricts food intake and some nutrient malabsorption

52
Q

how much of the stomach does sleeve gastrectomy remove

A

80-85% of stomach

53
Q

what does sleeve gastrectomy do

A

reduces gastric volume to tube or banana shaped pouch

54
Q

is sleeve gastrectomy irreversible

A

yes

55
Q

what drugs should be switched to immediate release after weight reduction surgery

A

enteric coated and sustained release formulations

56
Q

what are theoretically less prone to alterations in drug absoprtion compared to bypass surgery

A

restrictive procedures

57
Q

what is a risk with certain weight loss drugs after weight loss surgery

A

increased risk of ulcerations

58
Q

what may cause reduced absorption of drugs after weight loss surgery

A

an acidic environment for dissolution

59
Q

what percentage of pts successfully maintain their weight loss for 1-5 years

A

20%

60
Q

what are the phases of weight changes

A
  1. active weight loss
  2. transition
  3. weight maintenance
61
Q

what is pharmacist’s role in transition phase

A

congratulate, celebrate, plan

62
Q

what is national weight control registry (NWCR)

A

began in 1994.
participants had to have >= 30 lbs lost and kept it off for >= 1 yr and average of 66 lbs lost and kept it off for 5.5 yrs

63
Q

what macronutrients results in the greatest rise in insulin levels

A

carbs

64
Q

what is the stepwise energy balance involving leptin

A

leptin -> long term -> decreased food intake -> weight loss

65
Q

what is the stepwise energy balance involving ghrelin

A

ghrelin -> short term -> increased food intake -> weight gain

66
Q

what is involved in the yoyo effect

A

emotional conflict -> action -> weight loss -> less conflict -> less action -> weight gain

67
Q

what is a trigger event

A

an event that creates the desire to lose weight

68
Q

what % of pts recall a trigger event

A

83%

69
Q

what does medical triggers result in

A

more significant weight loss and better maintenance

70
Q

what is structural tension

A

the difference between where we are and where we want to be

71
Q

what is fundamental choice

A

defines our state of being (i.e. i choose to have optimal health)

72
Q

what is primary choices

A

defines our health goals (i.e. i will maintain a healthy weight)

73
Q

what is secondary choices

A

the day to day actions we take to achieve our primary choices (i.e. i will go to the pool 3 days/week)

74
Q

factors associated w/ weight gain

A

dietary disinhibition, decrease in physical activity, depression

75
Q

what is the BE-SLIM predictor of success

A

B - breakfast
E - exercise
S - support
L - low fat meals q3h
I - individual plan
M - monitor progress

76
Q

what are other predictors of weight loss success

A

consistent eating pattern, maintain high level of physical activity, minimization of dietary disinhibition, time of maintenance

77
Q

what does low fat, low calorie diet do for weight loss

A

reducing dietary fat intake promotes weight loss and maintenance

78
Q

what may augment the effects of a low fat, low calorie diet

A

high protein/low carb diets may augment this effect due to food thermogenesis and decreased circulating insulin levels

79
Q

what is thermogenesis

A

the energy expended to absorb, process, and store nutrients

80
Q

what is the goal of low fat, low calorie diet

A

maintain fat free mass, organs, muscle, bone, connective tissue, and preserve BMR and RMR

81
Q

what is the mediterranean diet linked to

A

decreased risk of death from cancer and heart disease, reduced incidence of alzheimer’s and parkinson’s

82
Q

what does the mediterranean diet emphasize

A

plant based foods, whole grains, replace butter with healthy fats, more fish and less red meat

83
Q

what does consistency and longevity lead to

A

participants that kept their weight off for at least 2 years had more than a 50% chance of not gaining it back

84
Q

what should physical activity focus on

A

development of lean muscle tissue - slow, controlled movements

85
Q

what is the target fiber goal

A

25-50 g/day

86
Q

how much fiber does an average american eat

A

16 g/day

87
Q

what does dietary fibers do

A

decrease LDL, blood glucose spikes, risk of colon cancer.
stimulates bowel movements.
increases satiety.

88
Q

who are candidates for weight loss pharmacotherapy

A

BMI >= 30 kg/m2 OR BMI >= 27 kg/m2 with other risk factors AND did not lose weight OR maintain weight loss with comprehensive lifestyle intervention (<5% loss in 3-6 months)

89
Q

what are the goals of weight loss pharmacotherapy

A
  1. reduction of body weight (initially: 5-10% of initial weight over 6 months)
  2. maintain body weight
  3. prevent weight gain
  4. improve obesity related conditions
90
Q

what is the stepwise process for initiating weight loss meds

A

initiate pharmacotherapy, initial f/up q1m for first 3 months of therapy, 3 month post initial f/up: q3m

91
Q

cns stimulants indication

A

adjunct to exercise, behavioral modification, and caloric restriction in the short term management of exogenous obesity

92
Q

cns stimulants moa

A

increase conc. of norepinephrine to stimulate receptors in the hypothalamus, resulting in appetite suppression

93
Q

cns stimulants SEs

A

palpitation, tachycardia, increased BP, overstimulation, restlessness, insomnia, tremor, dizziness, HA, dysphoria, dryness of mouth, euphoria

94
Q

orlistat (xenical and alli) moa

A
  1. reversibly inhibits gastric and pancreatic lipases, which are integral in absorption of long chain TGs
  2. decreases absorption of dietary fats by approx. 30%
  3. minimally absorbed and does not work systemically
95
Q

how to obtain orlistat (xenical)

A

by prescription

96
Q

orlistat (xenical) dosing

A

120mg orally three times daily, taken within 1 hour of eating fat containing meal

97
Q

who is orlistat (xenical) approved for

A

pts aged >= 12 yo

98
Q

how to get orlistat (alli)

A

OTC

99
Q

orlistat (alli) dosing

A

60mg orally three times daily, taken within 1 hour of eating a fat containing meal.
max OTC daily dose = 180mg.

100
Q

who is orlistat (alli) approved for

A

pts aged >= 18yo

101
Q

orlistat average weight loss

A

2.9 to 3.5 kg (6.5 to 7.5 lbs) after 1 year

102
Q

orlistat special considerations

A
  1. suggested for pts with CV disease
  2. a standard daily multivitamin supplement should be recommended for pts taking orlistat
103
Q

orlistat common AEs

A

GI, decreased absorption of fat soluble vitamins from diet

104
Q

orlistat CI

A

pregnancy, chronic malabsorption syndrome, cholestasis

105
Q

orlistat precautions/warnings

A

heptatotoxicity

106
Q

phentermine/topiramate ER moa

A

phentermine is a sympathomimetic amine -> stimulates the hypothalamus to release Ne, which stimulates satiety center, decreasing appetite
topiramate is an anticonvulsant -> blocks neuronal voltage dependent sodium channels, enhances GABA activity, and weakly inhibits carbonic anhydrase which is thought to cause appetite suppression and satiety enhancement

107
Q

phentermine/topiramate ER dosing

A
108
Q

phentermine/topiramate ER renal impairment dosing

A

CrCl <30ml/min: do not exceed 7.5/46 mg once daily.
If on dialysis, it is not recommended.

109
Q

phentermine/topiramate ER hepatic impairment dosing

A

Moderate impairment -> do not exceed 7.5/46 mg orally once daily.
Severe impairment -> not recommended.

110
Q

phentermine/topiramate ER pearls

A

Take in the morning to prevent insomnia.
Gradually decrease dose by taking every other day for at least one week prior to d/c.

111
Q

phentermine/topiramate ER average weight loss

A

6.6 to 8.6 kg (14.5 to 18.9 lb) after 1 year

112
Q

phentermine/topiramate ER common AEs

A

constipation, dry mouth, tachycardia, paresthesia, dysgeusia, dizziness, insomnia

113
Q

naltrexone/bupropion ER moa

A

Naltrexone - pure opioid antagonist; component may decrease food cravings.
Bupropion - weakly inhibits neuronal reuptake of dopamine and Ne; component may suppress appetite.

114
Q

naltrexone/bupropion ER dosing

A
115
Q

naltrexone/bupropion ER renal impairment dosing

A

Mild impairment - use with caution.
Moderate/severe impairment - do not exceed 1 tablet twice daily.
Dialysis - not recommended.

116
Q

naltrexone/bupropion ER hepatic impairment dosing

A

Do not exceed 1 tablet daily

117
Q

naltrexone/bupropion ER pears

A

Should not be taken with high fat meal.
Tablets should not be crushed, cut, or chewed.
Can cause increased BP.

118
Q

naltrexone/bupropion ER average weight loss

A

2.2 to 4.1 kg (4.9-9 lb)

119
Q

naltrexone/bupropion ER common AEs

A

HA, NVCD, htn, dizziness, insomnia, depression, anxiety

120
Q

naltrexone/bupropion ER black box warning

A

suicidal ideations

121
Q

naltrexone/bupropion ER CIs

A

pregnancy
major depressive disorder
uncontrolled htn

PHRM 852 (10 decks)

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