Obesity Flashcards
Most effective treatment for obesity
Bariatric surgery
Benefits of bariatric surgery
Weightloss maintained for up to 15 years
Imprvement of complication (DM2, HTN, dyslipidema & sleep apneal)
3 Requirements for antiobesity medications
decrease weight ≥ 5% in 12 months.
OR
35% of participants must lose > 5% (if double the
placebo and has achieved statistical significance).
Improve comorbidites
Weightloss from fat with low side effects
Name 5 FDA approved anti-obesity drugs
Alli and Xenical Qsymia Belviq Contrave Saxenda
OB gene codes for
Leptin
Leptin Role Expressed by? Link to obesity Short or long term signal Acts at
Supresses appetie & stimulates metabolis, dipose tissue Obese are insulin resistant Long term signal Pituatry
Name 4 short acting hormones hat reduce food intake prduced by GI tract/stomact
Regulated by
Act at
Peptide tyrosinetyrosine [PYY] glucagon-like peptide 1 [GLP-1] oxyntomodulin [OXM], cholecystokinin [CCK]
Sympathetic/parasympathetic
Hyothalamus
Name 1 short acting appetite stimulating hormone produced by GI system
Ghrenlin
Name 3 appetie ihibition hormone produced by the pancrease
These act
pancreatic polypeptide [PP]
amylin
Insulin
Thalamus & hypothalamus
Requirements for anti-obesity medications
Have a BMI ≥ 30 kg/m2 Have a BMI ≥ 27 kg/m2 and at least 1 concomitant obesity-related risk factor or disease: Type 2 diabetes, heart disease, atherosclerosis, sleep apnea, excessive waist circumference, dyslipidemia,
Antiobesity medications should always be given with
Lifestyle changes (diet, exercise, counseling about realist changes in weight)
When do you discontinue obesity medications
After weight gain because effectiveness of therapy decreases over time
What is the best reponse and over how many months
0-15% total body weight lost over 12
months
Most effective drug
Qysmia
Orlistat (Xenical OR Alli) Mechanism Benefits SE Why are there few SE SE dependent on Amount of weight loss Must be supplemented with
Mechanism
- Inhibits gastric & pancreatic lipase
Benefits
- Reduce LDL & total cholesterol
- Reduce CV risk
SE
- Steatorrhea, fecal incontinence & frequent/urgent bowel movements
SE dependent on
- fat intake
Few SE
- Not absorbed
Amount of W loss
- 9-10 Kg
Supplemented with
- ADEK
Phentermine (Adipex-p)
Mechanism
Benefits
SE
Mechanism
- Amphetamines
- Appetite suppression by reducing neuropeptide Y and increase lepton
- Release of dopamine & NE
- Reuptake inhibition of catechoolmine by suprssion MAO
Benefits
- Monotherapy for 12 weeks
SE - Elevated HR, BP, headace, dry mouth, insomnia, constiation, restlessness Why are there few SE SE dependent on Amount of weight loss Must be supplemented with
(Qsymia, formerly Qnexa)
Contains
Mechanism
Dosing
SE
Contains
- Phentermine + Extended release topiramate
Mechanism
- Topiramate (blocks voltage dependent Na, GABA activity, antagonizes glutamate & carbon anhydrase enzymes)
Dosing
- Low, middle & full strength, start low and then increase if there in no weight loss in 2 weeks
SE
- Pregancy catogory X (1st triester)
Lorcaserin (Belviq) Mechanism SE 5HT-2A receptor cause 5HT-2B receptor cause
Mechanism
- 5HT-2C serotonin receptor
SE
Headache
No impressive weightloss
5HT-2A: hallucinations
5HT-2B: Valvulopathy
Contrave
Contains
Contains
- Bupropion + Naltrexone
Mechanism
- Reduces the pleasure of food
Liraglutide (Saxenda)
Mechanisms (5)
SE/BB warning
Dosing
Cost
Mechanism
- GLP-1 agonist (glucagon like peptide) which prevents the breakdown of peptidase DPP-IV
- Improves action of insulin
- Delays gastric emptying
- CNS mediated appetite
- Reduction in liver fat content
SE
- Nausea & diarrhea but decreases with ongoing use
- BBW throud C cell tumor
- Very expensive
- !injectiom
Only obesity drug covered by medicaid
Liraglutide > Orlistat > Belviq
Why is the lower dose of OTC orlistat not avaible OT
DUE TO TAMPERING CONCERN ALLI NOT CURRENTLY
AVAILABLE
Drug that can be used as monotherapy and for how long
Phentermine
12 weeks
Empatic
Contains
uproprion & zonisamide (anticonvulsant)
