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Pharmacist Provided Care I > Obesity > Flashcards

Obesity Flashcards

1
Q

What is the only FDA approved OTC medication for obesity? (brand/generic)

A

Alli (orlistat)

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2
Q

What class is Alli in?

A

Lipase inhibitor that decreases absorption of dietary fats

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3
Q

What is Alli indicated for?

A

Obesity management

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4
Q

What strengths and dosage forms is Alli available in? (OTC and Rx)

A

OTC: 60 mg capsule
Rx: 120 mg capsule

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5
Q

How is Alli dosed?

A

60 mg TID with each fat containing meal (180 mg MAX dose)

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6
Q

What warnings and contraindications does Alli have?

A
  • pregnancy
  • cholestasis
  • chronic malabsorption syndrome
  • hepatoxicity
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7
Q

What pregnancy class is Alli?

A

X

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8
Q

What interactions does Alli have?

A
  • take a multivitamin at bed time
  • caution with levothyroxine and warfarin
  • avoid use with cyclosporine
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9
Q

What common side effects does Alli have?

A
  • headache
  • abdominal pain/discomfort
  • flatus with discharge
  • fecal urgency
  • fatty/oily stool
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10
Q

What other information is there about Alli?

A
  • use with a low calorie and low fat diet

* for patients with BMI higher than 25 (stop when BMI is lower than 25)

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11
Q

An underweight person has a BMI of what?

A

less than 18.5 kg/m^2

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12
Q

A normal weight person has a BMI of what?

A

18.5 to 24.9 kg/m^2

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13
Q

An overweight person has a BMI of what?

A

25 to 29.9 kg/m^2

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14
Q

An obese person has a BMI of what?

A

greater than 30 kg/m^2

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15
Q

What is BMI based on? What age range can it be used for?

A
  • based on height and weight

* for adults over 20 years of age

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16
Q

What does BMI not take into account?

A
  • muscle mass

* fat

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17
Q

What are 5 symptoms of Metabolic syndrome? How many do you have to have to be diagnosed?

A
  • central obesity
  • high blood pressure
  • high triglycerides
  • low HDL cholesterol
  • insulin resistance

Have to have 3 to be diagnosed with Metabolic Syndrome (Syndrome X)

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18
Q

Describe in detail the symptoms of Metabolic syndrome.

A
  • waist circumference: greater than 40 in men, greater than 35 in women
  • TG greater than 150 mg/dL
  • HDL less than 40 in men or greater than 50 in women
  • BP greater than 130/85
  • fasting BG greater than 100
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19
Q

What environmental factors can contribute to Metabolic syndrome?

A
  • increased portion size
  • increased caloric intake
  • decreased physical activity
  • decreased sleep duration
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20
Q

What are some types of medication that can cause weight gain?

A
  • atypical antipsychotics
  • antidepressants (TCA, MAOI)
  • contraceptives
  • systemic steroids
  • anticonvulsants
  • insulin
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21
Q

When is a patient excluded from self care for obesity?

A
  • severely obese (BMI greater than 40)
  • pregnant or breast feeding
  • less than 18 or more than 65 years old
  • cardiovascular disease
  • dyslipidemia
  • DM
  • hypertension
  • eating disorder
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22
Q

What are some non-pharmacologic therapies for weight loss?

A
  • dietary changes
  • use of food additives
  • commercial weight loss programs
  • meal replacement therapy
  • physical activity
  • behavioral therapy
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23
Q

What is a good weight loss goal for most overweight patients?

A

10% loss over 6 months

24
Q

What is the most common method for weight loss? Describe it. Is it successful?

A

*Dietary changes
*caloric restriction
*changes in proportions of fat, protein, and carbs
*use of sugar and fat substitutes
*changing timing and frequency of meals
*SHORT TERM success
(Most success seen in patients who combine low fat, low calorie diet with exercise (usually walking))

25
Q

When a person is restricting their calories, what are the recommendations for caloric intake for men and women?

A

men: 2200 to 3000 kcal/day
women: 1800 to 2800 kcal/day

26
Q

Diets that aim for weight loss should subtract how many calories from their current intake?

A

500 kcal/day

27
Q

How is a low calorie diet defined? What is the typical weight loss of a low calorie diet?

A
  • LCD: 1200 to 1800 kcal/day

* typical weight loss is 1 to 2 lbs/week

28
Q

How is a very low calorie diet defined? What is the typical weight loss of a very low calorie diet?

A
  • VLCD: less than 800 kcal/day

* 2x weight loss versus a LCD (long term is no better)

29
Q

What type of diet needs medical supervision?

A

Very low calorie diet

30
Q

When should you recommend a multivitamin to a person dieting?

A

To people consuming less than 1200 kcal/day

31
Q

How is altered proportions described?

A

As getting less than 35% of total calories from fat (less than 10% from saturated fats)

32
Q

Is low fat dieting enough for weight loss?

A
  • no it is inadequate

* it will lower LDL though

33
Q

What results from a low carbohydrate diet?

A
  • lowers triglycerides

* increases HDL

34
Q

What type of diet is Atkins, Zone, and Paleo?

A
  • low carb
  • high fat
  • high protein
35
Q

What results from low carb, high fat, and high protein diets?

A
  • These are ketogenic diets that can cause ketosis

* Need to measure ketones in urine with ketostix

36
Q

What is ketosis?

A
  • it is NOT ketoacidosis

* it is when you burn fat for energy

37
Q

What are different types of food additives?

A
  • artificial sweeteners

* fat substitutes

38
Q

What are some examples of artificial sweeteners?

A
  • saccharin (sweet n low)
  • aspartame (equal, sutra sweet)
  • sucralose (splenda)
39
Q

What are some examples of fat substitutes?

A
  • microparticulated protein (simplesse)
  • solufiber (oatrim)
  • sucrose polyester (olean)
40
Q

Describe meal replacement therapy.

A
  • replace 2 meals in combination with a reasonable 3rd meal
  • liquid drink, snack bar, or frozen meal
  • key benefit is portion control
  • normally 200 to 300 kcal/serving and low fat
41
Q

Who is more likely to use commercial weight loss programs?

A

Women

42
Q

What is the major drawback of commercial weight loss programs?

A

Expense

43
Q

What is the major benefit of commercial weight loss programs?

A

Social support and online resources

44
Q

What are two popular commercial weight loss programs?

A
  • Weight Watchers

* Jenny Craig

45
Q

What is physical activity important for?

A
  • initiating weight loss

* keeping the weight off

46
Q

Before starting exercise, what should men and women do?

A

Men over 40 and women over 50 should have a medical evaluation before starting an exercise program

47
Q

What is a good exercise to start with?

A

Walking

48
Q

What is the recommendation for adults for physical activity?

A
  • 150 minutes of moderate activity weekly
  • 75 minutes of vigorous activity weekly in greater than 10 minutes intervals
  • muscle strengthening 2x/week
49
Q

What is the recommendation for children and adolescents for physical activity?

A
  • greater than 60 minutes per day of moderate activity including vigorous activity at least 3 days/week
  • muscle strengthening 3x per week
50
Q

What are common techniques of behavioral therapy?

A
  • group or individual
  • 1 to 2 times per month
  • environmental modification
  • modifying thinking patterns
  • set reasonable goals
  • plan for obstacles
  • self efficacy (staying positive)
  • social support
51
Q

What does the FDA recommend for patients with BMI greater than 30 (men) and 27 (women)?

A

Those with concomitant diseases or risk factors should have pharmacologic therapy, better diet, and physical activity.

52
Q

What medications are FDA approved for weight loss?

A
  • Alli

* There are many herbal products on the market with mixed efficacy that are not FDA approved

53
Q

Allí decreases absorption of fat soluble vitamins. What vitamins are fat soluble?

A
  • A
  • D
  • E
  • K
54
Q

What should dieters be cautious of? Why?

A
  • Be cautious of reformulated weight los products and proprietary blends.
  • Because none have sufficient scientific evidence to support their usefulness in weight loss and can cause potentially serious adverse effects and drug interactions
55
Q

Summarize what recommendations we should make for weight loss to patients.

A
  • realistic, small changes for better long term adherence
  • recommend multivitamin and multi mineral preparation if consuming less than 1200 kcal/day
  • counsel about side effects of Alli
  • dietary supplements have no clear effectiveness and many are unsafe

Pharmacist Provided Care I (8 decks)

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