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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
When a person is restricting their calories, what are the recommendations for caloric intake for men and women?
men: 2200 to 3000 kcal/day women: 1800 to 2800 kcal/day
26
Diets that aim for weight loss should subtract how many calories from their current intake?
500 kcal/day
27
How is a low calorie diet defined? What is the typical weight loss of a low calorie diet?
* LCD: 1200 to 1800 kcal/day | * typical weight loss is 1 to 2 lbs/week
28
How is a very low calorie diet defined? What is the typical weight loss of a very low calorie diet?
* VLCD: less than 800 kcal/day | * 2x weight loss versus a LCD (long term is no better)
29
What type of diet needs medical supervision?
Very low calorie diet
30
When should you recommend a multivitamin to a person dieting?
To people consuming less than 1200 kcal/day
31
How is altered proportions described?
As getting less than 35% of total calories from fat (less than 10% from saturated fats)
32
Is low fat dieting enough for weight loss?
* no it is inadequate | * it will lower LDL though
33
What results from a low carbohydrate diet?
* lowers triglycerides | * increases HDL
34
What type of diet is Atkins, Zone, and Paleo?
* low carb * high fat * high protein
35
What results from low carb, high fat, and high protein diets?
* These are ketogenic diets that can cause ketosis | * Need to measure ketones in urine with ketostix
36
What is ketosis?
* it is NOT ketoacidosis | * it is when you burn fat for energy
37
What are different types of food additives?
* artificial sweeteners | * fat substitutes
38
What are some examples of artificial sweeteners?
* saccharin (sweet n low) * aspartame (equal, sutra sweet) * sucralose (splenda)
39
What are some examples of fat substitutes?
* microparticulated protein (simplesse) * solufiber (oatrim) * sucrose polyester (olean)
40
Describe meal replacement therapy.
* 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
Who is more likely to use commercial weight loss programs?
Women
42
What is the major drawback of commercial weight loss programs?
Expense
43
What is the major benefit of commercial weight loss programs?
Social support and online resources
44
What are two popular commercial weight loss programs?
* Weight Watchers | * Jenny Craig
45
What is physical activity important for?
* initiating weight loss | * keeping the weight off
46
Before starting exercise, what should men and women do?
Men over 40 and women over 50 should have a medical evaluation before starting an exercise program
47
What is a good exercise to start with?
Walking
48
What is the recommendation for adults for physical activity?
* 150 minutes of moderate activity weekly * 75 minutes of vigorous activity weekly in greater than 10 minutes intervals * muscle strengthening 2x/week
49
What is the recommendation for children and adolescents for physical activity?
* greater than 60 minutes per day of moderate activity including vigorous activity at least 3 days/week * muscle strengthening 3x per week
50
What are common techniques of behavioral therapy?
* 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
What does the FDA recommend for patients with BMI greater than 30 (men) and 27 (women)?
Those with concomitant diseases or risk factors should have pharmacologic therapy, better diet, and physical activity.
52
What medications are FDA approved for weight loss?
* Alli | * There are many herbal products on the market with mixed efficacy that are not FDA approved
53
Allí decreases absorption of fat soluble vitamins. What vitamins are fat soluble?
* A * D * E * K
54
What should dieters be cautious of? Why?
* 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
Summarize what recommendations we should make for weight loss to patients.
* 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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