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PT: Nutrition Exam 2 > Obesity > Flashcards

Obesity Flashcards

1
Q

overweight BMI

A

25 - 29.9

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2
Q

Obesity BMI

A

> 30

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3
Q

normal BMI

A

18.5 - 24.9

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4
Q

Prevalence of obesity 2015-2016

A

39.8% 93.3 million

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5
Q

Obesity is linked with increased risk of

A 
diabetes
HTN
hyperlipidemia
arthritis
breast and GI cancer
non alcoholic steatohepatitis
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6
Q

Medical costs related with obesity in 2008

A

$147 billion

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7
Q

What is the second leading cause of preventable death in US?

A

obesity

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8
Q

Metabolic syndrome

A
  • abdominal obesity
  • hyperinsulinemia
  • high fasting plasma glucose
  • impaired glucose tolerance
  • hypertriglyceridemia
  • low HDL cholesterol
  • HTN
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9
Q

CVD and metabolic syndrome

A

CVD mortality increased in metabolic syndrome

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10
Q

____% weight reduction in combo with ___ exercise daily = ____% reduction in development of diabetes vs control of diabetes prevention

A

5%
30 min
58%

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11
Q

T/F weight loss consistently demonstrates a + impact on triglycerides and HDL

A

true

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12
Q

each ___kg in weight loss reduces systolic BP _____ mmHg. roughly equal to effect _____

A

10kg
5-20mmHg
1 antihypertensive

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13
Q

T/F there is a positive correlation between weight and blood glucose

A

true

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14
Q

mainstay treatment such as ____ and ____ cause weight gain in diabetes

A

insulin

sulfonylureas

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15
Q

____ and ____ agonists are associated with weight loss

A

metformin

GLP-1

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16
Q

Secondary causes of weight gain

A
  • disease states
  • drugs
  • decreased food intake
  • increased food intake
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17
Q

What is the cornerstone of obesity management?

A

lifestyle modifications

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18
Q

T/F lifestyle modifications do not always need to be instituted when medication management becomes part of treatment plan

A

false!

Should always!!

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19
Q

Noradrenergic agents for obesity

A

amphetamines

phentermine

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20
Q

phentermine agent MOA

A

promote catecholamine release at pre-synaptic terminals: NE, DA or both

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21
Q

T/F phentermine can be used more than 6 months

A

False

approved for short term use up to 6 months

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22
Q

Max weight loss of ____% at ___ months with phentermine then usually plateau

A

5-10% at 6 months

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23
Q

T/F rapid tolerance can develop within a few weeks in phentermine

A

True

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24
Q

ADE of phentermine

A 
HA
insomnia
nervousness
tachycardia
HTN
dry mouth
diarrhea 
constipation
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25
Q

phentermine long term use ADE

A

primary pulmonary hypertension (PPH)

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26
Q

what should you monitor when on phentermine?

A

weight
BP
symptoms of PPH

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27
Q

phentermine CI

A

moderate to severe HTN
CVD
glaucoma
concomitant MOA

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28
Q

phentermine and SSRIs or other antidepressants

A

safety and efficacy unclear

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29
Q

SSRIs and obesity

A 
sertraline
fluoxetine
paroxetine
citalopram
escitalopram
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30
Q

SSRI MOA

A

inhibit CNS neuronal reuptake of serotonin

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31
Q

Sertaline and fluoxetine and obesity

A

demonstrate initial, but non-sustainable weight loss

not FDA approved for weight loss

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32
Q

Lorcaserin (Belviq)

A

serotonergic agent

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33
Q

Lorcaserin MOA

A

selective 5HT 2c receptor agonist

  • effects nearly exclusive in CNS/ hypothalamus
  • decreased caloric intake and increased satiety
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34
Q

Lorcaserin approved for

A

BMI >30

BMI >27, 1 weight related comorbidity

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35
Q

What are weight related co-morbidities?

A

T2D
HTN
hyperlipidemia

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36
Q

Lorcaserin dosing

A

10mg BID up to 1 year

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37
Q

Lorcaserin weight loss

A

5% in 40% of patients

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38
Q

When should you stop Lorcaserin?

A

when weight loss not achieved in 12 weeks

39
Q

Lorcaserin ADE CNS

A

HA, dizziness, blurred vision, somnolence, paresthesia

40
Q

Lorcaserin GI ADE

A

nausea

dry mouth

41
Q

Lorcaserin ADE CV

A

no increase risk of CV events

42
Q

Lorcaserin should not be used with what?

A

other serotonergic medications (antidepressants, triptans)

43
Q

Lorcaserin other ADE

A

hypoglycemia in diabetics

priapism

44
Q

Orlistat (Xenical) MOA

A

blocks intestinal absorption of dietary fat

lipase inhibitor

45
Q

How long can you use orlistat?

A

up to 2 years

46
Q

How should you take orlitstat?

A

only if eating fat containing meal

take during or up to 1 hour after meal

47
Q

Orlistat 360mg/day blocks ____% of dietary fat absorption

A

30%

48
Q

Orlistat weight loss

A

6-10g weight loss at 1 year

sustained in 65% of patients between 1-2 years

49
Q

Orlistat ADE

A

abdominal pain
flatulence
fecal urgency
incontinence (up to 80%)

50
Q

What increases the likelihood of ADE in orlistat?

A

high fat meal

51
Q

Orlistat decreases absorption of what?

A

fat soluble vitamins

- should take vitamin 2 hours separate

52
Q

Topiramate/phentermine (Qsymia) MOA

A

increased satiety
decreased appetite
taste aversion

53
Q

Qsymia approved for

A

BMI >30

BMI >27, obesity comorbidity

54
Q

Why is topiramate and phentermine a good combo?

A

both induce weight loss individually

combined can use smaller doses to improve side effects/tolerability

55
Q

How to dose Qsymia

A

low, mid, high dose: start low 14 days, titrate to mid dose

56
Q

When should you increase dose or discontinue Qsymia?

A

if weight loss 3% not achieved at 12 weeks

Discontinue if weight loss 5% not achieved after 12 weeks at highest dose

57
Q

Dose related weight loss on Qsymia

A

7-9% at 56 weeks

58
Q

Qsymia CNS ADE

A 
insomnia
dizziness
depression (suicide)
anxiety
**risk for seizure if sudden withdrawal from highest dose
59
Q

Qsymia GI/GU ADE

A 
dry mouth
dysguesia
constipation
kidney stones
elevated serum creatinine
60
Q

Qsymia CV ADE

A

palpitations

BP increase

61
Q

Who should you avoid Qsymia in?

A

patients with CVD

62
Q

Special note with qsymia

A

increased risk of fetal malformations

  • requires initial pregnancy test, monthly testing, contraception
  • *REMS
63
Q

Bupropion/Naltrexone (Contrave) MOA

A

synergistic
appetite regulation in hypothalamus
resolimbic dopamine circuit (reward system)

64
Q

Contrave approved for

A

BMI >30

BMI >27, comorbidity

65
Q

Contrave weight loss

A

Mean weight decrease 8.2%

- peak weight loss at 36 weeks, sustained through week 56

66
Q

Contrave dosing

A

dose titrate by 1 tablet weekly up to 2 tabs BID over 4 weeks to improve tolerance

67
Q

When should you discontinue contrave?

A

after 12 weeks if not at least 5% weight loss

68
Q

Contrave ADE

A 
N/C/dry mouth
Increased BP, HR
dizzy
tremor
risk for seizure
69
Q

CI contrave

A
  • seizure disorder
  • uncontrolled HTN
  • chronic opioid use
  • pregnancy
  • during or within 14 days of MAOI
70
Q

Liraglutide (Saxenda) MOA

A

increased satiety due to slowed gastric emptying

71
Q

Saxenda weight loss

A

5-10% body weight at 56 weeks

72
Q

Saxenda dosing

A

once daily
injectable
start at 0.6mg/day and increase in weekly intervals to target dose of 3mg/day

73
Q

Saxenda side effects

A

mostly GI, nausea, bloating

74
Q

Saxenda REMS

A

monitor for medullary thyroid carcinoma and pancreatitis

75
Q

What is Saxenda also approved for?

A

diabetes (Victoza)

76
Q

Stimulants for obesity

A 
Ma Huang
Ephedrine
Guarana
yerba mate
bitter orange
77
Q

Alternatives to obesity

A
  • stimulate release of NE, DA, direct stimulation of B receptors
78
Q

Appetite suppressants claim to increase _____

A

thermogenesis

79
Q

Stimulants ADE

A 
tremor
nervousness
insomnia
palpitations
GI
mania
HTN
80
Q

Reports of what in stimulants

A 
hemorrhagic stroke
MI
seizure
psychosis
deaths
81
Q

Do not use stimulants for weight loss if history of _____ or _____

A

HTN

CVD

82
Q

HCG for weight loss

A

no benefit

- usually concomitant very restrictive diet

83
Q

HCG risk for

A

thromboembolism, edema, behavior change

84
Q

St. John’s Wort for weight loss

A

synaptic reuptake inhibition of NE, DA, serotonin

- no studies showing efficacy

85
Q

Bulk fibers for weight loss

A

expand within GI to induce sensation of fullness

86
Q

Leptin for weight loss

A

believed to be involved in feedback system relating to body weight regulation
- human studies lacking

87
Q

Chromium picolinate for weight loss

A

proposed mechanism is increased insulin sensitivity resulting in more efficient metabolism
- studies not shown effecitveness

88
Q

White willow bark for weight loss

A

active component is salicylate

proposed to potentiate other ingredients

89
Q

Non-pharmacologic management for weight loss

A
  • behavior modification
  • bariatric surgery
  • diet
  • exercise
90
Q

Drugs that can cause weight gain

A 
Anticholinergic/H1 blockade
Progesterone
Neuroleptics
Corticosteroids
Insulin
Sulfonylureas
Lithium
TCAs
Anticonvulsants
THC
90
Q

Disease states cause of weight gain

A

Hypothyroidism
Cushing’s
Depression

90
Q

What leads to decreased food intake?

A

Stimulation of DA, NE

Increased 5HT concentration and stimulation

90
Q

What leads to increased food intake?

A

Block DA, NE, serotonin receptors or decreased concentration

Histamine receptor blockade

PT: Nutrition Exam 2 (10 decks)

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