Obesity and Satiety Drugs-She Burkin Flashcards
Over (blank) percent of adults are overweight or obese
66%
What are the complications of obesity?
sex hormone imbalance -Hormone dependent tumors increased FFAs -CV disease physical stress -SOB -Low back pain -osteoarthritis -sleep apnea Quality of life-depression Disease: type 2 DM fatty liver gall bladder disease pancreatitis gynecologic abnormalities pulmonary disease cataractis stroke
Orexigenic means?
anorexigenic means?
appetite stimulating
appetite suppressing
The body modulated hung and satietey by sensing metabolic parameters which are…?
blood glucose levels
amounts of stored fat
(blank) levels are critical to how hungry you are (short term). Declines are sensd in what organ? What does this organ signal to?
blood glucose
liver
the hypothalamus
What regulates long term hunger regulation?
amount of stored glycogen or ration of utilizing stored carbohydrate: lipid
Ghrelin, leptin, insulin and PYY all bind receptors on orexigenic or anoreigenic neurons in the ARC of the (blank). What does the hypothalamus do once it senses this?
Signals travel along axons to secondary neurons. The ultimate effect is change in the sensations of hunger or satiety.
hypothalamus
Release of eorexigenic neuropeptide or anorexigenic neuropeptides.
A lot of satiety responses travel along the (blank)
vagus nerve
T or F
When food is readily available, people eat when there is no physiological reason.
T
Where does fat store?
adipocytes and intraperitoneal cavity
can store in liver-fatty liver disease
Obesity is associated with increased (blank) of adipocytes
size and number!
Why is BMI stupid?
because it doesnt include muscle mass
Who gets bariatric surgery?
BMI > 40, exercise and diet doesn’t work, and obesity-related comorbid conditions
What is this:
resecting and rerouting the small intestine to a small stomach pouch
gastric bypass
What is this:
removal of a portion of the stomach
sleeve gastrectomy with duodenal switch
Complications of bariatric surgery?
40% complication in first 6 months
- gastric dumping syndrome (1/5 patients): food enters stomach uningested and small intestine expants to quickly and fluid shifts into gut lumen and you get n/v bloating, cramping, diarrhea, dizziness, fatigue
- infection, incisional hernia, leak at surgical site
- steopenia and secondary hyperparathyroidism
- gallstone and imparied kindey function
What is the vagus nerve stimulator?
Who can get it?
-over 18, BMI 35-40 with comorbid obesity condition
wire leads and electrodes are surgically implanted in the abdommen-> sends intermittent electrical pulses to the vagus nerve -> triggers sense of satiety
IS the vagus nerve stimulator effective?
TX group lost 8.5% more weight than control group
18 month study indicated weight loss was sustained
Who should you give obesity drugs to?
if you have BMI>30 w/out risk factors OR
BMI >27 w/ risk factors
What are the FDA approved appetite suppressants?
Phentermine monotherapy Phenteremine plus extended topiramate combo Lorcaserine (belviq) Diethylproprion Phendimetrazine
What are the FDA approved nutrient absorption blockers?
Orlistat (Xenical)
Phentermine contraindications?
history of drug abuse
SSRI or MAOI
Dont use with other weight loss drug
Pregnancy or breast feeding
What is this: level 2 evidence controlled release phentermine pus topiramate effects not specific to hypothalamus high drop out rate (bad SEs) SEs paresthesia, dry mouth, constipation, dysgeusia Pregnancy cat D: risk of cleft palate
Phenteremine plus extended topiramate combo (Qsymia)
What is this: Selective 5-HTc receptor agonist level 2 works only in hypothalamus selectovely activates serotonin 2C receptors -increase satiety
Lorcaserin (Belviq)
SEs of Lorcaserin?
Serotonin syndrome (changes in autonomic instability, fast onset (min to hours), neuromuscular hyperactivity) disturbances in attention and memory
What should you not take lorcaserin with?
SSRIs
MAOIs
Dopamine antagoinist
St john wart
When should you stop using lorcaserin?
discontinue use if failure to lose 5% weight after 12 weeks
NOTE: safe and effective known for 2 years.
What is this:
amphetamin derivative
ass. w/ weight loss in obese women (level 2)
short term use only
monotherapy
orally 3x daily 1 hr before meals or 1x daily
diethylpropion (tenuate)
What are the common side effects of diethylpropion?
insomnia dry mouth pulmonary HTN valvular hear disease CNS effects withdrawal abuse
Contraindications for diethylpropon?
drug abuse
pregnancy
MAOIs
What is this:
amphetamine derivative
anorexigenic activity, due to CNS stimulation
alpha-1 adrenergic receptor agonist
Phendimetrazine
What is this:
Alli or Xenical (generic names)
inhibitor of gastric and pancreatic lipases
reduces TAG hydrolysis and fat absorption
Moderately effective at losing weight
ONLY FDA approved treatment for LONG TERM tx of Obesity
orlistat
Contraindications for orlistat?
pregnancy cat B (but not recommended)
chronic malabsorption syndrome or cholestasis
do no give with cyclosporine
32 reports of liver injury!
What is this:
experimental drug in phase 2 trials for obesity
selective inhibito of methionine aminopeptidase 2 (MetAP2)
reduces lipid and cholesterol biosynthesis
increase fat oxidation and is associated with rapid weight loss
improved LDL levels and C-reactive protein and adiponectin
Beloranib
What is this:
works on intestinal FXR
better metabolic profiles
high VO2 consumption (enhanced use of sugar and fat)
Increased core body temp
Induced metabolic responses that promot lipolysys and mobilize fatty acids for oxidation I
“browning” of cells in WAT
(brown adipose tissue is metabolically activate and considered to be a good thing, so white adipose tissue cells act more like brown with this drug)
Fexaramine (FXR)
(blank) is the only FDA approved nonprescription weight loss aid
Orlistat (Alli)
Many OTC weight loss drugs are associated with FDA warning and alerts such as (blank)
hydroxycut
Medications with some evidence for modest weight loss at 6-12 months (level 2 evidence) in diabetics are…?
Orlistat (Xenical, Alli) FDA approved
Canaglifozin (type 2 diabetes inadequatley controlled with metformine)
Fluoxetine (prozac)
