Obesity drugs and surgery

Question 1

general med facts

Answer 1

• current meds give 5-12% wt loss
• benefits only last as long as you take the medicine
• drugs are rarely paid for by insurance
• issues of FDA approval and side effects

Question 2

2. List the medications that are used for other health problems that contribute to weight gain and describe an approach to minimizing this problem.

Answer 2

antidiabetics
-TZD’s, sulfonylureas, Insulin

mood stabilizers and antipsychotics

birth control pills

Glucocorticoids

Question 3

what does surgery do

Answer 3

lowers ghrelin levels-- less hungry
reduced mortality
less cancer
less sleep epnea, less HTN
less reflux
urinary incontinence improved

Question 4

4. Describe the patient who is best suited to both pharmacological and surgical treatments for obesity.

Answer 4

surgery- BMI >35 with comorbidities, >40 w/o
age 20-60
failed other forms of therapy
comorbidies of Diabetes, sleep apnea, reflux
dont have serious cardiac, pulm, or psycjiatric disease

Question 5

Phertermine

Answer 5

*cheapest, no evidence of serious long term issues
only FDA approved for 3 months…

MOA- increases NE content in the brain
Efficacy- 5-8% wt loss
S/E- HTN, HA, nervousness

Question 6

Orlistat

Answer 6

*safest
MOA- pancreatic lipase inhibitor, inhibits fat absorption by 30 %
efficacy- 5-8% wt loss
S/E- oily stools, urgency

recommended people take an MVI so they dont become fat soluble defficent

Question 7

Lorcasarin

Answer 7

MOA-Seratonin 2C receptor agonist
efficacy- 4-5%
*least side effects- minimal HA, dizziness, nausea

Question 8

Phentermine/Topiramate

Answer 8

MOA-antimigraine and increases NE in brain
efficacy- 5-10% wt loss
S/E- dry mouth, parathesias, insomnia, dizziness, anxiety, irritability, attention disturbances, risk of birth defects

• also lowers BP, glucose, TG’s, raises HDL

Question 9

Naltrexone/ Buproprion

Answer 9

MOA- Buproprion-stimulates hypothalmicPOMC neurons to reduce food intake
Naltrexone- blocks opiod receptor mediated POMC auto inhibition “alters reward pathways”
*intermediate in effectiveness and side effects

S/E- increase BP, suicidal ideation, anti muscarinic s/e, dont take during pregnancy

Question 10

Lap band

Answer 10

20% wt loss

very low mortality

Question 11

Sleeve Gastrectomy

Answer 11

25% wt loss

0.1% mortality

Question 12

Gastric Bypass

Answer 12

30% wt loss

0.2% mortality

Question 13

post surgery issues

Answer 13

b12 deficient, iron deficient, ca/vit D deficiency (osteoporosis)
anastomotic ulcers and strictures
slippage of lap band
depression
pregnancy (folate deficincy)

Question 14

what is best treatment for DM2

Answer 14

gastic bypass