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Endocrinology > Obesity/Metabolic Syndrome > Flashcards

Obesity/Metabolic Syndrome Flashcards

1
Q

BMI 25 - 30

A

overweight

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2
Q

BMI > 30

A

obese

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3
Q

BMI 30 - 34.9

A

class 1 obesity

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4
Q

BMI 35-39.9

A

class 2 obesity

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5
Q

What is considered class 3 obesity (extreme/morbid)?

A

> 40 or > 35 [with comorbid conditions]

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6
Q

Some causes of obesity

A

abundance of food, poor diet, decreased physical activity, medications, environmental toxins, stress, genetics (40-70%), sleep pattern, maternal factors, intestinal microbiota

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7
Q

Genes that have been found to be associated with obesity

A

Leptin (LEP), Leptin Receptor (LEPR), Proopiomelanocortin (POMC), melanocrotin-4 receptor (MC4R)

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8
Q

What is the hypothalamic circuit that controls entergy homeostasis and food intake?

A

Leptin-POMC-melanocortin axis

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9
Q

What is the minimum exercise goal for weight loss a week?

A

at least 150 minutes

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10
Q

What is a good starting point with a diet?

A

eliminate all calorie containing beverages and limiting processed foods

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11
Q

What BMI is pharmacotherapy reserved for in treating overweight patients?

A

BMI >27-30

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12
Q

Why is pharmacotherapy used less than other weight loss methods?

A

vastly more side effects

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13
Q

Drug that inhibits enzymatic action of lipase and is approved for “long term” use (1-2 years)

A

Orlistat

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14
Q

Side effects of Orlistat

A

fecal incontinence, anal leakage, diarrhea, bloating, borborygmi, reduction in absorption of fat-soluble vitamins (A,D,E,K), potential liver damage

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15
Q

How can patients on Orlistat improve side effects?

A

long tern use and learning to restrict dietary fat intake to <30%

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16
Q

Benefits of Orlistat

A

weightloss and LDL reduction

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17
Q

Schedule IV sympathomimetic amines

A

phentermine and diethylpropion

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18
Q

Schedule IIII sympathomimetic amines

A

benzphetamine and phendimetrazine

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19
Q

side effects of sympathomimetic amines

A

increased BP and HR, insomnia, nervousness, dry mouth, constipation

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20
Q

Con of using sympathomimetic amines

A

potential for drug abuse

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21
Q

Who are sympathomimetic amines contraindicated in?

A

patients with CHD, HTN, hyperthyroidism, history of drug abuse

22
Q

MOA of Lorcaserin

A

selective serotinin receptor agonist - causes appetite suppression

23
Q

Benefits of taking Lorcaserin

A

improves BP, HR, triglycerides, glucose, CRP

24
Q

Side effects of Lorscaserin

A

headache, nausea, dizziness, nasopharyngitis, fatigue

25
Q

Is Lorcaserin safe in pregnancy?

A

No

26
Q

Taking Lorcaserin is contraindicated if the patient is already taking

A

other serotonergic medication (SSRI, SNRI, tricyclic, etc)

27
Q

Liraglutide is a

A

GLP-1 analog

28
Q

Who is Liraglutide approved for?

A

BMI > 27 and at least one other comorbidity

29
Q

Side effects of Liraglutide

A

nause, vomiting, diarrhea, constipation, dizziness, dry mouth, hypoglycemia

30
Q

What adverse effects have been seen in animal studies with Liraglutide?

A

thyroid tumors

31
Q

Shown to have great weight loss over placebo (7.8-9.5%) and approved for “long term use”

A

topiramate and phentermine ER

32
Q

Side effects of topiramate and phentermine

A

tingling, paresthesia, tachycardia, dizziness, change in taste perception, insomnia, constipation, mood change, increased suicidal thoughts, cognitive dysfunction, fatigue

33
Q

Who is topiramine and phentermine not recommended in?

A

patients with CVD, pregnancy, glaucoma, hyperthyroidism, MOIs

34
Q

Side effects of buproprion and naltrexone

A

nausea, constipation, headache, insomnia, vomiting, dizziness, dry mouth

35
Q

Concerning side effects of buproprion and naltrexone

A

increased suicidal thoughts and behaviors, neuropsychiatric events, seizures, elevated BP and HR

36
Q

Who are bupropion and naltrexone contraindicated in?

A

chronic opioid use, uncontrolled HTN, seizure disorder, eating disorder, on MOI and other bupropion meds

37
Q

Who is qualified to receive Vagal Blockade Device?

A

BMI 40-45 BMI 35-39.9 with at least 1 obesity related comorbidity and have failed weight loss program in last 5 years

38
Q

Who can be considered for bariatric surgery?

A

BMI > 40 BMI > 35 with coomorbid conditions

39
Q

3 types of bariatric surgery

A

restrictive, malabsorptive, mixed

40
Q

How does restrictive bariatric surgery work?

A

reduces gastric volume and limits food intake

41
Q

how doe malabsorptive bariatric surgery procedures work?

A

alters digestions and decreases effectiveness of nutrient absorption

42
Q

Most popular weight loss surgery?

A

Roux-en-Y gastric bypass

43
Q

Typically how much weight loss will someone have with Roux-en-Y gastric bypass?

A

> 30%

44
Q

Complications seen in about 40% of Roux-en-Y procedures

A

peritonitis from anastomotic leak, abdominal wall hernia, staple line disruption, gallstones, neuropathy, marginal ulcers, stenosis, wound infections, thromboembolic disease, GI symptoms, nutritional deficiencies

45
Q

This procedure has less dramatic weight loss but fewer short term complications that Roux-en-Y gastric bypass

A

Gastric banding

46
Q

Procedure where 3/4 of the stomach is restricted but the GI tract is left intact

A

Sleeve gastrectomy

47
Q

Rank amount of weight loss for the procedures: RYGB, gastric banding, sleeve gastrectomy

A

RYGB > sleeve gastrectomy > gastric binding

48
Q

To be diagnosed with Metabolic Syndrome a patient must have ___ or more of what symptoms

A

3

elevated abdominal circumference (M>40, W>35)

elevated BP (>130/>85)

elvated triglycerides (>150)

elevated fasting BS (>100)

decreased HDL (M<40, W<50)

49
Q

What three things will be elevated in metabolic syndrome?

A

CRP, interleukin 6, plasminogen activator inhibitor

50
Q

Patients with metabolic syndrome are at risk for what three things?

A

CVD DM Type II

51
Q

Treatment for metabolic syndrome

A

educate/motivate, weight loss, exercise, smoking cessation, decreased carbohydrate and saturated fats

Endocrinology (7 decks)

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