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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
Is Lorcaserin safe in pregnancy?
No
26
Taking Lorcaserin is contraindicated if the patient is already taking
other serotonergic medication (SSRI, SNRI, tricyclic, etc)
27
Liraglutide is a
GLP-1 analog
28
Who is Liraglutide approved for?
BMI \> 27 and at least one other comorbidity
29
Side effects of Liraglutide
nause, vomiting, diarrhea, constipation, dizziness, dry mouth, hypoglycemia
30
What adverse effects have been seen in animal studies with Liraglutide?
thyroid tumors
31
Shown to have great weight loss over placebo (7.8-9.5%) and approved for "long term use"
topiramate and phentermine ER
32
Side effects of topiramate and phentermine
tingling, paresthesia, tachycardia, dizziness, change in taste perception, insomnia, constipation, mood change, increased suicidal thoughts, cognitive dysfunction, fatigue
33
Who is topiramine and phentermine not recommended in?
patients with CVD, pregnancy, glaucoma, hyperthyroidism, MOIs
34
Side effects of buproprion and naltrexone
nausea, constipation, headache, insomnia, vomiting, dizziness, dry mouth
35
Concerning side effects of buproprion and naltrexone
increased suicidal thoughts and behaviors, neuropsychiatric events, seizures, elevated BP and HR
36
Who are bupropion and naltrexone contraindicated in?
chronic opioid use, uncontrolled HTN, seizure disorder, eating disorder, on MOI and other bupropion meds
37
Who is qualified to receive Vagal Blockade Device?
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
Who can be considered for bariatric surgery?
BMI \> 40 BMI \> 35 with coomorbid conditions
39
3 types of bariatric surgery
restrictive, malabsorptive, mixed
40
How does restrictive bariatric surgery work?
reduces gastric volume and limits food intake
41
how doe malabsorptive bariatric surgery procedures work?
alters digestions and decreases effectiveness of nutrient absorption
42
Most popular weight loss surgery?
Roux-en-Y gastric bypass
43
Typically how much weight loss will someone have with Roux-en-Y gastric bypass?
\> 30%
44
Complications seen in about 40% of Roux-en-Y procedures
peritonitis from anastomotic leak, abdominal wall hernia, staple line disruption, gallstones, neuropathy, marginal ulcers, stenosis, wound infections, thromboembolic disease, GI symptoms, nutritional deficiencies
45
This procedure has less dramatic weight loss but fewer short term complications that Roux-en-Y gastric bypass
Gastric banding
46
Procedure where 3/4 of the stomach is restricted but the GI tract is left intact
Sleeve gastrectomy
47
Rank amount of weight loss for the procedures: RYGB, gastric banding, sleeve gastrectomy
RYGB \> sleeve gastrectomy \> gastric binding
48
To be diagnosed with Metabolic Syndrome a patient must have ___ or more of what symptoms
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
What three things will be elevated in metabolic syndrome?
CRP, interleukin 6, plasminogen activator inhibitor
50
Patients with metabolic syndrome are at risk for what three things?
CVD DM Type II
51
Treatment for metabolic syndrome
educate/motivate, weight loss, exercise, smoking cessation, decreased carbohydrate and saturated fats

Endocrinology (7 decks)

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