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DEMS unit 3 > Obesity Treatment: Drugs and Surgery > Flashcards

Obesity Treatment: Drugs and Surgery Flashcards

1
Q

Meds that may promote weight gain

A

anti-diabetic medications (Sulfonylureas, insulin, TZDs), mood stabilizers, antipsychotics, birth control pills (Depo provera), Glucocorticoids (prednisone)

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2
Q

Sibutramine

A

MOA: NE/5HT reuptake Inhibitor; inhibits apetite

Removed from market

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3
Q

Phentermine

A

5-8% weight loss
FDA approved for only 3 months; most widely Rx
CHEAPEST
MOA: Increases NE in the Brain; Inhibits Apetite

SE: HTN, HA, Nervousness, Usually Minimal if Rx as a single drug

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4
Q

Bupropion

A

NOT FDA approved for weight loss

Slow, gradual weight loss

If patient needs anti-depressant but is gaining weight, consider this

MOA: NE and DA reuptake inhibitor

SE: Dry mouth, Nausea, Insomnia, Tremor, Rash

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5
Q

available options for weight loss

A

accept weight, diet/exercise, drugs, medidcally supervised/combination of diet + Drug, surgery

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6
Q

Roux en Y Gastric Bypass (RYGB)

Benefits and Risks

A

Benefits in Glucose Control
28-30% weight loss – most effective, most risky
Decrease CVD and Cancer risk

Risk: • Risk of dying in first month post op is

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7
Q

drug efficacy

A

5-12 percent

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8
Q

Weight loss medication negatives

A
  • only 5-12% weight loss
  • benefits only as long as taken; chronic treatment likely needed
  • expensive and probs not paid for by insurance
  • issues of FDA approval/long term safety and efficacy
  • choice of mechanisms (OTC vs prescription, combos)
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9
Q

Medically supervised/combo of diet + Drug efficacy

A

10-15% weight loss

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10
Q

foundation of obesity treatment

A

lifestyle modification (Diet, physical activity)

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11
Q

Weight loss medication negatives

A
  • only 5-12% weight loss

- benefits only as long as taken; chronic treatment likely needed

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12
Q

Bupropion

A

NOT FDA approved for weight loss

Slow, gradual weight loss

If patient needs anti-depressant but is gaining weight, consider this

MOA: NE and DA reuptake inhibitor

SE: Dry mouth, Nausea, Insomnia, Tremor, Rash

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13
Q

Roux en Y Gastric Bypass (RYGB)

Mechanism

A

Jejunum is anastomosed to the stomach.
Food goes straight into intestine (without going through stomach) increased satiety
Decrease in serum ghrelin=decreased hunger

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14
Q

Roux en Y Gastric Bypass (RYGB)

Benefits and Risks

A

Benefits in Glucose Control
28-30% weight loss – most effective, most risky
Decrease CVD and Cancer risk

Risk:
• Risk of dying in first month post op is Wernicke Korsakoff

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15
Q

most widely prescribed anti-obesity drug

A

Phentermine

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16
Q

Phentermine

A
  • increases NE content in brain; chemically related to amphetamine but not addictive
  • cheapest
  • FDA approved for 3 months
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17
Q

Phentermine side effects

A

hypertention, headache, nervousness

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18
Q

Phentermine efficacy

A

5-8% weight loss

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19
Q

Lorcasarin mechanism

A

Serotonin 2C receptor agonist (only in brain/not heart)

  • EXPENSIVE (220/month)
  • prior serotonin agonists taken off market due to cardiac valve disease, so studies done on this drug but no evidence of valvulopathy
20
Q

drug with least side effects

A

Lorcasarin– minimal headache, dizziness and nausea

21
Q

Orlistat mechanism

A

Pancreatic lipase inhibitor to inhibit fat absorption by 30%

22
Q

Orlistat side effects

A

oily stools, urgency

23
Q

Orlistat considerations

A
  • SAFE!! but $100/month
  • OTC form
  • take multivitamin to prevent fat soluble vitamin deficiency

5-8% wt loss

24
Q

safest weight loss medication

A

Orlistat

25
Q

Lorcasarin mechanism

A

Serotonin 2C receptor agonist (only in brain/not heart)
- prior serotonin agonists taken off market due to cardiac valve disease, so studies done on this drug but no evidence of valvulopathy

26
Q

drug with least side effects

A

Lorcasarin– minimal headache, dizziness and nausea

27
Q

Laparoscopic Band

MOA

A

• Reduce size of stomach to increase satiety (about 50 mL)

28
Q

Laparoscopic Band

Benefits and Risks

A

20-24% weight loss – least weight loss, least risk. Low mortality
1% serious or 2.4% any complication
Reversible

Risks
Requires close follow up and adjustment
Risk of mechanical failure (erosion of band through stomach wall, slippage of band)

29
Q

Sleeve Gastrectomy

MOA

A

Removal of a portion of the stomach to increase satiety (about size of a banana)

30
Q

Sleeve Gastrectomy

Benefits and Risks

A

Benefits in glucose control in DM but not as much RYGB
24-27% weight loss; intermediate loss, intermediate risk.

Risks?
“Intermediate” surgical option no mechanical problems (like in lap band) or nutritional deficiency (like with RYGB)

31
Q

Lorcasarin efficacy

A

4-5% weight loss

32
Q

Who is a good candidate for Surgery?

A

BMI >35 kg/m2
Age 20-60 (can be done in adolescents)
Comorbidities: Diabetes, sleep apnea>HTN, DJD
Failed other forms of therapy
No serious active cardiac, pulmonologic or psychiatric diseases

33
Q

Late risks of Surgery

A 
B12 Deficiency 
Fe deficiency
Ca/VitD--> osteoporosis
Depression
Avoid Pregnancy for at least 1 year
Folate Deficiency
34
Q

most efficacious weight loss drug

A

phentermine/topiramate

35
Q

Naltrexone SR/Bupriopion SR

A
  • combo drug
  • Bupropion stimulates hypothalamic por-opiomelanocortin (POMC) neurons reduces food intake
  • Naltrexone blocks opioid receptor-mediated POMC auto-inhibition, augmenting POMC firing ain a synergistic manner. Alters reward pathways
36
Q

Naltrexone/Bupriopion efficacy and side effects

A

intermediate effectiveness and side effects

  • increased BP, lowers seizure threshold, suicidal ideation
  • common SE: nausea, constipation, diarrhea, headache, dry mouth
  • category X in pregnancy
  • EXPENSIVE (200/mo)
37
Q

Main point of Orlistat

A

safest option but limited weight loss, cost and lack of insurance coverage

38
Q

Main point of phentermine

A

less expensive so most prescribed but not FDA approved for long term use

39
Q

main point of phentermine/topiramate combo

A

most effective but costs a lot

40
Q

lorcasarin main point

A

only modestly effective but least side effects

41
Q

naltrexone/bupriopion main point

A

intermediate effectiveness

42
Q

weight loss drugs

A

Orlistat, Phentermine, Phentermine/topiramate, Lorcasarin, Naltrexone/bupriopion combo

43
Q

Bariatric Surgery Vs Usual Care?

A

Gastric bypass out to 20 years is 25% weight loss
Associated with a reduced mortality (especially with cancer!)

Dramatic affects on T2D

44
Q

Who is a good candidate for Surgery?

A

BMI >35 kg/m2
Age 20-60 (can be done in adolescents)
Comorbidities: Diabetes, sleep apnea>HTN, DJD
Failed other forms of therapy
No serious active cardiac, pull or psychiatric diseases

45
Q

who is good candidate for weight loss surgery

A
  • BMI >35 with co-morbidities, BMI >4- with no comorbidities
  • age 20-60 (controversial)
  • failed other forms of therapy
  • no serious, active cardiac, pulm or psych dz
  • comorbidities: diabetes, slep apnea, reflux > HTN, Degenerative joint disease
46
Q

Late risks of Surgery

A 
B12 Deficiency (Need to put your patients on this)
Fe deficiency: particularly in menstruating women (need PE Fe)
Ca/VitD--> osteoporosis

DEMS unit 3 (9 decks)

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