Obesity Treatment: Pharmacological and Surgical Treatments Flashcards

1
Q

BMI to start pharm

A

30-34.9

27-29.9 with comorbid

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2
Q

BMI for surgery

A

40

35-39 with comorbid

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3
Q

Pharmacological Treatment of Obesity

A

Current medications 5-12% wt loss

Benefits only last as long as patient takes the medication. Chronic treatment likely needed.

Drugs probably not paid for by insurance so cost is a big issue for patients.
Issues of FDA approval, long term safety, and efficacy.

Choice of mechanisms, OTC versus prescription, combinations?

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4
Q

Phentermine

A

Increases NE content in the brain

Chemically related to amphetamine, ‘not addictive’

Dose: 15-37.5 mg/d,
Cost: $15-25.00/month Cheapest

FDA approved for only 3 months use

5-8% weight loss

Side effects: hypertension, headache, nervousness

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5
Q

Increases NE content in the brain

Chemically related to amphetamine, ‘not addictive’

Dose: 15-37.5 mg/d,
Cost: $15-25.00/month Cheapest

FDA approved for only 3 months use

5-8% weight loss

Side effects: hypertension, headache, nervousness

A

Phentermine

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6
Q
Pancreatic Lipase inhibitor
Inhibits fat absorption by 30%
120 mg three times per day
Cost: $100.00/mo
GI side effects: oily stools, urgency
MVI to prevent fat soluble vitamin deficiency
A

Orlistat (Xenical)

Safest weight loss medication, approved for long term use, OTC form

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7
Q

Much greater weight loss (10-12%)

s/e: Dry mouth, paresthesias, insomnia, dizziness, anxiety, irritability, attention problems

A

Phentermine/topiramate

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8
Q
  • Recently approved
  • 4-5% weight loss (may be combined with phentermine in future to get greater combined loss)
  • $220-$250/month
A

Lorcasarin

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9
Q
  • Not systemically absorbed=no systemic side effects
  • Oily stools, sense of urgency, diarrhea, oily leakage
  • Fat soluble deficiency is not common, but still take multivitamin
  • DDI: Increased INR with warfarin, decreased levels cyclosporine
A

Orlistat (Xenical) side effects

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10
Q

Orlistat

A

safest

May be useful in those with poorly controlled hypertension or psych problems

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11
Q

Phentermine

A

cheapest

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12
Q

Lorcasarin

A

Least side effects

minimal headache, dizziness and nausea
Cost: $220/mo

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13
Q

The most effective treatment we have for obesity.

The best treatment we have for type 2 diabetes

A

Bariatric Surgery

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14
Q

Benefits of Weight Loss Surgery

A

Sleep apnea: Improved in almost all
Hypertension: improved in half
Gastroesophageal reflux: improved in most
Urinary incontinence: improved in most

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15
Q

Comparison of Operations

A

Lap band: 20% weight loss, very low mortality, 1% serious or 2.4% any complication

Sleeve gastrectomy: 25% weight loss, 0.1% mortality, 2.4% serious or 6.3% any complication

Gastric bypass: 30% weight loss, 0.2% mortality, 2.5% serious or 10% any complication

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16
Q

Naltrexone SR/Bupropion

A

Combination of Naltrexone SR and Bupropion

Bupropion stimulates hypothalamic pro-opiomelanocortin (POMC) neurons reduces food intake.

Naltrexone blocks opioid receptor-mediated POMC auto-inhibition, augmenting POMC firing in a synergistic manner. Alters reward pathways.

Intermediate in effectiveness and side effects

17
Q

_____ is the safest option but limited weight loss, cost and lack of insurance coverage.

A

Xenical

18
Q

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

A

Phentermine

19
Q

_________ is the most effective but costs a lot

A

Phentermine/topiramate

20
Q

______ is only modestly effective but least side effects

A

Lorcasarin

21
Q

_______intermediate effectiveness.

A

Naltrexone/bupropion

SI warning
sz risk