Obesity tx Flashcards

1
Q

indications for pharmacotherapy for weight loss

A

BMI 27-29.9 + Co morbidities

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2
Q

Antidiabetic medications

A

sulfonureas
insulin
TZDs

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3
Q

Meds that may promote weight gain

A
  1. anti-diabetic meds
  2. mood stabilizers, antipsychotics
  3. birth control pills (Depo)
  4. Glucocorticoids: prednisone
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4
Q

Phentermine

A

Increases NE content in brain
CHEAPEST

FDA aproved for only 3 mo use
5-8% weight loss

Side effects: HTN, headache, Nervousness
NO SERIOUS LONG TERM SIDE EFFECTS

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5
Q

Most widely prescribed med for anti obesity

A

Phentermine

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6
Q

Orlistat

A

pancreatic lipase inhibitor
inhibits fat absorption by 30%
- cost $100/mo
SAFEST

GI side effects: oily stools (1/3 of the fat in your meals goes out in your poo), urgency

Multivitamine recommended to prevent fat soluble vitamin deficiency

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7
Q

Lorcasarin

A

Serotonin 2C receptor agonist (only in brain, not heart)
LEAST SIDE EFFECTS
- min headache, dizziness, nausea

  • Cost$220/mo
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8
Q

Phentermine/Topiramate

A
Combo gives greater efficacy w/ fewer side effects
MOST EFFECTIVE (10-12%)

Side effects: dry mouth, paresthesias, insomnia, dizziness, anxiety, irritability and disturbance in attention

Associated with BIRTH DEFECTS - get preggo test

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9
Q

Naltrexone/Bupropion

A

Bupropion stimulates hypothalamic POMC neurons and reduces food intake
Naltrexone blocks opioid receptor - alters reward pathways

INTERMEDIATE IN EFFECTIVENESS AND SIDE EFFECTIVENESS

Worrisome side effects:
Increase BP + pulse
Lower seizure threshold
suicidal ideation (balck box)

CATEGORY X PREGNANCY

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10
Q

WEight loss drugs to avoid in pregnancy

A

Phentermine/Topiramate

Naltrexone/Bupropion

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11
Q

INTERMEDIATE IN EFFECTIVENESS AND SIDE EFFECTIVENESS

A

Naltrexone/Bupropion

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12
Q

MOST EFFECTIVE (10-12%) but cost alot

A

Phentermine/Topiramate

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13
Q

LEAST SIDE EFFECTS (modestly effective)

A

Lorcasarin

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14
Q

SAFEST, but limited weight loss and costly

A

Orlistat (xenical)

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15
Q

CHEAPEST, but not approved for long term use

A

Phentermine

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16
Q

Which is more effective, sleeve or gastric or lap band?

A

30% Gastric
( golf ball size stomach hooked up to Sm Int)
25% Sleeve gastrectomy
20% Lap band

Gastric>Sleeve>Lapband

  • same goes for mortality and complications
  • more risk with gastric
17
Q

Benefits of weight loss surgery

A

Improved:

1. HbA1c (

18
Q

Who is a good candidate for bariatric surgery?

A
  1. BMI >35 with comorbidities
    or
    BMI >40 w/o co
    - comorbidities: Diabetes, sleep apnea, reflux > HTN, DJD
  2. Failed other forms of therapy
  3. No serious, active cardiac, pulmonary, or psychiatric diseases
  4. Age 20-60
19
Q

4 statin benefit groups defined by 2013 ACC

A
  1. LDL >190
  2. 40-75 w/ DM or LDL 70-189
    - NO CVD
  3. 40-75, no DM, LDL 70-189, >7.5 10 year risk
  4. Secondary prevention + CVD!
20
Q

Risks of bariatric surgery

A
  1. Death
  2. Failure to produce weight loss
  3. Pulm Embolus
  4. Anastamotic leaks/sepsis
  5. Thiamin deficiency
    _______
    late risks:
  6. B12 deficiency
  7. Fe deficiency
  8. Ca/Vit D deficiency
  9. Folate deficiency
  10. Band/erosion/slippage
  11. Depression
21
Q

Weight loss surgery benefits

A
1. decrease HBA1C
Improved:
2. sleep apnea
3. HTN
4. GERD
5. Urinary incontinence