Obesity tx

Question 1

indications for pharmacotherapy for weight loss

Answer 1

BMI 27-29.9 + Co morbidities

Question 2

Antidiabetic medications

Answer 2

sulfonureas
insulin
TZDs

Question 3

Meds that may promote weight gain

Answer 3

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

Question 4

Phentermine

Answer 4

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

Question 5

Most widely prescribed med for anti obesity

Answer 5

Phentermine

Question 6

Orlistat

Answer 6

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

Question 7

Lorcasarin

Answer 7

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

• Cost$220/mo

Question 8

Phentermine/Topiramate

Answer 8

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

Question 9

Naltrexone/Bupropion

Answer 9

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

Question 10

WEight loss drugs to avoid in pregnancy

Answer 10

Phentermine/Topiramate

Naltrexone/Bupropion

Question 11

INTERMEDIATE IN EFFECTIVENESS AND SIDE EFFECTIVENESS

Answer 11

Naltrexone/Bupropion

Question 12

MOST EFFECTIVE (10-12%) but cost alot

Answer 12

Phentermine/Topiramate

Question 13

LEAST SIDE EFFECTS (modestly effective)

Answer 13

Lorcasarin

Question 14

SAFEST, but limited weight loss and costly

Answer 14

Orlistat (xenical)

Question 15

CHEAPEST, but not approved for long term use

Answer 15

Phentermine

Question 16

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

Answer 16

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

Question 17

Benefits of weight loss surgery

Answer 17

Improved:

1. HbA1c (

Question 18

Who is a good candidate for bariatric surgery?

Answer 18

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

Question 19

4 statin benefit groups defined by 2013 ACC

Answer 19

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!

Question 20

Risks of bariatric surgery

Answer 20

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

Question 21

Weight loss surgery benefits

Answer 21

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