Perry 2

Question 1

Guidelines for use of obesity medicatiosn

Answer 1

• BMI > 30 without comorbid conditions
• BMI > 27 with comorbid conditions
• Body fat > 30% for women, or >25 for men; without comorbid conditions

Decision takes into accoutn previous unsuccessful attepmts to lose weight and maintain the loss with conventional therapies

Question 2

Meridia (subutramine)

Answer 2

withdrawan in 2010

• Weightloss and maintenance
• norepinephrein and serotonin re-uptake inhibitory
• very expensive
• 5% wt. loss over 6 months
  
  • at 2yrs, 40% maintained
• Negatives
  
  • increae systolic and diastolic pressure
  • heart rate can be increased
  • contraindicated in pts with CVD and HTN

Question 3

Orlistat

Answer 3

• weight loss and maintenance
• Lipase inhibitor (decraese fat absorption)
  
  • 120mg/meal
• Patients instructed to follow a low fat diet (10-15g/meal)
• 5-10% at one year (15-303)

Question 4

Alli (OTC orlistat)

Answer 4

• 10# with dieting alone, 15# with alli
• Negatives
  
  • Gi side effects = loose stools, oily discharge, fecal incontiennce
  • small rsik of decreased absorption of fat soluble vitamins
    
    • recommend multivitamin 2 hours apart from orlistat

Question 5

Phentermine

Answer 5

• appetite suppressant-short term use only in obese pts when used along with diet exercise and behavior modification
• 5-10% weight loss
• BMI > 28
• NEGATIVE
  
  • Contra indivated in HTN, overactive thyroid, glaucoma, Heart or blood vessel disease or pregnant/breast feeding
  • side effects = insomnia, HBP, irritability, nervousness
  • short term use of 12 weeks

Question 6

Rimonabant

Answer 6

• cannabinoid-1 receptor blocker
  
  • appetitie suppressant
• NO APPROVED BY FDA due to suicidalitya nd depression caused

Question 7

Bariatric surgery

Answer 7

• recommended criteria for surgery:
  
  • BMI > 40
  • BMI > 35 + signficant comorbidities
  • PCP diet
  • psycholigcal readiness
  • free of disordered eating
  • no drugs or alcohol abuse

Question 8

Initial treatment for bariatric surgery

Answer 8

• Dieting and exercise
  
  • trial of diet and exercise for 3-6 months prior to considering bariatric srugery
• Physicain or dietitian supervision
  
  • weight, problems caused by weight,w hat you are doign to try to lose weight
• Lifestyle change
  
  • decrease how much you eat - reduced calorie intake
  • control of carbohydrate intake
  • increased physical activity
    
    • aeobic exercise 4-5x/week
    • weight training 2x/week

Question 9

Roux-en-Y (Bariatric surgery)

Answer 9

Malabsorptive (bypass) > restrictive

• Stomach is made smaller suing surgical staples
• Jejunum connected to small pouch
  
  • bypasses stomach and duodenum
• inpatient for 2 days and return to work after 2 weeks
• ADVANTAGE
  
  • 70% excess weight loss at 12-18 months (more with higher weights)
  • rapid cures of weight related disease
• Disadvantages
  
  • longer recovery/more invasive
  • nutrient deficiency
  • very diffiuclt to reverse
  • dumping syndrome (bathroom within 30 mins of eating)

Question 10

Gastric banding (rbariatric surgery)

Answer 10

restrictive

• adjustable lap band placed at top of stomach
• restricts consumption but does not lead to malabsorption
• 1 hr laproscopic procedure outpatient
• 1 week return to work
• ADVANTAGE
  
  • less invasive, shorter surgery,a nd shorter hospital stay
  • weight loss ismilar to roux-en-Y
  • fewer complications
• Disadvantage
  
  • must follow very strict diet
  • ulcer, slippage of band, port complications can be problems

Question 11

Vertical Sleeve gastrectomy

Answer 11

• Make stomach into long narrow sleeve by removing 2/3 of it
• Restrictive = small tubue
• metabolic = alters GI hormones
• laparoscopic
• ADVANTAGE (better than lap band)
  
  • rapid weight loss
  • metabolic procedure with restriction
  • lower risk than bypass
  • less change of vitamin deficiency, low risk of internal hernia/bowel obstruction, lower risk of ulcers
• Disadvantage
  
  • permanent
  • no long term data
  • possible sleeve dilation and weight regain

Question 12

general complicatiosn of bariatric surgery

Answer 12

• pulmonary embolism
• incisional hernia
• gallstone formation
• major wound infection and seroma
• abdominal fluid collection
• subphrenic abscess
• peritonitis

Question 13

describe the risk of vitamin and mineral deficiences post-op (RNY

Answer 13

• Ca and Vit D
  
  • reduce absorption d/t bypassed duodenum, proximal jejunum
  • reques life-lon supplemments
• Iron
  
  • absorption decrease d/t decraesed contact of food with gastric acid; reduced conversion of iron from ferrous to ferric form
• Vitamin B12
  
  • absortpion decrease d/t decreased contact with intrinsic factors
  • require supplementation
• Thiamine
  
  • Connection to wernicke’s syndrome