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OD2 - Applied Clinical Training & Research Studies in Vision and Optometry > PHARM - Obesity: A Multi-Targeted Treatment Approach - Week 8 > Flashcards

PHARM - Obesity: A Multi-Targeted Treatment Approach - Week 8 Flashcards

1
Q

Describe the formula for body mass index.

A

Weight (kg) / height^2 (m)

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2
Q

Describe the range and overall health risk for the underweight category for BMI.

A

<18.5 - low, but risk of other clinical problems increased

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3
Q

Describe the range and overall health risk for the normal category for BMI.

A

18.5 - 24.9 - average risk

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4
Q

Describe the range and overall health risk for the overweight category for BMI.

A

25 - 29.9 - some increased risk

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5
Q

Describe the range and overall health risk for the obese category for BMI.

A

> 30 - greater increase in health risk

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6
Q

Describe the range and overall health risk for the morbid obese category for BMI.

A

> 40 - severe increase in health risk

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7
Q

Name 9 complications of obesity.

A 
Diabetes
Sleep apnoea
Athsma
Osteoarthritis
Cancer
Non-alcoholic fatty liver disease
Coronary heart disease
Hypertension
Dislipidaemia
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8
Q

What effect does leptin have on apetite and what does it signal to?

A

Decreases apetite and signals to the hypothalamus.

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9
Q

What effect does insulin have on satiety and what does it signal to?

A

Increases satiety and signals to the hypothalamus.

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10
Q

What two organs send satiety signals and to what region of the brain? Through what pathway do they do this (3)?

A

The liver - by sympathetic input
The stomach - by vagus and sympathetic input
They both signal to the medulla

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11
Q

What regulates energy balance?

A

Leptin

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12
Q

Briefly describe in 3 steps the action of leptin (2).

A

Leptin is released by white adipose cells.
They bind to leptin receptors in the brain.
Neuropeptides are released that induce:
-decreased food intake
-increased energy usage

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13
Q

Does leptin deficiency cause or prevent morbid obesity? Is this relevant to many cases of patients?

A

Causes obesity. Only relevant to a very small number of patients with genetic abnormalities.

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14
Q

Define orexigenic and anorexigenic peptides.

A

Orexigenic - peptides that increase feeding

Anorexigenic - peptides that decrease feeding

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15
Q

Is the hormone ghrelin orexigenic or anorexigenic and does it act centrally or peripherally?

A

Peripheral orexigenic

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16
Q

Is the hormone leptin orexigenic or anorexigenic and does it act centrally or peripherally?

A

Peripheral anorexigenic

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17
Q

Is the hormone insulin orexigenic or anorexigenic and does it act centrally or peripherally?

A

Peripheral anorexigenic

18
Q

Is the hormone serotonin orexigenic or anorexigenic and does it act centrally or peripherally?

A

Central anorexigenic

19
Q

Is the hormone noradrenaline orexigenic or anorexigenic and does it act centrally or peripherally?

A

Central anorexigenic

20
Q

Name 2 genetic factors and 5 environmental factors that influence the development of diabetes.

A 
Genetic
-monogenic/inherited disease
-susceptibility genes
Environmental
-sleep deprivation
-food intake
-physical activity
-socioeconomic status
-cultural influences
21
Q

Describe what is meant by the obesogenic environment (4).

A

Decline in physical activity
Increased food portion size
Consumption of sugar-sweetened beverages
Consumption of palatable energy-dense foods

22
Q

Do high fat foods provide a stronger or weaker satiety response?

A

Weaker

23
Q

Describe the three components of energy expenditure.

A

Metabolism
Thermogenesis
Physical activity

24
Q

Do VLCDs induce weight loss? Can the effect it has be maintained? Why is this so?

A

It does but long-term maintenance is almost impossible. Hormonal adaptations to weight loss persist, increasing apetite.

25
Q

Name 5 non-pharmacological interventions to obesity.

A 
Increasing physical activity
Reducing calorie intake
Reducing fat intake to <30%
Consider stopping/replacing drugs causing weight-gain (corticosteroids)
Bariatric surgery
26
Q

Name three drugs that can be used to treat obesity and briefly how they work.

A

Phentermine - indirectly acting sympathomimetic
Orlistat - decreases dietary fat absorption
Liraglutide - GLP-1 receptor agonist

27
Q

Describe the mechanism for phentermine, what BMI it is used for, and whether it can be used short- or long-term.

A

Increases NA available to bind to receptors (induces NA release from the neuron into the cleft), suppressing apetite.
Used in BMI >30, only useful short-term.

28
Q

What three factors does phentermine reduce?

A

Body weight
Waist circumference
Dyslipidaemia

29
Q

Name 6 adverse effects of phentermine.

A 
Increased BP and HR
Insomnia
Nervousness
Headache
Dry mouth
30
Q

Is phentermine safe for pregnancy?

A

No

31
Q

Can phentermine be combined with anti-depressants?

A

No

32
Q

Describe the mechanism for orlistat, what BMI it is used for, and dosing.

A

Inhibits gastric and pancreatic lipases, decreasing dietary fat absorption by ~30%.
Used for BMI >30
Dosage is 3 times per day with a meal.

33
Q

What six factors does orlistat reduce?

A 
Body weight
Waist circumference
Blood glucose and insulin (type 2 diabetes)
Dyslipidaemia
Blood pressure
34
Q

Name two adverse effects of orlistat and when they may occur.

A

Explosive diarrhoea
Faecal fat leakage
Can be controlled if the patient adheres to a low fat diet.

35
Q

What two things must orlistat be combined with?

A

A low fat diet

Vitamin D & E supplementation (not a must but recommended)

36
Q

Describe the mechanism for liraglutide, what BMI it is used for, and dosing.

A

GLP-1 receptor agonist
BMI >30
Starts 0.6mg

37
Q

What five factors does orlistat reduce?

A 
Body weight
Waist circumference
Blood pressure
Diabetes
Dyslipidaemia
38
Q

What two conditions is topiramate typically used for? What drug is it usually combined with?

A

Typical use for epilepsy and migraines

Combined with phentermine

39
Q

Describe the mechanism for topiramate and what BMI it is used for.

A

Not completely known, but it increases energy expenditure and suppresses apetite.
Used for BMI >30

40
Q

Name 3 adverse effects of topiramate.

A

Dizziness
Taste alteration
Teratogenic

OD2 - Applied Clinical Training & Research Studies in Vision and Optometry (174 decks)

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