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

Question 1

Describe the formula for body mass index.

Answer 1

Weight (kg) / height^2 (m)

Question 2

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

Answer 2

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

Question 3

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

Answer 3

18.5 - 24.9 - average risk

Question 4

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

Answer 4

25 - 29.9 - some increased risk

Question 5

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

Answer 5

> 30 - greater increase in health risk

Question 6

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

Answer 6

> 40 - severe increase in health risk

Question 7

Name 9 complications of obesity.

Answer 7

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

Question 8

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

Answer 8

Decreases apetite and signals to the hypothalamus.

Question 9

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

Answer 9

Increases satiety and signals to the hypothalamus.

Question 10

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

Answer 10

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

Question 11

What regulates energy balance?

Answer 11

Leptin

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

Question 14

Define orexigenic and anorexigenic peptides.

Answer 14

Orexigenic - peptides that increase feeding

Anorexigenic - peptides that decrease feeding

Question 15

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

Answer 15

Peripheral orexigenic

Question 16

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

Answer 16

Peripheral anorexigenic

Question 17

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

Answer 17

Peripheral anorexigenic

Question 18

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

Answer 18

Central anorexigenic

Question 19

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

Answer 19

Central anorexigenic

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

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

Answer 22

Weaker

Question 23

Describe the three components of energy expenditure.

Answer 23

Metabolism
Thermogenesis
Physical activity

Question 24

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

Answer 24

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

Question 25

Name 5 non-pharmacological interventions to obesity.

Answer 25

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

Question 26

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

Answer 26

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

Question 27

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

Answer 27

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.

Question 28

What three factors does phentermine reduce?

Answer 28

Body weight Waist circumference Dyslipidaemia

Question 29

Name 6 adverse effects of phentermine.

Answer 29

``` Increased BP and HR Insomnia Nervousness Headache Dry mouth ```

Question 30

Is phentermine safe for pregnancy?

Answer 30

No

Question 31

Can phentermine be combined with anti-depressants?

Answer 31

No

Question 32

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

Answer 32

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

Question 33

What six factors does orlistat reduce?

Answer 33

``` Body weight Waist circumference Blood glucose and insulin (type 2 diabetes) Dyslipidaemia Blood pressure ```

Question 34

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

Answer 34

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

Question 35

What two things must orlistat be combined with?

Answer 35

A low fat diet | Vitamin D & E supplementation (not a must but recommended)

Question 36

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

Answer 36

GLP-1 receptor agonist BMI >30 Starts 0.6mg

Question 37

What five factors does orlistat reduce?

Answer 37

``` Body weight Waist circumference Blood pressure Diabetes Dyslipidaemia ```

Question 38

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

Answer 38

Typical use for epilepsy and migraines | Combined with phentermine

Question 39

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

Answer 39

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

Question 40

Name 3 adverse effects of topiramate.

Answer 40

Dizziness Taste alteration Teratogenic