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S3 Case 4 - Endocrine > Pharmaceutical Care of Obesity > Flashcards

Pharmaceutical Care of Obesity Flashcards

1
Q

What is the BMI for overweight?

A

25-29.9

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2
Q

What is the BMI for obese?

A

30.34.9

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3
Q

What are the 4 levels of intervention?

A

General advice on healthy weight + lifestyle
Diet + physical activity
Diet + physical activity - consider drugs
Diet + physical activity - consider drugs + surgery

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4
Q

What are the benefits of maintaining healthy weight?

A

Reduced risk of developing diseases - CHD, hypertension, liver disease, osteoarthritis, type 2 diabetes
Improved mental health
Reduced breathlessness
Improved fitness
Lower blood cholesterol
Improved oral health

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5
Q

When should pharmacological interventions only be introduced?

A

After behaviour approaches to diet + physical activity have been initiated

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6
Q

What is Orlistat?

A

Lipase inhibitor

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7
Q

What is Sibutramine?

A

Appetite suppressant
NOT recommended for treatment of obesity

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8
Q

What is Liraglutide?

A

Glucagon-like-peptide- 1 (GLP-1) receptor agonist
(Appetite suppressant)

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9
Q

Can Orlistat be given to children under 12?

A

YES - but if physical comorbidities (orthopaedic problems/sleep apnoea) or severe psychological comorbidities

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10
Q

Describe the mechanism of action of Orlistat

A

Lipase inhibitor
= reduces absorption of dietary fat
Forms covalent bond with active site of gastric + pancreatic lipases
= inactivated enzyme can’t hydrolyse fat into FAs

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11
Q

What is the dose of Orlistat?

A

60mg TDS

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12
Q

What is prescribed Orlistat licensed in?

A

Ages 18-75 - adjunct in obesity

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13
Q

What is the BMI for prescribed Orlistat?

A

30
OR 28 with other risk factors (Type 2, hypertension, hypercholesterolaemia)

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14
Q

What is the adult dose of prescribed Orlistat?

A

120mg up to 3x/day

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15
Q

How is prescribed Orlistat to be taken?

A

Immediately before, during or up to 1hr after each main meal
Review at 12 weeks
If meal missed or contains no fat miss dose

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16
Q

When is prescribed Orlistat stopped?

A

If the target of >5% weight lost not lost

17
Q

What must be done with Orlistat?

A

Additional contraceptive method
= may be lost in severe diarrhoea

18
Q

What may be taken with Orlistat?

A

Multivitamin supplement taken at least 2hrs after Orlistat/bedtime
= potentially impair absorption of fat-soluble vitamins

19
Q

What may Orlistat also be used for?

A

Maintain or reduce weight before surgery

20
Q

What needs to be considered with Orlistat?

A

Affect absorption of administered oral drugs

21
Q

What are some examples of interactions with Orlistat?

A

Coumarins = monitor INR
Levothyroxine = increased risk of hyperthyroidism
Antiepileptics = decrease absorption
Amiodarone = plasma conc reduced

22
Q

Can you buy Orlistat OTC?

A

YES

23
Q

What criteria must you meet to buy Orlistat OTC?

A

18 or older
BMI 28 or above
Taken with low fat diet

24
Q

What is the treatment course for OTC?

A

NOT exceed 6 months
60mg 3x/day

25
Q

How do you take OTC Orlistat?

A

Taken with water immediately before, during or up to one hour after each main meal
If meal missed or contains no fat dose missed

26
Q

What is contraindicated with OTC Orlistat?

A

People taking ciclosporin + anticoagulants
People with chronic malabsorption syndrome + cholestasis
Pregnant/breast-feeding

27
Q

What are the common side effects of Orlistat?

A

Abdominal distension
Abdominal pain
Anxiety
Faecal incontinence
Faecal urgency
Flatulence
Headaches
Liquid stools
Leakage from rectum

28
Q

What is the BMI needed for Liraglutide?

A

30
BUT 27 if Type 2, hypertension, dyslipidaemia or sleep apnoea

29
Q

How do GLP-1 agonists work?

A

Decrease appetite
Decrease gastric emptying = feeling fuller for longer

30
Q

What is the criteria for bariatric surgery?

A

BMI over 40
BMI 30-40 if Type 2, hypertension, ect.
All non-surgical options tried
Fit for surgery + anaesthetic

31
Q

What happens in bariatric surgery?

A

Part of stomach is excised + sometimes part of small intestine
= reduces amount can be eaten
= weight lost

32
Q

What may be the problem with a shorter GI tract?

A

Alter drug absorption

S3 Case 4 - Endocrine (17 decks)

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