Pharmaceutical Care of Obesity Flashcards
What is the BMI for overweight?
25-29.9
What is the BMI for obese?
30.34.9
What are the 4 levels of intervention?
General advice on healthy weight + lifestyle
Diet + physical activity
Diet + physical activity - consider drugs
Diet + physical activity - consider drugs + surgery
What are the benefits of maintaining healthy weight?
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
When should pharmacological interventions only be introduced?
After behaviour approaches to diet + physical activity have been initiated
What is Orlistat?
Lipase inhibitor
What is Sibutramine?
Appetite suppressant
NOT recommended for treatment of obesity
What is Liraglutide?
Glucagon-like-peptide- 1 (GLP-1) receptor agonist
(Appetite suppressant)
Can Orlistat be given to children under 12?
YES - but if physical comorbidities (orthopaedic problems/sleep apnoea) or severe psychological comorbidities
Describe the mechanism of action of Orlistat
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
What is the dose of Orlistat?
60mg TDS
What is prescribed Orlistat licensed in?
Ages 18-75 - adjunct in obesity
What is the BMI for prescribed Orlistat?
30
OR 28 with other risk factors (Type 2, hypertension, hypercholesterolaemia)
What is the adult dose of prescribed Orlistat?
120mg up to 3x/day
How is prescribed Orlistat to be taken?
Immediately before, during or up to 1hr after each main meal
Review at 12 weeks
If meal missed or contains no fat miss dose
When is prescribed Orlistat stopped?
If the target of >5% weight lost not lost
What must be done with Orlistat?
Additional contraceptive method
= may be lost in severe diarrhoea
What may be taken with Orlistat?
Multivitamin supplement taken at least 2hrs after Orlistat/bedtime
= potentially impair absorption of fat-soluble vitamins
What may Orlistat also be used for?
Maintain or reduce weight before surgery
What needs to be considered with Orlistat?
Affect absorption of administered oral drugs
What are some examples of interactions with Orlistat?
Coumarins = monitor INR
Levothyroxine = increased risk of hyperthyroidism
Antiepileptics = decrease absorption
Amiodarone = plasma conc reduced
Can you buy Orlistat OTC?
YES
What criteria must you meet to buy Orlistat OTC?
18 or older
BMI 28 or above
Taken with low fat diet
What is the treatment course for OTC?
NOT exceed 6 months
60mg 3x/day
How do you take OTC Orlistat?
Taken with water immediately before, during or up to one hour after each main meal
If meal missed or contains no fat dose missed
What is contraindicated with OTC Orlistat?
People taking ciclosporin + anticoagulants
People with chronic malabsorption syndrome + cholestasis
Pregnant/breast-feeding
What are the common side effects of Orlistat?
Abdominal distension
Abdominal pain
Anxiety
Faecal incontinence
Faecal urgency
Flatulence
Headaches
Liquid stools
Leakage from rectum
What is the BMI needed for Liraglutide?
30
BUT 27 if Type 2, hypertension, dyslipidaemia or sleep apnoea
How do GLP-1 agonists work?
Decrease appetite
Decrease gastric emptying = feeling fuller for longer
What is the criteria for bariatric surgery?
BMI over 40
BMI 30-40 if Type 2, hypertension, ect.
All non-surgical options tried
Fit for surgery + anaesthetic
What happens in bariatric surgery?
Part of stomach is excised + sometimes part of small intestine
= reduces amount can be eaten
= weight lost
What may be the problem with a shorter GI tract?
Alter drug absorption
