Pharmacology

Question 1

What are 2 sources of satiety signals?

Answer 1

Leptin from adipose tissue to hypothalamus

CCK from gut via vagus nerve to hypothalamus

Question 2

What are 3 ways we can get leptin resistance in obesity?

Answer 2

• Transporters saturated
• Decrease in hypothalamus receptor sensitivity
• Decrease in 2nd messengers in hypothalamus sensitivity

Question 3

What is the mechanism of phentermine?
For what BMI and for how long is it used?
What are some side effects?
What drug is being added to it in the USA?

Answer 3

Increases NA availability (acts like amphetamine) to suppress appetite
If BMI>30 for less than 12 weeks
Side effects; increase BP, HR, insomnia, anxiety
As still effects DA can get dependence and mild euphoria so have to watch carefully
Topiramate added to increase half life

Question 4

What is the mechanism of Orlistat?
For what BMI and for how long is it used?
What are some side effects?

Answer 4

Inhibits gastric and pancreatic lipase to decrease fat absorption
BMI >30 and can be used long term, have to take with each meal
Side effects; GI related; fat leakage, diarrhoea.
Decreases absorption of fat soluble vitamins so have to take them

Question 5

Why is glucagon like peptide used for diabetes and obesity in USA?

Answer 5

• Decreases glucagon
• Increases insulin sensitivity
• Suppresses appetite

Question 6

What is the mechanism and action of sulfonylureas

What are 2 adverse affects?

Answer 6

• Increases insulin secretion in B cells by inhibiting K channels.
• Hypoglycemia and weight gain

Question 7

What drug is in the class biguanides?
What is its mechanism of action?
What are some adverse effects?

Answer 7

Metformin
- Activates AMP kinase to increase insulin mediated glucose uptake in periphery, also decreases hepatic glucose production, decreases LDL, TG and less CHO absorption
GI disturbances and possible weight loss

Question 8

What is the mechanism of alpha-glucosidase inhibitors?

What are some adverse affects?

Answer 8

• block the enzymes that digest and promote absorption of starch in SI
• abdominal discomfort and loose stools

Question 9

How do both mimicking and stopping the break down of incretins help with type 2 DM?
What are some adverse effects of both drugs?

Answer 9

• GLP-1 agonist and dipeptidyl peptidase 4 inhibitors (stops breakdown) cause increased incretin action to increase insulin release for B cells and decrease glucagon release from a-cells
• GLP-1 can cause weight loss and nausea, vomiting and diarrhoea
• DP4 can cause URT infections and pancreatitis

Question 10

What drug slows glucose reabsorption?

Answer 10

Sodium glucose cotransporter 2 inhibitors