simple 45- overweight Flashcards
medical conditions which might predispose patients to secondary obesity
Cushing’s
Hypothyroidism
Hypogonadism
Ask about symptoms of medical conditions associated with obesity, including symptoms of cardiovascular disease.
Sleep apnea (snoring, fatigue, and morning HA)
Cardiovascular disease (chest pain or dyspnea)
Cerebrovascular disease (vision change, neuro deficits)
Peripheral vascular disease (claudication)
xanthelasma
Plaques or nodules composed of lipid-laden histiocytes on eyelids
hypoercholestolemia
Findings of vascular disease:
Carotid bruits
Diminished peripheral pulses
Hypertension
Increased abdominal aortic size
the diameter of a normal abdominal aorta should be less than
2 cm
retinal hemorrhages with pale centers, typically seen in bacterial endocarditis
roth spots
Obesity Evaluation for Co-Existing Risk Factors
DM: HgbA1C or fasting blood glucose
USPSTF strongly recommends screening for lipid disorders
men > 35 years old
women > 45 years old if they are at increased risk for coronary heart disease
There are four groups of patients who are most likely to benefit from statin therapy:
Current ASCVD
LDL cholesterol > 190 mg/dL
Diabetes (type 1 or 2) age 40-75 years
Estimated 10-year ASCVD risk by Pooled Cohort Equations > 7.5%.
Causes of Secondary Dyslipidemias
DM2: hypertriglyceridemia and low HDL cholesterol.
Cholestatic or obstructive liver disease, such as primary biliary cirrhosis: elevated total cholesterol levels.
Nephrotic syn: high serum total and LDL and triglyc.
Hypothyroidism: hypercholesterolemia and hypertriglyceridemia.
Acute hepatitis : hypertriglyceridemia.
Alcohol : hypertriglyceridemia.
meds that can cause modest changes in lipids
Thiazide diuretics, beta blockers, and oral estrogens and protease inhibitors
statin positive effects
stabilize existing plaques, decreasing the risk of plaque rupture and myocardial infarction decrease CHD and all-cause mortality decrease LDL by 18% to 55% increase HDL by 5% to 15% decrease triglycerides by 7% to 30%
Bile acid sequestrants, such as cholestyramine effects
modest lower LDL and raise HDL
but raise triglycerides
GI distress, constipation
Niacin effects
*increase HDL, modest LDL, tri decrease
flushing
first-line therapy for reducing triglycerides
Fibric acid derivatives
Ezetimibe MOA
inhibits absorption of cholesterol at the intestinal brush border and increases cholesterol clearance.
decreases LDL
moderate vs high dose of statin difference
Moderate: lower LDL cholesterol by 30- < 50%
High: lower LDL cholesterol by > 50%
High intensity therapy is recommended for:
patients ≤ 75 years of age with clinical ASCVD and no safety concerns
those with LDL cholesterol > 190 mg/dL
diabetics aged 40-75 with estimated 10-year ASCVD risk of > 7.5%
Moderate intensity therapy is recommended for:
patients > 75 years of age with clinical ACSVD
diabetics aged 40-75 with estimated 10-year ASCVD risk of < 7.5%
patients for whom high-dose therapy would be recommended but who are not candidates for high-intensity statins.
What caloric deficit is needed to lose one pound of body weight?
3500 calories
Oral drug therapy for obesity indications
All weight loss medications approved by the FDA are indicated for patients with BMI > 30;
most are also indicated for patients with BMI > 27 with at least one obesity-related comorbidity such as hypertension or diabetes.
Phentermine
Diethylpropion
Pendimetrazine
Benzphetamine
Noradrenergic appetite suppressant
Indicated for short-term (a few weeks) only
Orlistat MOA
Gastrointestinal lipase inhibitor
Decreases fat absorption
Lorcaserin MOA
Highly selective serotonergic receptor agonist appetite suppressant
Associated with hypoglycemia in diabetic patients
Qsymia (combination of phentermine and topiramate) MOA
Acts via multiple pathways to suppress appetite
Contrave (naltrexone/bupropion)
for obesity
bariatric surgery indications
Patients with BMI > 40 or BMI ≥ 35 with associated severe health complications who have not succeeded in losing weight with other treatment methods.
bariatric surgery options
Gastric bypass-partitioning of the stomach with attachment of the proximal stomach to the jejunum
Adjustable gastric banding-placement of an inflatable, adjustable band around the stomach
Vertical banded gastroplasty-partial partitioning of the proximal stomach with placement of a small, fixed-diameter gastric outlet stoma
