Treatment Flashcards
What are the three phases of chronic disease prevention in application to obesity?
Primary prevention —> Prevent the development of overweight and obesity through education, environment, and promoting healthy eating and regular physical exercise.
Secondary prevention —> Prevent future weight gain and the development of weight related complications in patients with excess weight or obesity by initiating lifestyle and behavioral intervention, which may or may not include pharmacological therapy.
Tertiary prevention —> Target weight loss to eliminate or mitigate weight-related complications and prevent disease progression by initiating lifestyle/behavioral interventions, weight loss medications, and or potentially considering metabolic surgery.
What BMI is approved for Laparoscopic adjustable gastric banding (LAGB)
BMI of 30 kg/m2 with an obesity comorbidity
has the lowest mortality rate.
considered least invasive surgical option.
Vertical sleeve gastrectomy (VSG) should be considered in patients with the following comorbdities…
Patients that are more chronically ill, including those with obesity related comorbidities such as pulmonary hypertension and heart failure with preserved ejection fraction due to shorter anesthesia times.
Recurrent renal stones: malabsorptive procedures increase oxalate absorption.
Risk of severe nutritional deficiencies
Organ transplant patients including those on chronic immunosuppression or those requiring critical medications that require adequate absorption.
What are the contraindications to AspireAssist Device?
AspireAssist aspiration device is FDA approved for…
long-term weight management in adults aged >22 years old with a BMI 35-55 kg/m2
Fiber benefits are…
Improve blood glucose levels
Reduce total cholesterol.
Reducing LDL cholesterol
Improving satiety
decreasing constipation (via stool-bulking)
Describe the different presentations of Thiamine (B1) deficiency
Presentations vary by chronicity, the most common are:
Wet beriberi: high output CHF, including cardiomegaly, cardiomyopathy, peripheral edema, and tachycardia
Dry beriberi: symmetric peripheral polyneuropathy (sensory and motor), primarily affecting the distal extremities.
Wernicke’s encephalopathy: Ataxia, nystagmus, ophthalmoplegia, and confusion; considered reversible.
Korsakoff syndrome: irreversible, a chronic neurological condition characterized by impaired short-term memory and confabulation.
Contraindications for Phentermine/Topiramate ER (QSYMIA)?
hypersensitivity to phentermine or other formulary components, concurrent MAOI use, hyperthyroidism, Glaucoma, and pregnancy
Avoid in those with renal calculus history, CAD, and severe anxiety.
Bariatric surgery is approved for what BMI in type 2 diabetics who are difficult to control?
BMI >30 kg/m2 with inadequate glycemic control, despite optimal medical therapy and lifestyle changes.
In the general population regardless of comorbidities metabolic surgery is recommended for what BMI cutoff?
> 35 kg/m2
Side effects of Topiramate
Change in taste (primarily soda): due to carbonic hydrase inhibition
Also causes non anion gap metabolic acidosis with hyperchloremia
Dizziness
Drowsiness
Forgetfulness
Paresthesias (transient and seen in ~30%of patients)
Nausea
Abdominal pain
Diarrhea
Mechanism of action for Orlistat
Pancreatic lipase inhibitor, prevents absorption of about 30% of ingested fat.
This medication can increase risk of seizures with abrupt withdrawal
Topiramate
BMI criteria for starting weight loss medications?
BMI ≥ 30 or BMI ≥ 27 with co-morbidities
The best weight loss med for patients who also have Migraines
Topamax
Weight loss medication to avoid in patients with history of bulimia or anorexia
Bupropion
This medication is probably the least effective as far as average weight loss
Orlistat
What are the approved uses for Setmelanotide?
Approved use in Pomc gene mutation, PCSK1 gene deficiency, LEPR, BBS
Mechanism of Setmelanotide
MC4R agonist usually used for treatment of POMC Def
Systemic absorption of this medication is minimal
Orlistat
How do you treat POMC deficiency
Setmelanotide
Contraindications for Lorcaserin
Taking an antidepressant, eGFR <30, on viagra, sickle cell (predisposes to priapism), or valvular heart disease
Now discontinued by the FDA for increased cancer risk
Systemic absorption of this medication is minimal
Orlistat
Bariatric surgery is recommended for which patient demographic?
Patients with a BMI > 40 kg/m2 (or > 35 kg/m2 with comorbidities) who have seen minimal results with lifestyle changes, a multidisciplinary team, and pharmacotherapy.
OR
BMI > 35 kg/m2 (or > 30 kg/m2 with obesity-related comorbidity (E.g., HTN, DM, DL, OSA, nonalcoholic fatty liver disease, GERD) based on the updated guidelines from the American society of metabolic and bariatric surgery and the International Federation for the surgery of obesity and metabolic disorders.
