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ABOM 2023 > Treatment > Flashcards

Treatment Flashcards

1
Q

What are the three phases of chronic disease prevention in application to obesity?

A

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.

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2
Q

What BMI is approved for Laparoscopic adjustable gastric banding (LAGB)

A

BMI of 30 kg/m2 with an obesity comorbidity

has the lowest mortality rate.
considered least invasive surgical option.

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3
Q

Vertical sleeve gastrectomy (VSG) should be considered in patients with the following comorbdities…

A

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.

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4
Q

What are the contraindications to AspireAssist Device?

A
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5
Q

AspireAssist aspiration device is FDA approved for…

A

long-term weight management in adults aged >22 years old with a BMI 35-55 kg/m2

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6
Q

Fiber benefits are…

A

Improve blood glucose levels

Reduce total cholesterol.

Reducing LDL cholesterol

Improving satiety
decreasing constipation (via stool-bulking)

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7
Q

Describe the different presentations of Thiamine (B1) deficiency

A

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.

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8
Q

Contraindications for Phentermine/Topiramate ER (QSYMIA)?

A

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.

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9
Q

Bariatric surgery is approved for what BMI in type 2 diabetics who are difficult to control?

A

BMI >30 kg/m2 with inadequate glycemic control, despite optimal medical therapy and lifestyle changes.

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10
Q

In the general population regardless of comorbidities metabolic surgery is recommended for what BMI cutoff?

A

> 35 kg/m2

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11
Q

Side effects of Topiramate

A

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

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12
Q

Mechanism of action for Orlistat

A

Pancreatic lipase inhibitor, prevents absorption of about 30% of ingested fat.

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13
Q

This medication can increase risk of seizures with abrupt withdrawal

A

Topiramate

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14
Q

BMI criteria for starting weight loss medications?

A

BMI ≥ 30 or BMI ≥ 27 with co-morbidities

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15
Q

The best weight loss med for patients who also have Migraines

A

Topamax

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16
Q

Weight loss medication to avoid in patients with history of bulimia or anorexia

A

Bupropion

17
Q

This medication is probably the least effective as far as average weight loss

A

Orlistat

18
Q

What are the approved uses for Setmelanotide?

A

Approved use in Pomc gene mutation, PCSK1 gene deficiency, LEPR, BBS

19
Q

Mechanism of Setmelanotide

A

MC4R agonist usually used for treatment of POMC Def

19
Q

Systemic absorption of this medication is minimal

A

Orlistat

20
Q

How do you treat POMC deficiency

A

Setmelanotide

21
Q

Contraindications for Lorcaserin

A

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

22
Q

Systemic absorption of this medication is minimal

A

Orlistat

23
Q

Bariatric surgery is recommended for which patient demographic?

A

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.

24
Q

Which bariatric surgery is also effective in decreasing gastroesophageal reflux disease symptoms?

A

Roux-En-Y gastric bypass

25
Q

What are FDA approved obesity medicines in ESRD?

A

Orlistat, semaglutide, and liralgutide can be used in selected patients with cation. Cellulose and citric acid hydrogel is not systemically absorbed and thus approved at any GFR.

26
Q

What is the only FDA approved pharmacologic treatment for binge eating disorder?

A

Lisdexamfetamine, it is a central nervous stimulant

27
Q

Mechanism of action of phentermine

A

Activates TAAR1 in monoamine neurons which releases norepinephrine. Leads to decreased perception of hunger and thus, weight loss.

28
Q

What are the side effects of phentermine?

A

Insomnia, constipation, xerostomia, and tachycardia

29
Q

True or false: All bariatric surgeries require a minimum of 2 daily multivitamins

A

False: laparoscopic adjustable gastric banding requires one adult daily MVI

30
Q

After any bariatric surgery what is the minimum daily vitamin recommendation for vitamin D?

A

Vitamin D 2000-3000 IU daily

31
Q

After bariatric surgery what is the minimum daily vitamin recommendation for Iron?

A

18 mg in men and 60 mg in menstruating females

32
Q

True or False: All bariatric surgeries require a minimum of 1200-1500 mg of calcium daily

A

False: BPD/DS & SADI-S require Calcium 1800-2400 mg daily

33
Q

What is the preferred weight loss medicine in obese patients who may also smoke, have depression, and/or seasonal affective disorder?

A

Bupropion

34
Q

What needs to be monitored when starting bupropion?

A

blood pressure

35
Q

Which bariatric surgery has the most significant diabetes remission?

A

SADI-S

36
Q

List bariatric surgeries from highest to lowest weight loss seen.

A
37
Q

This medicine is used in a combination anti-obesity medication, but is ineffective alone in causing weight loss

A

Naltrexone

ABOM 2023 (4 decks)

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