Weight loss treatment / meds and surgery

Question 1

Safest med?

Answer 1

Orlistat

Question 2

Naltrexone / buproprion side effect?

Answer 2

seizure

suicidal ideation

Question 3

Phentermine

Phentermine / topiramate side effect?

Answer 3

blood pressure
tachy

contraindicated in CV issues

Question 4

BMI category for Diet/PA treatment?

Answer 4

27+
or
25 with co-morbidity

Question 5

BMI category for Pharmacotherapy treatment?

Answer 5

30+
or
27 with co-morbidity

Question 6

BMI category for Surgical treatment?

Answer 6

40+
or
35 with co-morbidity

Question 7

PHENTERMINE

What does it do?

Answer 7

Increases NE content in the brain - chemically related to amphetamine but not addictive

Question 8

PHENTERMINE

Benefit?

Answer 8

Cheapest option (15-25/mo)

Question 9

PHENTERMINE
FDA approval?
Weight loss?

Answer 9

3 month approval

5-8% WL

Question 10

PHENTERMINE

Side Effects?

Answer 10

hypertension
headache
nervousness

Question 11

Orlistat

What?

Answer 11

Pancreatic lipase inhibitor
inhibits fat absorption by 30%
100$/mo

consider MVI to prevent fat soluble vitamin deficiency

Question 12

ORLISTAT

BENEFIT? 5-8%

Answer 12

SAFEST - good choice for those who have poorly controlled HTN (avoid phentermine) or psychiatric problemos (avoid bupropion/naltrexone)

Question 13

Lorcasarin

What?

Answer 13

Serotonin 2-C receptor agonist (only in brain so no cardiac valve SE)

Question 14

Lorcasarin - 4-5%

Benefit

Answer 14

Least side effects (note that side effect and safety are not synonymous)

Question 15

Phentermine/Topiramate

What?

Answer 15

Combination gives greater efficacy with fewer SE

Question 16

Phentermine/Topiramate

SE

Answer 16

Dry mouth 
paraesthesias
insomina
dizzy
anxious
irritable 
disturbed attention

NOTE may be teratogenic - no preggos

Question 17

Phentermine/Topiramate

BENEFIT?

Answer 17

Most effective medication available 10 - 12% weight loss

Question 18

Naltrexone / Bupropion
What does B do?
What does N do?

EFFECTIVENESS?

Answer 18

B stimulates POMC neurons (alphaMSH)

N blocks opioid receptor-augmenting POMC effect?

Intermediate effectiveness and SEs

Question 19

Naltrexone / Bupropion SEs?

Answer 19

HTN
PULSE
Lower seizure threshold
suicide ideation

Question 20

Is diet of medication better?

Answer 20

COMBO!

Question 21

Which med is most perscribed

Answer 21

Phentermine - least expensive :) but not approved for LTU

Question 22

Lap Band
weight loss
mortality
complication

Answer 22

20% WL
Very low mortality
1% serious comp
2.4% any comp

Question 23

Sleeve Gastrectomy
weight loss
mortality
complciation

Answer 23

25% WL

0. 1% mortality
1. 4% serious comp
2. 3% any comp

Question 24

Gastric bypass
weight loss
mortality
complication

Answer 24

30% weight loss
0.2% mortality
2.5% serious comp
10% any comp

Question 25

What happens to Grehline after Gastric bypass

Answer 25

plummet and do not vary

Question 26

Bariatric surgery is associated with reduced mortality from (2)

Answer 26

MI

Cancer

Question 27

Benefits of Bariatric surgery in T2DM?

Answer 27

Bypass 
42% has HbA1C below 6 wihtout meds after 1 year
compared with 
27% sleeve
0% medical (none)

Question 28

Risk of bariatric surgery?

Answer 28

Bypass
Death - 0.7% within 30days ; 2-3% within 2 years

Lap band 0.1%

failure to yield WL (10-15%)

PE

Anastamotic leaks / sepsis

Thiamin deficiency - early vomiting, Wernike Korsakoff

Question 29

LATE Risk Bypass surgery?

Answer 29

B12 deficiency - 30% complication 1-9 years post-op

Fe deficiency

CALCIUM / VITD

Question 30

What is the most effective treatment for obestiy?

Answer 30

BS

Question 31

What is the best treatment for T2DM

Answer 31

BS

Question 32

Does BS just lower food intake?

Answer 32

no, it is neurohormonal