Weight loss treatment / meds and surgery Flashcards
Safest med?
Orlistat
Naltrexone / buproprion side effect?
seizure
suicidal ideation
Phentermine
Phentermine / topiramate side effect?
blood pressure
tachy
contraindicated in CV issues
BMI category for Diet/PA treatment?
27+
or
25 with co-morbidity
BMI category for Pharmacotherapy treatment?
30+
or
27 with co-morbidity
BMI category for Surgical treatment?
40+
or
35 with co-morbidity
PHENTERMINE
What does it do?
Increases NE content in the brain - chemically related to amphetamine but not addictive
PHENTERMINE
Benefit?
Cheapest option (15-25/mo)
PHENTERMINE
FDA approval?
Weight loss?
3 month approval
5-8% WL
PHENTERMINE
Side Effects?
hypertension
headache
nervousness
Orlistat
What?
Pancreatic lipase inhibitor
inhibits fat absorption by 30%
100$/mo
consider MVI to prevent fat soluble vitamin deficiency
ORLISTAT
BENEFIT? 5-8%
SAFEST - good choice for those who have poorly controlled HTN (avoid phentermine) or psychiatric problemos (avoid bupropion/naltrexone)
Lorcasarin
What?
Serotonin 2-C receptor agonist (only in brain so no cardiac valve SE)
Lorcasarin - 4-5%
Benefit
Least side effects (note that side effect and safety are not synonymous)
Phentermine/Topiramate
What?
Combination gives greater efficacy with fewer SE
Phentermine/Topiramate
SE
Dry mouth paraesthesias insomina dizzy anxious irritable disturbed attention
NOTE may be teratogenic - no preggos
Phentermine/Topiramate
BENEFIT?
Most effective medication available 10 - 12% weight loss
Naltrexone / Bupropion
What does B do?
What does N do?
EFFECTIVENESS?
B stimulates POMC neurons (alphaMSH)
N blocks opioid receptor-augmenting POMC effect?
Intermediate effectiveness and SEs
Naltrexone / Bupropion SEs?
HTN
PULSE
Lower seizure threshold
suicide ideation
Is diet of medication better?
COMBO!
Which med is most perscribed
Phentermine - least expensive :) but not approved for LTU
Lap Band
weight loss
mortality
complication
20% WL
Very low mortality
1% serious comp
2.4% any comp
Sleeve Gastrectomy
weight loss
mortality
complciation
25% WL
- 1% mortality
- 4% serious comp
- 3% any comp
Gastric bypass
weight loss
mortality
complication
30% weight loss
0.2% mortality
2.5% serious comp
10% any comp
What happens to Grehline after Gastric bypass
plummet and do not vary
Bariatric surgery is associated with reduced mortality from (2)
MI
Cancer
Benefits of Bariatric surgery in T2DM?
Bypass 42% has HbA1C below 6 wihtout meds after 1 year compared with 27% sleeve 0% medical (none)
Risk of bariatric surgery?
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
LATE Risk Bypass surgery?
B12 deficiency - 30% complication 1-9 years post-op
Fe deficiency
CALCIUM / VITD
What is the most effective treatment for obestiy?
BS
What is the best treatment for T2DM
BS
Does BS just lower food intake?
no, it is neurohormonal
