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N216 A/B > Obesity > Flashcards

Obesity Flashcards

1
Q

[Review] What do anabolic and catabolic mean?

A

Anabolic: synthesis (think “anabolic” steroids to build muscle)
Catabolic: breakdown (cats break things down)

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2
Q

[Review] What is BMR?

A

Basal metabolic rate: energy required for body maintenance.

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3
Q

What is the average BMR?

A

10kcal/lb.

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4
Q

What 2 factors decrease BMR?

A
  1. High adipose tissue.

2. Low muscle tissue.

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5
Q

Which 3 populations tend to have high adipose tissues (and subsequently, low BMR)?

A

Females (d/t estrogen).
Elderly.
Obese pts.

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6
Q

When would we see an increase in energy/BMR requirements?

A

Illness/infection.

Exercise.

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7
Q

What is the primary regulator of hunger?

A

The hypothalamus.

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8
Q

What is the primary hormone that stimulates hunger?

A

Ghrelin.

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9
Q

Where is ghrelin synthesized?

A

The stomach.

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10
Q

Besides ghrelin, what other hormone stimulates hunger?

A

Dopamine.

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11
Q

Which 2 chemical mediators stimulate the feeling of satiety?

A

CCK (cholecystokinin).

PPY (peptide YY).

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12
Q

Which hormone is considered the “opposite of ghrelin” because it stimulates satiety?

A

Leptin.

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13
Q

List 3 possible causes of low hunger drive.

A
  1. Sympathetic stimulation.
  2. Low iron.
  3. Meds.
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14
Q

What is the primary purpose of brown adipose tissue?

A

Thermogenesis for insulation.

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15
Q

Who has the highest % of BAT?

A

Infants.

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16
Q

Adults in _________ will have higher BAT.

A

Cold climates.

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17
Q

What are 3 purposes of white adipose tissue?

A

Energy.
Insulation.
Organ protection.

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18
Q

Breakdown of WAT for energy is stimulated by:

A

Lipase.

19
Q

List the 3 substances synthesized by WAT.

A

Leptin.
Adiponectin.
Cytokines.

20
Q

What are 4 functions of adiponectin?

A
  1. Suppress fatty acid influx into the liver.
  2. Increase fatty acid oxidation (breakdown).
  3. Enhances insulin function & glucose uptake.
  4. Anti-inflammatory.
21
Q

What are 3 outcomes of high WAT r/t the 3 substances synthesized by it?

A
  1. Decreased leptin BBB distribution & receptor binding d/t resistance.
  2. Decreased adiponectin synthesis & secretion.
  3. Increased cytokine levels (r/t #2).
22
Q

What is the major risk r/t leptin resistance?

A

Continuous weight gain: decreased stimulation of satiety = don’t feel full = overating.

23
Q

What are 3 potential outcomes of decreased adiponectin synthesis?

A
  1. Increased fatty acid deposition (VAT, fatty liver, hyperlipidemia).
  2. Insulin resistance.
  3. Inflammation & risk of pro-inflammatory diseases.
24
Q

Why is high WAT a risk factor for cardiac disease? (2)

A
  1. Dysfunctional angiogenesis.

2. Increased oxidative stress > atherosclerosis.

25
Q

List 3 environmental factors that can lead to excess fat accumulation.

A

Inactivity.
Increased sugar intake.
Overeating.

26
Q

What are 3 metabolic causes of excess fat accumulation?

A
  1. High estrogen/estradiol levels.
  2. Low testosterone levels.
  3. Impaired thyroid function.
27
Q

The bacterial phylum of Firmicutes affects caloric absorption by:

A

Increasing digestion: more nutrients digested means more can be absorbed & stored.

28
Q

The bacterial phylum of Bacteroides can:

A

Help decrease possible weight gain by decreasing absorption.

29
Q

Why can obesity cause conditions such as gastric reflux, urinary incontinence and obstructive sleep apnea?

A

Increased abdominal girth = increased pressure on thoracic, abdominal and pelvic regions & less space for other organs (stomach, bladder, lungs) to expand.

30
Q

Obesity carries a risk of drug-drug interactions with ________ drugs. Explain.

A

Lipophilic: fat attracts lipophilic drugs and stores them, so we will see increased half-life & decreased elimination = longer drug effects.

31
Q

What are 4 risks of obesity in pregnant women?

A
  1. Gestational diabetes.
  2. Gestational HTN.
  3. Infertility.
  4. Large infant (& complicated delivery).
32
Q

What BMI is considered overweight? What BMI is considered morbidly obese?

A 
>25 = overweight.
>40 = morbidly obese.
33
Q

What waist circumferences in men and women would be indicators of obesity?

A

> 102 cm in men.

> 88 cm in women.

34
Q

List the 5 risks factors of metabolic syndrome.

A
  1. Large waist circumference.
  2. Elevated BP.
  3. Low plasma HDL.
  4. Elevated plasma triglycerides.
  5. Elevated fasting plasma glucose.
35
Q

Which 2 drug classes are helpful in treating obesity?

A

Lipase inhibitors.

Anorexiants.

36
Q

What is the mechanism of action for lipase inhibitors?

A

Prevent hydrolysis of fats = decreased absorption & increased excretion.

37
Q

Orlistat (Xenical) is pregnancy category:

A

X.

38
Q

What is the mechanism of action for anorexiants?

A

Stimulating the SNS to increase BMR.

39
Q

List 3 side effects of lipase inhibitors.

A
  1. Decreased lipophilic med/vitamin absorption.
  2. Fecal fat leakage.
  3. GI bloating & flatulence.
40
Q

Lipase inhibitors are effective for up to ____ of ingested fats.

A

30%.

41
Q

What is the prototype drug for lipase inhibitors?

A

Orlistat (Xenical).

42
Q

What is the prototype drug for anorexiants? What is it a combo of?

A

Contrave: combo of Biproprion + Naltrexone.

43
Q

What is bariatric surgery?

A

Creation of a gastric pouch to decrease stomach size and limit food intake/absorption.

44
Q

What should be monitored in patients who have undergone bariatric surgery? Why?

A

Vitamin & electrolyte levels: since we cut some of the duodenum out (where vitamins & electrolyes are absorbed), pt may be at a deficit.

N216 A/B (26 decks)

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