4. Obesity + Obesity PHARM

Question 1

Lorcaserin: how does it work?

Answer 1

agonist at the 5HT2C receptor. activates POMC, which causes MSH increase, activates melanocortin 4 receptor, incr satiety

Question 2

Lorcaserin: route? dose?

Answer 2

Oral. standard dose (hard to individualize)

Question 3

Lorcaserin: how quickly does wt loss occur?

Answer 3

weight loss evident at 2 wks

Question 4

Lorcaserin: key effects aside from wt loss?

Answer 4

decr HTN, decr triglycerides, decr fasting insulin, decr glucose measures (both fasting and HbA1c)

Question 5

Lorcaserin: adverse effects? how long do these effects persist?

Answer 5

sort of like a mild flu. URI, HA, dizziness, nausea, dry mouth, constipation. these effects decline after approx 1 yr of use.

Question 6

Lorcaserin: indicated for weight loss and what else?

Answer 6

maintenance of wt loss.

Question 7

Phentermine + Topiramate: dose? route?

Answer 7

Oral. titrated dose. easier to control SEs for individual patients

Question 8

Phentermine: general effect?

Answer 8

sympathominetic: sim to amphetamine. increases release of NE and DA in hypothal. effect is reduced appetite.

Question 9

Topiramate: drug class? general effect?

Answer 9

anticonvulsant, migraine prophylaxis. unclear mechanisms but general effect is to increase energy expenditure, decrease efficiency, decrease food intake

Question 10

Phentermine + Topiramate: AEs?

Answer 10

think sympathetic response. paresthesias, dry mouth, constipation, dysgeusia (altered taste), anxiety, insomnia, Preg X (teratogenic)

Question 11

what are definitions of Obese I, Obese II, Morbid/extreme Obesity?

Answer 11

Obese 1: BMI 30-34
Obese II: BMI 35-39
Morbid/Extreme: BMI 40+ OR ideal wt + 100#

Question 12

a 5% increase in BMI leads to what incr in overall mortality?

Answer 12

each 5% incr in BMI is a 30% incr in overall mortality.

Question 13

what is the worst kind of fat? what is it associated with?

Answer 13

visceral fat. associated with incr diabetes, HTN, cardiovasc disease, hyperlipidemia (independent of BMI)

Question 14

what are the healthy limits for waist circumference?

Answer 14

Men: 40 inches
women: 35 inches

Question 15

major causes of obesity?

Answer 15

behavior/lifestyle, neuroendocrine, genetic, pharm agents

Question 16

list the neuroendocrine causes of obesity (there are 6 that she mentioned)

Answer 16

• hypothalamic damage
• Cushing’s
• hypothyroid
• PCOS
• hypogonad
• Growth Hormone deficiency

Question 17

how does hypothalamic damage lead to obesity?

Answer 17

damage to the arcuate nucleus (ventromedial hypothalamus) leads to hyperphagia and obesity. basically damage to the structure that regulates appetite.

Question 18

Describe Cushing’s. what causes it?

Answer 18

cause = increased cortisol levels. central obesity of abdomen, trunk.

Question 19

how does hypothyroidism lead to obesity?

Answer 19

causes slowed metabolic activity. usually modest effect on obesity

Question 20

how does PCOS lead to obesity?

Answer 20

not known. but 50% of women with PCOS are obese

Question 21

how does hypogonadism lead to obesity?

Answer 21

menopause is associated with increased obesity and a shift toward abdominal distribution of fat.

Question 22

how does growth hormone deficiency lead to obesity?

Answer 22

causes an increase in abdominal and visceral fat

Question 23

what does agouti protein do? what does it compete with? where does it act?

Answer 23

increases appetite. competes with melanin-stim hormone (MSH). acts in hypothalamus. since it competes with MSH, it causes light colored mice

Question 24

what does MSH do? where does it act?

Answer 24

acts in hypothalamus. inhibits appetite.

Question 25

what does Neuropeptide Y do? where does it act? does loss of the gene have an effect?

Answer 25

incr appetite *significantly*. acts in hypothalamus. loss of gene or receptor doesn't cause weight loss.

Question 26

what neural structure regulates appetite?

Answer 26

proteins and neurotransmitters in the arcuate nucleus of the hypothalamus

Question 27

what does leptin do?

Answer 27

signals whether fat stores are adequate for growth and reproduction.

Question 28

what will a low level of leptin do? high level?

Answer 28

low: will increase appetite. leptin is a STOP sign for appetite: if there is enough body fat, appetite is not increased. but high levels of leptin do not decrease appetite.

Question 29

ghrelin: what does it do?

Answer 29

increases appetite

Question 30

what are the 3 categories of bariatric surgery? what is most effective?

Answer 30

- restrictive/banding - malabsorptive - combination (most effective)

Question 31

describe restrictive bariatric surgery?

Answer 31

creates small pouch for food, restricts volume of intake, increases satiety while allowing normal nutrient absorption.

Question 32

describe malabsorptive bariatric surgery?

Answer 32

surgical alteration of the intestinal tract. food bypasses portions of the small int.

Question 33

what are some complications of bariatric surgery?

Answer 33

nutrient deficiencies, gallstones, wound infection, dumping syndrome (stomach does not digest food adequately before it gets to small int).