Burkin: Obesity & Satiety Drugs Flashcards
(45 cards)
Over (blank)% of adults are overweight or obese
66%
Think about some complications of obesity…
sex hormone imbalance
increased free fatty acids –> dyslipidemia, insulin resistance, hypertension
physical stress –> sleep apnea, osteoarthritis, lower back pain, SOB
QOL –> low self esteem, anxiety, disordered eating
Appetite stimulating neurons are called (blank). Here are some examples…
orexigenic; Ghrelin, AgRP, NPY, Orexin
Appetite suppressing neurons are called (blank). Here are some examples…
anorexigenic; leptin, insulin, CCK, CRH, POMC, CART, PYY
These increase insulin secretion from the pancreas
incretins
What is glucostatic hypothesis involving short term hunger regulation
blood glucose levels are critical to hunger –> when blood glucose drops, this signals the hypothalamus to generate a “hunger” sensation to trigger eating behavior
In long term hunger regulation, declines in the amount of stored (blank) might function as orexigenic signals. Also the ratio of utilizing (blank):(blank) is involved
glycogen; carbohydrate:lipid
(List the hormones) bind receptors on orexigenic or anorexigenic neurons in the arcuate nucleus of the hypothalamus. Ultimately, this sends signals that cause changes in sensations of (blank) or (blank)
Ghrelin (stomach), leptin (adipose tissue), insulin (pancreas), PYY (small intestine);
hunger; satiety
In response to hunger, mechanoreceptor responses are transmitted along the (blank) nerve to the dorsal vagal complex in the medulla and terminating in the (NTS)
vagus
What is the difference between hunger & appetite
hunger = motivation for eating behavior
appetite = desire to eat even if there is no physiological reason
Weight loss is achieved by reducing the size of the stomach
Improvement in short term cardiovascular risk factors and reduction in mortality from 23% to 40%
Bariatric surgery
When is bariatric surgery warranted?
pts with BMI greater than 40
have tried adequate diet/exercise, but failed
present with obesity related comorbid condition
resecting and re-routing the small intestine to a small stomach pouch
gastric bypass
removal of a portion of the stomach
sleeve gastrectomy with duodenal switch
device similar to a heart pacemaker is implanted
electrical leads stimulate the external surface of the stomach
interpreted by the brain to give a sense of satiety
gastric band
What are some complications of bariatric surgery?
gastric dumping syndrome (20%) --> ingested foods bypass the stomach rapidly & enter the intestine largely undigested leaks at surgical site (12%) incisional hernia (7%) infection pneumonia
The vagus nerve stimulator is involves wire leads & electrodes that send intermittent electric pulses to the vagus nerve. What are some indications for the vagus nerve stimulator?
over 18yo
BMI 35-40
at least one other obesity-related condition
What are some serious adverse events that occur with vagus nerve stimulators?
nausea pain at neuroregulator site vomiting surgical complications pain heartburn problems swallowing
When are weight loss medications indicated?
BMI greater than 30 without obesity related risk factors
BMI greater than 27 with obesity related risk factors or disease
What was phen-fen & why was it withdrawn?
highly effective appetite suppressant, agonist at 5HT2c receptors; withdrawn due to high rates of valvular heart disease and pulmonary hypertension
What is phentermine? How does it work?
it is an amphetamine derivative - it increases NE, 5HT, and DA levels in the hypothalamus –> increases sympathetic tone
When is phentermine used?
for short term management of exogenous obesity (few weeks)
Used in conjunction with exercise & caloric restriction
Side effects of Phentermine?
dry mouth insomnia costipation headache rapid heartbeat dizziness
Adverse effects of Phentermine?
CNS: impaired alertness or physical coordination Pulmonary HTN Valvular heart disease Tolerance may develop w/i a few weeks Potential for abuse or addiction
