Burkin > Obesity & Satiety Drugzzz Flashcards
(162 cards)
1
Q
what % of adults are overweight or obese?
A
over 66%
2
Q
what are the 4 main categories of obesity complications?
A
- sex hormone imbalance
- increased FFAs
- physical stress
- decreased QoL
3
Q
what are the 3 BROAD manifestations of obesity complications in pts?
A
- inc mortality
- disability
- psychological FX
4
Q
define orexigenic
A
appetite stimulating
5
Q
name 4 examples of orexigenic compounds
A
- ghrelin
- AgRP
- NPY
- Orexin
6
Q
define anorexigenic
A
appetite suppressing
7
Q
name 3 anorexigenic compounds
A
leptin
insulin
incretins
8
Q
define satiety
A
feeling full
9
Q
what do incretins do?
A
increase insulin secretion from the pancreas
10
Q
how does the body modulate hunger & satiety in the “simple model”?
A
by sensing metabolic parameters
- blood glucose levels
- amts of stored fat
11
Q
what happens in a normal adult to achieve a close match btwn consumed foods & energy requirements?
A
control processes regulate eating behavior & metabolism of energy-rich molecules
12
Q
T/F: blood glucose levels are critical to hunger
A
true
13
Q
what detects a decrease in blood glucose (short term)?
A
liver
14
Q
what happens when there is a decrease in blood glucose (short term)?
A
the liver signals the hypothalamus & generates “hunger” sensations
15
Q
what 2 things might regulate hunger long-term?
A
- declines in the amt of stored glycogen = orexigenic
2. ratio of utilizing stored carb:lipid
16
Q
where is ghrelin?
A
stomach
17
Q
where is leptin?
A
adipose tissue
18
Q
where is insulin?
A
pancreas
19
Q
where is PYY?
A
small intestine
20
Q
where do ghrelin, leptin, insulin, & PYY bind?
A
receptors on orexigenic or anorexigenic neurons in the ARC of the hypothalamus
21
Q
which 2 molecules are orexigenic neuropeptides from the hypothalamus?
A
NPY
AgRP
22
Q
which 2 molecules are anorexigenic neuropeptides from the hypothalamus?
A
CART
alpha-MSH
23
Q
what is the ultimate effect of hormonal circuits involving the gut, fat, & brain?
A
change in the sensations of hunger or satiety
24
Q
Btwn meals, satiety signals (inc/dec) & hunger signals (inc/dec)
A
satiety signals decrease
hunger signals increase
25
when does the brain initiate responses to feeding?
before ingestion even starts
26
what does ingestion stimulate?
mechanoreceptors > distention & propulsion
27
how are mechanoreceptor responses transmitted (& to where)?
along the VAGUS NERVE
| to the dorsal vagal complex in the medulla, which ends in the NTS
28
where do NTS projections go & what do they do?
visceral sensory complex of the thalamus
| mediate the perception of satiety
29
what is hunger the motivation for?
eating behavior
30
what increases hunger?
low levels of energy-providing molecules in the body
31
eating reduces hunger, leading to (______)
satiety
32
what happens when food is readily available?
people eat when there is no physiological reason
33
what is it called when you have the desire to eat when there is no physiological need?
appetite
34
what are dieters doing?
attempting to bring eating behavior under cognitive control
35
how do you become obese?
when energy enters the body in greater quantities than are expended
36
how is most XS energy stored?
fat
37
where is most fat stored?
in adipocytes in subQ tissue & intraperitoneal cavity
| lesser extent: liver & other organs
38
when can new adipocytes differentiate from fibroblast-like precursors?
whenever they FEEL like it, MOM
39
T/F: obesity is assoc w/ increased NUMBER of adipocytes ONLY
FALSE
| NUMBER & SIZE!
40
what is the range for NORMAL BMI?
18.5 - 24.9
41
what BMI is considered underweight?
<18.5
42
what is the range for overweight BMI?
25 - 29.9
43
what is the range for Obese BMI?
>30
44
what is the BMI range for class I obesity?
30 - 34.9
45
what is the BMI range for class II obesity?
35 - 39.9
46
what is the BMI range for class III obesity (extreme obesity)?
= or > 40
47
what are 2 assessments besides BMI to evaluate obesity?
1. body fat content
| 2. index of intra-abdominal fat
48
how does body fat content measuring work?
skin fold thickness measured by calipers
49
How does the index of intra-abdominal fat work?
ratio of waist circumference to height
50
what are the cutoffs for body fat %?
males >20%
| females >30%
51
what are the cutoffs for intra-abdominal fat?
males >0.95
| females >0.8
52
how does bariatric surgery work?
reduce the size of the stomach to lose weight
53
T/F: bariatric surgery improves short term CVS risk factors & reduces mortality
TRUE
54
who can get bariatric surgery?
1. pts w/ BMI 40+
2. pts who have tried & failed adequate diet & exercise program (w/ or w/o drugs)
3. AND present w/ obesity-related comorbid crap (diabetes, HTN, etc)
55
what is gastric bypass?
resecting & rerouting the small intestine to a small stomach pouch
56
what is sleeve gastrectomy w/ duodenal switch?
removal of a portion of the stomach
57
what is gastric band?
implant a device similar to a pacemaker
electrical leads stimulate the ext surface of the stomach
brain interprets this as satiety
(NO THANK YOU)
58
what is the complication rate (%) in the first 6 mos of bariatric surgery?
40%
59
what is gastric dumping syndrome?
ingested foods bypass the stomach > enter the small int mostly undigested > small int expands too fast > fluid shifts into the gut lumen
60
what % of bariatric surgery pts have gastric dumping syndrome?
20%
61
what are the early sx of gastric dumping syndrome?
```
N/V
bloating
cramping
diarrhea
dizziness
fatigue
```
62
what are the late sx of gastric dumping syndrome?
weakness
sweating
dizziness
63
when do the early sx of gastric dumping syndrome start?
15-30 min (after a meal?)
64
when do the late sx of gastric dumping syndrome start?
1-3 hours (after a meal?)
65
other than gastric dumping syndrome, what are 4 other common complications of bariatric surgery?
1. leaks at surgical site
2. incisional hernia
3. infection
4. pneumonia
66
what are 2 uncommon complications of bariatric surgery?
osteopenia
secondary hyperparathyroidism
gallstones
impaired kidney fxn
67
who can get the vagus nerve stimulator?
over 18 yo
BMI 35-40
at least 1 other obesity-related condition
68
what is the vagus nerve stimulator?
wire leads & electrodes are surgically implanted in the abdomen > sends intermittent pulse to vagus nerve
69
what signals from the brain to the stomach does the vagus nerve involve?
1. gastric acid secretion
2. digestive enzyme secretion
3. gastric capacity
4. blood glucose
70
what % of vagus fibers go from the brain to the stomach?
20%
71
what % of vagus fibers go from the stomach to the brain?
80%
72
what signals from the stomach to the brain does the vagus nerve involve?
1. satiety (hunger)
2. satiation (fullness)
3. energy metabolism
73
how effective is the vagus nerve stimulator?
treatment group lost 8.5% more weight than control group & sustained the weight loss at 18 mos
74
what are the serious adverse FX assoc w/ vagus nerve stimulators?
```
NV
pain at neuroregulator site
surgical complications
heartburn
pain
trouble swallowing
belching
chest pain
```
75
what are the 4 classes of the NHLBI grading system for evidence?
Evidence A B C D
76
what is evidence A?
randomized controlled trials
| rich body of data
77
what is evidence B?
randomized controlled trials
| limited body of data
78
what is evidence C?
nonrandomized trials
| observational studies
79
what is evidence D?
expert panel consensus judgment
80
what evidence level is weight loss meds + diet + activity?
evidence level B
81
what are the indications for pts to start weight loss meds + diet + activity?
1. BMI > 30 w/o obesity-related risk factors or dz
| 2. BMI > 27 w/ obesity-related risk factors or dz
82
how often should you schedule follow ups for obese pts on weight loss meds + diet + activity?
2-4 weeks
then monthly for 3 mos
then every 3 mos for the first year
83
what are the 5 drugs that are FDA approved appetite suppressants?
1. phentermine
2. phentermine + topiramate aka Qsymia
3. phendimetrazine
4. lorcaserin/belviq
5. diethylproprion
(phen phen phen lor die)
84
what is Qsymia?
phentermine + extended topiramate
85
what drug is a metabolism accelerator?
fexaramine (in dvlpmnt)
86
which drugs are nutrient absorption blockers?
1. orlistat/xenical
| 2. beloranib (trial)
87
what is phen-fen?
phentermine + fenfluramine
| highly effective appetite suppressant
88
how is phen-fen an anorectic?
agonistic action of the metabolite norfenfluramine on 5-HT 2C receptors
89
why was phen-fen withdrawn?
high rates of valvular heart dz & pulmonary HTN
90
what 3 other drugs (besides phen-fen) were also withdrawn?
dexfenfluramine/redux
rimonabant (acomplia, zimulti)
sibutramine (meridia)
91
what is phentermine?
an amphetamine derivative
92
how does phentermine work?
increases 5-HT, noradrenaline, & DA levels in the brain
| increases NE in hypothalamus & increases sympathetic tone
93
what is phentermine approved for use as?
an adjunct to exercise, behavioral mods, & caloric restriction
94
why would you prescribe phentermine?
for SHORT TERM exogenous obesity management (a few weeks)
95
what are the top 10 side FX of phentermine in order from most reported to least reported? (sorry)
1. DRY MOUTH
2. insomnia
3. constipation
4. HA
5. dizziness
6. rapid HR
7. dysphoria (phen rage)
8. libido issues
9. urticaria
10. psychosis
96
what are the top 3 risks of phentermine use?
1. tolerance w/i a few weeks (that's why you use it short term)
2. impaired CNS
3. abuse/addiction potential
97
what side effects of phentermine can happen especially if you use it w/ another anorexigenic like fenfluramine?
valvular heart dz
| pulmonary HTN
98
what level of evidence is there to support Qsymia?
level 2
mid-level
(why not use the ABCD scale???)
99
what is topiramate?
sulfamated fructose derivate for addictive behaviors
100
T/F: Qsymia has a high drop-out rate
TRUE
101
what are the side FX of Qsymia?
paresthesia, dry mouth, constipation, dysgeusia
102
what pregnancy category is Qsymia?
D
| risk of cleft palate
103
are the effects of Qsymia specific to the hypothalamus?
nope
104
what is the mechanism of Lorcaserin/Belviq?
selective 5-HT 2C receptor agonist
105
what is the evidence level for Lorcaserin?
level 2
| mid-level
106
what is serotonin critical for?
CNS regulation of appetite & metabolism
107
T/F: serotonin increases satiety
TRUE
108
what are the side FX of Lorcaserin in pts w/o diabetes?
```
HA
dizziness
fatigue
nausea
dry mouth
constipation
```
109
what are the side FX of Lorcaserin in pts w/ diabetes?
```
hypoglycemia
HA
back pain
cough
fatigue
```
110
what are the uncommon but serious/potentially fatal side FX of lorcaserin?
serotonin syndrome
| attn & memory disturbances
111
what is serotonin syndrome?
```
mental status changes
autonomic instability
neuromuscular hyperactivity (esp if taken w/ SSRIs)
```
112
how long does it take for serotonin syndrome to manifest?
w/i minutes to hours
113
when should you discontinue use of lorcaserin?
if pt does not lose 5% of weight after 12 weeks
114
the safety & efficacy of lorcaserin beyond (?) years is unknown
2
115
which things should you NOT use lorcaserin w/?
SSRIs
MAOIs
dopamine antagonists
St. John's Wort
116
can you use Lorcaserin if you're pregnant?
NOPE
| it's category X
117
can you use Lorcaserin if you're nursing?
NOPE
118
what is diethylpropion (tenuate) a derivative of?
amphetamine
119
who should you use diethylpropion for?
obese women
120
Can you use diethylpropion long term?
NOPE
| short term only
121
T/F: you can only use diethylpropion as monotherapy
TRUE
122
how many times a day should you take diethylpropion?
3x daily 1 hour before meals
OR
1x daily (extended release)
123
what are the 3 most important side FX of diethylpropion?
insomnia
dry mouth
pulmonary HTN
124
what is the mechanism of phendimetrazine?
amphetamine derivative
anorexigenic d/t CNS stimulation
alpha-1 adrenergic receptor agonist
Na-dependent noradrenaline transporter antagonist
125
what is the most common side effect of phendimetrazine?
insomnia
126
how old do you have to be to take phendimetrazine?
12
127
does phendimetrazine have the same set of contraindications as the other phen drugs?
yup
128
what is the mechanism for orlistat?
reversible inhibitor of gastric & pancreatic lipases
| reduces trygly hydrolysis & fat absorption
129
is orlistat very effective?
"moderately effective"
130
what is the evidence level for orlistat?
level 2
| mid-level
131
what is the ONLY FDA-approved treatment for LONG TERM obesity??
ORLISTAT
132
what is the OTC form of orlistat?
alli
133
what is the RX form of orlistat?
xenical
134
what are the side FX of orlistat?
flatus w/ discharge (SHARTING???)
oily spotting
fecal urgency
fecal incontinence
135
how can you reduce the side FX of orlistat?
increase fiber intake
| decrease fat intake
136
what should your diet be like while you're taking orlistat?
well-balanced
| supplements of fat-soluble vitamins (ADEK)
137
what are the 4 contraindications of orlistat?
1. pregnancy category B
2. chronic malabsorption or cholestasis
3. do not give w/ cyclosporine
4. can cause serious liver injury
138
what is the mechanism of beloranib?
selective MetAP2 inhibitor to reduce lipid & cholesterol biosynth & increase fat oxidation & lipolysis
139
what is beloranib assoc w/?
RAPID weight loss
140
what 3 things also improve on beloranib?
lipids
CRP
adiponectin
141
where does fexaramine act?
specifically at intestinal FXR
142
how does fexaramine work on metabolic profiles?
makes them better
| glucose, insulin, leptin, cholesterol
143
how does fexaramine impact VO2?
increases VO2 consumption but has similar respiratory exchange ratios to placebo (suggests enhanced use of sugar & fat)
144
how does fexaramine impact body temp?
increases it
145
what do the induced metabolic responses do d/t fexaramine?
promote lipolysis
| mobilize fatty acids for oxidation
146
what does fexaramine do to cells in WAT?
browns them
| idk wtf this means
147
what 6 drugs are used off-label for obesity (hint: 2 are combos)
1. metformin
2. zonisamide
3. bupropion
4. bupropion + zonisamide
5. topiramate
6. naltrexone + bupropion
148
how much weight can you expect to lose on metformin?
only a small amount
149
what is metformin particularly useful for?
preventing weight gain assoc w/ antipsychotics
150
which off-label drug has level 1 evidence?
zonisamide
151
which drug is good for overweight or obese women w/ a binge eating disorder?
bupropion
152
what pt population does zonisamide improve weight loss in?
obese adults receiving diet & lifestyle counseling
153
which drug is the ONLY FDA-approved non-RX weight loss aid?
orlistat (alli)
154
T/F: hydroxycut KILLED SOMEONE
true
| dude
155
what is the best drug for weight loss in diabetics, even though it only gives pts modest weight loss at 6-12 mos?
orlistat (xenical, alli)
156
what drugs can you give to diabetic pts for weight loss, besides orlistat?
```
canagliflozin
fluoxetine
GLP-1 agonists (exanatide & liragutide)
amylin agonists
bupropion
lorcaserin
```
157
define "successful weight loss maintainers"
individuals who have intentionally lost at least 10% of their body weight & kept it off at least one year
158
is conscious restriction of energy intake usu successful?
NOPE
| 80-90% of the time, the weight is regained
159
in the nat'l weight ctrl registry, how much weight did pts lose on average & how long did they keep it off?
~66 lbs & kept it off for 5.5 years
160
how did people in the nat'l weight ctrl registry lose weight?
45% did it on their own
| 55% used a program
161
what 3 behaviors do participants in the nat'l weight ctrl registry do to maintain their weight loss?
weigh themselves at least 1x/wk
watch less than 10 hours of TV/wk
exercise ~1 hour/day
162
If individuals can succeed at maintaining their weight loss for (this long), they reduce their risk of subsequent regain by nearly 50%
2 years
