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IPC Endocrine Week 2 > Obesity > Flashcards

Obesity Flashcards

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1
Q

True or false: physical activity is a more effective method to treat weight gain rather than maintain weight loss.

A

False. Physical activity is more effective as a method to maintain weight loss.

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2
Q

Where is Ghrelin secreted?

A

P/D1 cells in fundus of stomach

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3
Q

What is the impact ghrelin has on appetite and metabolism?

A

-stimulates hunger: activate NPY/AgRP neurons
-reduces DIT
-reduces REE

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4
Q

What is DIT?

A

diet-induced thermogenesis

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5
Q

What is REE?

A

resting energy expenditure

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6
Q

Where is GIP secreted from?

A

K-cells in duodenum and proximal jejunum

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7
Q

What is GIP impact on appetite and energy metabolism?

A

-appetite: minimal when alone, suppression when with GLP-1
-decreases DIT/REE

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8
Q

Where is GLP-1 secreted from?

A

L-cells in ileum and proximal colon

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9
Q

What is the impact GLP-1 have on appetite and metabolism?

A

-appetite: strongly suppresses
-may increase DIT

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10
Q

Where is PYY secreted from?

A

L-cells in ileum and colon

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11
Q

What is the impact of PYY on appetite and metabolism?

A

-appetite: reduces by acting on Y2 receptors, inhibits NPY/AgRP

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12
Q

Which set of neurons is part of the feeding onset arc?

A
  1. NPY/AgRP
  2. POMC/CART
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13
Q

Which hormones act as adipose signals to feed into the arc?

A

-insulin
-leptin

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14
Q

Which gut hormones feed into the arc?

A

-Ghrelin
-GLP-1
-GIP
-PYY

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15
Q

Which set of neurons stimulates hunger?

A

NPY/AgRP

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16
Q

Which set of neurons suppresses hunger?

A

POMC/CART

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17
Q

Which set of NEUROTRANSMITTERS plays a role in stimulating appetite?

A

-GABA
-Glutamate

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18
Q

Which set of NEUROTRANSMITTERS plays a role in suppressing appetite?

A

-alpha MSH
-NE
-Serotonin
-Dopamine
-GLP-1 GIP
-miu receptors

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19
Q

True of false: obesity is a disease.

A

True

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20
Q

What is the core disease proccess of obesity?

A

adipose tissue dysfunction -> INFLAMMATION -> insulin resistance/atherogenesis/comorbidities

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21
Q

What are the major comorbidities of obesity?

A

-T2DM
-dyslipidemia
-HTN
-CHD
-OSA

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22
Q

Which medications promote weight gain as a ADE?

A

-antipsychotics
-steroids
-beta blockers
-insulin
-TZDs/SU

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23
Q

Which lab tests are recommended to screen for obesity-related comorbidities?

A

-FBG or A1c
-lipid panel
-LFTs
-TSH

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24
Q

What is the brand name of phentermine?

A

Adipex

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25
What are the CIs of phentermine？
-heart disease: CAD/HF/arrhythmias -uncontrolled HTN -glaucoma -hyperthyroidism -substance abuse -psychosis -PREGNANCY
26
What are the potential DDis of phentermine?
-MAOis -antihypertensives or caffiene -bupropion -antidiabetics
27
Do renal dose adjustments need to be made for phentermine?
Yes: -eGFR 15-29: max 15mg/day -avoid eGFR <15
28
What is the efficacy of phentermine?
-rapid tolerance develops and weight regains -poor evidence
29
What is the MOA of phentermine?
-increases release of NE -inhibits reuptake of NE -NE stimulates POMC to suppress appetite
30
What is the age and BMI indication for phentermine use?
-BMI >30 or 27 w/ comorbidities -age <17
31
What is the brand name of orlistat?
Xenical
32
What are the CIs of orlistat?
-PREGNANCY -malabsorption -cholestasis -kidney stones -severe liver disease
33
What are the potential DDIs of orlistat (xenical)?
-warfarin -anti-seizure -levothyroxine -cyclosporine
34
Are renal dose adjustments needed for orlistat?
no.
35
What is the efficacy of Orlistat?
-1 year: 4% weight loss -4 years: 2.6% weight loss
36
What is the MOA of Orlistat?
-binds gastric and pancreatic lipases in stomach and S.I -decreases fat absorption
37
What is the age and BMI indication for Orlistat?
-BMI >30 or 27 w/ comorbidities -age > or = to 12 years
38
What are some ADR of orlistat?
-fatty stool -fecal urgency -abdominal pain
39
What is the brand name of phentermine/topirmate combo med?
Qysmia
40
What are the contraindications of Qsymia?
-pregnancy -breastfeeding
41
Are renal and liver adjustments needed for Qysmia?
yes! -avoid in CrCl <30
42
What is the efficacy of Qysmia?
-1 year: 8.6% weight loss -2 year: 8.7% weight loss
43
What is the age and BMI indication of Qysmia?
-BMI >30 or 27 w/ comorbidities -age >18
44
What is the MOA of Qysmia?
Topiramate: -inhibits NPY/AgRP release of GABA -GABA suppresses POMC neurons so reducing GABA reduces suppression of POMC = more appetitive suppresion
45
What is the age and BMI indication of Qysmia?
-BMI >30 or 27 with cormorbidities -age >18
46
What are some ADR of Qysmia?
-paresthesia -concentration/memory loss -depression
47
What is the brand name of bupropion/naltrexone combo?
Contrave
48
What are the CIs of Contrave?
-PREGNANCY -Breastfeeding -uncontrolled HTN -seizure disorder -anorexia/bulimia -severe depression -MAOI
49
What are some potential DDIs with Contrave?
-MAOI -pimozide -thioridazine -SSRI
50
Does Contrave require renal dose adjustments?
yes
51
What is the efficacy of Contrave?
-1 year: 4.2% -no data available beyond 1 year
52
What is the MOA of Contrave?
1. Bupropion: increases dopamine levels, which stimulates POMC to suppress appetite 2. Naltrexone: blocks opiate receptor which prevents beta-endorphin from inhibiting POMC neurons
53
What is the age and BMI indication for Contrave?
-BMI >30 or 27 with cormorbidities -age > 18
54
What are the ADR of Contrave?
-N/V -HA -dizziness -dry mouth
55
What is the brand name for liraglutide with weight loss indication?
Saxenda
56
What are the CIs for Saxenda?
-PREGNANCY -breastfeeding -MEN2/
57
Does Saxenda require renal or liver dose adjustments?
no
58
What is the efficacy of Saxenda?
-1 year: 5.6% weight loss -no data beyond a year
59
What is the MOA of Saxenda?
-stimulates POMC neurons -decreases gastric emptying (via vagal afferent stimulation)
60
What is the BMI and age indication for Saxenda?
-BMI>30 or 27 with comorbidities -age >12 (7-11 off label)
61
How is efficacy evaluated for Saxenda?
-if not >4% weight loss at week 6=discontinue
62
What are some ADR of Saxenda?
-GI: N/V/D/C -tachycardia -gallstones -hypoglycemia
63
What is the brand name of Semaglutide indicated for weight loss?
-Wegovy -Ozempic
64
What are some CIs for semaglutide?
-pancreatitis -MEN2/MTC -acute gall bladder -pregnancy/breastfeeding
65
Does semaglutide require renal or liver dose adjustments?
-none
66
What is the efficacy of semaglutide?
-1 year: 12.4% weight loss (>2x Saxenda)
67
What is the age and BMI indication of semaglutide?
-BMI >30 or 27 with comorbidities -age > 12 (7-11 off label)
68
What is the efficacy of Zepbound?
-1 year: 20.9% (dose dependent)
69
At what BMI is bariatric surgical procedures indicated?
-BMI >40 or >35 with cormobidities
70

IPC Endocrine Week 2 (5 decks)

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