Obesity Flashcards
(93 cards)
1
Q
overweight BMI
A
25 - 29.9
2
Q
Obesity BMI
A
> 30
3
Q
normal BMI
A
18.5 - 24.9
4
Q
Prevalence of obesity 2015-2016
A
39.8% 93.3 million
5
Q
Obesity is linked with increased risk of
A
diabetes HTN hyperlipidemia arthritis breast and GI cancer non alcoholic steatohepatitis
6
Q
Medical costs related with obesity in 2008
A
$147 billion
7
Q
What is the second leading cause of preventable death in US?
A
obesity
8
Q
Metabolic syndrome
A
- abdominal obesity
- hyperinsulinemia
- high fasting plasma glucose
- impaired glucose tolerance
- hypertriglyceridemia
- low HDL cholesterol
- HTN
9
Q
CVD and metabolic syndrome
A
CVD mortality increased in metabolic syndrome
10
Q
____% weight reduction in combo with ___ exercise daily = ____% reduction in development of diabetes vs control of diabetes prevention
A
5%
30 min
58%
11
Q
T/F weight loss consistently demonstrates a + impact on triglycerides and HDL
A
true
12
Q
each ___kg in weight loss reduces systolic BP _____ mmHg. roughly equal to effect _____
A
10kg
5-20mmHg
1 antihypertensive
13
Q
T/F there is a positive correlation between weight and blood glucose
A
true
14
Q
mainstay treatment such as ____ and ____ cause weight gain in diabetes
A
insulin
sulfonylureas
15
Q
____ and ____ agonists are associated with weight loss
A
metformin
GLP-1
16
Q
Secondary causes of weight gain
A
- disease states
- drugs
- decreased food intake
- increased food intake
17
Q
What is the cornerstone of obesity management?
A
lifestyle modifications
18
Q
T/F lifestyle modifications do not always need to be instituted when medication management becomes part of treatment plan
A
false!
Should always!!
19
Q
Noradrenergic agents for obesity
A
amphetamines
phentermine
20
Q
phentermine agent MOA
A
promote catecholamine release at pre-synaptic terminals: NE, DA or both
21
Q
T/F phentermine can be used more than 6 months
A
False
approved for short term use up to 6 months
22
Q
Max weight loss of ____% at ___ months with phentermine then usually plateau
A
5-10% at 6 months
23
Q
T/F rapid tolerance can develop within a few weeks in phentermine
A
True
24
Q
ADE of phentermine
A
HA insomnia nervousness tachycardia HTN dry mouth diarrhea constipation
25
phentermine long term use ADE
primary pulmonary hypertension (PPH)
26
what should you monitor when on phentermine?
weight
BP
symptoms of PPH
27
phentermine CI
moderate to severe HTN
CVD
glaucoma
concomitant MOA
28
phentermine and SSRIs or other antidepressants
safety and efficacy unclear
29
SSRIs and obesity
```
sertraline
fluoxetine
paroxetine
citalopram
escitalopram
```
30
SSRI MOA
inhibit CNS neuronal reuptake of serotonin
31
Sertaline and fluoxetine and obesity
demonstrate initial, but non-sustainable weight loss
| not FDA approved for weight loss
32
Lorcaserin (Belviq)
serotonergic agent
33
Lorcaserin MOA
selective 5HT 2c receptor agonist
- effects nearly exclusive in CNS/ hypothalamus
- decreased caloric intake and increased satiety
34
Lorcaserin approved for
BMI >30
| BMI >27, 1 weight related comorbidity
35
What are weight related co-morbidities?
T2D
HTN
hyperlipidemia
36
Lorcaserin dosing
10mg BID up to 1 year
37
Lorcaserin weight loss
5% in 40% of patients
38
When should you stop Lorcaserin?
when weight loss not achieved in 12 weeks
39
Lorcaserin ADE CNS
HA, dizziness, blurred vision, somnolence, paresthesia
40
Lorcaserin GI ADE
nausea
| dry mouth
41
Lorcaserin ADE CV
no increase risk of CV events
42
Lorcaserin should not be used with what?
other serotonergic medications (antidepressants, triptans)
43
Lorcaserin other ADE
hypoglycemia in diabetics
| priapism
44
Orlistat (Xenical) MOA
blocks intestinal absorption of dietary fat
| lipase inhibitor
45
How long can you use orlistat?
up to 2 years
46
How should you take orlitstat?
only if eating fat containing meal
| take during or up to 1 hour after meal
47
Orlistat 360mg/day blocks ____% of dietary fat absorption
30%
48
Orlistat weight loss
6-10g weight loss at 1 year
| sustained in 65% of patients between 1-2 years
49
Orlistat ADE
abdominal pain
flatulence
fecal urgency
incontinence (up to 80%)
50
What increases the likelihood of ADE in orlistat?
high fat meal
51
Orlistat decreases absorption of what?
fat soluble vitamins
| - should take vitamin 2 hours separate
52
Topiramate/phentermine (Qsymia) MOA
increased satiety
decreased appetite
taste aversion
53
Qsymia approved for
BMI >30
| BMI >27, obesity comorbidity
54
Why is topiramate and phentermine a good combo?
both induce weight loss individually
| combined can use smaller doses to improve side effects/tolerability
55
How to dose Qsymia
low, mid, high dose: start low 14 days, titrate to mid dose
56
When should you increase dose or discontinue Qsymia?
if weight loss 3% not achieved at 12 weeks
Discontinue if weight loss 5% not achieved after 12 weeks at highest dose
57
Dose related weight loss on Qsymia
7-9% at 56 weeks
58
Qsymia CNS ADE
```
insomnia
dizziness
depression (suicide)
anxiety
**risk for seizure if sudden withdrawal from highest dose
```
59
Qsymia GI/GU ADE
```
dry mouth
dysguesia
constipation
kidney stones
elevated serum creatinine
```
60
Qsymia CV ADE
palpitations
| BP increase
61
Who should you avoid Qsymia in?
patients with CVD
62
Special note with qsymia
increased risk of fetal malformations
- requires initial pregnancy test, monthly testing, contraception
* *REMS
63
Bupropion/Naltrexone (Contrave) MOA
synergistic
appetite regulation in hypothalamus
resolimbic dopamine circuit (reward system)
64
Contrave approved for
BMI >30
| BMI >27, comorbidity
65
Contrave weight loss
Mean weight decrease 8.2%
| - peak weight loss at 36 weeks, sustained through week 56
66
Contrave dosing
dose titrate by 1 tablet weekly up to 2 tabs BID over 4 weeks to improve tolerance
67
When should you discontinue contrave?
after 12 weeks if not at least 5% weight loss
68
Contrave ADE
```
N/C/dry mouth
Increased BP, HR
dizzy
tremor
risk for seizure
```
69
CI contrave
- seizure disorder
- uncontrolled HTN
- chronic opioid use
- pregnancy
- during or within 14 days of MAOI
70
Liraglutide (Saxenda) MOA
increased satiety due to slowed gastric emptying
71
Saxenda weight loss
5-10% body weight at 56 weeks
72
Saxenda dosing
once daily
injectable
start at 0.6mg/day and increase in weekly intervals to target dose of 3mg/day
73
Saxenda side effects
mostly GI, nausea, bloating
74
Saxenda REMS
monitor for medullary thyroid carcinoma and pancreatitis
75
What is Saxenda also approved for?
diabetes (Victoza)
76
Stimulants for obesity
```
Ma Huang
Ephedrine
Guarana
yerba mate
bitter orange
```
77
Alternatives to obesity
- stimulate release of NE, DA, direct stimulation of B receptors
78
Appetite suppressants claim to increase _____
thermogenesis
79
Stimulants ADE
```
tremor
nervousness
insomnia
palpitations
GI
mania
HTN
```
80
Reports of what in stimulants
```
hemorrhagic stroke
MI
seizure
psychosis
deaths
```
81
Do not use stimulants for weight loss if history of _____ or _____
HTN
| CVD
82
HCG for weight loss
no benefit
| - usually concomitant very restrictive diet
83
HCG risk for
thromboembolism, edema, behavior change
84
St. John's Wort for weight loss
synaptic reuptake inhibition of NE, DA, serotonin
| - no studies showing efficacy
85
Bulk fibers for weight loss
expand within GI to induce sensation of fullness
86
Leptin for weight loss
believed to be involved in feedback system relating to body weight regulation
- human studies lacking
87
Chromium picolinate for weight loss
proposed mechanism is increased insulin sensitivity resulting in more efficient metabolism
- studies not shown effecitveness
88
White willow bark for weight loss
active component is salicylate
| proposed to potentiate other ingredients
89
Non-pharmacologic management for weight loss
- behavior modification
- bariatric surgery
- diet
- exercise
90
Drugs that can cause weight gain
```
Anticholinergic/H1 blockade
Progesterone
Neuroleptics
Corticosteroids
Insulin
Sulfonylureas
Lithium
TCAs
Anticonvulsants
THC
```
90
Disease states cause of weight gain
Hypothyroidism
Cushing’s
Depression
90
What leads to decreased food intake?
Stimulation of DA, NE
| Increased 5HT concentration and stimulation
90
What leads to increased food intake?
Block DA, NE, serotonin receptors or decreased concentration
| Histamine receptor blockade
