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nutrition > obesity and management pt 2 > Flashcards

obesity and management pt 2 Flashcards

1
Q

what are common behavioral strategies for obesity interventions

A
  1. setting realistic goals
    - benefits with as little as 5% loss
    - 5-7% with lifestyle changes
    - 5-10% or more with lifestyle and meds
    - 15-20% or more with bariatric surgery
  2. self-monitoring
  3. stimulus control
  4. slowing eating style
  5. nutritional education
  6. meal planning
  7. stress reduction and problem solving
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2
Q

benefits of losing weight with exercise alone

A
  1. slowing/preventing further weight gain
  2. reducing weight regain after successful weight loss
  3. attenuating diet-induced loss of muscle mass
  4. improved physical functioning
  5. offsetting reduced BEE/BMR that can occur with wt loss
  6. improved functional status - esp elderly
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3
Q

what type of exercise do we need?

A

both aerobic and resistance (mainly aerobic)

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4
Q

how often do we need to exercise?

A

150 min week
30 m/d

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5
Q

general diet principles

A
  1. minimizing or eliminating caloric beverages
  2. portion size control
  3. self monitoring
  4. viewing diet changes as long-term/lifelong
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6
Q

what is the ultimate goal of diet

A

reduce calorie intake
aiming for 1000-1500 kcal/day diet
- ensure adequate nutrition
- consider food volume/calorie density

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7
Q

what is the most important consideration for diet guidelines

A

patient compliance

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8
Q

what are the general guidelines for anti-obesity Rx?

A
  1. age - most for adults
  2. weight status - most for BMI >30, some >27 with obesity-related comorbidity
  3. duration of therapy - some only for short-term
  4. cost of rx
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9
Q

what is the anti-obesity Rx approved for ages 12+

A

orlistat (xenical)

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10
Q

when do you assess the efficacy for anti-obesity Rx?

A

12 week mark

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11
Q

what is the anti-obesity Rx that is sympathomimetic - stimulating NE release

A

phentermine (adipex)

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12
Q

what is the most common wt loss rx

A

phentermine

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13
Q

SE of phentermine (adipex)

A

HTN, ↑ HR, insomnia, agitation, palpitations, constipation, dry mouth

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14
Q

CI for phentermine (adipex)

A
  1. CV disease
  2. hyperthyroidism
  3. agitated state
  4. glaucoma
  5. substance use hx
  6. use within 14 days of an MAOI
  7. pregnancy/breastfeeding
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15
Q

DDI of phentermine (adipex)

A

Psych meds
antihypertensives
antihistamines
insomnia meds

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16
Q

Rx that inhibits intestinal lipase, blocking fat absorption, increasing fecal fat excretion

A

Orlistat (Alli, Xenical)

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17
Q

SE of Orlistat (Alli, Xenical)

A
  1. GI
    - borborygmi
    - cramps
    - flatus
    - oily spotting
    - fecal incontinence
  2. Decreased absorption of fat-soluble vitamins
    (Rare - liver injury, calcium oxalate stones, acute kidney injury)
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18
Q

CI for Orlistat (Alli, Xenical)

A
  1. pregnancy
  2. cholestasis/cholelithiasis
  3. hx of calcium oxalate stones
  4. chronic malabsorption syndrome
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19
Q

DDI of orlistat (alli, xenical)

A
  1. Multivitamins
  2. fat-soluble vitamins
  3. warfarin
  4. levothyroxine
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20
Q

Rx that acts as serotonin agonist for serotonin 2C receptor
Worked by suppressing appetite

A

Lorcaserin (Belviq)

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21
Q

SE of Lorcaserin (Belviq)

A

generally mild - headache, dizziness, nausea, URI

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22
Q

what rx is not on the market anymore and why?

A

Lorcaserin (Belviq)
Increased occurrence of colorectal, pancreatic, and lung cancers in clinical trials

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23
Q

what RX acts as an agonist of glucagon-like-peptide-1 (GLP-1) receptors

A

Liraglutide (Saxenda)/Semaglutide (Wegovy)

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24
Q

what is the dosing for Liraglutide (Saxenda)/Semaglutide (Wegovy)

A

Injected in abdomen, thigh, or upper arm
- Liraglutide: target dose of 3 mg SC daily
- Semaglutide: target dose of 2.4 mg SC weekly

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25
Q

SE of Liraglutide (Saxenda)/Semaglutide (Wegovy)

A
  1. N/V
  2. Diarrhea
  3. hypoglycemia
  4. anorexia
    Rarer - pancreatitis, gallbladder disease, kidney injury
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26
Q

CI of Liraglutide (Saxenda)/Semaglutide (Wegovy)

A
  1. Allergy to med
  2. pregnancy
  3. personal or family hx of medullary thyroid cancer or MEN 2A or 2B
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27
Q

DDI of Liraglutide (Saxenda)/Semaglutide (Wegovy)

A

Other hypoglycemic agents, serotonergic drugs, thiazides

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28
Q

what RX acts as an agonist of GLP-1 and GIP receptors

A

Tirzapetide (Mounjaro)

29
Q

what RX:
Originally developed for diabetes mellitus
↑ insulin release, ↓ glucagon release, slows gastric emptying
Thought to have greater effects than GLP-1 agonists alone

A

Tirzapetide (Mounjaro)

30
Q

dosing for tirzapetide (mounjaro)

A

Dose: Injected in abdomen, thigh, or upper arm
IM

31
Q

SE of Tirzapetide (Mounjaro)

A
  1. N/V
  2. diarrhea
  3. hypoglycemia
  4. anorexia
    Rarer - pancreatitis, gallbladder disease, kidney injury
    Associated with thyroid tumors in animal studies, but not human
32
Q

CI for Tirzapetide (Mounjaro)

A

Allergy to med, pregnancy, personal or family hx of medullary thyroid cancer or MEN 2A or 2B

33
Q

DDI of Tirzapetide (Mounjaro)

A

Other hypoglycemic agents, serotonergic drugs, thiazides

34
Q

what rx expands in the GI tract to create a sensation of satiety
Considered “medical devices” - not systemically absorbed

A

Cellulose and Hydrogel (Plenity)
No restriction on duration of use

35
Q

SE of Cellulose and Hydrogel (Plenity)

A

diarrhea, abdominal distension, pain, “adverse effects”

36
Q

Caution in patients with ___ when taking Cellulose and Hydrogel (Plenity)

A

impaired GI motility

37
Q

what RX is an opioid antagonist/norepinephrine and dopamine reuptake inhibitor with possible effects on hypothalamus and mesolimbic reward system

A

Naltrexone SR/Bupropion SR (Contrave)

38
Q

SE of Naltrexone SR/Bupropion SR (Contrave)

A
  1. Nausea
  2. constipation
  3. HA
  4. Stimulant-like effect - agitated mood, insomnia, HTN, tachycardia, palpitations
    Not recommended as first-line medication
39
Q

what RX has concern over potential for worsened mood, suicidality

A

Naltrexone SR/Bupropion SR (Contrave)

40
Q

CI of Naltrexone SR/Bupropion SR (Contrave)

A
  1. pregnancy
  2. uncontrolled HTN
  3. epilepsy
  4. bulimia/anorexia
  5. Meds
    - use within 14 days of an MAOI
    - current use of opioids or bupropion
41
Q

DDI of Naltrexone SR/Bupropion SR (Contrave)

A

ETOH, psych meds, opiates, metoprolol

42
Q

what rx stimulates NE release/anticonvulsant
Works by suppressing appetite/ causing early satiety

A

Phentermine/Topiramate (Qsymia)

43
Q

if there is no weight loss after 12 wks with Phentermine/Topiramate (Qsymia), what happens next?

A

may titrate to max dose of 15 mg/92 mg

44
Q

SE of Phentermine/Topiramate (Qsymia)

A
  1. dry mouth
  2. constipation
  3. paresthesia
  4. depression
  5. “brain fog”
  6. HA
  7. altered taste
  8. Stimulant effects - tachycardia, anxiety, insomnia
    (Rare reports of suicidal ideation)
45
Q

CI of Phentermine/Topiramate (Qsymia)

A
  1. hyperthyroidism
  2. glaucoma
  3. substance use hx
  4. use within 14 days of an MAOI
  5. pregnancy
46
Q

DDI of Phentermine/Topiramate (Qsymia)

A
  1. ETOH
  2. psych rx
  3. anti-HTN rx
  4. insomnia rx
  5. loop diuretics
  6. metformin
47
Q

what RX is alleged to increase metabolic rate and suppress appetite
Nearly always given along with very low-cal diet (200-800 kcal/day)

A

Human Chorionic Gonadotropin (HCG)
no good!

48
Q

who is a surgical candidate?

A

BMI - often used as initial determinant of eligibility
1. BMI ≥ 40
2. BMI ≥ 35 with 1+ obesity-related comorbidity:
- T2DM, HTN, HLD, OSA, NAFLD/NASH, OHS, GERD, asthma, pseudotumor cerebri, severe OA, severe UI, impaired quality of life, unable to get other surgery
3. Sometimes - BMI ≥ 30 with severe/progressive comorbidity:
- Metabolic syndrome, uncontrollable T2DM

49
Q

Many bariatric surgeons require pts _______ prior to surgery

A

to participate in a medically guided weight loss program
Anywhere from 3-12 months (usually 6 months)

50
Q

All pts undergo ___ looking at psychological status, social support, medical status, expectations for surgery, and anesthesia risk

A

pre-op assessment

51
Q

CI to bariatric surgery

A
  1. Not obese - to tx of HLD, DM, or to reduce CV risk w/o obesity
  2. Inability to comply with nutritional requirements
  3. Age - not usually done in pts < 18 or > 65
  4. Severe cardiac disease (cannot undergo anesthesia)
  5. Severe coagulopathy
  6. Current ETOH or drug use
  7. Psych - uncontrolled/untreated depression, psychosis, eating disorders (especially bulimia)
52
Q

2 ways of how does bariatric surgery work?

A
  1. Restriction
    - limitation of food intake by reducing the stomach’s reservoir capacity via resection
    - bypass
    or
    - creation of a more proximal gastric outlet
  2. malabsorption
    - decreases efficacy of nutrient absorption via shortening length of functional small intestine
    Some surgeries use both restriction and malabsorption
    Some surgeries may also have a neurohormonal effect
53
Q

One of the most common bariatric surgeries
A small gastric pouch is anastomosed to the small bowel
BOTH restrictive and malabsorptive
loses 70% of excess weight

A

Roux-en-Y Gastric Bypass (RYGB)
Also promotes ↑ hormones like GLP-1, ↓ hormones like ghrelin

54
Q

complications from Roux-en-Y Gastric Bypass (RYGB)

A
  1. healing
    - peritonitis - anastomotic leak
    - abdominal wall hernias
    - stenosis
    - staple disruption
  2. long-term
    - gallstones
    - neuropathy
    - GI symptoms - ulcers
  3. nutritional deficiencies - iron, vitamin B12, folate, calcium, vitamin D
55
Q

Removal of greater curvature of the stomach, leading to a tubular stomach
Often seen as “not as drastic” by pts, increasing in popularity

A

Sleeve Gastrectomy (SG)
Easier and safer to perform than RYGB

56
Q

Sleeve Gastrectomy (SG) is strictly what type of bariatric surgery?

A

restrictive
Also slows GI motility, ↑ hormones like GLP-1, ↓ hormones like ghrelin

57
Q

complications with Sleeve Gastrectomy (SG)

A

less overall than RYGB
1. healing
- surgical site leak (more than RYGB)
- hernias
- staple disruption
2. long-term
- GERD (more than RYGB)
- neuropathy
- N/V
3. nutritional - iron, vitamin B12, folate, calcium, vitamin D (less than RYGB)

58
Q

Compartmentalization of the upper portion of the stomach by placement of a restrictive, adjustable prosthetic band

A

Laparoscopic Adjustable Gastric Banding (LAGB)
declining popularity

59
Q

which bariatric surgery has high rates of revision and weight regain

A

Laparoscopic Adjustable Gastric Banding (LAGB)

60
Q

what type of bariatric surgery is Laparoscopic Adjustable Gastric Banding (LAGB)

A

restrictive

61
Q

Complications with Laparoscopic Adjustable Gastric Banding (LAGB)

A

less than RYGB or SG
may include:
1. device
- band slippage
- band erosion
- mechanical failure
2. long-term
- esophageal erosion
- reoperation
- weight regain

62
Q

Removal of fat tissue via saline injection or aspiration of fat tissue
No influence on comorbidity development or progression - cosmetic only

A

lipo

63
Q

Percutaneous gastrostomy tube is implanted endoscopically
20-30 min after meals, patients can open the tube and drain part of the food that has just been ingested into the toilet

A

Aspiration Therapy

64
Q

Mainly done for severely obese individuals (BMI of 50+)
Has high rates of complication

A

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

65
Q

what is SADI-S

A

variant Biliopancreatic Diversion with Duodenal Switch (BPD/DS) procedure using sleeve gastrectomy = lower complications

66
Q

Saline-filled balloon placed endoscopically for max 6 month period
Promotes a feeling of satiety and reduces gastric volume

A

Intragastric Balloon

67
Q

what anti-obesity rx’s are only for short-term use?

A
  1. Phentermine (Adipex)
  2. Phentermine/Topiramate (Qsymia)
68
Q

which rx must be taken 30 minutes before lunch and dinner

A

Cellulose and Hydrogel (Plenity)

nutrition (12 decks)

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