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Dems Unit 2 Part 2 YAAAY > Obesity Treatment: Drugs and Surgery > Flashcards

Obesity Treatment: Drugs and Surgery Flashcards

(58 cards)

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1
Q

4 options for overweight/ obese people

A
  1. accept
  2. modify diet/ activity
  3. medication
  4. surgery
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2
Q

physician resistance to weight loss medications

A
  1. unsafe medications: metabolife/ sibutramine–> ischemic heart disease
  2. behavioral problems: corrected with good diet and exercise
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3
Q

guidelines on weight loss medication

A

-prescribing weight loss medication is appropriate option for properly selected patients

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4
Q

3 considerations for weight loss medications

A
  1. only work as long as taking
  2. able and willing to pay for expensive med not covered by insurance
  3. amount of weight loss is modest ~5% baseline weight
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5
Q

phentermine MOA

A
  • chemically related to amphetamine and increases brain NE wo abuse potential
  • centrally to reduce satiety and reduce food intake
  • experience fullness at end of meals to reduce portion sizes
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6
Q

phentermine cost

A

-inexpensive $20-40 per month

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7
Q

phentermine side effects

A

nervousness, increased blood pressure (1-2% patients), difficulty sleeping, headache, dry mouth

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8
Q

phentermine contraindications

A

-uncontrolled HTN

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9
Q

phentermine dosing

A
  1. low dose with blood pressure rechecked 7-10 days

2. low dose for at least 1 month before increasing dose

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10
Q

phentermine FDA

A

-approved for 3 mths

> 3mths: off label

  • commonly done
  • no long term safety and efficacy data on drug because it is old and generic
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11
Q

phentermine effectiveness

A
  • 5% baseline weight

- range of responses

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12
Q

orlistat MOA

A
  • pancreatic lipase inhibitor and blocks dietary fat absorption from GI tract
  • scrip dose blocks 1/3 dietary fat from being absorbed
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13
Q

orlistat dose

A

OTC: Alli 60mg
Script: Xenical 120mg

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14
Q

orlistat cost

A

$90-200 per month

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15
Q

orlistat effectiveness

A
  • 5% baseline weight

- range of responses

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16
Q

orlistat actual side effect

A
  • Oily stools, urgency, diarrhea, oily leakage

- controlled by reducing dietary fat or not taking med with high fat meal

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17
Q

orlistat theoretical side effect

A

fat soluble vitamin deficiency

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18
Q

Orlistat FDA approval

A

-long term

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19
Q

Orlistat can treat what conditions

A
  • efficacy in adolescents
  • prevent DM in high risk
  • improves blood lipids
  • lowers HbA1c with DM
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20
Q

orlistat drug interactions

A
  • coumadin: increased INF

- cyclosporine: reduced drug levels

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21
Q

lorcasarin (Belviq) cost

A

$220-250

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22
Q

lorcasarin (Belviq) MOA

A
  • selective serotonin 2C receptor agonist

- 2C only in brain but not the heart

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23
Q

fenfluramide & dexfenfluramide

A
  • older nonspecific serotonin receptor agonists with moderate efficacy as weight loss drugs
  • taken off market: cardiac valve problems
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24
Q

loracsarin FDA

Study These Flashcards
A
  • FDA approval for post marketing surveillance for evidence of cardiac dysfunction
  • approved for long term use
25
Phen/fen: phentermine/fenfluramine | efficacy
- Phen/fen in late 90's - weight loss 12-15% - fenfluramine off the market
26
Does lorcasarin+ phentermine have a large efficacy?
we don't know if it is the new phen/fen
27
locasarin cost
$220-250/month
28
Phetermine/ topiramate (qsymia) Contraindication
Pregnancy: topiramate: teratogenic potential - requires negative pregnancy test once monthly
29
phetermine/ topiramate (qsymia) side effects
-dry mouth, paresthesias, insomnias, dizziness, irritability, attention disturbance
30
phetermine/ topiramate (qsymia) weight loss
10-12%
31
phetermine/ topiramate (qsymia) cost
$150
32
naltrexone SR/ bupropion SR (Contrave) MOA
-combination opioid receptor antagonist & dopamine/ NE reuptake inhibitor
33
naltrexone SR/ bupropion SR (Contrave) weight loss
5%
34
naltrexone SR/ bupropion SR (Contrave) FDA
- concerned about modest increase in pulse rate: passed CV safety trial - Black Box Warning: increased risk of suicidal ideation
35
naltrexone SR/ bupropion SR (Contrave) dosing
-gradually increase dose from 1pill/day to two pills twice a day over a month
36
naltrexone SR/ bupropion SR (Contrave) uncommon risks
-suicidal ideation, lowering seizure threshold, increased pulse and BP, rarely increase LFTs, closed angle glaucoma
37
Liraglutide 3mg (saxenda)
- recently approved by FDA as weight loss drug - not available in pharmacies - GLP-1 agonist - treatment of diabetes
38
weight loss drugs: | least expensive to most expensive
1. phentermine: $20-40 2. Orlistat: $90-200 3. Phetermine/topiramate (qsymia): $150 4. lorcasarin (belviq): $220-250 *no price provided for naltrexone/bupropion or liraglutide
39
weight loss drugs: | least effective to most effective
Modest: - Phentermine: 5% - otlistat: 5% - Lorcasarin: 4-5% - Naltrexone/Bupropion: 5% Moderate: - phetermine/topiramate (Qsymia): 10-12% - phentermine/fenfluramine: 12-15% (taken off the market)
40
psychiatric drugs and weight change
Weight Gain: - atypical antipsychotics - mood stabilizers - antidepressants Least likely Weight Gain: - ziprasidone (geodon) - aripiprazole (abilify) - bupropion (wellbutrin)
41
glucose lowering drugs and weight change
Weight gain: - insulin - sulfonylureas - TZDs Least likely Weight Gain: -GLP-1 agonists (weight loss) -DPP4 antagonists SGLT2 antagonists
42
other drugs that cause weight gain
- birth control with progesterone | - steroids
43
patients with migraines, seizures, or mood stabilizer
topiramate -15% weight loss in higher dose Side effects: dose related - paresthesias - neurocognitive
44
3 bariatric surgery subtypes & weight loss
1. lap band: 20-24% 2. sleeve: 24-27% 3. RYGB: 28-30%
45
long term weight loss following surgery
1. RYGB: maintain 25-28% weight loss for 15 years 2. Lap band: less impressive 3. Sleeve: no data
46
lap band advantages and disadvantages
advantages: - reversible - easier operations - fewer complications disadvantages: - close follow up - band is mechanical device with risk of failure including erosion of band through stomach - slippage of band from proper position - rupture of tube that connects band to subcutaneous port
47
reasons to choose sleeve
- intermediate between RYGB and lap - does not need adjustments - not associated with vitamin and nutritional deficiencies
48
RYGB Risks
-1% risk dying within first 30 days Perioperative risks: - thromboembolic disease - leak from staple line - pneumonia or wound infection -greater risk than lap or sleeve Nutritional deficiency: -niacin, B12, Vitamin D --> bone disease and iron deficiency
49
Diabetic Benefits Weight loss surgery
1. RYGB: >40% resolution of diabetes 2. effect sleeve is close to RYGB 3. lowest in lap band but still superior to standard medical therapy in controlling glucose in T2DM
50
6 other health conditions that benefit from weight loss surgery
- sleep apnea - gastroesophageal reflux - degenerative arthritis - weight related infertility - HTN - Cancer reduction
51
psychiatric effects of weight loss surgery
- QOL improves - depression and suicide increases post operatively - depression, substance abuse, behavioral issue that develop post-operatively - group support sessions help
52
BMI qualifications for Medications
1. BMI >30 | 2. BMI >27 + weight related co-morbid health conditions
53
BMI qualifications for Bariatric surgery
1. BMI >40 2. BMI >35 + weight related co-morbid health conditions 3. BMI >30 + 1 co-morbid condition for lap banding
54
bariatric surgery and risk of death
within 30 days: -0.7% (0-2%) with bypass and less with sleeve and banding Late death: within 2 years -2-3% after bypass surgery
55
patients who fail to lose weight following surgery
10-15% of all patients
56
gastric bypass deficiencies
-thiamine Vitamin D Iron B12
57
wernicke korsakoff syndrome in gastric bypass
- 3-10 weeks following surgery - associated with vomiting - double vision, ataxia, altered mental status
58
what to avoid for 1 year after gastric bypass surgery?
- use birth control | - avoid pregnancy because restriction in energy intake may not allow for optimal growth and development of baby

Dems Unit 2 Part 2 YAAAY (23 decks)

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