Obesity Treatment: Drugs and Surgery Flashcards Preview

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

Flashcards in Obesity Treatment: Drugs and Surgery Deck (58):
1

4 options for overweight/ obese people

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

2

physician resistance to weight loss medications

1. unsafe medications: metabolife/ sibutramine--> ischemic heart disease

2. behavioral problems: corrected with good diet and exercise

3

guidelines on weight loss medication

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

4

3 considerations for weight loss medications

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

5

phentermine MOA

-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

6

phentermine cost

-inexpensive $20-40 per month

7

phentermine side effects

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

8

phentermine contraindications

-uncontrolled HTN

9

phentermine dosing

1. low dose with blood pressure rechecked 7-10 days
2. low dose for at least 1 month before increasing dose

10

phentermine FDA

-approved for 3 mths

>3mths: off label
-commonly done
-no long term safety and efficacy data on drug because it is old and generic

11

phentermine effectiveness

-5% baseline weight
-range of responses

12

orlistat MOA

-pancreatic lipase inhibitor and blocks dietary fat absorption from GI tract

-scrip dose blocks 1/3 dietary fat from being absorbed

13

orlistat dose

OTC: Alli 60mg
Script: Xenical 120mg

14

orlistat cost

$90-200 per month

15

orlistat effectiveness

-5% baseline weight
-range of responses

16

orlistat actual side effect

-Oily stools, urgency, diarrhea, oily leakage
-controlled by reducing dietary fat or not taking med with high fat meal

17

orlistat theoretical side effect

fat soluble vitamin deficiency

18

Orlistat FDA approval

-long term

19

Orlistat can treat what conditions

-efficacy in adolescents
-prevent DM in high risk
-improves blood lipids
-lowers HbA1c with DM

20

orlistat drug interactions

-coumadin: increased INF
-cyclosporine: reduced drug levels

21

lorcasarin (Belviq) cost

$220-250

22

lorcasarin (Belviq) MOA

-selective serotonin 2C receptor agonist
-2C only in brain but not the heart

23

fenfluramide & dexfenfluramide

-older nonspecific serotonin receptor agonists with moderate efficacy as weight loss drugs

-taken off market: cardiac valve problems

24

loracsarin FDA

-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