Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

Obesity Treatment: Drugs and Surgery Flashcards

1
Q

4 options for overweight/ obese people

A
  1. accept
  2. modify diet/ activity
  3. medication
  4. surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

guidelines on weight loss medication

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

phentermine cost

A

-inexpensive $20-40 per month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

phentermine side effects

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

phentermine contraindications

A

-uncontrolled HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

phentermine effectiveness

A
  • 5% baseline weight

- range of responses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

orlistat dose

A

OTC: Alli 60mg
Script: Xenical 120mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

orlistat cost

A

$90-200 per month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

orlistat effectiveness

A
  • 5% baseline weight

- range of responses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

orlistat theoretical side effect

A

fat soluble vitamin deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Orlistat FDA approval

A

-long term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Orlistat can treat what conditions

A
  • efficacy in adolescents
  • prevent DM in high risk
  • improves blood lipids
  • lowers HbA1c with DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

orlistat drug interactions

A
  • coumadin: increased INF

- cyclosporine: reduced drug levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

lorcasarin (Belviq) cost

A

$220-250

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

lorcasarin (Belviq) MOA

A
  • selective serotonin 2C receptor agonist

- 2C only in brain but not the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

fenfluramide & dexfenfluramide

A
  • older nonspecific serotonin receptor agonists with moderate efficacy as weight loss drugs
  • taken off market: cardiac valve problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

loracsarin FDA

A
  • FDA approval for post marketing surveillance for evidence of cardiac dysfunction
  • approved for long term use
25
Q

Phen/fen: phentermine/fenfluramine

efficacy

A
  • Phen/fen in late 90’s
  • weight loss 12-15%
  • fenfluramine off the market
26
Q

Does lorcasarin+ phentermine have a large efficacy?

A

we don’t know if it is the new phen/fen

27
Q

locasarin cost

A

$220-250/month

28
Q

Phetermine/ topiramate (qsymia) Contraindication

A

Pregnancy:

topiramate: teratogenic potential
- requires negative pregnancy test once monthly

29
Q

phetermine/ topiramate (qsymia) side effects

A

-dry mouth, paresthesias, insomnias, dizziness, irritability, attention disturbance

30
Q

phetermine/ topiramate (qsymia) weight loss

A

10-12%

31
Q

phetermine/ topiramate (qsymia) cost

A

$150

32
Q

naltrexone SR/ bupropion SR (Contrave) MOA

A

-combination opioid receptor antagonist & dopamine/ NE reuptake inhibitor

33
Q

naltrexone SR/ bupropion SR (Contrave) weight loss

A

5%

34
Q

naltrexone SR/ bupropion SR (Contrave) FDA

A
  • concerned about modest increase in pulse rate: passed CV safety trial
  • Black Box Warning: increased risk of suicidal ideation
35
Q

naltrexone SR/ bupropion SR (Contrave) dosing

A

-gradually increase dose from 1pill/day to two pills twice a day over a month

36
Q

naltrexone SR/ bupropion SR (Contrave) uncommon risks

A

-suicidal ideation, lowering seizure threshold, increased pulse and BP, rarely increase LFTs, closed angle glaucoma

37
Q

Liraglutide 3mg (saxenda)

A
  • recently approved by FDA as weight loss drug
  • not available in pharmacies
  • GLP-1 agonist
  • treatment of diabetes
38
Q

weight loss drugs:

least expensive to most expensive

A
  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
Q

weight loss drugs:

least effective to most effective

A

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
Q

psychiatric drugs and weight change

A

Weight Gain:

  • atypical antipsychotics
  • mood stabilizers
  • antidepressants

Least likely Weight Gain:

  • ziprasidone (geodon)
  • aripiprazole (abilify)
  • bupropion (wellbutrin)
41
Q

glucose lowering drugs and weight change

A

Weight gain:

  • insulin
  • sulfonylureas
  • TZDs

Least likely Weight Gain:
-GLP-1 agonists (weight loss)
-DPP4 antagonists
SGLT2 antagonists

42
Q

other drugs that cause weight gain

A
  • birth control with progesterone

- steroids

43
Q

patients with migraines, seizures, or mood stabilizer

A

topiramate
-15% weight loss in higher dose

Side effects: dose related

  • paresthesias
  • neurocognitive
44
Q

3 bariatric surgery subtypes & weight loss

A
  1. lap band: 20-24%
  2. sleeve: 24-27%
  3. RYGB: 28-30%
45
Q

long term weight loss following surgery

A
  1. RYGB: maintain 25-28% weight loss for 15 years
  2. Lap band: less impressive
  3. Sleeve: no data
46
Q

lap band advantages and disadvantages

A

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
Q

reasons to choose sleeve

A
  • intermediate between RYGB and lap
  • does not need adjustments
  • not associated with vitamin and nutritional deficiencies
48
Q

RYGB Risks

A

-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
Q

Diabetic Benefits Weight loss surgery

A
  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
Q

6 other health conditions that benefit from weight loss surgery

A
  • sleep apnea
  • gastroesophageal reflux
  • degenerative arthritis
  • weight related infertility
  • HTN
  • Cancer reduction
51
Q

psychiatric effects of weight loss surgery

A
  • QOL improves
  • depression and suicide increases post operatively
  • depression, substance abuse, behavioral issue that develop post-operatively
  • group support sessions help
52
Q

BMI qualifications for Medications

A
  1. BMI >30

2. BMI >27 + weight related co-morbid health conditions

53
Q

BMI qualifications for Bariatric surgery

A
  1. BMI >40
  2. BMI >35 + weight related co-morbid health conditions
  3. BMI >30 + 1 co-morbid condition for lap banding
54
Q

bariatric surgery and risk of death

A

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
Q

patients who fail to lose weight following surgery

A

10-15% of all patients

56
Q

gastric bypass deficiencies

A

-thiamine
Vitamin D
Iron
B12

57
Q

wernicke korsakoff syndrome in gastric bypass

A
  • 3-10 weeks following surgery
  • associated with vomiting
  • double vision, ataxia, altered mental status
58
Q

what to avoid for 1 year after gastric bypass surgery?

A
  • 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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions