Pharmaceutical Care of Obesity

Question 1

What is the BMI for overweight?

Answer 1

25-29.9

Question 2

What is the BMI for obese?

Answer 2

30.34.9

Question 3

What are the 4 levels of intervention?

Answer 3

General advice on healthy weight + lifestyle
Diet + physical activity
Diet + physical activity - consider drugs
Diet + physical activity - consider drugs + surgery

Question 4

What are the benefits of maintaining healthy weight?

Answer 4

Reduced risk of developing diseases - CHD, hypertension, liver disease, osteoarthritis, type 2 diabetes
Improved mental health
Reduced breathlessness
Improved fitness
Lower blood cholesterol
Improved oral health

Question 5

When should pharmacological interventions only be introduced?

Answer 5

After behaviour approaches to diet + physical activity have been initiated

Question 6

What is Orlistat?

Answer 6

Lipase inhibitor

Question 7

What is Sibutramine?

Answer 7

Appetite suppressant
NOT recommended for treatment of obesity

Question 8

What is Liraglutide?

Answer 8

Glucagon-like-peptide- 1 (GLP-1) receptor agonist
(Appetite suppressant)

Question 9

Can Orlistat be given to children under 12?

Answer 9

YES - but if physical comorbidities (orthopaedic problems/sleep apnoea) or severe psychological comorbidities

Question 10

Describe the mechanism of action of Orlistat

Answer 10

Lipase inhibitor
= reduces absorption of dietary fat
Forms covalent bond with active site of gastric + pancreatic lipases
= inactivated enzyme can’t hydrolyse fat into FAs

Question 11

What is the dose of Orlistat?

Answer 11

60mg TDS

Question 12

What is prescribed Orlistat licensed in?

Answer 12

Ages 18-75 - adjunct in obesity

Question 13

What is the BMI for prescribed Orlistat?

Answer 13

30
OR 28 with other risk factors (Type 2, hypertension, hypercholesterolaemia)

Question 14

What is the adult dose of prescribed Orlistat?

Answer 14

120mg up to 3x/day

Question 15

How is prescribed Orlistat to be taken?

Answer 15

Immediately before, during or up to 1hr after each main meal
Review at 12 weeks
If meal missed or contains no fat miss dose

Question 16

When is prescribed Orlistat stopped?

Answer 16

If the target of >5% weight lost not lost

Question 17

What must be done with Orlistat?

Answer 17

Additional contraceptive method
= may be lost in severe diarrhoea

Question 18

What may be taken with Orlistat?

Answer 18

Multivitamin supplement taken at least 2hrs after Orlistat/bedtime
= potentially impair absorption of fat-soluble vitamins

Question 19

What may Orlistat also be used for?

Answer 19

Maintain or reduce weight before surgery

Question 20

What needs to be considered with Orlistat?

Answer 20

Affect absorption of administered oral drugs

Question 21

What are some examples of interactions with Orlistat?

Answer 21

Coumarins = monitor INR
Levothyroxine = increased risk of hyperthyroidism
Antiepileptics = decrease absorption
Amiodarone = plasma conc reduced

Question 22

Can you buy Orlistat OTC?

Answer 22

YES

Question 23

What criteria must you meet to buy Orlistat OTC?

Answer 23

18 or older
BMI 28 or above
Taken with low fat diet

Question 24

What is the treatment course for OTC?

Answer 24

NOT exceed 6 months
60mg 3x/day

Question 25

How do you take OTC Orlistat?

Answer 25

Taken with water immediately before, during or up to one hour after each main meal If meal missed or contains no fat dose missed

Question 26

What is contraindicated with OTC Orlistat?

Answer 26

People taking ciclosporin + anticoagulants People with chronic malabsorption syndrome + cholestasis Pregnant/breast-feeding

Question 27

What are the common side effects of Orlistat?

Answer 27

Abdominal distension Abdominal pain Anxiety Faecal incontinence Faecal urgency Flatulence Headaches Liquid stools Leakage from rectum

Question 28

What is the BMI needed for Liraglutide?

Answer 28

30 BUT 27 if Type 2, hypertension, dyslipidaemia or sleep apnoea

Question 29

How do GLP-1 agonists work?

Answer 29

Decrease appetite Decrease gastric emptying = feeling fuller for longer

Question 30

What is the criteria for bariatric surgery?

Answer 30

BMI over 40 BMI 30-40 if Type 2, hypertension, ect. All non-surgical options tried Fit for surgery + anaesthetic

Question 31

What happens in bariatric surgery?

Answer 31

Part of stomach is excised + sometimes part of small intestine = reduces amount can be eaten = weight lost

Question 32

What may be the problem with a shorter GI tract?

Answer 32

Alter drug absorption