Block 3 Pharm 4- Obesity

Front 1

When setting treatment goals for an obese patient, what is the most important thing to remember?

Back 1

keep them realistic and reachable

Front 2

What is an appropriate weight loss goal at the beginning?

Back 2

5-10% of total body weight

Front 3

If a patient has osteoarthritis, other physical problems, or sleep apnea, what should their weight-loss goal be?

Back 3

10-20% of total body weight

Front 4

When should you consider a prescription weight loss drug?

Back 4

When a BMI > or equal to 30; or 28 if a comorbidity is present.

Front 5

What line of treatment is prescription weight-loss drugs in children?

Back 5

LAST LINE: 4th

Front 6

What are two ways a patient can lose weight without pharmacological intervention?

Back 6

1. physical activity
2. low calorie diet

Front 7

What effects does obesity have on DM?

Back 7

- insulin resistance emerges

Front 8

What mechanisms are responsible for the insulin resistance that is associated with obesity?

Back 8

1. down-regulation of insulin receptors
2. abnormal post-receptor signals
3. presence of circulating insulin antagonists (fatty acids & cytokines)
4. impaired gene transcription in insulin-responsive cells

Front 9

The impaired insulin-response cells in DM patients who are obese leads to what result?

Back 9

hyperinsulinemia: due to increased production and release of insulin

Front 10

What are three other conditions (other than the effects of diabetes) that an obese patient may face?

Back 10

1. impaired lipid metabolism
2. HTN
3. osteoarthritis (in weight-bearing joints)

Front 11

What is serotonin's role in appetite?

Back 11

binding with different noradrenergic receptors can increase or decrease appetite.

Front 12

What are some common medications that cause weight-gain?

Back 12

1. steroids
2. TZDs
3. antipsychotics
4. antidepressants
5. Insulin
6. Sulfonylureas

Front 13

What is the transtheoretic model?

Back 13

helps to locate where a particular patient is in the scheme of change- helps to plan an appropriate treatment for the individual.

Front 14

What are the 5 stages of the transtheoretic model?

Back 14

1. precontemplation
2. contemplation
3. preparation
4. action
5. maintenance

Front 15

Betty is morbidly obese but has no inkling to even try to lose weight. She has low self-confidence and reports that her temptation to eat has increased. What stage of the transtheoretic model is she in?

Back 15

precontemplation

Front 16

Jo is morbidly obese and is beginning to consider adding exercise and a diet to his lifestyle. He states that he has recently re-evaluated himself and the chaotic environment that he lives in. What stage is he in?

Back 16

contemplation

Front 17

Betty is committed to no longer going to McDs three times a day and plans her "last supper" there tonight. What behavioral change stage is she in?

Back 17

Preparation

Front 18

Betty says she'll start losing weight this month and sees that it's a good idea for herself and her lacking social life. What stage is she in?

Back 18

Preparation

Front 19

Betty has been exercising routinely for the past 6 months and no longer feels as tempted to indulge in a pint of ice cream. What stage is she in?

Back 19

Action

Front 20

What stage of the transtheoretic model is self-efficacy ranked the highest?

Back 20

Maintenance

Front 21

What forms of lipase inhibitors are available?

Back 21

Orlistat (Xenical, Alli)

Front 22

What is the difference between Orlistat (Xenical) and Orlistat (Alli)?

Back 22

Xenical- Rx only
Alli- OTC

Front 23

what is the MOA of Orlistat/ Lipase inhibitors?

Back 23

1. binds pancreatic and gastric lipase in the GI tract, thereby inhibiting enzymatic action and the breakdown of fat in GI tract
2. promotes behavioral changes

Front 24

What is a counseling caution point that is important when prescribing Orlistat (Xenical) or recommending Alli?

Back 24

may take a toll on your liver

Front 25

What is a counseling point you DONT want to forget when you are incorporating a Lipase inhibitor into your patient's life?

Back 25

the many ADEs- if they DONT modify their behaviors they WILL be embarassed with the SEs that are not preventable.

Front 26

What are common ADEs associated with Orlistat (Alli and Xenical)

Back 26

1. headache
2. oily spotting
3. flatus with discharge
4. fecal urgency
5. fatty stools
6. steatorrhea
7. oil evacuation

Front 27

What are some less common ADEs associated with Lipase inhibitors?

Back 27

1. ANXIETY
2. fecal incontinence
3. pedal edema

Front 28

What is the pneumonic for side effects of Orlistat?

Back 28

Orlistat= GOTTA GO STAT
- fecal incontinence
- steatorrhea
- oil evacuation
- fecal urgency
- flatus with discharge
- oily spotting

Front 29

If a patient is considering using Alli, what other medications should she take alongside it? Why?

Back 29

Multivitamin (ADEK)- these are fat-soluble vitamins; without fat in the diet, they will not be absorbed.

Front 30

When should a patient take Xenical as opposed to Alli?

Back 30

Xenical: during or up to 1 hour ac
Alli: during meal

Front 31

what forms of noradrenergic agents are there for obesity?

Back 31

1. phentermine (Adipex-P)
2. Diethylpropion
3. Benzphetamine (Didrex)
4. Phendimetrazine (Bontril PDM, SR)

Front 32

Which noradrenergics are Class III Control?

Back 32

Benzphetamine
Phendimetrazine

Front 33

Which noradrenergics are Class IV control?

Back 33

Phentermine
Diethylproprion

Front 34

What does the control class tell you?

Back 34

the closer to 1 the agent is, the higher risk of addiction and increased risk of dependency.

Front 35

When writing a prescription for a noradrenergic agent, what must you remember to do?

Back 35

put your DHEA license number on it

Front 36

How long can a patient be on a noradrenergic agent?

Back 36

short term only- because CV ADEs are associated with long-term use.

Front 37

When should you take a noradrenergic agent?

Back 37

in the morning or early afternoon- otherwise you will be kept awake all night.

Front 38

what are common CI for noradrenergic agents?

Back 38

1. ateriosclerosis/CVD/HTN
2. Glaucoma
3. Hx of drug abuse
4. use of MAOIS
5. Hyperthyroidism

**REMEMBER: santa would be a good candidate- he's healthy, just fat**

Front 39

melissa has epilepsy but is morbidly obese and wants to be placed on a noradrenergic agent. Which agent should you NOT turn to for Melissa?

Back 39

Diethylproprion- there is an increased risk of Seizure associated with it.

Front 40

What is the MOA of noradrenergic agents?

Back 40

stimulates the hypothalamus to release norepinephrine, which subsequently decreases your appetite.

NORadrenergic = MORE NORepinephrine

Front 41

Becky comes back in after a month and says her Diethylproprion is not working. What should you do? why?

Back 41

STOP the tx. If it doesn't work or tolerance develops within 4 weeks, treatment should cease.

Front 42

What are common ADEs of noradrenergic agents?

Back 42

1. HTN
2. Tachycardia
3. Euphoria
4. Insomnia
5. Psychosis
6. restlessness
7. tremor

Front 43

Which noradrenergic agent has th emost ADEs?

Back 43

Diethylproprion

Front 44

Henry comes in complaining of going bald and having changes in his libido (and man parts). He says he is on some medicine that decreased his appetite. Which medicine is he likely on?

Back 44

Diethylproprion

Front 45

Name the pregnancy categories associated with each of the noradrenergic agents.

Back 45

1. Phentermine- Cat C
2. Diethylproprion- Cat B
3. Benzphetamine-Cat B
5. Phendimetrazine- Cat C

"Di had a BB named Ben"- Diethylproprion and Benzphetamine are both category B

Front 46

Name the controlled substance categories associated with each of the noradrenergic agents

Back 46

1. Phentermine- IV
2. Diethylproprion- IV
3. Benzphetamine- III
4. Phendimetrazine- III

Front 47

Controlled substance, Pregnancy
Phentermine

Back 47

IV
C

Front 48

Controlled Substance, Pregnancy
Diethylproprion

Back 48

IV
B

Front 49

Controlled Substance, Pregnancy
Benzphetamine

Back 49

III
B

Front 50

Controlled Substance, Pregnancy
Phendimetrazine

Back 50

III
C

Front 51

A pregnant lady who has a FHx of addiction comes in and needs to be put on a noradrenergic agent. Which is the best suited, with these circumstances? Why?

Back 51

Diethylproprion- Because IV = decreased risk of dependence/addiction; and Cat B.

Front 52

Noradrenergic drugs do WHAT

Back 52

increase norepinephrine

NORadrenergic = MORE NORepinephrine

Front 53

What is an example of a sertonergic (SSRI)?

Back 53

Fluoxetine (Prozac)

Front 54

What is a word of caution when switching a patient from one SSRI to another

Back 54

not all SSRIs are equal- they act on different receptors and have different associated ADEs.

Front 55

What is the MOA of SSRI

Back 55

1. inhibit 5HT reuptake (serotonin; not as much dopamine and norepi)
2. binds slightly with alpha adrenergic receptors- leads to activation of lipolysis and increased energy expenditure
3. slight binding to histamine receptors- results in decreased appetite.

Front 56

What class is Prozac in?

Back 56

anti-depressant

Front 57

When considering half-lifes of SSRIs, is it safer to use a drug with a longer, or a shorter half life? Why?

Back 57

longer- because the drug self-tapers off, which reduces the risk of associated withdrawal symptoms.

Front 58

BBW of Fluoxetine (Prozac)

Back 58

suicidal ideation

Front 59

What are Cautions associated with Prozac?

Back 59

1. Serotonin Syndrome
2. SIADH
3. weight loss
4. bleeding
5. withdrawal symptoms (with abrupt discontinuance)

Front 60

Why might you hesitate to prescribe prozac to an 84y/o woman?

Back 60

because of the rapid weight loss that is associated; elderly usually are frail and you don't want them to lose even more weight.

Front 61

Bob takes anticoagulation therapy because he had a DVT. Why would you NOT prescribe him Prozac when he comes in feeling depressed?

Back 61

because increased bleeding risk due to DDI between SSRI (Prozac) and the anticoagulation drug--leads to increased bleed risk

Front 62

Henry comes in with fever, fatigue, AMS, and mental confusion. He is irritable and says he has felt this way since he started his depression medicine. What is likely happening?

Back 62

Serotonin Syndrome- one of the cautions of Prozac.

Front 63

HAve alternative treatments proven effective for weight-loss?

Back 63

no

Front 64

How highly are alternative medications recommended for weight loss (such as Hoodia, Ephedra, etc)

Back 64

NOT recommended- due to increased CV risk with routine use.

Front 65

How effective are alternative drugs such as green tea and guarana extracts for weight-loss?

Back 65

not studied- most weight loss is water weight, not fat.

Front 66

What are some ADEs associated with long-term use of Hoodia and other alternative treatments?

Back 66

1. dehydration
2. constant stimulation
3. insomnia

Front 67

St John's Wort is an alternative treatment that acts on what molecule? Is it good for weight loss?

Back 67

serotonin
NO

Front 68

what are Side effects commonly reported with use of alternative OTC weight-loss drugs?

Back 68

1. fluid loss- dehydration
2. tachycardia
3. increased bp
4. increased metabolism

Front 69

What three Rx categories are used for weight-loss plans?

Back 69

1. Lipase inhibitor
2. noradrenergics (controlled)
3. serotnergics (SSRI)