Np614 Module 2 Obesity

Front 1

How many obese people are in the USA?

Back 1

1/3 of adults, over 72 mil, 33.3% of men and 35.3 women, black and hispanic women more likely to be obese

Front 2

Women obese statistics

Back 2

60+ women 61% black women obese, adults 40-59 likely to be obese more that hyounger people

Front 3

What are healthy people 2010 objective as far as obesity?

Back 3

reduce adluts down to 15% who are obese and increase proportion of adults who are healthy weight 60%

Front 4

For mass majority of childrne who are obese they take this weight into adulthood

Back 4

true

Front 5

Obesity is associated with what diseases?

Back 5

hypertension, hyperlipidemia, CAD, gallbladder dx, sleep apnea, certain cancers, storke and type 2 diabetes, every unit increase of BMI increased 12% risk of diabetes

Front 6

BMI 25.5-29.9% had increased risk of death at age of 50 overweight and obese puts one at risk for increased death

Back 6

true

Front 7

What good things does weight loss improve?

Back 7

b/p glycemic control, lipid profiles, lowers LDL, lower tri, raises HDL and lowers total cholesterol

Front 8

What is goal for health with weight loss?

Back 8

reduction of 10% over 6 months - this will improve insulin resistance, lipid profile and b/p

Front 9

Waist circumference non asian males

Back 9

< 37 OK, => 37-39 increased risk, high risk > 40

Front 10

Waist circumference non asian males

Back 10

< 32 OK, increased risk 32-34, high risk => 35

Front 11

What does abdominal fat do?

Back 11

think about this as an endocrine organ: secretes hormones, enzymes, cytokines, and complement factors which play a role in appietite , insulin resistance and immune functions - very bad

Front 12

chocolate and carbohydrates run in same pathway as cocaine as far as addictive properties

Back 12

true

Front 13

Resting metabolic rate due to what

Back 13

Free fat mass - muscle requires more energy than fat - need to lift weights, age: muscle mass decreases with age - if we weight train this would not happen) 3: sex - males have more muscle mass more than females, familial effect accounts for 41% of variance of RMR if one parents obese and 80% of both parents

Front 14

HOw does physical activity relate to body weight gain with age?

Back 14

the more active you are the less weight you gain

Front 15

Physical actiivty positive predictor of dieting success short and long term

Back 15

true

Front 16

What is key to weight loss?

Back 16

not specific diet, but adherance to a program that works for you

Front 17

How to diet

Back 17

Portions make a difference, need to reduce fat and need to reduce carbohydrates (chips, cakes, cookies, need to reduce 500-1000 calories a day - eat less or exercise more - the only way to loose weight - need to be hungry to lose weight

Front 18

Name meds approved for weight loss?

Back 18

orlistat, meridia, phentermine, Off label: topamax, glocophage, prozac, welbutrin, acrabose, in the works: leptic, cannibinoid 1 receptor blockade & gherline

Front 19

When are surgical interventions OK for weight loss?

Back 19

NIH apporved for morbid obesity BMI >35 with 2 or more co-morbid conditions

Front 20

What is risk of gastric bypass?

Back 20

40% develop complications vitamin dfeicience, bacterial growth and hernias - recently shown 30% reduction in death

Front 21

Use motivational interviewing with obesity

Back 21

No judgemental attitudes with obese individuals, they know they are obese - find out their goals don't blame everything on their weight - they feel bad anyway. Let me know BMI and ask what they think about it?

Front 22

The Body mass index reflects

Back 22

total body weight in relation to height - BMI is calcuated by takign the body weigh tin Kgs divided by height in meters squared

Front 23

When counseling patients about weight which statement is most accurate?

Back 23

belly fat is the most dangerous type of fat to your health - abdominal fat is metabolically active

Front 24

An adult BMI of ____ is considered obese

Back 24

30 Normal BMI 18-24.9, overweight 25-29.9, Obese 30+

Front 25

A reduction of how many calories a day is necessary to lose 1 pound of weight weekly?

Back 25

500

Front 26

What are reccommended testing ages for lipids and lipoprotiensby NCEP?

Back 26

beginning at age 20 and every 5 years thereafter (US Task force does not recoommend until 35 for men and 45 for women unless high risk for CAD then at age 20)

Front 27

Why test for lipids early?

Back 27

1.Early testing gives the individual the opportunity to begin primary prevention!
2.Identify early risk factors that are modifiable!
3.Increase awareness of personal risk for development of premature CHD even if the clinical disease could be decades away. (Now this is an interesting concept given that most in their 20s still feel very invulnerable to any ill of the world).
4.Individuals who have cholesterol levels in the upper quartile for the population are definitely at higher long term risk and life habit intervention to control risk factors is fundamental

Front 28

What labs need to be drawn for lipid panel?

Back 28

total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride level

Front 29

What are LDL's

Back 29

Bad cholesterol the major type of lipoproteins that carry cholesterol in the bloodstream to the body. These are the type that can lead to a buildup of cholesterol in the arteries and lead to heart disease. LDL correlates positively with arterial disease. Most guidelines concentrate on target ranges for LDL

Front 30

What are HDL's

Back 30

Good cholesterol. These particles carry cholesterol back to the liver to remove it from the body. Higher levels of HDL are considered good. They transport cholesterol away from cells. The higher the plasma levels of HDL, the lower the atherosclerosis risk. HDL can be raised by exercise

Front 31

What are triglycerides?

Back 31

These are the chemical form in which most fat exists in food as well as in the body. They are derived from fats eaten in foods or are made in the body from other energy sources like carbohydrates. Calories ingested in a meal and not used immediately by tissues are converted to triglycerides and transported to fat cells to be stored. Hormones regulate the release of triglycerides from fat tissue so they meet the body's needs for energy between meals. Not cardiovascular risk factor, but are markers for increased risk. > 1000 risk for pancreatitis, > 500 problematic & needs to be treated

Front 32

How to take cholesterol levels?

Back 32

fasting 10-12 hours, can have water, if do not fast affects triglyceride levels and then cannot calculate LDL

Front 33

How to calculate LDL?

Back 33

LDL = total cholesterol - HDL - (triglycerides/5).

Front 34

How to read total cholesterol readings?

Back 34

A total that is less than 200mg/dl is desirable, 200-239 mg/dl is borderline high, and over 240 mg/dl is high

Front 35

How to categorize risk with cholesterol levels

Back 35

High risk is defined as a >20% chance of CHD in the next 10 years.
Moderate risk is defined as 10-20 % chance of CHD in the next 10 years
Low risk is defined as less than 10% chance of CHD in the next 10 years.

Front 36

What are risk factors for CHD?

Back 36

Age > 45 for men > 55 women Hypertension >140/90 or on meds, low HDL < 40, family hs of CHD, smoker

Front 37

What foods are good to reduce cholesterol?

Back 37

•Eat more fish, chicken and turkey, reduce frying, reduce foods with fat - bacon, sausage or hamburger (cook drain and rinse), reduce meals with meat, no more than 2-3 eggs weekly, lower fat conent in milk, olive oil best, avoid palm and coconut oils, avoid hydrogenated oils or lard, low fat cheese - mozarella or swiss,

Front 38

What is included in liver function tests?

Back 38

Bilirubin, total & direct or conjugated, ALT, AST & Alakline phsphatase, GGT

Front 39

What do the transaminiase or ALT & AST look for?

Back 39

liver function at cells of liver

Front 40

What do the Cannicular alkaline phosphatase or GGT look for?

Back 40

gving us indication if problem of billiary ducts

Front 41

What is bilirubin?

Back 41

breakdown product of RBC''s, bound to albumin for trasnfer to liver. Conjugated is water soluable & excreted in bile & urine

Front 42

How to look at bili level?

Back 42

Total: 0.3-1.0 mg/dL elevated in hepatic disease or hemolytic disease states - when eleveated measure direct bili. Direct: greater than or equal to 0.4 mg/dL elevated in hepatic or biliary disease - water soluble will be seen in urine - dark tea colored urine

Front 43

Why would you see unconjugated bilirubin?

Back 43

overproduction of bilirubin or hemolysis, decreased uptake of bilirubin or decreased conjucation

Front 44

Why would you see increase in direct or conjugated bilirubin?

Back 44

impaired excretion of bile or biliiary obstruction

Front 45

When would ALT be elevated?

Back 45

with damage to liver not sensitive for biliiary obstruction, more specific for liver injury than AST as AST can be found in other tissues. Range 10-35 u/L - higher in infants

Front 46

Where is AST found?

Back 46

liver, striated muscle, heart, kidney, pancreas, spleen & lung

Front 47

When would AST be elevated?

Back 47

alchol liver damage high AST than ALT
Range: 20-48 m/L 2-3 x higer in infants

Front 48

What disease process when see both increase of ALT & AST?

Back 48

hepatitis (viral - 10x increase), cirrhosis, tylenol overdose (even higher than hepatitis), alcholic liver disease, mono

Front 49

What disease process when see increase in alkaline phosphatase?

Back 49

sensitive for cholestasis, biliary obstruction, cirrhosis, modest increase in viral hepatitis, 10 fold incrase with carconoma of head of pancreas, hyperthyroidism, hyperparthryoidism, osteogenic sarcoma, limited specficity - wide tissue distribution especially bone 50-120 u/L, high in infants and during growth spurts d/t bone growth, after bone growth stopped ALT mostly liver orgin

Front 50

What is GGT?

Back 50

biliary excretory enzymne, - may be helpful for obstructive jaundice and cholestatis and pancretitis

Front 51

What are first line meds for cholesterol lowering?

Back 51

statins or HMG-Co A reductase inhibitors. These reduce LDL

Front 52

What are risks of taking statins?

Back 52

liver problems - processes through liver - baseline AST and perodic AST, can cause muscle pain baseline CK & CPK levels

Front 53

When shoudl statins be taken?

Back 53

At bedtime - this is when cholesterol synthesis is highest

Front 54

What is 2nd level choice for lowering cholesterol?

Back 54

Bile acid sequesterants - cause GI complaints

Front 55

What is best med to help increase HDL?

Back 55

Nicotinic Acid or fibric acid derivatives - increases flushing take with aspirin to decrease flusing

Front 56

What is the goal of cholesterol lowering drugs?

Back 56

Lower LDL

Front 57

When should you refer a patient for high cholesterol to lipid specialist?

Back 57

LDL > 250, HDL < 20, Triglycerides > 500 in non diabetic, CAD under 30, first treat then send

Front 58

Know Lipid meds

Back 58

go over lipid cards

Front 59

What you need to know for obesity and lipid test.

Back 59

BMI (what BMI tells you and what it does not tell you), waist circumference, know gastric bypass banding read case study who gets it, why, how to treat afterwards, diet, vitamin issues, anemia & meds, protien, lipids who to screen, when to screen why to screen, atpIII - know what is in this, what target first on lipid panel (LDL) then triglycerides, what drugs hit LDL and what drugs hit triglycerides, what are optional goals vs optimal goals (LDL) - look at test question wording carefully, waht to do if elevated liver enzymes, what shouldn't be doing if elevated liver enzymes (case study), elevated CK know levels how high go, know statins side effects how to give, how to stop, rule of 6,

Front 60

How is BMI calculated?

Back 60

dividing his or her weight in kilograms by the height in meters squared or weight in lbs, / height in inches squared x 703

Front 61

What BMI is considered overweight?

Back 61

25 greater than 30 are obese, greater than 35 are severely obese, greater than 40 are morbid obese

Front 62

What does BMI not tell you?

Back 62

muscle mass vs fat, bone mass. difficult in athletes, children and older adutls

Front 63

What factors influence obesity?

Back 63

RMR, excessive calories, lack of exercise, genetics, parental influence (having an obese mother doubles risk fo child beig obese), medical conditions, lack of sleep & increased stress, large portioni sizes

Front 64

What drugs are used to combat obesity?

Back 64

Orlistat (inhibits pancreatic enzyme that reduced fat absorption) sibutramine (appetite suppressant)

Front 65

What are health risks of obesity?

Back 65

type 2 diabetes, CHD, dyslipidemia, metaboic syndrome (excessive fat in stomach), sleep apnea, gallbladder disease, increased risk of breast, colon, kidney and esophagus CA, arthritis, impairment of immune system

Front 66

What are o;ptional LDL goals in very high risk populations?

Back 66

70 or less, less than 100 in high risk populations

Front 67

How is HDL good?

Back 67

when free cholesterol binds with HDL then it is taken to liver and broken down and excreted in bile, low levels of HDL independent risk factor of CVD, > 60 makes it a negative risk factor, exercise can increase HDL

Front 68

How do dietary fats contribute to high cholesterol?

Back 68

saturated fats contribute to hyperlipidemia, slows down breakdown of LDL receptors which increases concentration in blood, animal products contain lots of dietary cholesterol

Front 69

What foods contain saturated fats that increase cholesterol?

Back 69

palmitic acid, meats, eggs and dairy products, palm and coconut oils found in commercially baked goods

Front 70

Which foods contain monounsaturated fats?

Back 70

peanuts, olives, avocados, & almonds - mono unsaturated fats not not lower or raise cholesterol

Front 71

Which foods contain polyunsaturated fats?

Back 71

vegetable oils, and fish oils

Front 72

What are worst fats?

Back 72

Trans fats found in fried foods, margarine, commercial baked goods

Front 73

What is metabolic syndrome?

Back 73

progressive insulin resistance that is affected by abdominal fat

Front 74

Which lipid level is affected by dietary fats w/i last 12 hours

Back 74

Triglycerides and this level is used ot determine LDL so patient must be fasting to obtain correct LDL

Front 75

What is the LDL goal level for the moderate risk group for NCEP ATP III

Back 75

2 or more risk factors, 130 or less

Front 76

What is LDL goal for low risk CVD?

Back 76

patients have zero or one major risk factors 160 or less

Front 77

What are the risk factors included when using Framington Point scoring?

Back 77

Diabetes, stroke or know cerebrovascular disease, peripheal vasuclar disedase, abdominal aortic aneurysm

Front 78

How does statin therapy work?

Back 78

Higher dose show works better to decrease LDL, usually increase dose to max dose before trying something else, Rule of 6 when increaseing dose will lower LDL 6%

Front 79

Why take a baseline of creatine kinase (CK) when startign on statins?

Back 79

can cause muscle pain, CK can rise up to 10 times above normal and this is OK as long as pt has no symptoms

Front 80

What are statin drugs?

Back 80

Lovastantin (Mevacor), Pravastatin (Pravachol), Simvastatin (Zocor), Fluvastatin (Lescol), Antrovastatin (Lipitor), Rosuvastatin (Crestor)

Front 81

Name the cholesteorl absorption inhibitors?

Back 81

Ezetimibe (Zetia) combo drug statint iwth ezetimibe (Vyorin)

Front 82

Name Fibric Acids?

Back 82

Genfibrozil (Lopid), Fenofibrite (Tricor)

Front 83

Name Bile Acid Sequestrants

Back 83

Cholestyramine, Colstipol, colesevelam - bind with bile so not absorbed & slows down gastric motility, causes GI upset and constipation

Front 84

Drugs that lowers HDL and increases LDL

Back 84

anabolic steroids, progestins, corticosteroids

Front 85

What are normal LDL ?

Back 85

optimal: < 100
near optimal 100-129
borderline high 130-159
high 160 -189
very high 190

Front 86

What are normal HDL values?

Back 86

low < 40
high >60 (high is better)

Front 87

What are normal total cholesterol levels?

Back 87

< 200 desireable
200-240 borderline
> 240 high

Front 88

What are normal triglyceride levels?

Back 88

< 150 normal
150-199 borderline
200-499 high
> 500 very high

Front 89

What drugs can be added to statins to decrease triglycerides?

Back 89

fibric salts or nicotinic acids

Front 90

What are normal ALT values?

Back 90

normal 10-34

Front 91

What are normal AST values?

Back 91

9-36

Front 92

What are normal Alk Phosphatase values?

Back 92

53-141

Front 93

What is the critera for diagnosis of metaboic syndrome?

Back 93

3 or more of the following:
•Blood pressure equal to or higher than 130/85 mmHg

•Fasting blood sugar (glucose) equal to or higher than 100 mg/dL

•Large waist circumference (length around the waist):

•Men - 40 inches or more

•Women - 35 inches or more


•Low HDL cholesterol:

•Men - under 40 mg/dL

•Women - under 50 mg/dL


•Triglycerides equal to or higher than 150 mg/dL

Front 94

When should statins not be used?

Back 94

Statins are not recommended with elevated liver enzymes due to liver toxicity.

Front 95

What diseases does obesity predispose one for?

Back 95

type 2 DM, heart disease, sleep apnea, gallbladder disease, and certain cancers

Front 96

What does the Framingham scale look at?

Back 96

Age
Total cholesterol
B/P
Smoker/Non-smoker

Front 97

How to calculate BMI?

Back 97

: determined by weight/height² Waist measurement is significant to predict a health risk

Front 98

What to test initially and every 2 months x 2 if prescribing statin?

Back 98

LFT's - then take q6 months

Front 99

What is important to know besides BMI?

Back 99

hip/waist ratio

Front 100

How high can CK (creatine kinase) go before dangerous with statin therapy?

Back 100

10 times normal, Crestor is considered the harshest/worst of the statins for causing myopathies

Front 101

What else coudl cuase muscle pain than statin drugs?

Back 101

what labs would you draw when considering the myalgia besides a CK...think.....hard on this..........it is very in vogue right now......

If I was concerned about Fibromyalgia I would get CBC with sed rate, and test for rheumatoid factor.

I would also want to do the tender point location exam for fibromyalgia

Front 102

Why avoid grapefruit juice when on statins?

Back 102

the chemicals in grapefruit juice can inhibit CYP3A4- causing a slowing of the inactivation of statins and these effects can persist for up to 3 days.

Front 103

What statins should not be taken with grapefruit juice?

Back 103

Lipitor (atorvastatin), Mevacor (lovastatin), and Zocor (simvastatin)