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26 Cards in this Set
- Front
- Back
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Obesity Increases risk of:
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HTN
Type 2 diabetes coronary heart disease gallbladder disease certain cancers dyslipidemia stroke osteoarthritis sleep apnea |
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Overweight/Obese BMIs
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Overweight 25-29.9
Obese > 30 BMI = weight (kg) / height (m2) |
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Waist circumference high risk for men and women
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Men > 40 inches
Women > 35 inches |
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Assessment of Weight
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BMI
Waist Disease conditions (CHD, DM, OSA) other obesity associated sieases (gynecological abnormalities, osteoarthritis) CV risk factors Other risk factors (inactivity, high TG) |
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Management goals
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prevent further weight gain
reduce body weight maintain lower body weight over long term |
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Realistic Target Weight Goals
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Short term: 5-10 percent loss (1-2 lbs a week)
Interim goal: maintenance Long term: additional weight loss, maintenance Decrease BW by 10% |
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Strategies for Weight Loss and Maintenance
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Dietary therapy
physical activity behavior therapy combined therapy weight loss surgery Pharmacotherapy |
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Lipase Inhibitor
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Orlistat-Xenical
GI lipases (gastric, pancreatic, carboxylester) are essential for LCT absorption |
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MOA of Lipase inhibitors
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results in decreased FFA formation from dietary TG
lowers dietary fat absorption (need to have fat in food to exert effect) 30% decrease in fat absorption daily |
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SE of Lipase inhibitors
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soft stools
diarrhea ab pain/colic fecal urgency incontinence most common in first 1-2 months Malabsorption of fat soluble vitamins may occur |
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Drug Interactions: Lipase inhibitors
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Cyclosporine--decrease in cyclosporine concentration
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Noradrenergic-Serotonergic Agent
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Sibutramine- Meridia
w/drawn from market--raises risk of HA and stroke, little benefit |
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Contrave
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Combines naltrexone and buproprion to suppress food cravings
FDA asked for further trials to check for CV risk |
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Evidence Category B
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BMI > 30 w/ no concomitant risk factors or disease
BMI > 27 w/ other risk factors or disease (HTN, dyslipidemia, CHD, DM, sleep apnea) |
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Evidence Category A interventions
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caloric deficit diet
increased physical activity behavioral treatment |
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ALLHAT Trial Implications
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Systolic BP more difficult to control than diastolic
Avg 2 drugs required for BP control in 2/3 of patients, primarily to control systolic Chlorthalidone decreased systolic most Amlodipine decreased most diastolic |
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ACCOMPLISH Study Implications
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In high risk pts with stage 2 HTN--ACEI + CCB seem better than diuretic + ACEI
But large number of diabetics in study, though same results for rest of the group |
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STITCH Study
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4 Step algorithm for therapy:
1. low dose 2 drugs: ACEI-diuretic, ARB/diuretic 2. increase dose 3. Add CCB and increase 4. Add one of non first line --alpha blocker, BB, spironolactone more decrease in STITCH than guideline group |
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Cardio-SIS Trial
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Analyzed if <140/90 is an appropriate goal--pushing < 140/90 does not reduce total mortality or other endpoints
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J Curve
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Minimum threshold may exist for BP, particularly in pts with heart disease
If less than 110-120 SBP and < 60-70 DBP increases risk of future CV events |
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ACCORD BP
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Is < 130/80 optimal goal in pts with diabetes? Flaw in trial..didn't test 130/80 as goal
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Elderly considerations in treatment
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Low and slow
promote lifestyle modifications Target < 140/90 AE more common |
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Diuretics in Elderly
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low slow
decrease morbidity and mortality greater reduction in SBP Monitor electrolytes, lipids, glucose |
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Children and Adolescents
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95th percentile is stage 1, 99th stage 2
Lifestyle modifications Attempt to determine other causes of high BP and CV risk factors BB preferred Valsartan approved Drugs started for Stage 2, stage 1 if asymptomatic or unresponsive to lifestyle changes |
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Pregnancy
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differentiate between eclampsia and HTN
ACE and ARB contraindicated Methyldopa recommended for HTN diagosed during pregnancy BB (metroprolol, labetolol) Diuretics: okay if prescribed before gestation and volume depletion avoided Hydralazine: parenteral drug of choice |
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Causes for inadequate response to drug therapy
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Pseudoresistance: white coat HTN, improper technique
Nonadherence volume overload: salt intake, renal disease drug related causes: dose, NSAIDs associated conditions: smoking, sleep apnea, insulin resistance, ethanol, chronic pain |
