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16 Cards in this Set
- Front
- Back
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A 35 year old female presents to her primary care physician seeking treatment for weight loss. She has tried several “fad diets” which incorporate the intake of low carbohydrates and has failed at each attempt. She states that she does exercise” when she finds the time”.
BMI = 32; Waist Circumference = 38 inches, BP = 167/99 and HR = 82 Labs: TC 253 mg/dl LDL 154 mg/dl HDL 33 mg/dl TG 267 mg/dl ALT 23 IU/l HgA1c 6.8 % Gluc 109 mg/dl What is the most appropriate weight loss goal for this patient? a. 5-10% of body weight b. 15-20% of body weight c. 20-25% of body weight d. BMI < 25 |
The correct answer is a. By achieving 5-10% body weight loss, a significant change in comorbid conditions, such as her hypertension, may be accomplished. Although the other goals may be desirable, particularly to the patient, they may not be realistic and can set the patient up for what they consider failure and relapse. See objective 4.
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The patient is amenable to another attempt at lifestyle modifications. Which diet would be the most appropriate for this particular patient?
a. Low Fat b. Low Carbohydrate c. Balanced low calorie diet d. A or C |
d. A or C
The correct answer is d. We know the patient has failed several attempts at a low carb diet. The one diet recommended for individuals is the one they will best adhere to. Therefore, either A or C may be a good choice for the patient. See objective 4. |
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26. Once the diet has been implemented, is this patient also a candidate for weight loss medication?
a. Yes, she her BMI is greater than 27 and she has two comorbid conditions b. No, her BMI is greater than 27, but she does not have two comorbid conditions c. Yes, her BMI is greater than 30 d. No, her BMI is not greater than 35 |
c. Yes, her BMI is greater than 30
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27. If Pharmacotherapy is deemed appropriate which medication below would be most correct to recommend?
a. Sibutramine b. Orlistat c. Phentermine d. A or C |
b. Orlistat
The correct answer is b. We would rule out both sibutramine and phentermine given the fact that the patient has uncontrolled hypertension. See objective 4. |
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16. According to the NIH Overweight and Obesity classification, how would a 39 year old African American female with a BMI= 36 and a waist circumference = 35 inches be classified?
a. Overweight b. Obesity Class I c. Obesity Class II d. Obesity Class III |
c. Obesity Class II
Answer c is correct. Classification is based strictly on BMI. This classification chart is found in the NIH guidelines. |
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Which of the following statements is FALSE?
a. If a patient being treated for obesity does not lose 2 lbs within the first 4 weeks of drug therapy, it is unlikely that drug therapy will be successful b. Obesity-related risk factors include: coronary heart disease, Type 2 diabetes, hypertension and sleep apnea c. Ghrelin regulates food intake and energy expenditure by acting as a satiety signal to decrease appetite in the CNS d. Pharmacotherapy is indicated for patients who have a BMI > 30 or a BMI > 27 with concomitant obesity-related risk factors or diseases. |
c. Ghrelin regulates food intake and energy expenditure by acting as a satiety signal to decrease appetite in the CNS
Ghrelin is a neurotransmitter that stimulates food intake. |
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Which of the following statements is FALSE?
a. Patients taking orlistat should be counseled to expect gastrointestinal side-effects such as oily spotting, abdominal pain, flatus with discharge; which should improve over time b. Sleep deprivation, viruses, and toxins are potential environmental factors that may contribute to obesity c. The goals of therapy for obesity include: prevent further weight gain, reduce body weight by 10% in the first 6 months, and maintain a lower body weight, long term d. Sibutramine is a safe drug therapy for treatment of obesity in patients with uncontrolled hypertension |
d. Sibutramine is a safe drug therapy for treatment of obesity in patients with uncontrolled hypertension
Answer d is correct. Sibutramine has the potential to raise blood pressure and therefore should be avoided in patients with uncontrolled hypertension. |
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Ms. White is a 42 year-old white female with a medical history significant for hypertension and sleep apnea. Her current body weight is 190 lbs, BMI is 33 and waist circumference is 37 inches. Ms. White’s blood pressure today is 148/92 mmHg. Current medications include: lisinopril 20 mg qd, HCTZ 12.5 mg qd and Yasmin (an oral contraceptive pill containing ethinyl estradiol and drosperinone). Ms. White states that she has struggled with her weight and has been on and off diets all of her life. While she tries to eat healthy she admits that there are numerous high fat foods that she just “cannot give up”. She states that she power- walks during her lunch hour 5 days per week for 30 minutes. This has helped her keep her weight from going up. It is noted that Ms. White’s insurance does not cover prescriptions for weight loss. Dr. Albert has asked for your assistance in selecting a drug therapy.
Which pharmacological strategy is most appropriate for Ms. White? a. Alli (Orlistat) 60 mg three times daily with fat-containing meals only b. Phentermine 15 mg every morning c. Sibutramine 10 mg every morning d. Do not start drug therapy in this patient because she does not meet the National Institutes of Health obesity guideline criteria for pharmacotherapy. |
d. Do not start drug therapy in this patient because she does not meet the National Institutes of Health obesity guideline criteria for pharmacotherapy.
A, This patient does not have any contraindications to use orlistat; whereas, all other approved drug therapies for treatment of obesity may increase the risk to raise BP. B, Phentermine would not be a good choice because of its potential to raise blood pressure and this patient has uncontrolled HTN C, Sibutramine would not be a good choice because of its potential to raise blood pressure and this patient has uncontrolled HTN D, This patient meets the criteria for drug therapy in that he has failed diet and exercise and has a BMI > 30 or BMI > 27 with risk factors (sleep apnea, HTN) |
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According to the NIH Overweight and Obesity classification, how would a 39 yo BF with a BMI= 34 and a waist circumference= 31” be classified?
a. weight b. Obesity Class I c. Obesity Class II d. Obesity Class III |
b. Classification is based strictly on BMI. This classification chart is found in the NIH guidelines.
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Which of the following statements is FALSE ?
a. If a patient being treated for obesity does not lose 2 lbs within the 1st 4 weeks of drug therapy, it is unlikely that drug therapy will be successful. b. Obesity related risk factors include: coronary heart disease, Type 2 diabetes, hypertension and sleep apnea. c. Leptin regulates food intake and energy expenditure by acting as a satiety signal to decrease appetite in the CNS. d. Pharmacotherapy is indicated for patients who have a BMI ≥ 25 or a BMI ≥ 27 with concomitant obesity related risk factors or diseases. |
d. Pharmacotherapy is indicated for patients who have a BMI ≥ 25 or a
BMI ≥ 27 with concomitant obesity related risk factors or diseases. d. Pharmacotherapy is indicated in patients who have a BMI ≥ 30 or a BMI ≥ 27 with concomitant obesity related risk factors or diseases. |
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Which of the following statements is FALSE?
a. Patients taking orlistat (xenical) should be counseled to expect GI sideeffects such as oily spotting, abdominal pain, flatus with discharge; which should diminish over time. b. Sleep deprivation, viruses and toxins are potential environmental factors that may contribute to obesity. c. The goals of therapy for obesity include: prevent further weight gain, reduce body weight by 10% in the first 6 months and maintain a lower body weight, long term. d. Sibutramine (Meridia) is a safe drug of therapy for treatment of obesity in patients with uncontrolled hypertension |
d. Sibutramine (Meridia) is a safe drug of therapy for treatment of obesity in patients with uncontrolled hypertension
d. sibutramine has the potential to raise blood pressure and therefore should be avoided in patients with uncontrolled hypertension. |
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Mr. Fulmore is a 52 year old white male with a past medical history of Type 2
diabetes, hypertension, and sleep apnea. Current wt= 280 lbs, BMI = 38 and waist circumference = 46”. Blood pressure today is 166/92 mmHg. Current medications include: glucophage (Metformin) 850 mg tid, Glucotrol (glipizide) 10 mg qd and pioglitazone (Actos) 30 mg qd. Mr. Fulmore has tried “every diet under the sun (including the Dunkin Donuts only diet) ” over several years with little success. He walks for 45 minutes/ 5 days per week. This has helped him lose 40 lbs. Dr. Albert has asked for your assistance in choosing a drug therapy. Mr. Fulmore states that he has a terrific health insurance plan through the state of Tennessee. a. Orlistat (Xenical) 120 mg tid with high-fat meals only b. Phentermine (Adipex) 15 mg q am c. Sibutramine (Meridia) 10 mg q am d. Do not start drug therapy in this patient because he does not meet the NIH obesity guideline criteria for pharmacotherapy. |
a. Orlistat (Xenical) 120 mg tid with high-fat meals only
a. This patient does not have any contraindications to use orlistat; whereas, all other approved drug therapies for treatment of obesity may increase the risk to raise BP. b. Phentermine would not be a good choice because of it’s potential to raise blood pressure and this patient has uncontrolled HTN c. Sibutramine would not be a good choice because of it’s potential to raise blood pressure and this patient has uncontrolled HTN d. This patient meets the criteria for drug therapy in that he has failed diet and exercise and has a BMI > 30 or BMI > 27 with risk factors (HTN, Type 2 DM, sleep apnea) |
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According to the NIH Overweight and Obesity classification, how would a 43 year-old white female with a Body Mass Index (BMI) of 29 kg/m2 and a waist circumference of 31 inches be classified?
A. Overweight B. Obesity Class I C. Obesity Class II D. Obesity Class III Answer A: Classification is based strictly on BMI. This classification chart is found in the NIH guidelines. |
A. Overweight
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Which of the following statements is FALSE?
A. If a patient being treated for obesity does not lose 2 lbs within the first 4 weeks of drug therapy, it is unlikely that drug therapy will be successful for him/her. B. Pharmacotherapy is indicated for patients who have a BMI ≥ 25 or a BMI ≥ 20 with concomitant obesity-related risk factors or diseases. C. Obesity related risk factors include: dyslipidemia, Type 2 diabetes mellitus, hypertension and sleep apnea. D. Leptin regulates food intake and energy expenditure by acting as a satiety signal to decrease appetite in the CNS. |
B. Pharmacotherapy is indicated for patients who have a BMI ≥ 25 or a BMI ≥ 20 with concomitant obesity-related risk factors or diseases.
Answer B: Pharmacotherapy is indicated in patients who have a BMI ≥ 30 or a BMI ≥ 27 with concomitant obesity-related risk factors or diseases. |
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Which of the following statements is FALSE?
A. Patients taking orlistat should be counseled to expect GI side-effects such as oily spotting, abdominal pain, and flatus with discharge, each which should improve over time. B. Sleep deprivation, viruses and toxins are potential environmental factors that may contribute to obesity. C. The goals of therapy for obesity include: prevent further weight gain, reduce body weight by 10% in the first 6 months and maintain a lower body weight long term. D. Sibutramine is a safe drug of therapy for treatment of obesity in patients with uncontrolled hypertension. |
D. Sibutramine is a safe drug of therapy for treatment of obesity in patients with uncontrolled hypertension.
Answer D: sibutramine has the potential to raise blood pressure and therefore should be avoided in patients with uncontrolled hypertension. Answer D: sibutramine has the potential to raise blood pressure and therefore should be avoided in patients with uncontrolled hypertension. |
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Mr. Fulmore is a 52 year-old white male with a past medical history of Type 2 diabetes mellitus, hypertension, sleep apnea and cholestasis. Current weight is 280 lbs, BMI is 38 kg/m2 and waist circumference is 46 inches. Blood pressure today is 166/92 mmHg. Current medications include: metformin 850 mg tid, glipizide 10 mg qd and pioglitazone 30 mg qd. Mr. Fulmore has tried “every diet under the sun (including the Dunkin’ Donuts only diet)” over several years with little success. He walks for 45 minutes for 5 days per week which has helped him lose 40 lbs. Dr. Albert has asked for your assistance in choosing a drug therapy for this patient. Mr. Fulmore states that he will pay cash for any medications needed to help him lose weight. What would be the most appropriate choice for this patient?
A. Orlistat 120 mg tid with high-fat meals only B. Diethylpropion CR 75 mg qam C. Sibutramine 10 mg qam D. Do not start drug therapy in this patient because he does not meet the NIH obesity guideline criteria for pharmacotherapy. |
Answer A is correct.
A. This patient does not have any contraindications to orlistat use; whereas, all other approved drug therapies for treatment of obesity of the risk to increase blood pressure. B. Diethylpropion would not be a good choice because of its potential to raise blood pressure and this patient has uncontrolled hypertension C. Sibutramine would not be a good choice because of it’s potential to raise blood pressure and this patient has uncontrolled hypertension D. This patient meets the criteria for drug therapy in that he has failed diet and exercise and has a BMI > 30 or BMI > 27 with risk factors (hypertension, Type 2 diabetes mellitus, sleep apnea) Note: this patient needs to be started on antihypertensive therapy. |
