Management of BMI >/= 25 correct answers Diet, Exercise, Behavior
Management of BMI >/=30 correct answers Diet, exercise, behavior + pharmacotherapy
Management of BMI >/= 27 + comorbidity correct answers Diet, exercise, behavior +
pharmacotherapy
Management of BMI >/=35 + cormorbidity correct answers Bariatric surgery
Management of BMI >/=40 correct answers Bariatric surgery
Co-morbidities correct answers T2DM
HTN
OSA and other respiratory disorders
NAFLD
OA
lipid abnormalities
gastrointestinal disorders
heart disease
Medication assessment correct answers Every month x3 months, then every 3 months
Effective weight loss % correct answers >/=5% in 3 months
Avoid these wt loss meds with HTN/HD correct answers Sympathomimetics
(phentermine/diethylproprion)
Avoid these wt loss medications with CVD correct answers Sypathomimetics
T2DM treatment + medications to support weight loss correct answers GLP-1 analog
(mitigates associated weight gain due to insulin) or SGLT-2 inhibitors + metformin. If using
insulin, recommend basal instead of combo
Drugs that induce weight gain correct answers Tricyclic antidepressants (Amitriptyline)
oral contraceptives (Ortho Tri-Cyclen, Yaz)
antipsychotics (Risperidone)
anticonvulsants
glucocorticoids (cortisol)
sulfonyureas- ( Glimepiride, Glipizide)
glitazones (Actos)
B-blockers (Propranolol, Metoprolol, Atenolol)
Hormonal signals for appetite correct answers CCK- duodenum
K cells- duodenum and jejunum: gatric inhibitory polypeptide
PYY- ileum and colon
GLP-1 -ileum
Pancreas- Insulin
,Adipose tissue: Leptin
Liver- glucagon
GLP-1 correct answers Secreted in response to glucose and promotes insulin release from
pancreas and satiety
Ghrelin correct answers produced in the stomach, orexigenic
Leptin correct answers proportional to fat mass, anorexigenic
Inhibits appetite
PYY correct answers Ileum and colon, anorexigenic
CCK correct answers duodenum, anorexigenic
Insulin correct answers Pancreas, anorexigenic
Phentermine correct answers noradrenergic, dopaminergic sympathomimetic amine
Start with 7.5-15mg/d, increase only with no results
Do not prescribe for someone with hx of psych dz or substance abuse
Lorcaserin (Belviq) correct answers Seratonin agent, stimulates seratonin type 2 receptor
Brand name: Phentermine/Topiramate correct answers Qysemia
Phentermine/Topiramate (Qysemia) correct answers Phentermine- stimulant
Topiramate- neurostabilizer + antiseizure
Bupropion (Wellbutrin) correct answers Dopamine + norepinepherine reuptake inhibitor
Stimulates POMC neurons
Sibutramine (Meridia) correct answers Discontinued-
Norepinephrine, Serotonin, and Dopamine Reuptake Inhibitor Anorectic
Approved for use in adolescents >/=16
Orlistat correct answers blocks absorption of 25-30% of fat calories
SLGT-2 inhibitors (best for T2DM patients)- ex. Invokana correct answers promote weight
loss by preventing the reabsorption of glucose as well as water
Band name: Victoza/Sandexa correct answers Liraglutide
, Liraglutide (Victoza/Sandexa) correct answers Injectable, long acting GLP-1 receptor agonist
Diethylpropion correct answers Anorexiants, Sympathomimetic Amine Anorectic
Cautions with use of Phentermine and Diethylpropion correct answers may elevate mean BP
and pulse
Do not use with pts. with hx of CVD
Monitor patient with HTN
Caution with: HTN, cardiac arrhythemia, seizures
Better choice: Lorcaserin (Seratonin receptor angonist)
cautions with Obese patients on SSRI/SNRI correct answers Do not use LORCASERIN
(seratonin syndrome)
Better choice- phentermine/topiramate (Qysemia) or phentermine alone or Orlistat
Appetite suppressant to avoid before/during pregnancy correct answers Topiramate
Medication recs for CVD correct answers Lorcacserin or Orlistat
Behavioral treatment of Obesity correct answers Weekly: 4-6 months, then bi-weekly
Group: 10-15 participants
60-90 minutes
Private measurements of weight
Participants provide brief report of his/her success with goals
New weight mgmt skill taught each session
Goal: 0.5-1 kg/wk, ultimate goal 10%
Look Ahead structure correct answers 3 group + 1 indiv. session for 6 months
2 group + 1 indv. session for months 7-12
year 2-4: individual monthly + contact by phone or email and opt. group sessions
Leading causes of death in obese patients correct answers Ischemic heart disease
Diabetes
Respiratory disease
Cancer: liver, kidney, breast, endometrial, prostate, colon