pharmacy practice III

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alvo2234
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185985
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pharmacy practice III
Updated:
2012-11-29 10:50:36
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final exam
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pharmacy practice III final (overweight and obesity)
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  1. obesity associated morbidity and mortality
    • CVD
    • type II DM
    • respiratory problems
    • gallbladder disease
    • osteoarthritis
  2. Anorexic BMI
    <17.5
  3. underweight BMI
    17.5-18.4
  4. Normal Weight
    18.5-24.9
  5. Overweight
    25-29.9
  6. Obese 
    > or = 30
  7. metabolic syndrome risk factors
    • Waist circumference        40 inch (men) 35 inch (women)
    • triglycerides                     >= 150mg/dL
    • HDL                               men< 40mg/dL  women <50mg/dL
    • blood pressure                >= 130/85 mmHg
    • fasting blood glucose       >= 100 mg/dL
  8. weight gain results from
    energy intake > energy expenditure
  9. one pound of adipose tissue
    3500 calories
  10. Environment pathophysiology
    • activity level
    • food availability
    • increase in portion size and calorie density
    • occupation
    • sleep duration
  11. energy homeostasis
    • basal metabolism 60-70%
    • thermogenesis 10%
    • physical activity 15-30%
  12. satiety (pathophysiology)
    • leptin
    • ghrelin
    • GLP-1
  13. Medications (pathophysiology)
    • atypical antipsychotics (respiradone, quetiapine)
    • hormonal contraceptives
    • steroids 
    • anticonvulsants (valporic acid, lithium)
    • insulin
  14. goals of therapy
    • reduce body weight by 5-10% over 6 months
    • maitenance of weight loss
    • prevent future weight gain
  15. exclusions to self-treatment
    • severe obesity (BMI > 40)
    • pregnancy or breast-feeding
    • < 18 or > 65 years
    • eating disorders
  16. comprehensive lifestyle modification
    • dietary change
    • physical activity
    • behavior therapy
  17. pharmacotherapy treatment
    • BMI > 30
    • BMI > 27 + co-morbidities
    • short term vs long term
    • single therapy vs. comination therapy
    • lowest effective doses
    • should be used with concomitant lifestyle changes
  18. average adult man calorie intake
    2200-3000 kCal/day
  19. average adult woman 
    1800-2800 kCal/day
  20. weight loss cal reduction
    300-1000 per day
  21. low cal diet (LCD)
    • 800-1500 kCal/day
    • goal is to lose 1-2 lbs per wk
  22. very low cal diet (VLCD)
    • < 800 kCal/day
    • goal is to lose 2-4lbs/ wk
    • must be conducted under supervisor
  23. Dietary change (exercise)
    adults should exercise for at least 30 min and children for at least 60 min for most days
  24. low fat diet
    • 30% of total 
    • 8-10% of total calories from saturated fat
    • include more mono/polyunsaturated fats
    • inadequate to lose weight (must be a reduce tot calories)
  25. very low fat vegetarian diets
    • possible benefit in patients with CHD
    • must choose dietary fat carefully to avoid deficiency
  26. meal replacement therapy advantage/servings/replacement
    • portion control
    • usual serving = 200-300 calories
    • -low fat selection
    • -low carbohydrate selection
    • replace 1-2 meals/day (eat reasonable 3rd meal)
  27. Physical activity for adults/children
    children and adolescents >= 60 min of mod/vigorous activity every day

    adults 150 min of moderate aerobic exercise or 75 min of vigorous physical activity 
  28. behavior therapy
    • group or individual therapy (group may be better)
    • face to face communication
    • diet planning
    • online food diary tracking
    • environmental modification (eliminate high density cal food)
    • thinking pattern modification
    • optimistic approach
    • encouragement from others
  29. Orlistat
    • Alli
    • only FDA approved non Rx drug
    • ages >= 18
  30. Alli MOA
    • decreases fat absorption
    • -inhibiting pancreatic and gastric lipases
    • -inhibiting hydrolysis of FAs
  31. Alli Dosing/Goal
    • 60mg PO TID with meals (should contain fat)
    • goal is 5-10 lb loss over 6 months
  32. Alli AE
    • flatulence 
    • oily spotting
    • loose/frequent, fatty stools
    • fecal urgency and incontinence
    • symptoms are worst over first two months then improve
  33. Alli drug interactions
    • warfarin
    • cyclosporine
    • levothyroxine
    • amiodarone
    • oral hypoglycemic agents
  34. consult PCP bere starting orlistat
    • thyroid disease
    • DM
    • kidney stones (nephrolithiasis)
    • gall stones (cholelithiasis)
    • pancreatitis
    • should not be used in patients with a malabsorption disorder
  35. Alli patient education
    • take multivitamin at bedtime
    • should be used in combination with lifestyle changes
    • side effects can be minimized by reducing the amount of ingested fat
  36. bannned products
    • phenylpropanolamine
    • ephedra/ma huang
    • Aloe + cascara sagrada

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