PHRD5985 Pharmacotherapy Lecture 14 - Obesity

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daynuhmay
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PHRD5985 Pharmacotherapy Lecture 14 - Obesity
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2014-05-15 08:18:34
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Obesity
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Obesity
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  1. overweight BMI
    25-29 kg/m2
  2. class 1 obese BMI
    30-35kg/m2
  3. class 2 obese BMI
    35-40kg/m2
  4. class 3 obese (extreme obesity) BMI
    40+ kg/m2
  5. estimates central adiposity
    waist circumference
  6. "Obesity Paradox"
    data suggests those who are obes have a survival advantage
  7. sarcopenic
    having low lean muscle mass
  8. gynecoid distribution
    • fat distributed gluteofemorally (pear-shaped)
    • mainly subcutaneous fat
    • lower risk of mortality
  9. Thrifty gene theory
    • evolutionary survival advantage to being able to store fat when food wasn't as readily available as it is now 
    • may contribute to etiology of obesity
  10. percentage of weight loss assoc'd w/ benefits
    3-5%
  11. BMI indicated for bariatric surgery
    40+ OR 35+ w/ comorbidity
  12. % weight loss from bariatric surgery after 2-3 years
    20-35%
  13. small pouch created as stomach, bypassing most of stomach & duodenum
    Roux-en-Y gastric bypass
  14. procedure associated w/ T2DM remission before weight loss
    Roux-en-Y
  15. issues assoc'd w/ bariatric surgery
    • gallstone formation 
    • cholecystitis
    • food intolerance
    • hyperinsulinemic hypoglycemia 
    • nutrient deficiency
  16. difference in mean % loss from baseline active vs placebo (how much weight was lost on average?)
    mean changes
  17. proportion of subjects that lose at least 5% of their body weight active vs placebo
    categorical changes
  18. MOA of phentermine & diethylpropion
    • sympathomimetic amine
    • stimulates release of NE in CNS
  19. duration of use for phentermine or diethylpropion
    FDA approved for ST use (<12weeks)
  20. MOA of orlistat
    • reversible GI lipase inhibitor
    • inactivates hydrolyzation of dietary fat
    • prevents absorption of dietary fat by ~30%
  21. duration of use of orlistat
    approved for LT use (>12mos)
  22. MOA of lorcaserin (Belviq)
    • 5HT 2C-R agonist
    • selectively activates serotonin 2C in hypothalamus to decrease food consumption & promote satiety
  23. evaluation of lorcaserin @ 3mos
    d/c if 5% wt loss not achieved
  24. SE's of lorcaserin
    primarily CNS  - headache, dizzieness, nausea
  25. population to use caution in w/ lorcaserin
    pts w/ valvular heart disease
  26. SE's assoc'd w/ Qsymia (phentermine/topiramate)
    • dry mouth
    • paraesthesia
    • constipation
    • (SE's dose related)
  27. CI's w/ phentermine/topiramate (Qsymia)
    • pregnancy
    • glaucoma
    • hyperthyroidism
    • concomitant use of MAOI's
  28. MOA of GLP1 agonists
    dec gastric emptying, inc satiety
  29. CAM appetite suppressants
    • 5HTP
    • hoodia
    • St. John's wort
  30. CAM thermogenic agents
    • bitter orange
    • ephedra
  31. CAM digestion inhibitors
    • barley
    • psyllium
    • chitosan
  32. MOA of ephedrine, bitter orange
    • CNS stimulant
    • appetite suppressant
    • thermogenic agent
  33. possibly effective OTC agents
    • dietary calcium (NOT supplemental)
    • CLA (conjugated linoleic acid)
    • green coffee extract (safest rec)

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