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which is most correlated with body fat than others?
A) waist circumf
(this multiple choice question has been scrambled)
BMI < ___ is malnutrition.
< ___ is severe.
BMI > ____ is overweight.
BMI > ___ is obese.
severe obese is BMI > ___.
what are the limits of BMI?
- over-estimate body fat in very muscular people
- under-estimate body fat in those who lost a lot of muscle.
what does waist circumference assess?
- abdominal fat.
- this is an independent predictor of risk of obesity related complication.
men over > __ waist circumference is at risk of obesity.
women over > ___.
when can you not apply standard waist circumference measure to assess obesity?
- under 5 feet tall
- BMI >35 kg/m2 (derr already obese)
waist to hip ratio of > ___ is at risk of obesity.
- > 1
- (waist should be tinier than hip)
ABW < __% IBW: severe
ABW ____% IBW: moderate
ABW ____% IBW: mild
ABW > __% IBW: severely obese
ABW ____% IBW: obese
ABW ____% IBW: overweight
which two provide best assessment of obesity.
excessive central adiposity increases risk of what diseases?
- type 2 DM, HTN, dyslipidemia
- heart disease (MI, stroke, CHF)
- colon cancer, breast cancer (b/c fat = estrogen)
- gall bladder disease, GERD
- sleep apnea
- complication of COPD asthma
___% weight loss can significantly improve all type 2 DM, HTN and dyslipidemia in overweight and obese patients!
healthy weight loss is rate of ___ lbs/week.
- 1-2 lbs
- (rate is usu faster in the beginnig)
obesity medication is reserved for BMI ___ with additional risk factors.
what are medications that cause weight gain?
- atypical antipsychotic
- SSRI, TCA
- birth control (progestin component - water weight alone)
- anabolic and corticosteroid
- beta blocker
3 neurotransmitters that increas food intake
- alpha 2
- 5 HT 1A
- neuropeptide Y
three meds for obesity
- Adipex (phentermine)
- Tenuate (diethylpropion)
- Alli, Xenical (orlistat)
phentermine is similar to ___ but has less ___.
- thus addiction potential
- less CNS stim and abuse potential
pharmacology of Adipex
enhance norepi and dopamine action.
dose of Adipex
- 30mg qd in the morning
- don't give in the evening - insomnia (stimulatory effect)
what are some examples of MAOi?
selegiline, tranylcypromine, phenelzine
what meds are contra-ind with MAOi and why?
- adipex, Zyvox, SSRI, amphetamine, pseudafed
- anything that enhances norepi b/c MAOi break enzym that break down neurotransm
Adipex is contraindicated if..
- using MAOi
- hx of substance abuse
Adipex is used with caution in what disease states and why?
- all due to inc NE
- diabetes: tremor/palp/tachy (hypoglyc) so NE released and triggers liver to break glycogen
- HTN: inc NE --> inc BP
- CV disease: vaso-constrict by adipex so risk of arrhyth/heart attack/stroke, also inc HR and BP (due to direct stimulation)
pharmacology of diethylpropion
works by stimulating nor-epi release (suppress appetite)
dose of diethylpropion?
- 25mg TID
- or 75mg SR qd in the morning
diethylpropion should be used with caution in which diseases.
CV disease, HTN, diabetes
which has more insomnia? adipex vs. tenuate
what is class of orlistat?
- lipase inhibitor
- binds to gastric and pancreatic lipases and make them ineffective.
what is fxn of lipase and where is it released?
- break down fat into absorbable portions
- released from pancreas and stomach
how much fat does orlistat 60mg block from being absorbed? how much cal is this? so how much is absorbed?
- block 25%
- absorb 75%
- about 45 cal of the meal
counsel side effects of orlistat.
- oily stool, indigestion, leakage of stool, urgency b/c blocking fat from being absorbed.
- but the good/bad thing is that this is all based on what you eat!!!
how much of diet should be fat? (%)
where is orlistat excreted?
how long does orlistat take to work?
- 3-5 days
- (time to complete excretion from GI could be 3-5 days)
- COUNSEL do not "skip dose and splurge"
3 important points of orlistat.
- inhibit lipase
- local action in gut oily stool
orlistat can be started after following the eating plan for at least ___.
3 differences btwn Xenical and Alli.
- Rx vs. OTC
- xenical for adolescent and adult (>12yo), alli for adult >18yo.
- xenical is 120mg, alli 60mg
is 120mg Xenical double more effective (and double more SE) than 60mg Alli?
can you use orlistat if you had kidney transplant or have cyclosporin?
can you use orlistat if pregnant or breastfeed?
can you use orlistat if gall bladder dz?
can you use orlistat if gastric bypass?
can you use orlistat if crohn's disease?
can you use orlistat is celiac dz?
can you use orlistat if anorexia or bullimia?
you cannot use orlistat if... (list 6)
- not overweight or not >18yo
- allergic to any component
- pregnant or breastfeed
- probs absorbing food (crohns, gallbladder dz, gastric bypass, celiac dz)
- organ transplant or cyclosporine
- eating disorder (anorex, bullimia)
why are diabetes and thyroid disease a concern for patients who want to buy Alli?
the change of diet plan and weight loss can affect dose adjust and levels, not orlistat affecting drug directly.
which 3 conditions do you need to monitor well if you use obesity meds?
- gallbladder, kidney stone, pancreatitis
- gallstone can flare up when diet changes.
why do you need to monitor warfarin when on diet pill?
b/c the pill can inhibit some vitamin K absorption.
is alli safe with sibutramine and phentermine?
how many kg can you lose with orlistat vs. placebo?
- 3kg vs. 2kg
- you have slow steady wt loss.
before you start orlistat, you should follow the diet plan for __ days.
diet plan consists of __% of calories from fat. this is about __g per meal.
treatment effect of orlistat is usually controlled within first ___, IF THE PATIENT RESTRICT fAT.
alli can decrease absoprtion of ____.
fat soluble vitamin - ADEK