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Therapeutics #4 - Obesity
N/A
38
Health Care
Graduate
11/07/2009

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Term
Obesity
Definition
results from energy imbalance where more calories are consumed than used; it is a complex multifactorial chronic disease that includes genetic, environmental, and physiological factors
Term
Genetic Factors that contribute to Obesity
Definition
correlation in body weight between parents & children & siblings; single-gene mutations have been identified; still determining # & identity of contributing genes
Term
Environmental Factors that contribute to Obesity
Definition
sedentary lifestyle; unhealthy food choices; large portion sizes; socioeconomic barriers
Term
Medications associated with Weight Gain
Definition
Psychotropic agents: tricyclic antidepressants (amitriptyline, nortriptyline), monoamine oxidase inhibitors (MAOIs - selegiline, phenelzine), antipsychotic drugs (clozapine, olanzapine), lithium; Anticonvulsant agents: valproic acid, carbamazepine; Steroid Hormones: corticosteroids (prednisone), estrogen, progesterone, testosterone; Insulin & most oral hypoglycemic agents EXCEPT Metformin
Term
Medical Conditions Associated with Weight Gain
Definition
hypothyroidism, Cushing's disease, hypothalamic lesions, psychosocial disorders
Term
Conditions more prevalent in Obese Populations
Definition
HTN, stroke, CHF, CAD, sleep apnea, pulmonary HTN, type 2 DM, dyslipidemia, osteoarthritis
Term
Underweight BMI
Definition
< 18.5 kg/m^2
Term
Normal BMI
Definition
18.5 - 24.9 kg/m^2
Term
Overweight BMI
Definition
25.0 - 29.9 kg/m^2
Term
Class I Obesity BMI
Definition
30.0 - 34.9 kg/m^2
Term
Class II Obesity BMI
Definition
35.0 - 39.9 kg/m^2
Term
Class III Extreme Obesity BMI
Definition
> or = 40 kg/m^2
Term
Waist Circumference
Definition
measure of abdominal fat; >40 inches in men & >35 inches in women associated with an increased risk for type 2 DM, dyslipidemia, HTN, and CVD
Term
Goals of Initial Weight Loss
Definition
initially, should be 5-10% of body weight over a 6 month period at a rate of approximately 1-2 lbs per week
Term
Other Goals of Weight Management
Definition
to prevent further weight gain; to safely lose weight; to maintain lower body weight; to reduce the risk of obesity-related disorders; prevent or minimize weight regain over long-term while minimizing treatment-related adverse effects & improving quality of life
Term
Non-pharmacological Therapies
Definition
reduce diet; increase physical activity; behavior modification; bariatric surgery
Term
Goals of Reducing Diet in Treatment of Obesity
Definition
reduce calorie intake by 500-1,000 kcal/day; reduce portion sizes; limit alcohol consumption; less than 30% from fat, 0.8 g protein/kg of desirable body weight
Term
Goals of Physical Activity in Treatment of Obesity
Definition
at least 30 min of moderate-intensity physical activity on most or all days of the week (can be broken down into 10 min increments); includes common chores & sporting activities; use a gradual increase in order to avoid injuries; must obtain Physician authorization prior to start of regimen
Term
Goals of Behavior Modification in Treatment of Obesity
Definition
patient motivation critical; self-monitoring; rewards; stimulus control; social support; frequent contact; stress management
Term
Bariatric Surgery in treatment of Obesity
Definition
only indicated in pts with a BMI > 40 kg/m^2 or a BMI > 35 kg/m^2 with comorbid conditions when all other treatment methods have failed
Term
Major Types of Bariatric Procedures
Definition
stapled gastroplasty; adjustable gastric banding; conventional Roux-en-y gastric bypass (RGB)
Term
Adjustable Gastric Binding
Definition
bariatric procedure that "restricts" amount of food stomach can hold by reducing stomach size
Term
Conventional Roux-en-y Gastric Bypass
Definition
restricts amount of food stomach can hold by reducing size & by bypassing portions of small intestine to decrease absorption of calories & nutrients; MOST COMMON procedure; MOST EFFECTIVE procedure; possible adverse outcomes (surgical complications, gallbladder disease, impaired digestion)
Term
Indications for Pharmacotherapy in Treating Obesity
Definition
low-calories diet, increasing physical activity, and behavior therapy maintained for at least 6 months prior to carefully considering this long-term treatment plan; long term use should be considered in pts with a BMI of > or = 30 kg/m^2 or a BMI of > or = 27 kg/m^2 with concomitant obesity-related risk factors or diseases; used as an adjunct to a low-calorie diet, increased physical activity, and behavior therapy
Term
sibutramine (Meridia)
Definition
RX only; MoA: inhibits neuronal reuptake of NE, SE, & DA; induces weight loss by decreasing appetite and maintaining or increasing thermogenesis; Indication: long-term treatment of overweight & obesity
Term
Adverse Effects of sibutramine (Meridia)
Definition
HTN, tachycardia, anorexia, insomnia, constipation, dry mouth, dizziness, & nausea
Term
Contraindications for Sibutramine (Meridia)
Definition
Don't take if: receiving MAOIs, taking other centrally-acting appetite suppressant drugs, that have anorexia nervosa, with uncontrolled or poorly controlled HPN, history of CAD, CHF, arrhythmias, or stroke
Term
orlistat (Xenixal [RX], alli [OTC])
Definition
inhibits gastrointestinal lipases; prevents enzymes from hydrolyzing dietary fat into FFAs, decreasing systemic absorption of dietary fat contributing to reduced caloric intake; Indications: long-term treatment of overweight & obesity; Take WITH EACH MAIN MEAL CONTAINING FAT; Take vitamin supplement containing fat-soluble vitamins AT BEDTIME
Term
Adverse Effects & C/I of orlistat (Xenical, alli)
Definition
flatus with discharge, fecal urgency, fatty/oily stool, increased defecation, fecal incontinence, abdominal pain, decreased absorption of fat-soluble vitamins, & increased levels of urinary oxalate; Pts with chronic malabsorption syndrome or cholestasis or pts with history of kidney stones
Term
Drug Interactions with orlistat (Xenical, alli)
Definition
reduction in cyclosporine plasma levels; monitor changes in coagulation parameters for pts on chronic, stable doses of warfarin; thyroid hormones (levothyroxine - separate by at least 2 hrs)
Term
phentermine-fenfluramine combo (Phen-Fen)
Definition
caused numerous cases of valvular heart damage and pulmonary HTN, removed from market in 1997
Term
ephedra
Definition
OTC herbal product that contains ephedrine; suppresses appetite by increasing NE relase, also increases thermogenesis; often combined with caffeine to enhance weight loss; currently BANNED by FDA due to serious adverse events
Term
Bitter Orange and Country Mallow (Heartleaf)
Definition
sources of ephedrine & related compounds to avoid their use
Term
Chitosan
Definition
heavily marketed as "fat blocker", claims it binds to dieatary fat & prevents absorption; studies show it is CLINICALLY INEFFECTIVE
Term
Starch Blockers
Definition
made from a protein in white kidney beans; lack of reliable research to support claim of reducing carb breakdown & absorption by inhibiting alpha-amylase in GI tract
Term
phentermine CR/topiramate CR (Qnexa)
Definition
combo product; one drug already marketed as anticonvulsant & for prophylaxis of migraines; received FDA approval in Sept 2009
Term
Future Directions in Pharmacotherapy in Obesity
Definition
CCK and SE; leptin; neuropeptide Y
Term
Pharmacist's Role in treatment of Obesity
Definition
highly accessible; have knowledge & skills to provide care services in weight management; help determine if any of pt's current meds are causing weight gain; counsel pts on non-pharm and pharm therapies; recommend & monitor pharmacotherapy
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