-
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which is most correlated with body fat than others?
A) BMI
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BMI < ___ is malnutrition.
< ___ is severe.
-
BMI > ____ is overweight.
25
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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.
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men over > __ waist circumference is at risk of obesity.
women over > ___.
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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)
-
undernutrition:
ABW < __% IBW: severe
ABW ____% IBW: moderate
ABW ____% IBW: mild
-
over nutrition:
ABW > __% IBW: severely obese
ABW ____% IBW: obese
ABW ____% IBW: overweight
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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)
- osteoarthritis
- gall bladder disease, GERD
- sleep apnea
- infertility
- complication of COPD asthma
-
___% weight loss can significantly improve all type 2 DM, HTN and dyslipidemia in overweight and obese patients!
5%
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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.
> 27
-
what are medications that cause weight gain?
- atypical antipsychotic
- SSRI, TCA
- insulin
- 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 ___.
- amphetamine
- 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
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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
- glaucoma
- 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
adipex
-
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? (%)
25-35%
-
where is orlistat excreted?
feces
-
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 days
-
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?
nope nope
-
can you use orlistat if you had kidney transplant or have cyclosporin?
nope!
-
can you use orlistat if pregnant or breastfeed?
nope
-
can you use orlistat if gall bladder dz?
nope
-
can you use orlistat if gastric bypass?
nope
-
can you use orlistat if crohn's disease?
nope
-
can you use orlistat is celiac dz?
nope
-
can you use orlistat if anorexia or bullimia?
nope
-
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.
3 days
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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.
2 weeks
-
alli can decrease absoprtion of ____.
fat soluble vitamin - ADEK
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