Week 15 HPP

dinosaur1234's version from 2015-04-29 16:48


Question Answer
Prevalence of obesity in US1/3 adults is overweight or obese
Amount of weight loss needed to have significant benefit on metabolic activity5-10%
Tips for weight lossstart with small steps, make sure goals are realistic, seek support from those who can relate to your struggle, keep careful track of caloric intake, keep portions under control, plan and structure meals, always make sure physical activity is part of life
Set point infobody’s “normal weight”; no re-set of point, can go up but will not come back down; survival mechanism, weight range
Recommendations for exercise in adultsat least 150 minutes per week of moderate intensity aerobic exercise; some form of muscle strengthening exercise at least 2x/week
Exercise recommendation in children60 minutes of moderate-to-vigorous activity every day for children
3 goals for weight lossdecrease total daily calories by 500-1000 per day (and increase energy output); weekly weight loss goal of 1-2 pounds per week; lost 10% of body weight in 6 months
When pharmacotherapy is FDA approved for management of obesityBMI >30; or BMI >27 with RF (HTN, dyslipidemia, CHD, T2DM, sleep apnea)
Meds used for weight lossPhentermine, Orlistat, phentermine/topiramate, Lorcaserin, bupropion/naltrexone, Liraglutide
When is pharmacotherapy considered ineffective<5% weight loss at 3 months; would d/c med at this point
When to asses for efficacy and safety of obesity medsassess for efficacy and safety monthly for the first 3 months, then every 3 months during pharmacotherapy
3 reasons why vaccinations are necessaryfor common diseases, the choice to not geet vaccine is a choice to get the disease; run a risk of outbreak of disease; some diseases have been eliminated in the US, but not entire world (i.e. polio)
Reasons to tell HCP that child is not vaccinatedso HCP can consider possibility of vaccine-preventable disease; so people can take proper precautions so that the disease does not spread to others
Risks associated with vaccinesall have mild SE (pain, tenderness, redness), risks are small
Why are there so many vaccineswe need vaccines to protect us- more vaccines, fewer diseases
Can infant handle all the vaccines we give themyes, their immune systems are well developed before they are born
Is it better to be naturally infectedNO! price for natural infection is uch higher than immunizations- more hospitalizations and death; vaccination is safer than natural infection
Can you prove that vaccines do not cause chronic illnesswhen we’ve looked, we have been reassured; vaccines keep healthy children healthy
Should we wait to vaccinate to see long-term effectsno- while parents are waiting, they take the risk that their child will get infected; there is ongoing surveillance to establish safety. Vaccine is continuously monitored for safety
Age group with above average rate of rx drug abuse18-25
Indicators that Rx may be fraudulentprescriber writes significantly more prescriptions (or in larger quantities) compared to other practitioners in the area; the patient appears to be returning too frequently; prescriber write prescription for antagonistic drugs; patient presents prescriptions written in the names of other people; a number of people appear simultaneously bearing similar prescriptions from same physician; people who are not regular patrons or residents of the community, show up with rx from same physicians
What is SBIRTscreeing, brief intervention, referral to treatment; get the patient help if necessary

Weight loss drugs

Question Answer
Phentermine dose15-37.5 mg qd; 8 mg TID with food
Phentermine SEincrease HR and BP; insomnia, palpitations/arrhythmias
Phentermine CICVD, moderate/severe HTN, glaucoma, concomitant MAOI
Orlistat SEHA, oily spotting, ab pain, flatus with discharge, fecal urgency
Orlistat CIchronic malabsorption syndrome, cholestasis
Orlistat counselingtake vitamin with fat-soluble vitamins 2 hr before or after dose; avoid high-fat fat (>30% total daily calories) to dec GI events; if no fat in meal, skip dose; most GI effects last 1-4 weeks
Drugs that are C4phentermine, phentermine/topiramate, Lorcaserin
Phentermine/topiramate (Qsymia) doseinitial is 3.75/23 mg x14d, then 7.5/46 mg qd; if increase in dose is needed, 11.25/69 mg qd x14d, then 15/92 mg qd
Phentermine/topiramate SEC, HA, insomnia, memory/concentration impairment, altered taste sensation
Phentermine/topiramate CI pregnancy, glaucoma, hyperthyroidism
Phentermine/topiramate counselingpatients who do not lose >3% of bodyweight by 12 weeks should increase dose. If a 5% weight loss is not seen in another 12 weeks, d/c med; women of child-bearing age must have negative preganancy test monthly; may cause incease in breakthrough bleeding in women on OC; taper off med!! Don’t d/c abruptly; may case worsening of depression/suicidal ideation; may disturb attention, concentration, memory, and word-finding; can only be dispense by special pharmacies
Lorcaserin dose10 mg BID
Lorcaserin SEHA, N, dizziness, fatigue, back pain, dry mouth, HYPOGLYCEMIA, C
Lorcaserin cautionpatient may be at risk of serotonin syndrome when used with other serotonergic agents
Lorcaserin CIpregnancy
Lorcaserin counselingT2DM patient may have an increase in hypoglycemic events; associated with euphoria; may have increased risk of depression and priapism; disturbances in memory and concentration
Bupropion/Naltrexone (Contrave) dosing 90mg/8mg tablet; 1 PO qd x 1 week; 1 PO BID x1wk; 2 PO am + 1 PO OM x1wk; 2 PO BID
Bupropion/naltrexone SEN, C, HA, insomnia, dizziness, dry mouth, tremor, upper abdominal pain, tinnitus
Bupropion/naltrexone CIseizure disorder, hx of bulimia or anorexia; uncontrolled HTN, abrupt d/c of alcohol, opioid use, MAOI use in last 14 days
Bupropion/naltrexone counselingmonitor HR and BP; avoid if history of seizure; don’t take opioids while on ed; cannot crush/break/chew; avoid taking with high fat meal
Liraglutide dose0.6 mg SQ x1wk; 1.2 mg x1wk; 1,8 mg x1wk; 2.4 mgx1wk; 3 mg SQ QD
Liraglutide SEN, V, D, C, HA, hypoglycemia, dyspepsia, fatigue
Liraglutide CIpersonal or FH of medullary thyroid carcinoma
Liraglutide counselingif patient has not lost at least 4% of body weight at 16 weeks, d/c med; dose of insulin secretagogues should be decreased by half’ decrease meal sizes by half to decrease N and dyspepsia; store in fridge prior to use, then leave at room temp for 30 days once opened