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Chapter 82

Chapter 82. Drugs for Weight Loss. Obesity.

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Chapter 82

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  1. Chapter 82 Drugs for Weight Loss

  2. Obesity • May be associated with hypertension, coronary heart disease, stroke, type 2 diabetes, gallbladder disease, kidney stones, osteoarthritis, sleep apnea, dementia, and certain cancers, although underweight or normal-weight patients also suffer from these conditions

  3. Assessment of Obesity-Related Health Risk • Assessment: obesity • Degree of obesity • Body mass index (BMI) • Pattern of fat distribution • Waist circumference • Presence of risk factors • Coronary heart disease, diabetes, hypertension • Other atherosclerotic diseases, sleep apnea

  4. Overview of Obesity Treatment • Who might want to be treated? • Body mass index (BMI) of 30 or more • BMI of 25 to 25.9 plus two risk factors • Weight circumference (WC) greater than 40 inches (in men) or greater than 35 inches (in women) plus two risk factors • Treatment goals

  5. Treatment Modalities • Nutritious diet • Exercise • Behavior modification • Drug therapy • Bariatric therapy

  6. Weight-Loss Drug • Only weight-loss drug currently approved for long-term use: • Orlistat (Xenical, Alli)

  7. Sibutramine (Meridia) • Withdrawn in 2010 because of risk of stroke and myocardial infarction • Additional adverse effects included: • Headache • Dry mouth • Constipation • Elevated heart rate • Insomnia • Elevated blood pressure • Nervousness and anxiety

  8. Orlistat (Xenical, Alli) • Acts in the GI tract to reduce absorption of fat • Adverse effects • GI effects • Fecal incontinence • Fecal urgency • Oily spotting • Oily stools • Can be reduced somewhat with decreased fat intake and psyllium • Reduced absorption of fat-soluble vitamins • Take vitamin supplement: 2-hour window

  9. Orlistat (Xenical, Alli) Cautions Vitamin K deficiency can intensify effects of warfarin Associated with severe liver damage May cause hypothyroidism in patients taking levothyroxine 9

  10. Miscellaneous Appetite Suppressants • Sympathomimetic amines • Nonamphetamines • Amphetamines • Bupropion • Fluoxetine • Topiramate and zonisamide

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