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JESSICA FORDHAM, MSN, APRN, FNP-C MISSISSIPPI UNIVERSITY FOR WOMEN 12/02/14 TREATING OBESITY...
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Transcript of JESSICA FORDHAM, MSN, APRN, FNP-C MISSISSIPPI UNIVERSITY FOR WOMEN 12/02/14 TREATING OBESITY...
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J E S S I C A F O R D H A M , M S N , A P R N , F N P - CM I S S I S S I P P I U N I V E R S I T Y F O R W O M E N
1 2 / 0 2 / 1 4
TREATING OBESITY PHARMACOLOGICALLY
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THE DREAM
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BACKGROUND
• Obesity is caused by an imbalance among food intake, absorption, and energy expenditure.• Underlying organic causes may be
psychiatric disturbances, hypothyroidism, hypothalamic disorder, insulinoma, and cushing syndrome• Medications: corticosteroids, neuroleptics ,
and antidepressants
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EPIDEMIOLOGY
•More than one-third of U.S. adults are obese•Non-Hispanic blacks have the Highest age adjusted rates of obesity•Obesity is higher among middle age adults, 40-59 years old
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RISK FACTORS
• Parental obesity• Sedentary lifestyle• Calorie dense
foods• Low socioeconomic
status• >2 hours a day of
television viewing
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MEDICAL CONDITIONS ASSOCIATED WITH OBESITY
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HEALTHCARE FINANCIAL BURDENS RELATED TO OBESITY
• Medical cost of obesity in the U.S was 147 billion dollars in 2008 (Center for Disease Control, 2014)• Medical costs for people who are obese
were $1,429 higher than those of normal weight in 2006 (CDC, 2014)• North Americans spend $60 billion
annually trying to lose pounds
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METHODS TO DECREASE OBESITY
National Institution of Health guidelines suggest non-pharmacologic treatment for at least 6 months which includes:
• Diet – Limitation of carbohydrates, Tracking of po intake (women 1200-1500kcal/day and Men 1500-1800kcal/day)
• Exercise- Encouraging at least 30 minutes of physical activities a day or 1 hour sessions 3x/week
• Behavior therapy and cognitive-behavioral methods to overcome barriers of weight loss
• Use of Commercial weight loss programs (ex: weight watchers)
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WHAT TO DO WHEN ALL THE NON-PHARMACOLOGIC METHODS FAILS????
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DRUG THERAPY
• Patient with BMI ≥30, or BMI ≥27 with other risk factors (eg, hypertension, diabetes, dyslipidemia), who did not lose weight after 6 months of non-pharmacologic treatment.•Dietary therapy, physical activity, and behavioral therapy should be used cohesively with drug therapy
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FIRST LINE DRUG IN WEIGHT MANAGEMENT
Orlistat• Brand Names: Xenical, Alli (OTC)• Xenical: 120mg po 3 times daily with
each main meal containing fat (during or up to 1 hour after meal) Suggested to omit dose if no fat in diet• Alli: OTC Labeling: 60mg 3 times daily
with each main meal containing fat
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ORLISTAT
Xenical Alli
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BACKGROUND
• Lipase Inhibitor- Inhibits pancreatic lipase and fat absorption from the intestine.• In April 1999, the FDA approved orlistat
for long term use • Is not an appetite suppressant and has a
different mechanism of action; it blocks about one-third of fat absorption
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INDICATION
• Rx: Obesity Management: encourage weight loss, weight management, reduce risk for weight regain after prior weight loss•OTC: Enabling weight loss in overweight adults. Should be used cohesively with a reduce low calorie diet
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SIDE EFFECT/RISK
• Abdominal bloating • Abdominal pain
and cramping• Steatorrhea• Fecal incontinence
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DRUG MANAGEMENT /MONITORING
• BMI should be monitored- healthy weight loss is 1-2lbs week• Diet (calorie and fat intake)• Thyroid Function- thyroid disease• Liver function tests- especially patients exhibiting
hepatic dysfunction• Serum Glucose- diabetics• Weight loss in diabetics may affect glycemic control
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WARNINGS AND PRECAUTIONS/CONTRAINDICATIONS
• Gallbladder Disease• Malabsorption
Disorders• Impaired Liver
Disease• Pancreatic Disease
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RELEVANCE TO NURSE PRACTITIONER PRACTICE
• Low Adverse Reactions• Alternative to phentermine containing drugs•Not a scheduled drug• Allow NPs in prescriptive restrictive states to offer the medication
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QSYMIA
• Phentermine 3.75mg/topiramate 23mg po daily for 14 days. • Phentermine 7.5mg/topiramate 46mg po once
daily for 12 weeks• Phentermine 11.25mg/topiramate 69mg po for 14
days• Phentermine 15mg/topiramate 92mg po once
daily
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BACKGROUND
•Sympathomimetic and anticonvulsant;•Appetite suppressor•Satiety enhancer
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INDICATION
• Chronic weight management• Adjunct to reduced calorie diet and increased physical activity, in patients with the following:• BMI ≥30 or ≥27 and at least one weight-
related comorbid condition (HTN, Dyslipidemia, type 2 diabetes)
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WARNINGS AND PRECAUTIONS/CONTRAINDICATIONS
• Cardiovascular effects• CNS effects• Glaucoma• Hyperthermia• Hypokalemia• Hypotension
• Metabolic acidosis• Renal calculi• Suicidal ideation• Abuse potential• Withdrawal
symptoms
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SIDE EFFECTS
• Constipation• Xerostomia• Insomnia• Paresthesia• Dysgeusia• Diarrhea• Asthesnia• Mood changes• Concentration, memory, and speech difficulties
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RELEVANCE TO NURSE PRACTITIONER PRACTICE
• Increase risk for an adverse reaction in patients with co-morbid diseases (cardiovascular disease, diabetes, stroke, and etc)• Scheduled Drug C-IV• NPs in prescriptive restrictive states will
not be able to offer the medication to their patients
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BELVIQ
•Belviq 10mg po twice daily • Serotonin 5-HT2c receptor agonist; Leads to simulation of neurons in the hypothalamus, causing a decrease in food intake• Anorexiant
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INDICATION
• Chronic weight management• Adjunct to reduced calorie diet and increased physical activity in patients with the following:• BMI ≥30 or ≥27 and at least one weight-
related comorbid condition (HTN, Dyslipidemia, type 2 diabetes)
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WARNINGS AND PRECAUTIONS/CONTRAINDICATIONS
• CNS effects• Hematological effects• Hyperprolactinemia• Priapism• Primary pulmonary hypertension• Psychiatric disorders• Serotonin Syndrome• Valvular heart disease
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SIDE EFFECT/RISK
•Dyspepsia•Xerostomia•Constipation•Back pain•Rhinitis
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RELEVANCE TO NURSE PRACTITIONER PRACTICE
• Overall, has a low risk for adverse reactions. However, there is an increase risk for serotonin syndrome• Scheduled Drug C-IV• NPs in prescriptive restrictive states will
not be able to offer the medication to their patients
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CONTRAVE
•Naltrexone 8mg/bupropion 90mg po once daily• Week 2 increase to 1 tablet twice daily• Week 3 increase to 2 tablets in the
morning and 1 tablet in the evening• Week 4 and onward 2 tablets twice daily
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BACKGROUND
•Anorexiant•Antidepressant, dopamine/noreqpinephrine-reuptake inhibitor•Opioid antagonist
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INDICATION
• Adjunct to reduced calorie diet and increased physical activity in patients with the following:• BMI ≥30 or ≥27 and at least one weight-
related comorbid condition (HTN, Dyslipidemia, type 2 diabetes)
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WARNINGS AND PRECAUTIONS/CONTRAINDICATIONS
• Black Boxed Warning: Not approved for use in the treatment of major depressive or psychiatric disorders; it contains bupropion the same active ingredient in some other antidepressant medication. Antidepressants increase the risk of suicidal thinking and behavior in children, adolescent, and young adults with major depressive disorder and other psyciatric disorders
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WARNINGS AND PRECAUTIONS/CONTRAINDICATIONS
• Do not prescribed to individuals with the following:• Chronic opioid• Opiate agonist• Acute opioid withdrawal• Uncontrolled hypertension• Seizure disorder• Abrupt discontinuation of alcohol, benzodiazepines, and
antiepileptic drugs
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SIDE EFFECTS
• Nausea• Constipation• Headache• Vomiting• Dizziness• Trouble sleeping• Dry mouth• Diarrhea• Mood changes
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RELEVANCE TO NURSE PRACTITIONER PRACTICE
• Increase risk for an adverse reaction in patients with mental illness and chronic pain. May causes seizures and increase blood pressure. • Scheduled Drug C-IV• NPs in prescriptive restrictive states will
not be able to offer the medication to their patients
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AFTER CONSIDERING ALL THE ANTI-OBESITY MEDICATIONS ON THE MARKET… DOES THE RISK
OUTWEIGH THE BENEFITS? ARE THEY WORTH IT??