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13 Cards in this Set
- Front
- Back
Obesity
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can lead to organ complications adipose haslimited ability to store fat theexcess fat that does NOT go to adipose causes the health problems adipose expansion: becomes insulin resistant |
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Process
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-dysregulated lipolysis --> flux of fatty acids to liver |
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Metabolic syndrom
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-high serum triacyglycerides -low HDL -hypertension -hyperglycemia |
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Medical management of obesity
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--> asses and screen for depression and mood disorders --> treat comorbidities and other health risks if present -->assess readiness to change behaviours and barriers to weight loss |
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Medical management of obesity
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Pharmacotherapy if BMI is above 27 plus risk factors or if its straight above 30 |
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Pharmacological treatment of obesity |
Only 2 classes of drugs are currently available 1. appetite suppressants 2. lipase inhibitors safety concerns over long term use of appetite suppressants (3 month use limit) Lipase inhibitors have significant GI advers effects
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Appetite supressants |
-alter the release and reuptake of neurotransmitters involved in controlling appetite -Sibutramine: limits reuptake of norepinephrine and serotonin by nerve terminals -- prolongs sympathetic activation, supresses appetite -increased risk of CVD in high risk cardiac patients Phentermine: sympathomimetic amine -only currently available member of this group --> promotes the release of norepinephrine and dopamine - prolongs sympathetic activation, supresses appetite elevationsin heart rate and blood pressure with phentermine limit its duration of use to3 months |
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Lipase inhibitors
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thisgroup of drugs inhibits the digestive enzymes, lipases ... decreases breakdownof dietary fat, thus limiting fat absorption from the intestine orlistat is the only currently availablemember of this group, and is the only anti-obesity medication with worldwideapproval orlistat inhibits both gastric andpancreatic lipases adversegastrointestinal side effects limit the tolerability in many patients(especially if dietary fat intake is greater than 30% of total calories) |
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Potential future pharmacological treatment of obesity
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1. thyroid hormone receptor agonist 2. GLP-1 analogs, such as liraglutide 3. direct specific AMPK activators |
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Thyroid hormone receptor agonists |
•in adults, thyroid hormones regulate basalmetabolic rate through the following actions: 1) stimulation of Na+/K+ATPaseactivity 2) stimulation of carbohydrate absorption fromthe intestine and release of fatty acidsfrom adipocytes 3) upregulation of b-adrenergic receptors in many tissues, including the heart and nervoussystem |
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Thyroid hormone rece
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TRa = heart and brain --> HR and anxiety increase TRB = in adipose and liver --> increased metabolism (increasing lipolysis and FA oxidation) TRB activation also seems to lower circulating LDL THyroid hormones act at the liver to increase LDL receptor expression thyroidhormones normally increase the expression of low density lipoprotein (LDL)receptors in the liver to increase the uptake of cholesterol from blood inhypothyroid patients less cholesterol is removed from the blood by the liver,resulting in less cholesterol excretion in bile |
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GLP-1 Analogs
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liraglutide (degradation-resistant GLP-1analog) is approved (in Canada, 2010) for the treatment of T2DM, and is underclinical investigation for the treatment of obesity incretins(GLP-1, GIP) bind incretinreceptors on bcells to stimulate insulin secretion |
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Direct, specific AMPK activators
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metformin acts predominantly onliver, indirect activation of AMPK opportunity for development ofdirect , specific AMPK activators that target adipose (and other metabolictissues) The net effect of AMPK activation is stimulation of hepatic fatty acid oxidation and ketogenesis, inhibition of cholesterol synthesis, lipogenesis, and triglyceride synthesis, inhibition of adipocyte lipolysis and lipogenesis, stimulation of skeletal muscle fatty acid oxidation and muscle glucose uptake, and modulation of insulin secretion by pancreatic beta-cells.[1] |