Transcript Chapter 16 Cholinesterase Inhibitors

Chapter 82
Drugs for Weight Loss
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Obesity
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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
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Assessment of Obesity-Related
Health Risk
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Assessment: obesity
1. Degree of obesity
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Body mass index (BMI)
2. Pattern of fat distribution
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Waist circumference
3. Presence of risk factors
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Coronary heart disease, diabetes, hypertension
Other atherosclerotic diseases, sleep apnea
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Overview of Obesity Treatment
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Who might want to be treated?
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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
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Treatment Modalities
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Nutritious diet
Exercise
Behavior modification
Drug therapy
Bariatric therapy
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Weight-Loss Drug
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Only weight-loss drug currently approved for
long-term use:
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Orlistat (Xenical, Alli)
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Sibutramine (Meridia)
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Withdrawn in 2010 because of risk of stroke
and myocardial infarction
Additional adverse effects included:
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Headache
Dry mouth
Constipation
Elevated heart rate
Insomnia
Elevated blood pressure
Nervousness and anxiety
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Orlistat (Xenical, Alli)
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Acts in the GI tract to reduce absorption of fat
Adverse effects
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GI effects
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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
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Orlistat (Xenical, Alli)
● Cautions
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Vitamin K deficiency can intensify effects
of warfarin
 Associated with severe liver damage
 May cause hypothyroidism in patients
taking levothyroxine
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Miscellaneous Appetite
Suppressants
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Sympathomimetic amines
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Nonamphetamines
Amphetamines
Bupropion
Fluoxetine
Topiramate and zonisamide
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