Thursday, March 11, 2010

Obesity

Obesity - Chronic
Rahul Soman, M. Pharm


 


 

Definition  

Chronic, relapsing disease characterized by an excessive accumulation of body fat


 

Ongoing Assessment  


 

Screening Criteria  


 

Suspected or known hyperlipidemia or dyslipidemia  

* Fasting lipid profile: A fasting lipid profile is the primary test for diagnosing, making management decisions, and monitoring treatment of dyslipidemia .


 

Suspected diabetes mellitus  

* Plasma fasting glucose measurement: Fasting plasma glucose levels of 126 mg/dL (7 mmol/L) or greater are diagnostic of diabetes mellitus. In the absence of unequivocal hyperglycemia, results must be confirmed with repeat testing on another day .


 

Suspected impaired fasting glucose (IFG) (prediabetes)  

* Plasma fasting glucose measurement: Impaired fasting glucose is defined as a fasting plasma glucose level of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) and indicates prediabetes .


 

Medical History  

* Gets no exercise

* Alteration in nutrition: more than body requirements

* Polycystic ovary syndrome [Polycystic ovary syndrome - Chronic]

* Abnormal hormone production

* Antipsychotic use

* Family history of Obesity

* Antidepressant use

* Smoking


 

Findings  

* Weight increased

* Obese abdomen

* Increased blood pressure

* Depression - Chronic

* At risk for psychosocial dysfunction


 

Tests  


 

Suspected or known hyperlipidemia or dyslipidemia  

* Fasting lipid profile: A fasting lipid profile is the primary test for diagnosing, making management decisions, and monitoring treatment of dyslipidemia .


 

Suspected diabetes mellitus  

* Plasma fasting glucose measurement: Fasting plasma glucose levels of 126 mg/dL (7 mmol/L) or greater are diagnostic of diabetes mellitus. In the absence of unequivocal hyperglycemia, results must be confirmed with repeat testing on another day .


 

Suspected impaired fasting glucose (IFG) (prediabetes)  

* Plasma fasting glucose measurement: Impaired fasting glucose is defined as a fasting plasma glucose level of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) and indicates prediabetes .


 

Suspected or known hypothyroidism  

* Thyroid stimulating hormone measurement: Overt hypothyroidism is classified as a TSH above the upper limit of the reference range in the presence of a low serum free thyroxine (FT4) . Subclinical hypothyroidism is a laboratory diagnosis defined as a TSH above the upper limit of the reference range in the presence of a normal FT4.


 

Treatment  


 

Drug Therapy  


 


 

Patients with an initial body mass index (BMI) of 30 kg/m2 or greater or 27 kg/m2 or greater in the presence of other risk factors, such as hypertension, diabetes, dyslipidemia, coronary heart disease, or sleep apnea  


 

ORLISTAT  

Adults: 120 mg orally 3 times daily with meals


 

PHENTERMINE HYDROCHLORIDE  

Adults: Short-term (a few weeks) adjunct: 37.5 mg orally daily before breakfast or 1 to 2 hours after breakfast or divided into 2 doses; some patients may only require 18.75 mg daily


 

DIETHYLPROPION HYDROCHLORIDE  

Adults: Short term (a few weeks) adjunct: controlled release, 75 mg orally daily, take midmorning or immediate release, 25 mg orally 3 times a day, 1 hr before meals; may take 1 dose mid-evening, if desired, to overcome night hunger


 

SIBUTRAMINE HYDROCHLORIDE  

Adults: Initial: 10 mg orally once daily; after 4 weeks may increase to a maximum dose of 15 mg orally once daily


 

Procedural Therapy  


 

Adjunctive therapy of overweight and obese patients  

* Behavioral therapy: Behavior therapy is important for the success of any weight loss program to facilitate changes in eating and activity behaviors .


 

Patients with a body mass index (BMI) of at least 40 kg/m2 or 35 kg/m2 with comorbid conditions and acceptable operative risks  

* Gastric bypass surgery: Studies have shown that weight loss is greater with the gastric bypass procedure than with vertical-banded gastroplasty .


 

Non-Procedural Therapy  


 

Treatment of overweight and obese patients  

* Dietary Therapy


 

Treatment of overweight and obese patients  

* Physical Activity

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SYSTEM BASED CLASSIFICATION OF DISEASES

SYSTEM BASED CLASSIFICATION OF DISEASES

Bone and Joint Diseases

  1. Gout and Hyperurecemia
  2. Osteoarthritis
  3. Rheumatoid Arthritis
  4. Acute coronary Syndroms

Cardiovascular Diseases

  1. Arrhymias
  2. Cardiopulmanary Resuscitation
  3. Heart Failure
  4. Hypertension
  5. Hyperlipidemia
  6. Ischemic Heart Diseases
  7. Shock
  8. Stroke
  9. Venous Thromboembolism

Dermatrologic Diseases

  1. Acne
  2. Psoriasis
  3. Skin Disorders and Cutaneous Drug Eruptions

Endocrine Diseases

  1. Cirrhosis
  2. Portal Hypertension

Gastrointestinal Diseases

  1. Irritable Bowel Syndrome
  2. Constipation
  3. Diarrhea
  4. Gastroesophagal Reflux Disease
  5. Hepatitis, Viral
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
  6. Nausea and Vomiting
  7. Pancreatitis
  8. Peptic Ulcer disease

Gynecologic and Obstetric Diseases

  1. Contraception
  2. Hormone therapy

Hematologic Diseases

  1. Anemia
    1. Megaloblastic Anemia

i. Megaloblastic Anemia due to Folate Deficiency

ii. Megaloblastic Anemia due to Vitamine B12 Deficiency

    1. Sickle Cell anemia
    2. Hemolytic Anemia
    3. Iron Deficiency Anemia
    4. Aplastic Anemia
    5. Iron Deficiency Anemia

Infectious Diseases

  1. Central Nervous System infections
  2. Endocarditis
  3. Fungal infections, Invasive
  4. Gastrointestinal Infection
  5. HIV / AIDS
  6. Intra-Abdominal Infection
  7. Respiratory Tract infections, Lower
  8. Respiratory Tract infections, Upper
  9. Sepsis and Septic Shock
  10. Sexually transmited Diseases (STD)
  11. Skin and soft tissue infection
  12. Tuberculosis
  13. Urinary tract infection and prostatitis

Neurologic Diseases

  1. Epilepsy
  2. Headache
    1. Migraine
    2. Cluster Headache
  3. Pain management
  4. Parkinson’s Diseases
  5. Status epilepticus

Nutritional Diseases

  1. Enteral Nutrition
  2. Obesity
  3. Parentaral Nutrition

Onchologic Diseases

  1. Breast cancer
  2. Colorectal Cancer
  3. Lung cancer
  4. Lymphomas
  5. Prostate cancer
  6. Cervical Cancer
  7. Esophageal Cancer
  8. Gastric Cancer
  9. Head and Neck Cancer
  10. Lung Cancer
  11. Ovarian Cancer
  12. Pancreatic Cancer
  13. Primary bone Cancer
  14. Primary Brain cancer
  15. Testicular Cancer
  16. Thyroid Gland Cancer
  17. Urinar Bladder cancer
  18. Uterine Cancer

Ophtalmic Diseases

  1. Glaucoma

Psychiatric Diseases

  1. Alzhimer’s Diseases
  2. Anxiety Disease
  3. Bipolar Diseases
  4. Depressive diseases
  5. Schizophrenia
  6. Sleep Diseases
  7. Substance-Related Diseases

Renal Diseases

  1. Acid base Diseases
  2. Acute renal Failure
  3. Chronic Renal Failure
  4. Drug Dosing in renal insufficiency
  5. Electrolyte Homeostasis

Respiratory Diseases

  1. Allergic Rhinitis
  2. Asthma
  3. Chronic Obstructive Pulmonary Diseases

Urologic Diseases

  1. Benign Prostatic, Hyperplasia
  2. Erectile Dysfunction
  3. Urinary Incontinence