Weight-loss Therapies

The patient should be assessed in 2 to 4 weeks following the implementation of therapy to determine effectiveness of and intolerance to treatment. Monthly visits are encouraged during the first 3 months. More frequent follow-up maybe necessary in the presence of other medical conditions. Less frequent followup occurs after 6 months of effective weight-loss therapy. 

Topiramate can be described as a broad-spectrum neurotherapeutic agent with multiple modes of action, and its weight-loss promoting activity came to attention in trials of therapy for epilepsy [104], and explored further in animal experiments [105, 106], It has also been successfully used in the treatment of obesity associated with eating disorders [107, 108], As specific weight-loss therapy in one short-term [109] and one long-term study [110] in non-diabetics without co-morbid neuropsychiatric conditions, topiramate has been shown to produce a modest dose-related benefit compared to placebo, and with a reasonable side-effect profile. 

Lucas KH, Kaplan-Machlis B (2001) Orlistat - a novel weight loss therapy. Ann Pharmacother 35 314—328... 

Rimonabant is an inverse agonist for CBl cannabinoid receptors, which is approved in Europe for weight-loss therapy, but has significant side effects on the central nervous system. 

HERBAL, NATURAL, AND FOOD SUPPLEMENT WEIGHT LOSS THERAPIES... 

Nephropathy, or inflammation of the kidneys, was brought about by a weight loss therapy which included the Chinese herb, M. officinalis. Aristolochic acid (45), a major component in the plant extract was determined to form DNA adducts in the renal tissue from patients with the Chinese herb induced nephritis [66]. 

The nurse is discussing weight loss therapy with a client who is obese who has been prescribed sibutramine (Meridia). Which information should the nurse provide Select all that apply. 

Metformin. Metformin [657-24-9] (1,1-dimethylbiguanide), mol wt 129.17, forms crystals from propanol, mp 218—220°C, and is soluble in water and 95% ethanol, but practically insoluble in ether and chloroform. Metformin, an investigational dmg in the United States, does not increase basal or meal-stimulated insulin secretion. It lowers blood glucose levels in hyperglycemic patients with Type II diabetes but has no effect on blood glucose levels in normal subjects. It does not cause hypoglycemia. Successful metformin therapy usually is associated with no or some weight loss. 

The disease affects predominantly young women. Nearly all of the patients suffer from symptoms such as fatigue, weight loss, and fever and have chronic arthritis. In addition, nearly all organs of the body can be affected to various degrees. Clinically, the severity of the disease can vary within wide ranges. In cases where organs are affected, the disease in former times was lethal without therapy within 10 years in 50% of the patients. 

Anorexia (loss of appetite) is an example of a mild adverse reaction. Unless it becomes severe and pronounced weight loss occurs, it may not be necessary to discontinue sulfonamide therapy. 

If diuretic therapy is warranted, monitor for therapeutic response by assessing weight loss and improvement of fluid retention, as well as exercise tolerance and presence of fatigue. 

Exercise facilitates both weight loss and blood pressure reduction. In addition, regular exercise improves functional capacity and symptoms in chronic stable angina.1 Once drug therapy for IHD is instituted, patients should be encouraged... 

More specific diagnostic tests may be warranted in patients not responding to empiric (prescription) therapy, those with complicated or alarm symptoms (e.g., weight loss or dysphagia), or those with long-standing symptoms who are at risk for Barrett s esophagus. 

Gastric outlet obstruction occurs in approximately 2% of patients with PUD and is usually caused by ulcer-related inflammation or scar formation near the peripyloric region. Signs and symptoms of outlet obstruction include early satiety after meals, nausea, vomiting, abdominal pain, and weight loss. Ulcer healing with conventional acid-suppressive therapy is the primary treatment, but if this is unsuccessful then an endoscopic procedure (e.g., balloon dilation) is required. 

Metformin also has been shown to produce beneficial effects on serum lipid levels and thus has become a first-line agent for type 2 DM patients with metabolic syndrome. Triglyceride and low-density lipoprotein (LDL) cholesterol levels often are reduced by 8% to 15%, whereas high-density lipoprotein (HDL) cholesterol improves by approximately 2%. A modest weight loss of 2 to 3 kg (4.4—6.6 lb) also has been reported with metformin therapy. Metformin often is used in combination with a sulfonylurea or a thiazolidinedione for synergistic effects. 

Exanatide is available in 5 and 10 meg injectible prehlled disposable pens. Initial therapy is 5 meg twice daily, injected before the two largest meals of the day. Meals should be separated by at least 5 to 6 hours. Doses then are increased after a month to 10 meg if the patient s blood glucose is improving and nausea is limited. Exanatide can be given up to 60 minutes before a meal, but practical use indicates that injection just before a meal may decrease nausea. An average weight loss of 3 to 5 pounds (1.36-2.27 kg) commonly occurs with the 5 meg dose, whereas a weight loss of 5 to 10 pounds (2.27-4.55 kg) is observed with the 10 meg dose. 

Patient education is an important component of care. Educate patients about the benefits of proper therapy, the importance of adherence, and the importance of receiving a consistent LT4 product. Some patients will take excessive amounts of LT4 in an effort to feel better or as a weight-loss treatment. Explain to patients that excessive amounts of LT4 will not improve symptoms more than therapeutic doses and that this drug is not an effective treatment for obesity. 

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