فصل 10 زیست شناسی - تغییرات زیستی و مسیرها

Pharmacotherapy in Obesity

• This presentation discusses various medications used in obesity treatment.
• It highlights the history of anti-obesity medications, from early approvals to more recent regulations.
• Several medications, like sibutramine (Meridia) and lorcaserin (Belviq), have been withdrawn due to safety concerns.
• Currently, there are several FDA-approved medications for long-term weight management.
• Some medications focus on suppressing appetite, while others target specific processes in the body.
• Important factors considered during medication approval include efficacy, benefit-risk ratio, and safety concerns.
• Consideration of potential side effects and contraindications is crucial.
• Nine FDA-approved medications for AOMs remain on the market.
• Some medications are geared towards long-term weight loss, while others are for specific genetic conditions.

BMI and All-Cause Mortality

• A meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants demonstrated a non-linear relationship between BMI and mortality risk.
• The lowest risk was observed at a BMI of 23-24 in never smokers and 20-22 in participants with longer follow-up periods.
• The risk increased as BMI deviated from this optimal range, with higher risks at lower and higher BMI values.

History of Anti-Obesity Medications

• Initial drug approval in the 1940s didn't prioritize rigorous controlled trials.
• The development of amphetamine derivatives led to weight loss medications, but many have since been removed due to side effects.
• FDA regulations now require rigorous evaluation of efficacy and safety.

Table 1: Recently Recalled Anti-Obesity Medications

• Sibutramine (Meridia, 1997-2010) was recalled due to increased cardiovascular risk.
• Lorcaserin (Belviq, 2012-2020) was later withdrawn due to increased cancer risk.

FDA Approved Medications for Weight Management

• Several FDA-approved medications remain on the market for long-term weight loss, targeting different mechanisms as per the specific genetic factors.

Short-Term Use Medications

• Phentermine (Adipex, Lomaira) is a sympathomimetic that suppresses appetite.
• Diethylpropion (Tenuate) is another sympathomimetic appetite suppressant, derived from bupropion.

Orlistat (Xenical, Alli)

• Orlistat inhibits intestinal lipases. It can reduce fat absorption by 30%.
• Side effects include fatty/oily stool, fecal urgency, oily spotting, and increased defecation and fecal incontinence; liver failure and oxalate nephropathy.

Topiramate/Phentermine (Qsymia)

• Topiramate promotes taste aversion, decreasing caloric intake
• Phentermine acts as an adrenergic agonist.
• This combination is approved for long-term use and promotes weight loss through synergistic mechanisms.

Safety and Side Effects of Medications (Buropion/Naltrexone, Contrave)

• Possible side effects of Bupropion/Naltrexone include nausea, vomiting, constipation, headache, dizziness, and dry mouth; this combination should be avoided in individuals with hypertension, seizure history, bulimia, or anorexia nervosa.
• There are specific precautions for these medications, including interactions with MAO inhibitors.

Liraglutide (Saxenda)

• Liraglutide is a GLP-1 receptor agonist.
• It reduces appetite and increases satiety.
• Studies show positive effects in adolescents.
• Adverse events may include gastrointestinal issues and in rare cases, medullary thyroid cancer.

IMCIVREE™ (setmelanotide)

• Targets specific rare genetic conditions of obesity.
• It's administered via daily injection under the skin..
• The action of this medication is based on proopiomelanocortin, proprotein convertase subtilisin-kexin type 1, and leptin receptor deficiency.
• Various side effects have been associated with the use of IMCIVREE™.

Semaglutide (Wegovy)

• Semaglutide is a long-acting GLP-1 analogue
• Administered weekly, slows gastric emptying and reduces hunger.
• Common side effects are nausea, diarrhea, vomiting, and constipation.

Gelesis100 (Plenity)

• A hydrogel matrix that absorbs water in the stomach, increasing fullness.
• It's FDA-approved for adults with overweight or obesity.

Other Considerations

• Age, underlying health conditions, other medications, pregnancy status, and relevant allergies are significant factors to consider.
• Detailed consultations with healthcare professionals are essential for safe and effective medication use.

این آزمون به بررسی تغییرات زیستی و نقش ژن‌ها در انتقال پیام‌ها بین مغز و بدن می‌پردازد. همچنین، به بررسی نیاز به IMCIVREE™ و شرایط مختلفی که با آن مرتبط است، می‌پردازد. سوالات شامل جزئیات درباره واکنش‌های بدن به سیگنال‌ها و احساسات مرتبط با چاقی هستند.