1. Therapeutics IV Tutoring May 6, 2016 Lisa Hayes lhayes3@uthsc.edu

2. Topics Heart Transplant Childhood Obesity Adult Obesity

3. Heart Transplant Disclaimer – We were not tested on this last year!

4. What is the most common reason for a heart transplant? A – congenital dz B – cardiomyopathy C - CAD D – valvular dz

5. Which of the following is an appropriate reason to recommend a heart transplant/VAD? A – ejection fraction of 18% B – major limitation to ADL + peak VO2 of 8mL/kg/min C – recurrent ischemia not able to use CABG or PCI D – cardiogenic shock responding to oral med

6. Which of the following is NOT a contraindication to transplant? A – malignant brain tumor, removed 4 years ago B – MRSA bacteremia with WBC 17K C – severe diabetes with kidney damage (SCR 1.4) D – BMI 23

7. Which type of patient may require a VAD more often than others? A – HLA mismatch B – “A” blood types C – transplant decision made easily

8. Which of the following can be a significant complication of a VAD? A – bleeding B – thromboembolism C – infection D – all of the above

9. I did not cover transplant meds. Please remember to review these. Interactions with tacrolimus/sirolimus – Remember dilt + tacrolimus Review risk factors for rejection

10. Childhood obesity

11. Which of the following is not associated with metabolic syndrome? A – hypercoagulability B – normotension C – dyslipidemia D – insulin resistance

12. Which of the following statements about sleep and childhood obesity is true? A – sleep duration is not associated with increased risk of obesity in ages 0-5y B – short sleep duration is associated with increased risk of becoming obese in years 5-13 C – daytime naps help decrease the risk of obesity D – decreased sleep duration is tied to increased food intake

13. Know what a microbiome is.

14. In which patient would Orlistat be appropriate? A – 10 year old female with BMI 26 B – 9 year old male with BMI 25 C – 13 year old male with BMI 27 D – 11 year old female with BMI 28

15. Which of the following is most appropriate regarding Metformin for obesity in pediatrics? A – Metformin is an approved treatment for obesity in pediatrics B – Metformin works better in Caucasian patients C – Metformin works better if a higher BMI is present at baseline D – Metformin should be started at 1000mg BID

16. Adult Obesity

17. Calculate and BMI for BH and quantify his obesity. 5’7” 317# A – BMI 43 - obese B – BMI 50 – extreme obesity C – BMI 48 – extreme obesity D – BMI 42 – morbidly obese

18. Which of the following drugs is not known to contribute to weight gain? A – Levemir B – Valproate C – Lo Estrin D - HCTZ

19. TR is a 5’4” female who weighs 170 pounds. PMH: migraines, HTN, DM. Which recommendation is most appropriate? A – Recommend 5-10% body weight loss in 6 months B – Recommend no weight loss but no weight gain C – Recommend 3% body weight loss in 3 months D – recommend 5-10% body weight loss in 3 months

20. 28 y/o RT presents to your clinic requesting help with losing weight. She has a BMI of 33. PMH HTN, hypothyroid, migraine, seizure disorder. Which of the following would be most appropriate for short term therapy? A – phentermine B – qysmia C – belviq D – none of the above

21. WH has been on Qysmia at 7.5mg/46mg dose for 12 weeks. Patient has been compliant with medication + diet. Weight loss is 12 pounds. Starting weight 227 pounds. What should you recommend? A - titrate up to 15mg/92mg for additional 6 weeks B – titrate up to 15mg/92mg for additional 12 weeks C – discontinue therapy D – continue 7.5mg/46mg dose

22. EW has been on Belviq for 13 weeks. Initial weight 223 pounds. Weight loss 7 pounds. She says her heart is racing all the time. What do you recommend? A – continue for additional 12 weeks B – address adherence C – discontinue D – get full medication list

23. TR is a patient who is 31 years old and has a BMI of 32. She is considering becoming pregnant in the next 3- 6months. Which of the following could you recommend to her for weight loss? A – Qysmia B – Phentermine C – Belviq D – Orlistat

24. Which of the following does not show improvement with weight loss? A – sleep apnea B – COPD C – HTN D – cancer

25. What is an appropriate counseling point for Orlistat? A – there are no drug interactions for this medication because it works in the gut B – Use only for 3 months at a time C – Use caution when eating high fat foods, this is not recommended D – This drug has no other names so don’t worry about confusing it with an OTC product

26. True or False: Fat can function as an endocrine organ. A – true B – false

27. Which of the following is not a recommendation for a patient post bariatric surgery? A – avoid ER tablets B – split pills larger than the size of a thumbnail to avoid blocking the band C – recommend using calcium citrate over calcium carbonate D – recommend appropriate vitamin supplementation (ADEK, folic acid, etc)

28. What is the difference between Saxenda and Victoza? A – contraindications B – starting dose C – ending dose D – drug component

29. Which of the following should not be used if the patient has an eating disorder due to the component medication? A – phentermine B – Contrave C – Belviq D – Orlistat

30. Thanks!!! Please email me with questions. lhayes3@uthsc.edu Good Luck! Happy P3 status!