Obesity

Obesity skin signs
  • striae distensae
  • keratosis pilaris
  • acanthosis nigricans
    • DDx: confluent & reticulated papulomatosis (Rx monocyclin, azithromycin)
    • Terra-firma forme dermatosis (wash with alcohol, diagnose with wood’s lamp)
    • Work-up triggers
      • Polycystic ovary syndrome
      • Early onset acanthosis nigricans (monogenic disorders)
        • Ex. rabson mendelhall, needs treatment
      • Paraneoplastic acanthosis nigricans very rare in children
      • Cushing syndrome
  • acne
  • acrochordons
  • hidradenitis supurativa
 
Perder peso
  • Dulaglutide (Trulicity) 1 injeção por semana fica no frigorífico
    • 0,75mg uma vez por semana
    • Pode aumentar para 1,5, 3 ou 4,5mg
    • 2 canetas com 1,5mg custa 53€
    • 2 canetas com 0,75mg custa 53€
  • Liraglutide (Saxenda) versão não comparticipada do Trulicity é diário 3 mg daily
    • subcutaneously in the abdomen, thigh, or upper arm
    • Dose
      • A dose terapêutica é 1,8mg/dia (EADV Sevilha) ou 3mg (RCM)
      • Começar com 0,6mg/dia, aumentar 0,6mg a cada 2-4 semanas (1.2, 1.8, 2.4, 3 mg) dependendo dos efeitos gastrointestinais até à dose terapêutica
      • 5 canetas com 3mL cada com 6mg/mL (tem 90mg) custa 244€ (2.7€ por mg)
    • Victosa tem mais dose e é usado na diabetes
  • Semaglutido (ozempic) é o que tem maior eficácia, 2.4 mg weekly sc (uptodate)
    • The initial dose is 0.25 mg once weekly for four weeks. The dose is increased at four-week intervals (0.5, 1, 1.7, 2.4 mg) to the recommended dose of 2.4 mg once weekly
    • contraindicated during pregnancy and in patients with a personal history of pancreatitis or a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia 2A or 2B
    • 1 caneta com 3mL a 1mg/0,74mL (tem 4,05 mg) custa 114€ (28,14€/mg) ou 11€ se comparticipado
  • Bydureon
    • Exenatido [Bydureon], 2 mg/0.85 ml, Suspensão injetável de libertação prolongada, Caneta pré-cheia - 4 unidade(s) - 0.85 ml
    • 1x/sem
  • Buproprion
  • Orlistat 120 mg three times daily
    • advise patients to take a multivitamin at bedtime because orlistat may decrease the absorption of fat-soluble vitamins. (See 'Adverse effects' above.)
    • Should not be used during pregnancy or in patients with chronic malabsorption, cholestasis, or a history of calcium oxalate stones.