Author Question: A patient who has hypothyroidism and is obese begins therapy with orlistat. The primary care NP ... (Read 76 times)

WhattoUnderstand · **on:** Jul 24, 2018

A patient who has hypothyroidism and is obese begins therapy with orlistat. The primary care NP teaches the patient about this drug and then asks the patient to describe its use.

Which statement by the patient indicates understanding of the teaching? a. I may eat a high-fat diet while taking orlistat.
b. I can expect the most benefit in the first few months.
c. I should take fat-soluble vitamins each time I take orlistat.
d. I should take an increased dose of levothyroxine while I am taking orlistat.

Question 2

A patient comes to the clinic to discuss weight loss. The primary care NP notes a BMI of 32 and performs a health risk assessment that reveals no obesity-related risk factors. The NP should recommend:

a. orlistat (Xenical).
b. surgical intervention.
c. changes in diet and exercise.
d. changes in diet and exercise along with short-term phentermine.

shayla · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

B
In long-term studies on the use of orlistat, most of the weight loss occurred during the first months. Patients should not be counseled to eat a high-fat diet; the maximum amount of fat excretion is around 25 to 30. Patients should take fat-soluble vitamins, but the vitamins should be taken at different times and not with orlistat. Orlistat interferes with levothyroxine absorption, so the two drugs should be taken at different times, and thyroid levels should be monitored with an increase in levothyroxine dose only when indicated by thyroid levels.

Answer to Question 2

D
This patient is grade 2 overweight (obese), so a short-term course of phentermine is useful, especially as there are no cardiovascular risk factors. Orlistat is a second-line drug. Surgical intervention is indicated when other therapies fail. Changes in diet and physical activity alone do not bring immediate results, and patients often get discouraged.