ASSIGNMENT

Module Code MPP102T

Module Name PHARMACOTHERAPEUTICS-1
Programme M-PHARM
Department PHARMACY PRACTICE
Faculty PHARMACY

Name of the Student VANDANA KATYAN

Reg. No 21PHPP062005
Batch 2021

Module Leader Dr. G R Saraswathy

Dr. E Maheshwari
Declaration Sheet
Student Name VANDANA KATYAN
Reg. No 21PHPP062005
Course M-PHARM Batch 2021
Module Code MPP102T
Module Title Pharmacotherapeutics I
Module Date To
Module Leader Dr. E Maheswari, Dr. GR Saraswathy

Declaration
The assignment submitted herewith is a result of my investigations and I have
conformed to the guidelines against plagiarism as laid out in the Student Handbook. All
sections of the text and results, which have been obtained from other sources, are fully
referenced. I understand that cheating and plagiarism constitute a breach of University
regulations and will be dealt with accordingly.

Signature of the
Date
student

Submission date stamp

(by Examination & Assessment
Section)

Signature of the Module Leader and date Signature of Reviewer and date
 Faculty of Pharmacy

M. S. Ramaiah University of Applied Sciences

Department Pharmacy Practice Programme M.Pharm.

Year /Batch I SEM / 2021
Course Code MPP102T Course Title Pharmacotherapeutics I
Course Leader(s) Dr. E Maheswari, Dr. GR Saraswathy
ASSIGNMENT
Reg No. 21PHPP062005 Name of Student VANDANA KATYAN
Marks
Sections

Marking Scheme Max Marks

Marks Scored

1.1 Explain cognitive behavioral therapy in weight reduction 04

Pros and cons of cognitive-behavioral therapy in weight 04
1.2
Part A

reduction
1.3 Measures that could be taken to minimize obesity 02

Part A-Max Marks 10

1.1 List of medications with its mechanism that leads to obesity 05

Different patterns of fasting techniques utilized for weight 05
Part B.1

1.2
reduction
B.1 Max Marks 10

2.1 Compile a ketogenic diet, its advantages, and disadvantages 08

Part
B.2

B.2 Max Marks 08

Citation and References 02
Total Assignment Marks 30
(Marks out of 15)

Signature of Examiner:
Date:
SL.NO TITLE PAGE NO

PART A

1.1 Cognitive-behavioral therapy in weight reduction 5

1.2 Pros and cons of cognitive-behavioral therapy in weight reduction 6

1.3 Measures that could be taken to minimize obesity 7

1.4 References 7

PART B.1

1.1 Medications causing obesity 8

1.2 Different patterns of fasting techniques are utilized for weight 10

reduction.
1.3 References 13

PART B.2

2.1 Introduction 14

2.2 Advantages of ketodiet 14

2.3 Disadvantages of the keto diet 14

2.4 References 15
 Part -A
The main cause of obesity is an imbalance between calories consumed and calories expended,
although, in a small number of cases, genetics and diseases such as hypothyroidism, Cushing’s disease,
depression, and use of medications such as antidepressants and anticonvulsants are responsible for
fat accumulation in the body. The main treatment for obesity is dieting, augmented by physical
exercise and supported by cognitive behavioral therapy.
In this context write an essay on “cognitive behavioral therapy”
Your essay should emphasize on:
Explain the cognitive behavioral therapy in weight reduction
Discuss the pros and cons of cognitive-behavioral therapy in weight reduction
Discuss the measures that could be taken to minimize obesity

1.1 COGNITIVE BEHAVIORAL THERAPY IN WEIGHT REDUCTION

Cognitive-behavioral therapy (CBT) is a form of psychotherapy treatment that teaches people how
to recognize and alter harmful or troubling thinking patterns that affect their behavior and
emotions. Cognitive-behavioral therapy focuses on modifying automatic negative thinking that
can exacerbate emotional problems, sadness, and anxiety. These uncontrollable unpleasant
thoughts have a bad impact on mood. CBT identifies these thoughts, challenges them, and
replaces them with more objective, realistic ones.
Self-monitoring, goal planning, stimuli control, contingency management, behavioral substitution,
skills for strengthening social support, problem-solving, and relapse prevention are all part of
personalized cognitive-behavioral therapy for obesity (CBT-OB). These assist patients to address
the cognitive processes linked to treatment termination, weight reduction, and long-term weight
loss maintenance, according to recent studies. The treatment programme contains six modules
that are presented according to the particular patient's needs as part of a flexible, tailored
approach.

The treatment lasts 11 months and is divided into two phases: weight reduction and weight
maintenance. The 1st phase's goal is both to lose weight while also addressing expected barriers to
long-term weight maintenance. The 2nd phase focuses on assisting patients in developing the mindset
and behaviors required for effective long-term weight management.

The initial 24–30 weeks of therapy are referred to as Phase 1. Patients who are pregnant or
nursing, taking medicine that affects body weight, have medical comorbidities related to weight loss,
or have severe psychological illnesses should avoid CBT-OB (e.g., major depression, acute psychotic
disorders, substance use disorders, and bulimia nervosa).

The primary goals of CBT-OB are to help patients to:

(i) achieve, accept and maintain healthy weight loss;
(ii) adopt a lifestyle conducive to weight control
(iii) develop a stable “weight-control mindset”.

1.2 PROS AND CONS OF COGNITIVE-BEHAVIORAL THERAPY IN WEIGHT REDUCTION

Advantages

 Helping a person control their diet

 Helping to increase motivation to do exercise
 Provide coping skills to handle any lapses in diet that the person will experience
 Provide long term weight maintenance skills
 Changing a person’s body image and their expectation of body image
 Improving a person’s self-esteem
 Helping with stress management (a major reason for ‘comfort eating’)
 Helping set reasonable goals for both weight loss and maintenance.

Limitations
 Need to commit yourself to the process to get the most from it – a therapist can help and
advise you, but they need your co-operation
 Attending regular CBT sessions and carrying out any extra work between sessions can take up
a lot of your time
 It may not be suitable for people with more complex mental health needs or learning
difficulties, as it requires structured sessions
 It involves confronting your emotions and anxieties – you may experience initial periods
where you're anxious or emotionally uncomfortable
 It focuses on the person's capacity to change themselves (their thoughts, feelings, and
behaviours) – this does not address any wider problems in systems or families that often have
a significant impact on someone's health and wellbeing.
1.3 MEASURES TO MINIMIZE OBESITY
 Decrease dietary fat consumption

 Skip meals or don't skip meals

 Decrease fizzy drinks or replace them with low sugar drinks

 Avoid sugary foods and processed high-fat meat products

 Increase low energy foods (such as fruits and vegetables)

 Choose natural foods if possible, but if buying manufactured or packaged foods, buy those
low in energy density

 Eat off small plates; avoid large portions (never “supersize”)

 Never eat with fingers

 Only eat when sitting down

 Join a gym

 Walk more and don't bother with the gym

 Get a pedometer and use it to monitor increased walking

1.4 REFERENCES
1. Lean, M., Lara, J., & Hill, J. O. (2006). ABC of obesity. Strategies for preventing
obesity. BMJ (Clinical research ed.), 333(7575), 959–962.
https://doi.org/10.1136/bmj.333.7575.959
2. Castelnuovo G, Pietrabissa G, Manzoni GM, et al. Cognitive behavioral therapy to aid
weight loss in obese patients: current perspectives. Psychol Res Behav Manag.
2017;10:165-173. Published 2017 Jun 6. doi:10.2147/PRBM.S113278
3. Wilfley, D.E., Kolko, R.P. and Kass, A.E., 2011. Cognitive-behavioral therapy for weight
management and eating disorders in children and adolescents. Child and Adolescent
Psychiatric Clinics, 20(2), pp.271-285.
 4. Alimoradi, M., Abdolahi, M., Aryan, L., Vazirijavid, R. and Ajami, M., 2016. Cognitive-
behavioral therapy for treatment of adult obesity. International journal of medical
reviews, 3(1), pp.371-379.

PART-B
B.1.

Medications utilized for the treatment of fewer illness ends up in obesity. Intermittent fasting (IF),
also known as alternate day fasting (ADF), periodic fasting, or intermittent energy restriction (IER)
is a relatively new dietary approach to weight management that involves interspersing normal daily
caloric intake with a short period of severe calorie restriction/fasting. In terms of the possible
underlying biological benefits of intermittent fasting, there is some evidence, to demonstrate
beneficial effects on weight loss and cardio-metabolic risk factors.

Concerning the above context,

5. Mention the list of medications with their mechanism that leads to obesity.
6. Specify the different patterns of fasting techniques utilized for weight reduction.

B.1.1 MEDICATIONS CAUSING OBESITY

The class of medications that leads to weight gain is as follows:

i. Tricyclic Antidepressants
ii. Corticosteroids
iii. Antihistamines
iv. Epilepsy Medications
v. Beta-Blockers
vi. SSRIs (selective serotonin reuptake inhibitors)
vii. MAOI(monoamine oxidase inhibitor)
viii. Insulin
ix. Sulphonylureas
x. Antipsychotics
 1. Tricyclic Antidepressants-

Antidepressants interfere with serotonin, the neurotransmitter that regulates anxiety and mood
while also controlling appetite. These changes may increase cravings for carbohydrate-rich foods,
such as bread, pasta, and desserts. When people are depressed, their appetites are affected. In
some people, this may make them hungrier while others lose their appetite. It may be the case that
when antidepressants take effect, someone’s usual appetite returns and this has an impact on their
weight. It should also be noted that depression can lead to fatigue and inactivity, and a lack of
physical activity can cause weight gain. If a person is experiencing weight gain while taking
antidepressants, it may be an indication that the medication is not combatting their depression
effectively.

2. Corticosteroids

Steroids cause weight gain by altering the body's electrolyte and water balances, as well as its
metabolism — the way it uses and stores lipids, amino acids, protein, carbohydrates, and glucose,
among other things. These factors contribute to weight gain by causing: increased appetite. fluid
retention.

Many people on steroids notice increased fat in the abdomen, face, and neck. Even if you
successfully control steroid-induced weight gain, you’re apt to look heavier while on these drugs
because of this fat redistribution. How much and even if you will gain weight (it’s not definite)
depends on a lot of factors, including dose and duration. Generally, the higher the dose of the
steroid and the longer you’re on it, the more likely you are to encounter weight gain. Short courses
of a few days to a couple of weeks don’t usually produce many side effects.

3. Antipsychotic

Antipsychotic drugs treat schizophrenia, bipolar disorder, and other mental health disorders. They can
ease your symptoms and help you avoid a relapse (when your symptoms come back), but they can also
cause weight gain.

People often quickly put on weight after they start antipsychotics and keep gaining over time. Children
are more likely to gain weight. Being overweight raises your risk of diabetes, heart attack, stroke, high
blood pressure, arthritis, sleep apnea, and some cancers.
Antipsychotic drugs can make you hungrier, so you might eat more. That's because they change the
way your brain and hormones work together to control your appetite. You might crave sweets or
fatty foods. They can also raise the amount of sugar and fat in your blood.

4. Beta-Blockers

Treatment with beta-blockers reduces the facultative thermogenesis by 50-100 kcal/d, which
corresponds to the weight gain of 2-5 kg/year reported in clinical trials. Treatment with beta-
blockers also results in insulin resistance, which may aggravate existing diabetes and elicit diabetes
in predisposed patients. Obesity is associated with defective sympathetic activity, and treatment
with beta-blockers may further reduce facultative thermogenesis and promote weight gain.

B.1.2 DIFFERENT PATTERNS OF FASTING TECHNIQUES UTILIZED FOR WEIGHT REDUCTION

Intermittent fasting involves entirely or partially abstaining from eating for a set amount of time,
before eating regularly again. Some studies suggest that this way of eating may offer benefits such
as fat loss, better health, and increased longevity. Proponents claim that an intermittent fasting
program is easier to maintain than traditional, calorie-controlled diets. Each person’s experience of
intermittent fasting is individual, and different styles will suit different people.

Different types of fasting Techniques:

1. Fast for 12 hours a day

The rules for this diet are simple. A person needs to decide on and adhere to a 12-hour fasting
window every day. According to some researchers, fasting for 10–16 hours can cause. Trusted
Source the body to burn its fat stores into energy, which releases ketones into the bloodstream.
This should encourage weight loss.

This type of intermittent fasting plan may be a good option for beginners. This is because the fasting
window is relatively small, much of the fasting occurs during sleep, and the person can consume
the same number of calories each day.
The easiest way to do the 12-hour fast is to include the period of sleep in the fasting window. For
example, a person could choose to fast between 7 p.m. and 7 a.m. They would need to finish their
dinner before 7 p.m. and wait until 7 a.m. to eat breakfast but would be asleep for much of the time
in between.

2. Fasting for 16 hours

Fasting for 16 hours a day, leaving an eating window of 8 hours, is called the 16:8 method or the
Leangains diet. During the 16:8 diet, men fast for 16 hours each day, and women fast for 14 hours.
This type of intermittent fast may be helpful for someone who has already tried the 12-hour fast
but did not see any benefits. On this fast, people usually finish their evening meal by 8 p.m. and
then skip breakfast the next day, not eating again until noon.

A study by Trusted Source on mice found that limiting the feeding window to 8 hours protected
them from obesity, inflammation, diabetes, and liver disease, even when they ate the same total
number of calories as mice that ate whenever they wished.

3. Fasting for 2 days a week

People following the 5:2 diet eat standard amounts of healthful food for 5 days and reduce calorie
intake on the other 2 days. During the 2 fasting days, men generally consume 600 calories and
women 500 calories.

Typically, people separate their fasting days in the week. For example, they may fast on a Monday
and Thursday and eat normally on the other days. There should be at least 1 non-fasting day
between fasting days. There is limited research on the 5:2 diet, which is also known as the Fast Diet.
A study by Trusted Source involving 107 overweight or obese women found that restricting calories
twice weekly and continuous calorie restriction both led to similar weight loss.

The study also found that this diet reduced insulin levels and improved insulin sensitivity among
participants.
 4. Alternate day fasting

There are several variations of the alternate-day fasting plan, which involves fasting every other
day. For some people, alternate day fasting means a complete avoidance of solid foods on fasting
days, while other people allow up to 500 calories. On feeding days, people often choose to eat as
much as they want.

One study trusted reports that alternate-day fasting is effective for weight loss and heart health in
both healthy and overweight adults. The researchers found that the 32 participants lost an average
of 5.2 kilograms (kg), or just over 11 pounds (lb), over 12 weeks.

Alternate day fasting is quite an extreme form of intermittent fasting, and it may not be suitable for
beginners or those with certain medical conditions. It may also be difficult to maintain this type of
fasting in the long term.

5. A weekly 24-hour fasting

Fasting completely for 1 or 2 days a week, known as the Eat-Stop-Eat diet, involves eating no food
for 24 hours at a time. Many people fast from breakfast to breakfast or lunch to lunch.

People on this diet plan can have water, tea, and other calorie-free drinks during the fasting period.
People should return to normal eating patterns on the non-fasting days. Eating in this manner
reduces a person’s total calorie intake but does not limit the specific foods that the individual
consumes.

A 24-hour fast can be challenging, and it may cause fatigue, headaches, or irritability. Many people
find that these effects become less extreme over time as the body adjusts to this new pattern of
eating. People may benefit from trying a 12-hour or 16-hour fast before transitioning to the 24-hour
fast.

6. Meal skipping
This flexible approach to intermittent fasting may be good for beginners. It involves
occasionally skipping meals. People can decide which meals to skip according to their level
of hunger or time restraints. However, it is important to eat healthful foods at each meal.
Meal skipping is likely to be most successful when individuals monitor and respond to their body’s
hunger signals. Essentially, people using this style of intermittent fasting will eat when they are
hungry and skip meals when they are not. This may feel more natural for some people than the
other fasting methods.

7. The Warrior Diet

The Warrior Diet is a relatively extreme form of intermittent fasting.

The Warrior Diet involves eating very little, usually just a few servings of raw fruit and vegetables,
during a 20-hour fasting window, then eating one large meal at night. The eating window is usually
only around 4 hours.

This form of fasting may be best for people who have tried other forms of intermittent fasting
already. Supporters of the Warrior Diet claim that humans are natural nocturnal eaters and that
eating at night allows the body to gain nutrients in line with its circadian rhythms.

During the 4-hour eating phase, people should make sure that they consume plenty of vegetables,
proteins, and healthful fats. They should also include some carbohydrates. Although it is possible to
eat some foods during the fasting period, it can be challenging to stick to the strict guidelines on
when and what to eat in the long term. Also, some people struggle with eating such a large meal so
close to bedtime.

There is also a risk that people on this diet will not eat enough nutrients, such as fiber. This can
increase the risk of cancer and harm digestive and immune health.

B.1.3 REFERENCES

 Jayne Leonard, April 16, 2020, Seven ways to intermittent fasting,

https://www.medicalnewstoday.com/articles/322293, 20th may’2022.

 Astrup A. V. (1990). Fedme og diabetes som bivirkninger til beta-blokkere [Obesity and
diabetes as side-effects of beta-blockers]. Ugeskrift for laeger, 152(40), 2905–2908.
  Moraczewski J, Aedma KK. Tricyclic Antidepressants. [Updated 2022 May 2]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK557791/

B.2
A keto diet limits carbs and has many potential health benefits. Eating fewer carbs, the body begins
to burn fat for fuel. This can put the body into a metabolic state called ketosis. In this state, the liver
turns fat into small energy molecules called ketones, which the brain and other organs can use for
energy. Eating a keto diet lowers insulin levels, often dramatically, which can help to access body
fat stores for energy. Many studies show significant weight loss on keto, without having to count
calories. Keto diets may have other positive health effects, such as reducing blood sugar levels.
Compile a ketogenic diet, its advantages, and disadvantages.

B.2.1 INTRODUCTION
Ketogenic diets are characterized by a significant reduction in (<50 g/day) and an increase
in fats and proteins- frequently extraordinarily high-fat percentages due to the difficulty of
increasing proteins beyond a certain point.

B.2.2 ADVANTAGES OF THE KETOGENIC DIET

 Reduces insulin and glucose levels in the body, as well as possibly inflammation
 Restricts or avoids carbs consumption to lose weight
 Elevates fat metabolism to decrease weight
 Might improve cognitive function
 Can decrease migraine attacks
 May improve symptoms of some neurological conditions such as Parkinson’s disease,
Alzheimer’s disease, and epilepsy
 May improve outcomes after traumatic brain injury
 May slow progression of some cancers
 Excellent approach to detox from sugar because all foods with added sugar are prohibited
 May boost female fertility
B.2.3 DISADVANTAGES OF THE KETOGENIC DIET
 There is a scarcity of long-term data supporting the KD.
 Initial weight loss can be short term and quickly reversible largely due to water loss
 Transition to KD may cause Keto flu
 In patients with psychological well-being issues, side effects might be felt more intensely
 Decreases intake of fruits and vegetables, limiting the intake of nutrients, vitamins, and
fiber
 Increases risk of consuming saturated fats
 Dangerous for persons suffering from eating disorders
 Increases the risk of renal calculi
 Increases the risk of ketoacidosis in DM patients
 May cause digestive upset and decreased physical performance

B.2.4 REFERENCES
1. Deep Dutta, Soumitra Ghosh, Sanjay Kalra, Indira Maisnam and Meha Sharma., 2020. Is the
Ketogenic Diet an Effective and Safe Approach to Type 2 Diabetes Management and Weight
Loss?. Research Gate, 16(1):15
2. Anya Romanowski, MS, RD.2018. Ketogenic Diet: Which Patients Benefit?. Medscape. Available
at: https://www.medscape.com/viewarticle/894041_2.