altering the CYP enzyme activity or pharmacodynamic changes in receptor affinity. There are many pharmacodynamic changes in obese patients including decreased sensitivity for certain receptors, especially acetylcholine, and increased psychomotor response to benzodiazepines has been reported.21,27 Additionally, there are alternations in receptors' expression and affinity. For example, the cytokine tumor necrosis factor alpha is produced in excessive amounts, which further perpetuates insulin resistance.52 Adipose tissue has greater