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57 Cards in this Set
- Front
- Back
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What is the moa of Phentermine? |
Sympathomimetic (Stimulant): release of norepinephrine stimulates the satiety center which decreases appetite |
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Obese BMI? |
>/= 30 kg/m^2 |
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Overweight people are at increased risk for __? |
“CHOPS CD” Coronary heart disease, hypertension, stroke, T2DM, osteoarthritis, certain types of cancer, premature death |
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Weight loss must involve __? |
“energy deficit” : calories must be decreased and/or energy expenditure increased |
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Drugs that cause weight gain? |
KEY DRUGS: “DAD Let Me See Hypo” Antipsychotics (Clozapine, Olanzapine, Risperidone, Quetiapine) Diabetic medications (Insulin, Meglitinides, Sulfonylureas, Thiazolidinediones : “MIST”) Divalproex/Valproic acid Lithium Mirtazapine!!!! Anti-depressant sedating Steroids: wt redistribution like Cushing effect long term SE Conditions: Hypothyroidism
OTHER: Betablockers, Dronabinol, Gabapentin, Pregabalin, Hormones (estrogen, megestrol), MAO inhibitors, SSRIs (paroxetine, others may be weight neutral), TCAs (amitriptyline, nortriptyline), Vasodilators (minoxidil) |
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OTC weight loss supplements? |
“Bitch you gunna go” Bitter orange, and or excessive amounts of caffeine (packaged under different names: Yerba mate, guarana, concentrated green tea powder) **generally ineffective don’t recommend. People develop tolerance quickly so will try to increase dose which causes increased BP, strokes, and heart attacks |
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When are prescription weight loss medications indicated? |
BMI >/= 30 kg/m^3 or BMI >/= 27 kg/m^3 with at least one weight related condition (dyslipidemia, hypertension, or diabetes) Prescription drugs are NOT appropriate for patients with small amounts of weight to lose. Weight loss medications are only used in addition to dietary plan and increased physical activity. |
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Which weight loss medications can be continued long-term for weight maintenance? |
Qsymia, Belviq, Contrave, Saxenda, and Orlastat |
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When should weight loss drugs be discontinued? |
If they do not produce at least 5% weight loss at 12 weeks. |
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What drugs can cause weight loss? |
“Girl PAS THIC” ADHD drugs (amphetamine, methylphenidate) GLP-1 agonists (exenatide, liraglutide) Pramlintide SGLT2 inhibitor (canagliflozin, empagliflozin) Topiramate Conditions: Hyperthyroidism, Celiac disease, inflammatory bowel disease (IBD) |
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Which prescription weight loss drugs can be used in pregnancy? |
None! Avoid all weight loss drugs!! |
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What is the brand name of Phentermine/Topiramate? |
Qsymia |
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Qsymia is contraindicated in what types of pts? |
Pregnant |
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What is the generic name of Qsymia? |
Phentermine/Topiramate ER |
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T/F: Qsymia is not on the REMS program. |
False! Qsymia is a REMS drug due to teratogenic risk. Obtain pregnancy test before treatment and monthly thereafter; use effective contraception during treatment. Only available through certified pharmacy network due to teratogenic effects. C-IV |
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Qsymia has what important side effects? |
Tachycardia, CNS effect’s Note: Taper off due to seizure risk |
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What is the generic for Contrave? |
Naltrexone/Bupropion |
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What is the moa of Naltrexone? |
Decrease food cravings |
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What is the moa of Bupropion? |
Decrease appetite |
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What are some contraindications for Contrave? |
“HOOPS” Opioid use, uncontrolled hypertension, seizure disorder, other bupropion containing product use, pregnancy |
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Contrave has what warning associated with it? |
Use caution with psychiatric disorders |
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What does the Naltrexone component do? |
Blocks opioids (and buprenorphine) |
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What is the generic name for Belviq? |
Lorcaserin |
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What is/are contraindications with Belviq? |
Pregnancy |
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What warnings is/are associated with Lorcaserin? |
Serotonin syndrome, hypoglycemia (may need to reassess in DM pts as they lose wt their BG improves so with this risk increases), priapism |
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What is the moa of Belviq? |
Serotonin 5-HT2C receptor agonist: increasingly satiety C-IV |
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What diabetic medication can be used for weight loss? |
Victoza |
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What is the generic name of Saxenda? |
Liraglutide |
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What is/are contraindications with Saxenda? |
Pregnancy |
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What are some warnings associated with Saxenda? |
Pancreatitis, hypoglycemia |
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What is the primary side effect associated with Saxenda? |
Nausea |
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What is the moa of Orlistat? |
Decrease absorption of dietary fats by ~30% |
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What is the moa of Saxenda? |
Increases satiety |
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What is the prescription name for Orlistat? What is the OTC name for Orlistat? |
Rx: Xenical OTC: Alli |
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Orlistat must be used with what kind of diet plan? |
Low-fat |
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What is/are contraindications for Orlistat? |
Pregnancy |
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What are side effects for Orlistat? |
GI (flatus with discharge, fatty stool) |
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What are some important notes for Orlistat and vitamins as well as diet? |
Take multivitamin with A,E,D,K and beta carotene at bedtime or separate by >/= 2 hours Max of 30% kcal from fat |
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What is the moa of Adipex-P and what is the generic name? |
Phentermine Moa: sympathomimetic (stimulant) |
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What are some contraindications for Adipex-P? |
Cardiovascular disease (uncontrolled hypertension) hyperthyroidism, glaucoma, pregnancy, drug abuse |
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What are some side effects of Phentermine? |
Tachycardia, agitation, increased blood pressure |
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When a patient is taking Adipex-P it is important to monitor for what? |
HR, BP |
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T/F: It is okay to use Phentermine long term. |
False! Used short-term up to 12 weeks to jump-start a diet. |
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When is bariatric surgery an option? |
Adults when BMI >/= 40 or when BMI >/= 35 with an obesity related condition. |
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What are common nutrient deficiencies with bariatric surgery? |
Ca (Ca citrate preferred cuz non-acid dependent absorption), Vit.B12, iron, Vit.A,E,D,K *Give Ca and iron supplements 2 hrs before or 4 hrs after antacids |
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What should you do if a medication requires a dose reduction after bariatric surgery? |
May need to crush and put in liquid or use a transdermal form for up to two months post surgery. |
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Rapid weight loss can cause what and what medication may be needed to help? |
Rapid weight loss can cause gallstones. Ursodiol dissolves gallstones. |
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Overweight BMI? |
BMI 25 - 29.9 kg/m^2 |
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Underweight BMI? |
BMI <18.5 kg/m^2 |
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How much should you increase physical activity per week for weight loss? |
>/= 150 mins/week |
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When should you start pharmacotherapy vs lifestyle changes? |
Life style modifications: BMI 25-29.9 Pharmacotherapy: BMI >/= 27 + 1 condition (HTN, DMT2, Dyslipidemia)
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What are all the medication options used in weight loss? |
“NO PALL” |
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T/F: Contrave is to be avoided in HTN and seizures but is okay in depression and concomitant opioid use. |
FALSE! Avoid in all pts with additional issues. |
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T/F: It is not okay to use Qsymia if you are currently taking Selegiline (Zelapar). |
True because it’s an MAOi |
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T/F: Saxenda is a part of the REMS program. |
True!! It has a risk of medullary thyroid cancer (MTC) and pancreatitis |
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T/F: Diethylpropion (Tenuate) and Phentermine (Adipex-P) are stimulants and C-V meditations. |
False!
Diethylpropion (Tenuate) and Phentermine (Adipex-P) are stimulants and C-IV meditations. |
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1. Would you recommend medication therapy for this patient? 2. What medications would you NOT recommend this patient? 3. What medications would you recommend this patient? |
1. Yes 2. Contrave, Qsymia, or any short acting stimulates with HTN pts (technically you can use Contrave in controlled but he just started 3 months ago so don’t know if it’s the most appropriate choice) 3. Lorcaserin (Belviq), Liraglutide (Saxenda), Orlistat (Xenical, Alli) |
