57. Weight Loss Flashcards
BMI for Overweight
25-29.9
BMI for obese
BMI ≥30
A person who is overweight is higher risk for ___
coronary heart disease, HTN, stroke, T2DM, certain types of cancer and premature death
Drugs/conditions that can cause weight gain
Antipsychotis (e.g. clozapine, olanzapine, risperidone, quetiapine)
DM drugs (insulin, SU, meglitinides, thiazolidinediones)
Divalproex/valproic acid
Gabapentin, pregabalin
Lithium
Mirtazapine
Steorids
TCAs (eg. amitriptyline, nortriptyline)
Conditions: hypothyroidism
Others: Beta-blockers, dronabinol, hormones (e.g. estroogen, megestrol) MAOi, SSRIs (paroxetine, others may be weight neutral), vasodilators (e.g. minoxidil)
OTC supplements used for weight loss
Bitter orange
Caffeine (e.g. yerba mate, guarana, concentrated green tea powder)
T/F: Rx weight loss meds can be used in any pt who desires weight loss despite lifestyle changes
False - not appropriate for pts with small amts of weight to lose
Indicated for BMI ≥ 30 or BMI ≥ 27 with at least 1 weight-related condition (dyslipidemia, HTN, DM)
Older stimulant drugs (e.g. phentermine, diethylpropion) are only used short-term to “jump-start” a diet. New weight loss drugs such as _____ can be continued long-term for weight maintenance
Qsymia, Contrave, Saxenda, Wegovy, and orlistat formulations
Weight loss drugs should be d/c if they do not produce at least ___% weight loss at __weeks
at least 5% weight loss at 2 weeks
Drugs that can cause weight loss
ADHD drugs(e.g. amphetamine, methylphenidate)
Bupropion
GLP-1 RA (e.g. exenatide, liraglutide)
Pramlintide
Rofluimilast
SGLT2i (e.g. cangliflozin, empagliflozin)
Topiramate
Tirzepatide
Conditions: hyperthyroidism, celiac disease, IBD
Others: ACEi (e.g. donepezil, rivastigmine, galantamine), antiepileptic drugs (zonisamide, ethosuximide), interferons, thyroid drugs (e.g. levothyroxine), conditions: cystic fibrosis, GERD or PUD, Lupus, tuberculus (active disease)
Concern with Rx weight loss drugs and pregnancy
Avoid all weight loss drugs
Concern with Rx weight loss drugs and HTN
Avoid Contrave - contraindicated with uncontrolled BP (contains bupropion)
Caution with Qsymia - monitor HR (contains phentermine)
Concern with Rx weight loss drugs and depression
Caution in young adults and adolescents Contrave - suicide risk (contains burpropion)
Concern with Rx weight loss drugs and seizures
Avoid Contrave - lowers seizure threshold (contains bupropion)
Caution with Qsymia - must taper off slowly if used (contains topiramate)
Concern with Rx weight loss drugs and opioid use
Avoid Contrave - blocks opioid receptors (contains naltrexone)
Contraindications with phentermine/topiramate ER (Qsymia)
Pregnancy, glaucoma, hyperthyroidism, MAOi within past 14 days
phentermine/topiramtae ER (Qsymia) requires REMS d/t ____ risk
teratogenic risk
Pregnancy test needed before treatment and monthly thereafter, use contraception during treatment
Side effects of phentermine/topiramate ER (Qsymia)
Tachycardia, CNS effects (e.g. insomnia (take in morning to decrease risk), depression, anxiety, suicidal thoughts, HA, paresthesias), vision problems
Others: constipation, dry mouth, decrease HCO3, URTI, increased SCr
MOA phentermine/topiramate ER (Qsymia)
Phentermine - sympathomimetic(stimulant)»_space; release NE stimulates satiety center which decreases appetite
Topiramate = increases satiety, decreases appetite, possibly by increase GABA, blocking glutamate receptors and/or inhibition of carbonic anhydrate
Pt was on phentermine/topiramte ER (Qsymia) and prescriber will like to d/c med. What do you recommend?
Taper off d/t seizure risk
MOA naltrexone/bupropion (Contrave)
Naltrexone - decreased food cravings
Bupropion - decreased appetite
Contraindications for naltrexone/bupropion (Contrave)
Pregnancy, chronic opioid use or acute opiate withdrawal, uncontrolled HTN, seizure disorder, use of other bupropion-containing products, use of MAOi within 14 days
Others: bulimia/anorexia, abrupt d/c of alcohol, BZDS, barbiturates, or antiepileptic drugs
Warnings with naltrexone/bupropion (Contrave)
Use caution with psychiatric disorders, d/c with s/sx of hepatotoxicity, can increase HR, and BP, glaucoma
what controlled schedule is phentermine/topiramte ER (Qsymia)
C-IV
MOA of Orlistat (Rx = Xenical, OTC = Alli)
Lipase inhibitor, decrease absorption of dietary fats by ~30%
Examples GLP1-RAs used for weight loss
Liraglutide (Saxenda) SC daily
Semaglutide (Wegovy) SC weekly
Note: Liraglutide (Victoza) and semaglutide (Ozempic and Rybelsus) are for diabetes
Warnings with GLP1 RAs used for weight loss
pancreatitis, hypoglycemia
Others: acute gallbladder disease, gastroparesis (slows gastric emptying)
Contraindications with GLP1RAs used for weight loss
Saxenda: pregnancy
Personal or family hx of MTC or MEN2
Contraindications of orlistat (Xenical (Rx), Alli (OTC))
Pregnancy
Others: chronic malabsorption syndrome, cholestasis
Orlistat (Xenical (Rx), Alli (OTC)) must be used with ____
low fat diet plan
Side effects of orlistat (Xenical (Rx), Alli (OTC))
GI (flatus with discharge, fatty stool, fecal urgency)
When taking orlistat (Xenical (Rx), Alli (OTC), take multivitamin containing _______ at bedtime or separated by ≥ ____hrs
Vitamin A, D, E, K and beta carotene
Examples of appetite suppressants used in weight loss
Phentermine (Adipex-P, Lomaira)
Diethylpropion
Phendimetrazine
Benzphetamine
MOA of appetite suppressants used in weight loss (phentermine, diethylpropion, phendimetrazine, benzphetamine)
Sympathomimetics (stimulants), release NE stimulants satiety center which decreases appetite
Contraindications of appetite suppressants used in weight loss
CV disease (e.g. uncontrolled HTN, arrhythmias, HF, CAD), hyperthyroidism, glaucoma, pregnancy, hx of drug abuse, MAOi within past 14 days, breastfeeding
Side effects of appetite suppressants used in weight loss (phentermine, diethylpropion, phendimetrazine, benzphetamine)
Tachycardia, agitation, increase BP
Others: insomnia, dizzines, tremor, psychosis
Appetite suppressants used in weight loss (phentermine, diethylpropion, phendimetrazine, benzphetamine) are used short-term, up to _____, to “jump-start” a diet
12 weeks
Guidelines recommend weight loss or bariatric surgery for pts with BMI ≥___ or BMI ≥ ___ with an obestiy-related condition
BMI ≥ 40
BMI ≥ 35 with obesity-related condition
Concern with calcium and bariatric surgery
Calcium mostly absorbed in duodenum, which may be bypassed
Calcium citrate supplementation is preferred as it has non-acid-dependent absorption
In pts that has bariatric surgery, what type of calcium formulation is preferred?
Calcium citrate supplementation is preferred as it has non-acid-dependent absorption
Common nutrient deficiencies with bariatric surgery
Calcium (absorbed in duodenum, may be bypassed)
Vit B12 and iron deficiency (may lead to anemia and require supp)
Fat soluble vitamins Vit A, D, E, K (d/t fat malabsorption, may require life-long supp)
Note: iron and calcium supps should be taken 2 hrs prior or 4 hrs after antacids
Medications may require dose reduction and may need to be crushed and put in liquid or used in transdermal form for up to ____ post bariatric surgery.
2 months post-surgery
Rapid weight loss can cause gallstones. ____ can be used to dissolve gallstones and may be needed (unless gallbladder was removed)
Ursodiol (Actigall, Urso 250, Urso Forte)