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NAPLEX 2024 > 57. Weight Loss > Flashcards

57. Weight Loss Flashcards

1
Q

BMI for Overweight

A

25-29.9

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2
Q

BMI for obese

A

BMI ≥30

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3
Q

A person who is overweight is higher risk for ___

A

coronary heart disease, HTN, stroke, T2DM, certain types of cancer and premature death

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4
Q

Drugs/conditions that can cause weight gain

A

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)

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5
Q

OTC supplements used for weight loss

A

Bitter orange
Caffeine (e.g. yerba mate, guarana, concentrated green tea powder)

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6
Q

T/F: Rx weight loss meds can be used in any pt who desires weight loss despite lifestyle changes

A

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)

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7
Q

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

A

Qsymia, Contrave, Saxenda, Wegovy, and orlistat formulations

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8
Q

Weight loss drugs should be d/c if they do not produce at least ___% weight loss at __weeks

A

at least 5% weight loss at 2 weeks

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9
Q

Drugs that can cause weight loss

A

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)

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10
Q

Concern with Rx weight loss drugs and pregnancy

A

Avoid all weight loss drugs

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11
Q

Concern with Rx weight loss drugs and HTN

A

Avoid Contrave - contraindicated with uncontrolled BP (contains bupropion)
Caution with Qsymia - monitor HR (contains phentermine)

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12
Q

Concern with Rx weight loss drugs and depression

A

Caution in young adults and adolescents Contrave - suicide risk (contains burpropion)

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13
Q

Concern with Rx weight loss drugs and seizures

A

Avoid Contrave - lowers seizure threshold (contains bupropion)
Caution with Qsymia - must taper off slowly if used (contains topiramate)

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14
Q

Concern with Rx weight loss drugs and opioid use

A

Avoid Contrave - blocks opioid receptors (contains naltrexone)

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15
Q

Contraindications with phentermine/topiramate ER (Qsymia)

A

Pregnancy, glaucoma, hyperthyroidism, MAOi within past 14 days

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16
Q

phentermine/topiramtae ER (Qsymia) requires REMS d/t ____ risk

A

teratogenic risk
Pregnancy test needed before treatment and monthly thereafter, use contraception during treatment

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17
Q

Side effects of phentermine/topiramate ER (Qsymia)

A

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

18
Q

MOA phentermine/topiramate ER (Qsymia)

A

Phentermine - sympathomimetic(stimulant)&raquo_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

19
Q

Pt was on phentermine/topiramte ER (Qsymia) and prescriber will like to d/c med. What do you recommend?

A

Taper off d/t seizure risk

20
Q

MOA naltrexone/bupropion (Contrave)

A

Naltrexone - decreased food cravings
Bupropion - decreased appetite

21
Q

Contraindications for naltrexone/bupropion (Contrave)

A

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

22
Q

Warnings with naltrexone/bupropion (Contrave)

A

Use caution with psychiatric disorders, d/c with s/sx of hepatotoxicity, can increase HR, and BP, glaucoma

23
Q

what controlled schedule is phentermine/topiramte ER (Qsymia)

A

C-IV

24
Q

MOA of Orlistat (Rx = Xenical, OTC = Alli)

A

Lipase inhibitor, decrease absorption of dietary fats by ~30%

25
Q

Examples GLP1-RAs used for weight loss

A

Liraglutide (Saxenda) SC daily
Semaglutide (Wegovy) SC weekly

Note: Liraglutide (Victoza) and semaglutide (Ozempic and Rybelsus) are for diabetes

26
Q

Warnings with GLP1 RAs used for weight loss

A

pancreatitis, hypoglycemia

Others: acute gallbladder disease, gastroparesis (slows gastric emptying)

27
Q

Contraindications with GLP1RAs used for weight loss

A

Saxenda: pregnancy
Personal or family hx of MTC or MEN2

28
Q

Contraindications of orlistat (Xenical (Rx), Alli (OTC))

A

Pregnancy

Others: chronic malabsorption syndrome, cholestasis

29
Q

Orlistat (Xenical (Rx), Alli (OTC)) must be used with ____

A

low fat diet plan

30
Q

Side effects of orlistat (Xenical (Rx), Alli (OTC))

A

GI (flatus with discharge, fatty stool, fecal urgency)

31
Q

When taking orlistat (Xenical (Rx), Alli (OTC), take multivitamin containing _______ at bedtime or separated by ≥ ____hrs

A

Vitamin A, D, E, K and beta carotene

32
Q

Examples of appetite suppressants used in weight loss

A

Phentermine (Adipex-P, Lomaira)
Diethylpropion
Phendimetrazine
Benzphetamine

33
Q

MOA of appetite suppressants used in weight loss (phentermine, diethylpropion, phendimetrazine, benzphetamine)

A

Sympathomimetics (stimulants), release NE stimulants satiety center which decreases appetite

34
Q

Contraindications of appetite suppressants used in weight loss

A

CV disease (e.g. uncontrolled HTN, arrhythmias, HF, CAD), hyperthyroidism, glaucoma, pregnancy, hx of drug abuse, MAOi within past 14 days, breastfeeding

35
Q

Side effects of appetite suppressants used in weight loss (phentermine, diethylpropion, phendimetrazine, benzphetamine)

A

Tachycardia, agitation, increase BP
Others: insomnia, dizzines, tremor, psychosis

36
Q

Appetite suppressants used in weight loss (phentermine, diethylpropion, phendimetrazine, benzphetamine) are used short-term, up to _____, to “jump-start” a diet

A

12 weeks

37
Q

Guidelines recommend weight loss or bariatric surgery for pts with BMI ≥___ or BMI ≥ ___ with an obestiy-related condition

A

BMI ≥ 40
BMI ≥ 35 with obesity-related condition

38
Q

Concern with calcium and bariatric surgery

A

Calcium mostly absorbed in duodenum, which may be bypassed
Calcium citrate supplementation is preferred as it has non-acid-dependent absorption

39
Q

In pts that has bariatric surgery, what type of calcium formulation is preferred?

A

Calcium citrate supplementation is preferred as it has non-acid-dependent absorption

40
Q

Common nutrient deficiencies with bariatric surgery

A

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

41
Q

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.

A

2 months post-surgery

42
Q

Rapid weight loss can cause gallstones. ____ can be used to dissolve gallstones and may be needed (unless gallbladder was removed)

A

Ursodiol (Actigall, Urso 250, Urso Forte)

NAPLEX 2024 (74 decks)

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