57. Weight Loss Flashcards by Brynn Gilbert

BMI for Overweight

25-29.9

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BMI for obese

BMI ≥30

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A person who is overweight is higher risk for ___

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

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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)

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OTC supplements used for weight loss

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

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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)

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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

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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

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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)

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Concern with Rx weight loss drugs and pregnancy

Avoid all weight loss drugs

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Concern with Rx weight loss drugs and HTN

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

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Concern with Rx weight loss drugs and depression

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

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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)

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Concern with Rx weight loss drugs and opioid use

Avoid Contrave - blocks opioid receptors (contains naltrexone)

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Contraindications with phentermine/topiramate ER (Qsymia)

Pregnancy, glaucoma, hyperthyroidism, MAOi within past 14 days

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

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

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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)&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

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)