Block 2: Obesity Medication Flashcards
Describe the assessment of obesity?
What are the metabolic complications of obesity?
- Prediabetes
- T2DM
- MS
- NAFLD/NASH
Obesity prevention is based on ___?
Staging and complication to determine weight loss and clinical goals
How do you stage weight loss?
What does primary diagnosis and prevention look like?
What does secondary diagnosis and prevention look like?
What does secondary diagnosis and prevention look like? *Slide 12-14
When should you initiate weight loss medication?
Phentermine?
Brand, MOA, Dosing, Indication ADR, CI, BBW
Adipex-P
MOA: Sympathomimetic amine anorectic similar to amphetamine; stimulations CNS, and elevates BP
Dosing: 14 day washout perioid post MAOI (antidepressant) therapy
* Only for short term use
Indications: Short-term adjunct to diet and exercise in patients
CI: CVD, MAOI, Hyperthyroidism, glaucoma, pregnant, lactation
ADRs: Dry mouth, restlessness, insomnia, tachycardia, HTN
BBW:
1. TX duration ≤12 weeks
2. Coadministration with other weight loss drugs is not recommended
3. Causes HTN
Orlistat
Brand, MOA, Dosing, Indications, CI, ADR, BBW
Alli-OTC, Xenical-Rx
MOA: : synthetic derivative of lipstatin, a reversible gastrointestinal lipase inhibitor -> bonds covalently -> unavailable to hydrolyze dietary triglycerides into absorbable fatty acids and monoglycerides
Dosing: 120 mg TID with each main meal containing fat, taken during or up to 1 hour after eating
* Taken with daily vitamins ADEK, and beta-carotene 2 hr defore or after Orlistat
Indication: Preferred for CVD Weight loss and weight maintenance in conjunction with a reduced calorie diet
* BMI >30 kg/m^2
* BMI≥27 kg/m^2 with≥1 weight-related comorbidity
CI: Pregnancy, Chronic malabsoprtion syndrome, cholestasis
ADR: Oily spotting, flatus with discharge, fecal urgency and incontinence
BBW: Multivitamin supplement containign fat-soluble vitamine recommend for nutrition
Phentermine/Topiramate ER
Brand, MOA, Dosing, CI, ADR, BBW
Qysmia (Sch IV)
MOA:
* Phentermine: sympathomimetic amine -> increase hypothalamic catecholamine release -> reduced appetite and decreased food consumption
* Topiramate ER: gabanergic, voltage-gated ion channel modulator, AMPA-kainite glutamate receptor inhibitor, and carbonic anhydrase inhibitor -> reduced appetite and enhanced satiety
Indications: Preffered in patients with depression on SSRI or SNRI
Dosing: Take in AM to avoid insomnia
CI: Pregnancy, glaucoma, hyperthyroidism, MOAIs, HD, Uncontrolled HTH
ADR: Dry mouth, tingling (paresthesia), constipation, insomnia, kidney stones
BBW: fetal tox, tachycardia, psychiatric disorders, Acute myopia and glaucoma
Naltrexone/Bupropion SR
Brand, MOA, Dosing, CI, ADR, BBW
Contrave
MOA:
* Naltrexone: opioid receptor antagonist
* Bupropion: aminoketone antidepressant
Dosing:
* 14 day washout between MAOI
* 7-10 day washout between opiod use
CI: Uncontrolled HTN, Seizures, anorexia, D/C alcohol, benzodiazepines, barbiturates, or antiepileptic drugs, chronic opioid use, use of other bupropion products or MAOIs, pregnancy
ADR: N/V/C/D
BBW: Suicidal thoughts, seizure, angle closure glaucoma
Avoid use in patients taking opioids since naltrexone will antagonize opioid
Liraglutide
Brand, MOA, CI, ADR, BBW
Saxenda
Daily SQ injection increasing to weekly increments
MOA: GLP-1 receptor agonist -> increases insulin release in the presence of elevated glucose, decrease glucagon secretion, and delaying gastric emptying, regulates appetite, and caloric intake
CI: Personal or family h/o MTC or MEN 2, Pregnancy
ADR: N/V/D/C, dyspepsia, abdominal pain
BBW: Pancreatitis risk increases with elevated TG, alcohol abuse, or gallstones
Semaglutide
Brand, MOA, CI, ADR
Wegovy
MOA: GLP-1 receptor agonist: SQ once weekly
CI: Personal or family h/o MTC or MENs, Pregnancy
ADR: N/V/D/C, dyspepsia, abdominal pain
BBW: Pancreatitis risk increases with elevated TG, alcohol abuse, or gallstones
Tirepatide
Brand, MOA, ADR, CI
Mounjaro (Off-label)
MOA: Glucose-dependent insulinotropic polypeptide (GIP)/GLP-1
ADR: N/V/D, constipation, dyspepsia, abdominal pain
CI: T1DM, thyroid carcinoma, MEN2
Setmelanotide
Brand, MOA, Indication
Imcivree
MOA: Melanocortin4 receptor agonist
Indication: genetic defiency
When should you DC Naltrexone ER/bupropion ER and lorcaserin?
Patient has not lost at least 5% of BLBW at 12 weeks
When should you DC Phentermine/topiramate ER?
Patient patient has not lost at least 3% of baseline body weight at 12 weeks
Max dose (15 mg/92 mg): if they havent lost 5% at 12 additional weeks -> DC
When should you DC liraglutide?
Patient has not lost at least 4% of baseline body weight at 16 weeks
When should semaglutides be DCd?
Least 5% of baseline body weight loss has not been achieved within 3 month
How do you monitor obesity medications?
- Monthly for the first 3 months, every 3 months in all patients prescribed
- Monitor weight, BMI, waist, BP, HR
- Screen for comorbidities annually with BMI >30kg/m^2
Preferred Obesity TX of patient factors?
Uncontrolled HTN, Depression, Opioid use, Alcohol use, Preg/Lac, Old
How does obesity med effect PK?
- Vd
- GFR
