Ch 78: Weight Loss

Question 1

overwt BMI

Answer 1

25-30

Question 2

obese BMI

Answer 2

> 30

Question 3

wt loss meds indicated for

Answer 3

BMI >30 or BMI >27 with wt related condition (HLD/HTN/DM). not if small amt of wt to lose. in addition to dietary plan and inc phsycial activity via FDA + ACE/AACE.

Question 4

OTC supplements

Answer 4

commonly contain stimulants like bitter orange +/- caffeine. ineffective and potentially harmful, espec for patients with CVD

Question 5

indications for med DC

Answer 5

if they do not produce at least 5% wt loss at 12 wks

Question 6

Qsymia - generic, schedule, ADRs, contraindications

Answer 6

phentermine/topiramate ER. CIV. REMS, teratogenic. ADRs: anxiety, depression, suicidal thoughts, tachycardia. Contraindications: MAOI use <14 d, hyperthyroid, preg. taper d/t topiramate seizure risk. avoid in uncontrolled HTN.

Question 7

Contrave - generic, BBW, contraindications, warnings,

Answer 7

naltrexone/bupropion. do not take with high fat meal. BBW: not approved for psych disorders or peds. Contraindications: chronic opioid use, uncontrolled HTN d/t phentermine, seizure disorder, other bupropion products, bulimia/anorexia, preg, MAOIs <14 d. Warnings: caution in psych disorder, seizure risk, DC if hep tox, inc HR/BP. DC opioids and buprenorphine 7-10 d before use.

Question 8

Belviq - generic, contraindications, warnings, schedule, MOA

Answer 8

Lorcaserin. Contraindications: preg. warnings: 5HT syndrome, NMS with other 5HT agents. CIV. MOA: 5HT2 agonist, inc satiety.

Question 9

Saxenda - generic, BBW, warnings, ADRs

Answer 9

liraglutide (Victoza for DM). BBW: thyroid C-cell tumors in animals. Warnings: hypoglycemia, inc HR. ADRs: nausea. REMS.

Question 10

Short Term appetite suppressants - MOA, examples

Answer 10

stimulants –> inc NE like amphetamines. phentermine (adipex-P) CIV, diethylpropion 9Tenuate) CIV, phendimetrazine CIII, benzphetamine (Regimex) CIII

Question 11

Short Term appetite suppressants - ADRs, contraindications

Answer 11

Contraindications: MAOIs <14 d, avoid use with HTN/PAH/hyperthyroid/glaucoma/abuse potential. ADRs: tachycardia, agitation, inc BP (monitor BP/HR)

Question 12

Orlistat - brands, ADRs, MOA

Answer 12

Rx - Xenical. OTC - Alli. ADRs: GI (flatus with discharge, fecal urgency, fatty stool). MOA: dec absorption of diet fat ~30%. use with low-fat diet plan. take with MV ADEK + beta carotene QHS or separated by 2+ h. do not use with cyclosporine or separate by >3 h. separate levothyroxine by 4+ h.

Question 13

Bariatric surgery

Answer 13

wt loss or bariatric surgery for adults BMI >40 or with BMI >35 with obesity related condition.

Question 14

nutrient deficiencies in bariatric surgery

Answer 14

Ca - use ca citrate to supplement d/t acid-independent absorption. b12 and fe - supplement or might lead to anemia. ADEK d/t fat malabsorption

Question 15

bariatric surgery med concerns

Answer 15

avoid GI irritants (NSAIDs, bisphosphonates). meds may need dose reduction + crush or liquid or transdermal form for up to 2 mo post-surgery. may need ursodiol (Actigall, urso 250) to dissolve gallstones (risk with rapid wt loss) unless gallbladder is removed.