Chapter 28: Drugs For Obesity

Question 1

28.1 A 45-year-old female presents seeking treatment for
weight loss. She has tried several fad diets in the past
with very little success. She exercises twice weekly at
the gym for 30 minutes and tries to watch what she eats.
Her BMI is 31 and she has diabetes and uncontrolled
hypertension. Which of the following medications would
be most appropriate to treat her obesity?
A. Phentermine.
B. Phentermine/topiramate.
C. Orlistat.
D. Diethylpropion.

Answer 1

Correct answer = C. Orlistat is the only medication of those
listed that does not increase heart rate and blood pressure.
Since this patient’s blood pressure is currently uncontrolled,
choosing a drug that does not affect blood pressure would
be best at this time.

Question 2

28.2 Which of the following drugs requires patients to take a
multivitamin while on the medication?
A. Phentermine.
B. Phentermine/topiramate.
C. Orlistat.
D. Diethylpropion.
E. Lorcaserin.

Answer 2

Correct answer = C. Orlistat interferes with the absorption of
fat-soluble vitamins and β-carotene. It is important that indi-
viduals take the multivitamin 2 hours before or after admin-
istration of the orlistat.

Question 3

28.3 A 38-year-old obese male with depression is considering
a weight loss medication following several failed
attempts with diet and exercise. Which of the following
medications should be avoided in this individual?
A. Phentermine.
B. Phentermine/topiramate.
C. Orlistat.
D. Diethylpropion.
E. Lorcaserin.

Answer 3

Correct answer = E. Lorcaserin may cause suicidal ideation
and would not be advisable for an individual with depression.
Also, he is likely on a medication that may increase sero-
tonin levels. The addition of lorcaserin, a serotonin recep-
tor agonist, could lead to serotonin syndrome. Therefore,
avoidance of the combination is advisable.

Question 4

28.4 A 27-year-old recently married female is asking about
treatment options for her obesity. She recently stopped
taking her birth control medications, as she felt these
were contributing to her weight gain. Which of the
following medications should be avoided in this patient?
A. Phentermine.
B. Phentermine/topiramate.
C. Orlistat.
D. Diethylpropion.
E. Lorcaserin

Answer 4

Correct answer = B. The topiramate component of this med-
ication is contraindicated in pregnancy. Since this patient
stopped her birth control, she is at risk of becoming preg-
nant and her fetus is at risk of developing birth defects if she
is taking this medication.

Question 5

28.5 A fellow health care provider is concerned about
prescribing orlistat to his adolescent patients. He
understands that it is approved for adolescents aged
12 years and older and, therefore, prescribes this
medication more often than any other for adolescent
obesity. Unfortunately, many of his adolescent patients
are stopping the medication during the first month of
treatment. Which of the following side effects is the
most likely reason these adolescents are stopping the
drug?
A. Tachycardia.
B. Valvulopathy.
C. Suicidal ideation.
D. Drowsiness.
E. Flatulence.

Answer 5

Correct answer = E. Flatulence is a very common side effect
with orlistat, along with several other GI disturbances. For
adolescents, these side effects may be embarrassing and
difficult to manage. It is important to counsel patients about
these gastrointestinal side effects with orlistat and recom-
mend a low-fat diet as well as cholestyramine to counteract
the effects should they become bothersome. The other side
effects listed have been seen with other obesity medica-
tions, but not with orlistat.