Chapter 57: Weight loss

Question 1

BMI for an overweight person

Answer 1

25-29.9 kg/m2

Question 2

BMI for an obese person

Answer 2

> / = 30 kg/m2

Question 3

Key drugs/conditions that can cause weight gain

Answer 3

• Antipsychotics (e.g., clozapine, olanzapine, risperidone, quetiapine)
• Diabetes drugs (insulin, meglitinides, SU, TZDs)
• Divalproex/valproic acid
• Gabapentin, pregabalin
• Lithium
• Mirtazapine
• Steroids
• TCAs (e.g., amitriptyline, nortriptyline)
• Conditions: hypothyroidism

Question 4

Physical activity should increase to > / = ___ minutes per week, performed on __-__ separate days

Answer 4

150 minutes

3-5 days

Question 5

OTC weight loss supplements commonly contain stimulants, such as

Answer 5

bitter orange and/or excessive amounts of caffeine

Question 6

What other names can caffeine be packaged under

Answer 6

Guarana and concentrated green tea powder

Question 7

When are prescription weight loss meds indicated

Answer 7

BMI > / = 30 kg/m2 or a BMI > / = 27 kg/m2 with at least one weight-related condition (such as dyslipidemia, HTN or diabetes)

Question 8

Weight loss meds are only used in addition to

Answer 8

a dietary plan and increased physical activity

Question 9

Which newer agents for weight loss can be continued long-term for weight maintenance

Answer 9

Qsymia, Contrave, Saxenda and the orlistat formulations

Question 10

Which 5-HT2C receptor agonist has been withdrawn from the US market due to an increased risk of cancer

Answer 10

Lorcacerin (Belviq, Belviq XR)

Question 11

When should weightloss drugs be d/c

Answer 11

if they do not produce at least a 5% weight loss at 12 weeks

Question 12

Key drugs/conditions that can cause weight loss

Answer 12

• ADHD drugs (e.g., amphetamine, methylphenidate)
• Bupropion
• GLP-1 agonists (e.g., exenatide, liraglutide)
• Pramlintide
• Roflumilast
• SGLT2 inhibitors (e.g., canagliflozin, empagliflozin)
• Topiramate
• Conditions: hyperthyroidism, celiac disease, inflammatory bowel disease

Question 13

Which weight loss drugs can be used in pregnancy

Answer 13

NONE - AVOID

Question 14

Which weight loss drugs should be avoided in HTN

Answer 14

Contrave - CI with uncontrolled BP (contains bupropion)

Question 15

Which weight loss drugs should be used with caution in HTN

Answer 15

Qsymia - monitor HR (contains phentermine)

Question 16

Which weight loss drugs should be used with caution in young adults and adolescents with depression

Answer 16

Contrave - suicide risk (contains bupropion)

Question 17

Which weight loss drugs should be avoided in seizures

Answer 17

Contrave - lowers seizure threshold (contains bupropion)

Question 18

Which weight loss drugs should be used with caution in seizures

Answer 18

Qsymia - must taper off slowly if used (contains topiramate)

Question 19

Which weight loss drugs should be avoided if taking opioids

Answer 19

Contrave - blocks opioid receptor (contains naltrexone)

Question 20

Phentermine drug class

Answer 20

Sympathomimetic (stimulant)

Question 21

Which medications are found in Qsymia

Answer 21

Phentermine and topiramate ER

Question 22

Which medications are found in Contrave

Answer 22

Naltrexone and bupropion

Question 23

What does naltrexone do for weight loss

Answer 23

decreases food cravings

Question 24

What does bupropion do for weight loss

Answer 24

decreases appetite

Question 25

Which weight loss drug has a REMS progrm

Answer 25

Qsymia

Question 26

Qsymia SE

Answer 26

Tachycardia, CNS effects (i.e, insomnia)

Question 27

GLP-1 receptor agonist mechanism for weight loss

Answer 27

increases satiety

Question 28

Liraglutide brand name for weight loss

Answer 28

Saxenda

Question 29

Saxenda warnings

Answer 29

pancreatitis, hypoglycemia

Question 30

Saxenda SE

Answer 30

nausea

Question 31

Which weight loss drug is a lipase inhibitor

Answer 31

Orlistat

Question 32

Orlistat rx name

Answer 32

Xenical

Question 33

Orlistat OTC name

Answer 33

Alli

Question 34

Orlistat MOA

Answer 34

decreases absorption of dietary fats by ~30%

Question 35

Orlistat must be used with

Answer 35

a low-fat diet plan

Question 36

Orlistat SE

Answer 36

GI (flatus with discharge, fatty stool)

Question 37

What must be taken with Orlistat

Answer 37

Multivitamin A, D, E & K and beta carotene at bedtime or separated by > / = 2 hrs

Question 38

What is the max % of kcals from fat that can be taken with Orlistat

Answer 38

30%

Question 39

Phentermine brand name

Answer 39

Adipex-P

Question 40

Phentermine CI

Answer 40

CV disease (e.g., uncontrolled HTN), hyperthyroidism, glaucoma, pregnancy, hx of drug abuse

Question 41

Phentermine SE

Answer 41

Tachycardia, agitation, increased BP

Question 42

Phentermine monitoring

Answer 42

HR, BP

Question 43

How long can phentermine be used for

Answer 43

short-term up to 12 weeks to "jump-start" a diet

Question 44

Guidelines recommend weight loss or bariatric surgery for adults when BMI > / = ___ kg/m2 or when BMI > / = __ kg/m2 with an obesity-related condition

Answer 44

40 | 35

Question 45

Which calcium supplement is preferred for bariatric surgery and why

Answer 45

calcium citrate since it has non-acid dependent absorption

Question 46

Anemia can present from which vitamin deficiencies

Answer 46

B12 and iron

Question 47

Iron & Ca supplements should be taken how many hrs prior or how many hours after antacids

Answer 47

2 hrs prior and 4 hrs after

Question 48

Medications may require dose reduction, and may need to be crushed and put in liquid or used in transdermal form for up to ____ months post-surgery

Answer 48

2

Question 49

Which medication can be used to dissolve gallstones after rapid weight loss

Answer 49

Ursodiol