Chapter 57: Weight Loss

Question 1

Overweight is what BMI?

Answer 1

25-29

Question 2

Obese is what BMI?

Answer 2

> 30

Question 3

Drugs/Conditions that can cause weight gain

Answer 3

• Antipsychotics (clozapine, olanzapine, risperidone, quetiapine)
• Diabetes drugs (insulin, meglitinides, sulfonylureas, TZDs)
• Divalproex/valproic acid
• Gabapentin/pregabalin
• Lithium
• Mirtazapine
• Steroids
• TCAs
• Hypothyroidism

Question 4

Drugs/Conditions that can cause weight loss

Answer 4

• ADHD drugs
• Bupropion
• GLP-1 agonists
• Pramlintide
• Roflumilast
• SGLT2 inhibitors
• Topiramate
• Hyperthyroidism
• Celiac disease
• IBS

Question 5

Weight loss drugs in pregnancy?

Answer 5

Avoid all

Question 6

Weight loss drugs with hypertension?

Answer 6

Avoid Contrave (CI with uncontrolled BP)
Caution with Qsymia (monitor HR)

Question 7

Weight loss drugs with depression?

Answer 7

Caution in young adults and adolescents

Contrave- suicide risk (bupropion)

Question 8

Weight loss drugs with seizures?

Answer 8

Avoid Contrave (lowers seizure threshold)
Caution Qsymia (must taper off slowly [topiramate])

Question 9

Weight loss drugs and taking opioids?

Answer 9

Avoid Contrave (blocks opioid receptors, contain naltrexone)

Question 10

Phentermine MOA

Answer 10

Sympathomimetic (stimulant); release of NE stimulates the satiety center which decreases appetite

Question 11

Topiramate MOA

Answer 11

Increases satiety and decreases appetite, possible by increasing GABA, blocking glutamate receptors and/or inhibition or carbonic anhydrase

Question 12

Qsymia

Answer 12

phentermine and topiramate
REMs due to teratogenicity (-pregnancy test required)
CIs: pregnancy, glaucoma, hyperthyroidism, MAOi w/i 14 days

Question 13

Naltrexone MOA

Answer 13

Decreases food cravings

Question 14

Bupropion MOA

Answer 14

Decreases appetite

Question 15

Contrave

Answer 15

Naltrexone/Bupropion
BOXED WARNING: not approved for treatment of MDD or psychiatric disorders; can increase risk of suicidal thinking/behavior in children, adolescents, and young adults; not approved in pediatric patients

Question 16

Contrave CIs

Answer 16

• Pregnancy
• Opioid use or acute opioid withdrawal
• Uncontrolled HTN
• Seizure disorder
• Use of other bupropion containing products
• Bulemia/anorexia
• Abrupt d/c of alcohol, benzos, barbiturates, antiepileptics
• Use of MAOi in 14 days

Question 17

GLP-1 receptor agonist MOA

Answer 17

Increases satiety

Question 18

saxenda (liraglutide) CIs

Answer 18

Victoza-diabetes

• Pregnancy
• Personal or family history of medullary thyroid carcinomas, or patients with multiple endocrine, neoplasia syndrome type 2

Question 19

Saxenda warnings

Answer 19

• pancreatitis
• hypoglycemia
• acute gallbladder disease
• gastroparesis

Question 20

Lipase inhibitor MOA

Answer 20

Decreases absorption of dietary fats by about 30%

Question 21

Orlistat CIs

xenical-rx, alli- otc

Answer 21

• Pregnancy
• Chronic malabsorption syndrome
• cholestasis
• not CI but must be used with a low fat diet*

Question 22

Appetite suppressants and MOA

Answer 22

MOA: sympathomimetics (stimulants); release of NE stimulates the satiety center with decreases appetit

• phentermine (C-IV)
• Diethylpropion (C-IV)
• Phendimetrazine (C-III)
• Benzphetamine (C-III)

Question 23

Stimulant CIs

Answer 23

• Cardiovascular disease (uncontrolled htn, arrhythmias, hf, cad)
• hyperthyroidism
• glaucoma
• pregnancy
• breast feeding
• hx of drug abuse
• MAOi’s w/in 14 days

Question 24

When is bariatric surgery recommened?

Answer 24

When BMI >=40 or when BMI >=35 and obesity related condition

Question 25

Common nutrient deficiencies with bariatric surgery

Answer 25

• Calcium (absorbed in duodenum) citrate is preferred
• Anemia from B-12 and iron deficiency
• ADEK (fat-soluble vitamins)