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Pamela - Naplex 2023 > Chapter 57 - Weight Loss > Flashcards

Chapter 57 - Weight Loss Flashcards

1
Q

Overweight BMI

A

25 - 29.9 kg/m2

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2
Q

Obese BMI

A

> = 30 Kg/ m2

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3
Q

BMI formula

A

Weight (KG) / Height 2 (m2)

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4
Q
A
  • Anti psychotics (clozapine, olanzapine, risperidone, quetiapine)
  • Diabetes drugs (insulin, meglitinides, sulfonylureas, thiazolidinediones)
  • Divalproex/valproic acid
  • Gabapentin, pregabalin Lithium
  • Mirtazapine
  • Steroids
  • TCAs (amitriptyline, nortriptyline)
  • Conditions: Hypothyroidism

Others:
- Beta-blockers Dronabinol
- Hormones (e.g., estrogen, megestrol)
- MAO inhibitors
- SSRls (paroxetine, others may be weight neutral)
- Vasodilators (e.g., minoxidil)

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5
Q

Treatment principles - Lifestyle modifications

A
  • Reduced calorie (daily deficit ~500 - 750 kcal)
  • Mediterranean, DASH, low-carb, low-fat, volumetric, high protein and vegetarian diets.
  • Physical activity should increase to >= 150 minutes per week, performed on three to five separate days
  • Behavioral Interventions
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6
Q

OTC SUPPLEMENTS

A
  • Stimulants: bitter orange
  • Excessive amounts of caffeine
    – yerba mate
    – guarana
    – concentrated green tea powder
  • Generally ineffective and are not recommended, as they can be harmful, especially in patients with cardiovascular disease
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7
Q

PRESCRIPTION WEIGHT LOSS MEDICATIONS:
- Indication

  • What drugs are used short term and for long term (maintenance)
  • What drugs are removed from the US market and why?
  • When should weight loss drugs be discontinued?
A
  • They are indicated with a BMI >= 30 kg/m2, or BMI >= 27kg/m2 + at least one weight- related condition, such as dyslipidemia, hypertension or diabetes
  • Older stimulant drugs (phentermine, diethylpropion) are only used short-term to “jump-start” a diet.
  • The newer drugs Qsymia, Contrave, Saxenda and the orlistat formulations can be continued long-term for weight maintenance.
  • Lorcaserin (Belviq,BelviqXR), a serotonin 5-HT2C receptor agonist, has been withdrawn from the U.S. market due to an increased risk of cancer.
  • Weight loss drugs should be discontinued if they do not produce at least a 5% weight loss at 12weeks_
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8
Q

SELECT DRUGS/CONDITIONS THAT CAN CAUSE WEIGHT LOSS

A
  • ADHD drugs (amphetamine, methylphenidate)
  • Bupropion
  • GLP-1 agonists (exenatide, liraglutide(Victoza))
  • Pramlintide
  • Roflumilast
  • SGLT2 inhibitors (canagliflozin, empagliflozin)
  • Topiramate

Conditions:
- Hyperthyroidism
- Celiac disease
- Inflammatory bowel disease

Others:
- Acetylcholinesterase inhibitors (e.g.,donepezil, rivastigmine, galantamine)
- Antiepileptic ethosuximide)
- Interferons
- Thyroid drugs (e.g., levothyroxine)

Conditions:
- Cystic fibrosis
- GERD or peptic ulcer disease
- Lupus
- Tuberculosis (active disease)

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9
Q

Rx drugs and Pregnancy:

A

Avoid all weight loss drugs

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10
Q

Rx drugs and HTN:

A

Avoid:
- Contrave (Naltrexone/ Bupropion): contraindicated with uncontrolled BP (contains bupropion)

Caution
- Qsymia (Phentermine/ Topiramate): monitor HR (contains phentermine)

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11
Q

Rx Drugs and Depression

A

Caution in young adults and adolescents
- Contrave - suicide risk
(contains bupropion)

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12
Q

Rx drugs and SEIZURES

A

Avoid
Contrave- lowers seizure threshold (contains bupropion)

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

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13
Q

Rx drugs and taking opioids

A

Avoid
Contrave- blocks opioid receptors (contains naltrexone)

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14
Q

Phentermine and Topiramate MOA

A
  • Phentermine: sympathomimetic (stimulant); release of norepinephrine stimulates the satiety center which dec appetite
  • Topiramate: inc satiety and dec appetite, possibly by inc GABA, blocking glutamate receptors and/or inhibition of carbonic anhydrase
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15
Q

Phentermine/Topiramate ER:
- Brand?
- Control?
- REMS Why?

A

(Qsymia)
C-IV
REMS drug due to teratogenic risk; pregnancy test needed before treatment and monthly thereafter; use effective contraception during treatment

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16
Q

CI Phentermine/Topiramate ER:

A

Pregnancy, glaucoma, hyperthyroidism, MAO inhibitor use within past 14 days

17
Q

SE of Phentermine/Topiramate ER:

A
  • Tachycardia
  • Insomnia (take in the morning)
  • Vision Problems
  • Taper off due to seizure risk
18
Q

Naltrexone/Bupropion
- Brand
- How does each work

A

(Contrave)

  • Naltrexone: Dec food cravings
  • Bupropion: Dec appetite
19
Q

CI of Naltrexone/Bupropion

A
  • Pregnancy
  • Chronic opioid use or acute opiate withdrawal
  • Uncontrolled hypertension
  • Seizure disorder
  • Use of other bupropion-containing products
  • Bulimia/anorexia
  • Abrupt discontinuation of alcohol
  • Benzodiazepines
  • Barbiturates
  • Antiepileptic drugs
  • Use of MAO inhibitors within 14 days
20
Q

Warning of Naltrexone/Bupropion

A

Use caution with psychiatric disorders, discontinue with s/sx of hepatotoxicity, can inc HR and BP, glaucoma

21
Q

Naltrexone and opioids
Can you give them together?

A
  • Naltrexone blocks opioids and buprenorphine, which blocks analgesia and can induce withdrawal;
  • Discontinue opioids or buprenorphine 7-14 days prior to use of Contrave
22
Q

GLP-1 receptor agonist:
- How does it work
- Brand names
- For what is it approved?
- Administration?

A
  • Inc satiety
  • Liraglutide (Saxenda)
  • Victoza- for diabetes
  • Approved for use in children age >= 12 years with weight > 60 kg and BMI corresponding to >= 30 kg/m 2 for adults
  • SC daily
23
Q

Liraglutide
- CI
- Warnings

A
  • CI: pregnancy
  • Warning: Pancreatitis, hypoglycemia
  • SE: Nausea
  • Notes: May need to dec insulin or sulfonylurea/ meglitinide doses to dec risk of hypoglycemia
24
Q

Lipase inhibitor:

A

Orlistat
Rx-Xenical
OTC-Alli

  • Dec absorption of dietary fats by 30%
  • Must be used with a low-fat diet plan
  • SE: GI (flatus with discharge, fatty stool, fecal urgency)
  • Take multivitamin with A, D, E, Kand beta carotene at bedtime or separated by > 2 hours
  • Diet: max 30% of kcals from fat
25
Q

Appetite suppressants:
Phentermine

A
  • Sympathomimetics (stimulants), release of norepinephrine stimulates the satiety center which dec appetite
  • Phentermine (Adipex-P)
26
Q

CI of phentermine

A
  • Cardiovascular disease (uncontrolled hypertension, arrhythmias, heart failure, CAD),
  • Hyperthyroidism (since it could inc thyroid activity)
  • Glaucoma
  • Pregnancy, breast feeding
  • History of drug abuse
  • MAO inhibitors within the past 14 days
27
Q

SE and monitoring of phentermine

when do you take it?

A

Tachycardia, agitation, inc BP, insomnia, dizziness, tremor, psychosis

Monitor: HR, BP

Used short-term, up to 12 weeks, to “jump-start” a diet

Stimulants taken later in the day can cause insomnia

Potential for misuse/dependence

28
Q

When do we recommend bariatric surgery?

A

BMI >= 40 kg/m2 or when BMI >= 35kg/m2 with an obesity-related condition

29
Q

COMMON NUTRIENT DEFICIENCIES

A

■ Calcium is mostly absorbed in the duodenum, which may be bypassed. Calcium citrate supplementation is preferred as it has non-acid-dependent absorption.

■ Anemia can result from vitamin Bl2 and iron deficiency; both may require supplementation.

■ Iron and calcium supplements should be taken two hours prior or four hours after antacids.

■ Patients may require life-long supplementation of the fat- soluble vitamins A, D,E and K due to fat malabsorption.

30
Q

MEDICATION CONCERNS

A

■ Medications may require dose reduction and may need to be crushed and put in liquid or used in transdermal form for up to two months post-surgery. Pharmacists need to assess which drugs can be safely crushed and provide alternatives to drugs that cannot be crushed (i.e., extended- release formulations).

■ Rapid weight loss can cause gallstones. Ursodiol (Actigall, Urso 250, Urso Forte) dissolves gallstones and may be needed, unless the gallbladder has been removed.

31
Q

counseling ALL WEIGHT LOSS MEDICATIONS

A
  • Weight loss can improve diabetes and hypertension.
  • Monitor these conditions closely; dose reductions may be needed for medications.
32
Q

Phentermine/Topiramate (Qsymia) counseling

A

■ Take this medication in the morning. Avoid taking this medication in the evening, to prevent insomnia.

■ Phentermine can cause increased heart rate.

33
Q

Naltrexone/Bupropion (Contrave) counseling

A

■ Do not take with opioids or with a history of seizures.

■ Can cause increased blood pressure.

34
Q

Liraglutide (Saxenda}

A

■ Subcutaneous injection.
■ Can cause:
o Hypoglycemia.
o Pancreatitis.
o Nausea.

■ Do not take with Victoza.

These medications contain the same ingredient.

35
Q

Orlistat (Xenical and Alli)

A

■ Take one capsule at each main meal, or up to one hour after a meal that contains fat.

■ You should be eating a healthy diet that is low in fat in order to reduce GI side effects.

■ Can cause stomach issues (fatty/oily stool, oily spotting, intestinal gas with discharge, need to have a bowel movement right away, increased number of bowel movements or poor bowel control).

36
Q

Appetite Suppressants

A

■ Can cause:
o Increased blood pressure.
o Increased heart rate.

Pamela - Naplex 2023 (32 decks)

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