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

When should weightloss drugs be d/c

Answer 10

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

Question 11

Key drugs/conditions that can cause weight loss

Answer 11

• 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 12

Which weight loss drugs can be used in pregnancy

Answer 12

NONE - AVOID

Question 13

Which weight loss drugs should be avoided in HTN

Answer 13

Contrave - CI with uncontrolled BP (contains bupropion)

Question 14

Which weight loss drugs should be used with caution in HTN

Answer 14

Qsymia - monitor HR (contains phentermine)

Question 15

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

Answer 15

Contrave - suicide risk (contains bupropion)

Question 16

Which weight loss drugs should be avoided in seizures

Answer 16

Contrave - lowers seizure threshold (contains bupropion)

Question 17

Which weight loss drugs should be used with caution in seizures

Answer 17

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

Question 18

Which weight loss drugs should be avoided if taking opioids

Answer 18

Contrave - blocks opioid receptor (contains naltrexone)

Question 19

Phentermine drug class

Answer 19

Sympathomimetic (stimulant)

Question 20

Which medications are found in Qsymia

Answer 20

Phentermine and topiramate ER

Question 21

Which medications are found in Contrave

Answer 21

Naltrexone and bupropion

Question 22

What do the components of Contrave do for weight loss

Answer 22

naltrexone: decreases food cravings
bupropion: decreases appetite

Question 23

Which weight loss drug has a REMS progrm

Answer 23

Qsymia

due to teratogenic risk

Question 24

Qsymia contraindications

Answer 24

pregnacy, glaucoma

Question 25

Qsymia SE

Answer 25

Tachycardia, CNS effects (i.e, insomnia)

Question 26

Contrave contraindications

Answer 26

pregnancy, chronic opioid use, uncontrolled HTN, seizure disorder, other-bupropion containing products, MAO inhibitors within past 14 days

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 contraindications

Answer 30

pregnancy

Question 31

Saxenda SE

Answer 31

nausea

Question 32

Which weight loss drug is a lipase inhibitor

Answer 32

Orlistat

Question 33

Orlistat rx name

Answer 33

Xenical

Question 34

Orlistat OTC name

Answer 34

Alli

Question 35

Orlistat MOA

Answer 35

decreases absorption of dietary fats by ~30%

Question 36

Orlistat must be used with

Answer 36

a low-fat diet plan

Question 37

Orlistat SE

Answer 37

GI (flatus with discharge, fatty stool)

Question 38

What must be taken with Orlistat

Answer 38

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

Question 39

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

Answer 39

30%

Question 40

orlistat contraindication

Answer 40

pregnancy

Question 41

Phentermine brand name

Answer 41

Adipex-P

Question 42

Phentermine CI

Answer 42

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

Question 43

Phentermine SE

Answer 43

Tachycardia, agitation, increased BP

Question 44

Phentermine monitoring

Answer 44

HR, BP

Question 45

How long can phentermine be used for

Answer 45

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

Question 46

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

Answer 46

40 35

Question 47

Which calcium supplement is preferred for bariatric surgery and why

Answer 47

calcium citrate since it has non-acid dependent absorption

Question 48

Anemia can present from which vitamin deficiencies

Answer 48

B12 and iron

Question 49

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

Answer 49

2 hrs prior and 4 hrs after

Question 50

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 50

2

Question 51

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

Answer 51

Ursodiol