Chapter 57: Weight loss Flashcards
BMI for an overweight person
25-29.9 kg/m2
BMI for an obese person
≥ 30 kg/m2
Key drugs/conditions that can cause weight gain
- 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
Physical activity should increase to ≥ ___ minutes per week, performed on __-__ separate days
150 minutes
3-5 days
OTC weight loss supplements commonly contain stimulants, such as
bitter orange and/or excessive amounts of caffeine
What other names can caffeine be packaged under
Guarana and concentrated green tea powder
When are prescription weight loss meds indicated
BMI ≥30 kg/m2 or a BMI ≥ 27 kg/m2 with at least one weight-related condition (such as dyslipidemia, HTN or diabetes)
Weight loss meds are only used in addition to
a dietary plan and increased physical activity
Which newer agents for weight loss can be continued long-term for weight maintenance
Qsymia, Contrave, Saxenda and the orlistat formulations
When should weightloss drugs be d/c
if they do not produce at least a 5% weight loss at 12 weeks
Key drugs/conditions that can cause weight loss
- 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
Which weight loss drugs can be used in pregnancy
NONE - AVOID
Which weight loss drugs should be avoided in HTN
Contrave - CI with uncontrolled BP (contains bupropion)
Which weight loss drugs should be used with caution in HTN
Qsymia - monitor HR (contains phentermine)
Which weight loss drugs should be used with caution in young adults and adolescents with depression
Contrave - suicide risk (contains bupropion)
Which weight loss drugs should be avoided in seizures
Contrave - lowers seizure threshold (contains bupropion)
Which weight loss drugs should be used with caution in seizures
Qsymia - must taper off slowly if used (contains topiramate)
Which weight loss drugs should be avoided if taking opioids
Contrave - blocks opioid receptor (contains naltrexone)
Phentermine drug class
Sympathomimetic (stimulant)
Which medications are found in Qsymia
Phentermine and topiramate ER
Which medications are found in Contrave
Naltrexone and bupropion
What do the components of Contrave do for weight loss
naltrexone: decreases food cravings
bupropion: decreases appetite
Which weight loss drug has a REMS progrm
Qsymia
due to teratogenic risk
Qsymia contraindications
pregnacy, glaucoma
Qsymia SE
Tachycardia, CNS effects (i.e, insomnia)
Contrave contraindications
pregnancy, chronic opioid use, uncontrolled HTN, seizure disorder, other-bupropion containing products, MAO inhibitors within past 14 days
GLP-1 receptor agonist mechanism for weight loss
increases satiety
Liraglutide brand name for weight loss
Saxenda
Saxenda warnings
pancreatitis, hypoglycemia
Saxenda contraindications
pregnancy
Saxenda SE
nausea
Which weight loss drug is a lipase inhibitor
Orlistat
Orlistat rx name
Xenical
Orlistat OTC name
Alli
Orlistat MOA
decreases absorption of dietary fats by ~30%
Orlistat must be used with
a low-fat diet plan
Orlistat SE
GI (flatus with discharge, fatty stool)
What must be taken with Orlistat
Multivitamin A, D, E & K and beta carotene at bedtime or separated by ≥ 2 hrs
What is the max % of kcals from fat that can be taken with Orlistat
30%
orlistat contraindication
pregnancy
Phentermine brand name
Adipex-P
Phentermine CI
CV disease (e.g., uncontrolled HTN), hyperthyroidism, glaucoma, pregnancy, hx of drug abuse
Phentermine SE
Tachycardia, agitation, increased BP
Phentermine monitoring
HR, BP
How long can phentermine be used for
short-term up to 12 weeks to “jump-start” a diet
Guidelines recommend weight loss or bariatric surgery for adults when BMI ≥ ___ kg/m2 or when BMI ≥ __ kg/m2 with an obesity-related condition
40
35
Which calcium supplement is preferred for bariatric surgery and why
calcium citrate since it has non-acid dependent absorption
Anemia can present from which vitamin deficiencies
B12 and iron
Iron & Ca supplements should be taken how many hrs prior or how many hours after antacids
2 hrs prior and 4 hrs after
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
2
Which medication can be used to dissolve gallstones after rapid weight loss
Ursodiol
