CNS Stimulants And Weight Loss

Question 1

CNS stimulants

Answer 1

Increase NE and dopamine. Dont want to give with a MAOI bc of DDI : HTN crisis

Question 2

Quillivant XR

Answer 2

Methylphenidate XR oral susp

Question 3

Ritalin, Ritalin LA / concerta

Answer 3

Methylphenidate

Question 4

Metadate CD ; Metadate ER

Answer 4

Methylphenidate ER

Question 5

Daytrana

Answer 5

Methylphenidate patch

Put patch on 2 hours before needed

Up to 9 hours on

Seems to a cause ticks in some. Switch if it does

Question 6

Methylin

Answer 6

Methylphenidate

Question 7

Dexmethylphenidate

Answer 7

Focalin XR

Question 8

Dexedrine

Answer 8

Dextroamphetamine

Question 9

Lisdexamefetamine

Answer 9

Vyvanse

Can’t abuse this like adderall

Question 10

Modafinil

Answer 10

Provigil

Question 11

Armodafinil

Answer 11

Nuvigil

Question 12

Amphetamine + dextroamphetamine

Answer 12

Adderall

Question 13

Atomoxetine

Answer 13

Strattera ( non stimulants )
MOA: selective NE reuptake inhibitor
Major thing we worry about is hepatotoxicity ( LFT )

Question 14

Guanfacine

Answer 14

Intuniv

Alpha 2 agonist

Question 15

Clonidine

Answer 15

Kapvay

Alpha 2 agonist.

Alpha 2 adrenergic agonist are usually reserved for children / adolescents ( 6 through 17 ) who respond poorly to stimulants or have unacceptable side effects. Alpha 2 agonist may take up to 2 weeks for initial response.

Question 16

Stimulants adverse effects

Answer 16

Can slow growth ( monitor ). Drug holiday.

Palpitations, cardiac arrhythmias, angina, tachycardia
Weight loss, priapism emergency

Question 17

DDI with MAOIs

Answer 17

HTN crisis

Question 18

Viloxazine

Answer 18

Qelbree: a selective NE reuptake inhibitor for ADHD 6-17 years old.
Not controlled

Can open cap and sprinkled onto applesauce. Never chew or crush bc it’ll release all at once.

( recall atomoxetine also in capsules. Cannot open straterra )

Contraindication within 14 days of d/c MAOI. No linezolid , tedizolid, selegiline ( EMSAM )

1A2 inhibitor ( never combine with theophyline or clozapine )

Question 19

Somnolence can occur in up to 38% of patients taking alpha 2 agonist.

Answer 19

T

Question 20

Phentermine

Answer 20

Adopted P , Lomaira

C-4

Similar to amphetamines

No MAOIs

Question 21

Orlistat

Answer 21

Xenical ( RX )
Alli ( OTC )

MOA: binds to fat. If patient doesn’t have a fatty meal dont take this. If you have fruit for lunch don’t take this.

When to take? With meal or up to hour after. If meal is skipped or no fat in meal, dont take.

SE: flatulence, fecal urgency, oily stool.

Malabsorption of fat soluble vitamins. ADEK. Counseling point: take fat soluble ( ADEK ) vitamins at least 2 hours before or after orlistat

Pregnancy category X

Question 22

Qsymia

Answer 22

Phentermine + topiramate ER Caps

Topmax can cause kidney stones, stop sweating and cause hyperthermia

Topiramate can cause birth defects.

Question 23

Contrave

Answer 23

Naltrexone + Buproprion

( contrave — contraaaindicated if you’re on opioids and if you have seizures )

Opioid antagonist + antidepressant

Duplicate therapy caution: If patient is Wellbutrin, or aplenzin( buproprion), or 450 or zyban dont add Contrave

Question 24

Liraglutide

Answer 24

Saxenda for weight loss ( recall victoza for diabetes )
MOA: GLP-1 agonist.
Memorize dosing 3 mg subQ QD. ( in diabetes victoza: we use up to 1.8 mg subq QD ).

GLP-1 agonists: pancreatitis ( alcohol makes it worse )

Question 25

Semaglutide

Answer 25

Wegovy : weight go away

MOA: GLP-1 agonist.

Dosing: weight loss : 2.4 mg sub once weekly ( in diabetes we do 1 mg sub weekly )

BBW: thyroid tumors
Acute pancreatitis

Question 26

GLP 1 side effects

Answer 26

Question 27

Plenity

Answer 27

Not a drug. A device that is taken. RX only.

MOA: Cellulose and citric acid form a matrix that occupies volume in the stomach.

Question 28

Sunosi

Answer 28

C4
Solriamfetol

MOA: dopamine and NE reuptake inhibitor ( DNRI )

Indication: improve wakefulness in patients with narcolepsy or Obstructive sleep apnea ( OSA )

Question 29

Pitolisant

Answer 29

Wakix
MOA: histamine 3 receptor antagonists. / inverse agonist

Indication : non controlled med for narcolepsy.