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My Obesity Pharmacotherapy > Fundamentals Of Obesity Pharmacotherapy > Flashcards

Fundamentals Of Obesity Pharmacotherapy Flashcards

1
Q

Documentation best practices for obesity meds

A

Initial drug Rx rationale

Vs, appearance, mood every visit

Beneficial and adverse effects every visit

Rationale for Rx change

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2
Q

What is qsymia

A

Phertermine and topiramate

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3
Q

What is saxenda

A

Liraglutide

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4
Q

What is contrave

A

Naltrexone/bupropion

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5
Q

Orlistat dosage

A

60 mg po tid with meals

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6
Q

Orlistat mechanism of action

A

Pancreatic lipase inhibitor, prevents absorption of 30 percent ingested fat

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7
Q

Orlistat contraindications

A

Pregnancy
Chronic malabsorption syndrome
Cholestasis
Hypersensitivity

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8
Q

Orlistat adverse effects

A 
Diarrhea
Oily stools
Fecal incontinence
Fat soluble vitamin def
Increase urinary oxalate
Rare hepatotoxicity
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9
Q

Orlistat weight loss 2 yr

A

2.3 percent

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10
Q

Qsymia dose

A

Start AM dosing 3.75/23 x 14 days

Increase to 7.5/46

After 12 weeks:
If wt loss < 3% increase to 11.25/69 x 14 days then increase to 15/92

Stop medication if weight loss < 5% after 12 weeks at 15/92

If downtitrating from max dose, need to downtitrate QOD for at least 7 days to reduce sz risk

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11
Q

Phentermine MOA

A

Release of NE in hypothalamus => decreased appetite and food intake

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12
Q

Topiramate MOA

A

Unknown

Possibly augmenting GABA or inhibiting carbonic anhydrase to help with increased satiety

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13
Q

Qsymia response rate

A

5% WL: 67% at full dose vs 17% placebo

10% WL: 47% at full dose vs 7% placebo

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14
Q

Qsymia contraindications

A

Pregnancy
Glaucoma
Hyperthyroidism
MAOI use 14 days

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15
Q

Qsymia adverse reactions

A 
Paresthesias
Dizziness
Dysguesia
Insomnia
Constipation
Dry mouth
Makes carbonated beverages taste bad

Fetal toxicity (oral cleft lip/palate)

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16
Q

Qsymia monitoring

A

Check urine pregnancy monthly (can be done by patient at home)

Or

Document 2 forms contraception

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17
Q

Contrave dosing

A

Titration of 8 mg naltrexone and 90 mg bupropion over 4 weeks

Week 1: 1 tab AM
Week 2: 1 tab AM and 1 tab PM
Week 3: 2 tabs AM and 1 tab PM
Week 4: 2 tabs AM and 2 tabs PM

18
Q

Naltrexone MOA

A

Opioid antagonist

Works in hypothalamus and mesolimbic/DA circuit to decrease appetite and reward

19
Q

Bupropion MOA

A

Weak inhibitor of reuptake of DA and NE

Works in hypothalamus and mesolimbic/DA circuit to decrease appetite and reward

20
Q

Contrave wight loss percentages

A

42-56 percent had 5 percent weight loss

21-35 percent has 10 percent weight loss

21
Q

Contrave contraindications

A

Black box: inc SI in young people

Uncontrolled HTN
Seizure
Anorexia
Bulimia
Undergoing abrupt discontinuation etoh, benzo, barb, anti-sz meds
Chronic opiate use 
MAOI usage in last 14 days
22
Q

Contrave adverse reactions

A

N/V/D/C

HA
Dizziness
Insomnia

Dry mouth

Avoid contaminant opioid usage with high fat foods

23
Q

Saxenda dosage

A

Titrate over 5 weeks once daily with SC injection

Week 1: 0.6 mg SC x 7 days
Week 2: 1.2 mg SC x 7 days
Week 3: 1.8 mg SC x 7 days
Week 4: 2.4 mg SC x 7 days
Week 5: 3.0 mg SC ongoing

Can change injection site and timing without dose adjustment

If less than 4 percent weight loss after 16 weeks, consider stopping

24
Q

Saxenda MOA

A

GLP-1 agonist

Results in activation of areas in hypothalamus to reduce food intake, increased satiety, and decreased caloric intake

Also improves glucose metabolism

25
Q

Saxenda weight loss percentages

A

62 percent had 5 percent weight loss

34 percent had 10 percent weight loss

26
Q

Saxenda contraindications

A

Pregnancy

Personal or fam hx medullary thyroid CA or MEN 2

Hypersensitivity

Black box: causes c cell tumors in mice, unk in humans

27
Q

Saxenda adverse reactions

A 
Nausea/vomiting 
Hypoglycemia esp when used with insulin
Diarrhea
Constipation
HA
Dec appetite
Fatigue
Dizziness 
AP
Inc lipase
Acute pancreatitis
GB disease
Tachycardia
Renal impairment
SI
28
Q

Which obesity med can increase systolic bp

A

Contrave (naltrexone/bupropion)

29
Q

Daily recommended phentermine doses

A

15-37.5 mg

30
Q

Phentermine adverse effects

A

Most common:
Dry mouth
Insomnia, usually fades, helped with melatonin
Constipation

Less common:
Bruxism
Palpitations
Urinary retention in setting of BPH
HA

Uncommon:
Impotence
Dysphoria
Irritability

31
Q

How to use diethylpropion and phentermine

A

Am phentermine with 25 diethylpropion as late afternoon or evening dose because no of shorter half life

32
Q

Weight loss metformin

A

2% in DM2/insulin resistance

33
Q

Obesity dose of topiramate

A

start at 25 mg Qhs, inc dose every 2 weeks by 25 mg (usually BID) based on clinical response, up to 100 BID, tolerate, ASE

34
Q

Topiramate adverse effects

A 
Attention/memory difficulty
Fatigue
Acute myopia and glaucoma (rare)
Kidney stones (rare)
paresthesias, dysguesia
Depression, anxiety, SI
Increase risk oral clefts if taken during pregnancy in first trimester (use caution in child bearing age)
35
Q

First choice for obesity pt with MDD

A

bupropion/contrave

36
Q

First choice for obesity pt with binge eating disorder

A

Lisdexamfetamine (Vyvanse)

Topiramate (not FDA approved for BED)

37
Q

Dosing of lisdexamfetamine (Vyvanse)

A

start 30 mg po q daily in AM
titrate in increments of 20 mg weekly
usual maintenance dose is 50-70 mg q AM

38
Q

First choice obesity pt with night eating syndrome

A

sertraline
citalopram
escitalopram

39
Q

First choice obesity pt with diabetes

A

metformin
GLP1 agonists
SGLT2 inhibitors
flubosidase inhibitors

Dpp4 inhibitors weight neutral

40
Q

First choice obesity pt with premenstrual carb cravings

A

spironolactone in later half of cycle to 2nd day of menses

Caution with pts who may be pregnant, scant medical literature

My Obesity Pharmacotherapy (2 decks)

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