Module 8: Unit E Flashcards
Example Anorexiant, CNS Stimulant, Sympathomimetic
diethylpropion
phentermine
Indication:
diethylpropion
phentermine
weight loss - short-term (3 mos)
diethylpropion
phentermine
MOA
CNS stimulants that promote weight loss by ↓ appetite by ↑ norepinephrine availability at receptors in the brain
diethylpropion
phentermine
Safety
Hypersensitivity or idiosyncrasy to sympathomimetic amines; advanced arteriosclerosis, severe hypertension; pulmonary hypertension; hyperthyroidism; glaucoma; agitated states, history of drug abuse; during or within 14 days following MAO inhibitor therapy, concurrent use with other anorectic agents
Tachycardia, angina, HTN
Can exacerbate anxiety, nervousness, insomnia
diethylpropion and phentermine prescribing tips/info
Controlled substance, check local prescribing rules, Schedule IV
Phentermine is used more often than diethylpropion
Good choice for validated slow metabolism (via testing resting metabolic rate)
Anorexient/ Anticonvulsant, Sympathomimetic example
Phentermine /topiramate (Qsymia)
Phentermine /topiramate (Qsymia) indication
weight loss and management
Phentermine /topiramate (Qsymia) MOA
Topiramate is thought to ↑ satiety by ↓ glutamate, carbonic anhydrase, and gamma-aminobutyric acid.
Phentermine /topiramate (Qsymia) Cautions/Contraindications
CI: Glaucoma, hyperthyroid, pregnancy
Caution with hepatic impairment and HTN
Phentermine /topiramate (Qsymia) SE and AE
AE: HTN, tachycardia, birth defects, acute myopia in angle-closure glaucoma, acidosis, impairment of memory and/or concentration.
SE: Dry mouth, altered taste, constipation, blurred vision, dizziness, insomnia, some reports of numbness/tingling in extremities,
Phentermine /topiramate (Qsymia) weight loss goal and who it is good for
Expect a 10% loss of TBW and ↓ BP over 56 weeks
Good choice for patients who struggle with feeling full after meals (always hungry).
GLP-1 Receptor Agonist example
-TIDES
liraglutide (Saxenda, Victoza)
semaglutide (Wegovy, Ozempic)
liraglutide (Saxenda, Victoza)
semaglutide (Wegovy, Ozempic)
Indication
Weight loss and management
liraglutide (Saxenda, Victoza)
semaglutide (Wegovy, Ozempic)
MOA
Activates receptors for GLP-1, causing ↓ gastric emptying, ↑ glucose-dependent release of insulin, ↓ glucagon release. Centrally acting appetite suppression. May ↑ # beta cells
liraglutide (Saxenda, Victoza)
semaglutide (Wegovy, Ozempic)
Safety
Pregnancy: risk of fetal harm
Hypersensitivity
hypoglycemia (dose-dependent) and usually with other hypoglycemic meds, GI s/s nausea, vomiting, diarrhea, constipation, pancreatitis, renal insufficiency, increased risk for CA: medullary thyroid and theoretical risk with multiple endocrine neoplasms (MENs)
May increase HR.
Some postmarketing reports of fatigue, HA, weakness
liraglutide (Saxenda, Victoza)
semaglutide (Wegovy, Ozempic)
BBW
Risk of thyroid C-cell tumors:
In rodents, semaglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures.
Semaglutide is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
liraglutide (Saxenda, Victoza)
semaglutide (Wegovy, Ozempic)
Prescribing and route of administration
SQ injections
Titrate up slowly to minimize adverse effects.
Liraglutide requires daily dosing; semaglutide is dosed weekly.
Anorexiant, Antidepressant, Dopamine/Norepinephrine-Reuptake Inhibitor, Opioid Antagonist example
naltrexone and bupropion (Contrave)
naltrexone and bupropion (Contrave) indication
Promoting and maintaining weight loss
naltrexone and bupropion (Contrave) MOA
Unknown MOA. Theoretical action regulation of appetite through action in the hypothalamus and mesolimbic dopamine system (reward system). It helps decrease appetite and curb cravings (think late-night snackers, stress eaters).
naltrexone and bupropion (Contrave) CI and SE
CI: any other bupropion-containing medications, opioid analgesics (will ↓analgesia), or within 14 days of MAOI
Nausea, vomiting, constipation, HA, dizziness, insomnia, ↑BP, dry mouth, diarrhea, anxiety, fatigue, GI discomfort
naltrexone and bupropion (Contrave) BBW
Increased risk of suicidal thoughts and behavior in children, adolescents, and young adults.
Increased risk of severe neuropsychiatric reactions when given to patients who are taking or discontinuing (weaning) off bupropion. In patients of all ages who are started on Contrave, monitor closely for worsening and for the emergence of suicidal thoughts and behaviors
Lipase Inhibitor example
Orlistat (OTC-Alli and by Rx-Xenical)
Orlistat (OTC-Alli and by Rx-Xenical) MOA
Acts in the GI tract to reduce the absorption of fat via the irreversible inhibition of gastric and pancreatic lipase (up to 30% reduction of ingested fats)
Orlistat (OTC-Alli and by Rx-Xenical) contraindications and D2D
CI: malabsorption syndrome or cholestasis
Absolute CI: pregnant, breastfeeding, renal impaired
Can reduce the absorption of medications like levothyroxine, cyclosporine
Increases warfarin - d/t Vik K absorption
Reduced absorption of fat-soluble vitamins A, D, E, K
Orlistat (OTC-Alli and by Rx-Xenical) SE and AE
GI: oily stools, flatulence (with discharge), rectal leakage of oily discharge, fecal incontinence, increased BMs.
Rare liver damage, pancreatitis, kidney stones
Orlistat (OTC-Alli and by Rx-Xenical)
Education for Orlistat
if not eating fatty meal, hold dose
