Module 8: Unit E

Question 1

Example Anorexiant, CNS Stimulant, Sympathomimetic

Answer 1

diethylpropion
phentermine

Question 2

Indication:
diethylpropion
phentermine

Answer 2

weight loss - short-term (3 mos)

Question 3

diethylpropion
phentermine
MOA

Answer 3

CNS stimulants that promote weight loss by ↓ appetite by ↑ norepinephrine availability at receptors in the brain

Question 4

diethylpropion
phentermine
Safety

Answer 4

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

Question 5

diethylpropion and phentermine prescribing tips/info

Answer 5

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)

Question 6

Anorexient/ Anticonvulsant, Sympathomimetic example

Answer 6

Phentermine /topiramate (Qsymia)

Question 7

Phentermine /topiramate (Qsymia) indication

Answer 7

weight loss and management

Question 8

Phentermine /topiramate (Qsymia) MOA

Answer 8

Topiramate is thought to ↑ satiety by ↓ glutamate, carbonic anhydrase, and gamma-aminobutyric acid.

Question 9

Phentermine /topiramate (Qsymia) Cautions/Contraindications

Answer 9

CI: Glaucoma, hyperthyroid, pregnancy
Caution with hepatic impairment and HTN

Question 10

Phentermine /topiramate (Qsymia) SE and AE

Answer 10

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,

Question 11

Phentermine /topiramate (Qsymia) weight loss goal and who it is good for

Answer 11

Expect a 10% loss of TBW and ↓ BP over 56 weeks
Good choice for patients who struggle with feeling full after meals (always hungry).

Question 12

GLP-1 Receptor Agonist example

Answer 12

-TIDES
liraglutide (Saxenda, Victoza)
semaglutide (Wegovy, Ozempic)

Question 13

liraglutide (Saxenda, Victoza)
semaglutide (Wegovy, Ozempic)
Indication

Answer 13

Weight loss and management

Question 14

liraglutide (Saxenda, Victoza)
semaglutide (Wegovy, Ozempic)
MOA

Answer 14

Activates receptors for GLP-1, causing ↓ gastric emptying, ↑ glucose-dependent release of insulin, ↓ glucagon release. Centrally acting appetite suppression. May ↑ # beta cells

Question 15

liraglutide (Saxenda, Victoza)
semaglutide (Wegovy, Ozempic)
Safety

Answer 15

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

Question 16

liraglutide (Saxenda, Victoza)
semaglutide (Wegovy, Ozempic)
BBW

Answer 16

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).

Question 17

liraglutide (Saxenda, Victoza)
semaglutide (Wegovy, Ozempic)
Prescribing and route of administration

Answer 17

SQ injections
Titrate up slowly to minimize adverse effects.
Liraglutide requires daily dosing; semaglutide is dosed weekly.

Question 18

Anorexiant, Antidepressant, Dopamine/Norepinephrine-Reuptake Inhibitor, Opioid Antagonist example

Answer 18

naltrexone and bupropion (Contrave)

Question 19

naltrexone and bupropion (Contrave) indication

Answer 19

Promoting and maintaining weight loss

Question 20

naltrexone and bupropion (Contrave) MOA

Answer 20

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).

Question 21

naltrexone and bupropion (Contrave) CI and SE

Answer 21

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

Question 22

naltrexone and bupropion (Contrave) BBW

Answer 22

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

Question 23

Lipase Inhibitor example

Answer 23

Orlistat (OTC-Alli and by Rx-Xenical)

Question 24

Orlistat (OTC-Alli and by Rx-Xenical) MOA

Answer 24

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)

Question 25

Orlistat (OTC-Alli and by Rx-Xenical) contraindications and D2D

Answer 25

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

Question 26

Orlistat (OTC-Alli and by Rx-Xenical) SE and AE

Answer 26

GI: oily stools, flatulence (with discharge), rectal leakage of oily discharge, fecal incontinence, increased BMs.
Rare liver damage, pancreatitis, kidney stones

Question 27

Orlistat (OTC-Alli and by Rx-Xenical)

Question 28

Education for Orlistat

Answer 28

if not eating fatty meal, hold dose