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Foundation exam 4 > Obesity > Flashcards

Obesity Flashcards

1
Q

Generic name for Adipex

A

Phentermine

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2
Q

Adipex: MOA

A

Increases release and inhibits reuptake of norepinephrine and thereby stimulates POMC neurons to suppress appetite

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3
Q

Adipex: Contraindications, Medication considerations, Adjustments

A

CI: Cardiac disease (CAD, stroke, arrhythmias, heart failure, uncontrolled hypertension), glaucoma, hyperthyroidism, substance abuse, psychosis, pregnancy

Medication considerations: MAOIs (Level 1 DDI – CI, HTN Crisis), Antihypertensive or Caffeine, (↑HR, BP), Bupropion (↑Seizure Risk) Antidiabetics (↑Glucose), Geriatric (Start low dose)

Adjustments:
-Renal Adjustments: eGFR 15-29 = Max of 15 mg/day, Avoid <15

-Liver Adjustments: Unknown

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4
Q

Adipex: Dosing & Efficacy

A

Dosing (p.o. once a day):

  • 15–37.5 mg: Q.D or in divided doses (15, 18.75, 37.5 mg)
  • Lomaira (2016) = 8 mg T.I.D, 30 minutes before meals

Total Body Weight Loss vs. Placebo:

  • Poor evidence base
  • Rapid tolerance develops (8-12 weeks) and weight regain
  • Intermittent Treatment = Continuous Treatment (36-weeks)
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5
Q

Adipex: Indication, AACE/ ACE, Timing, Dose escalation, Monitor,

A

Indication: BMI >30 or 27 w/comorbs. Short-term (few weeks), Age >17

AACE/ACE: Short-term pharmacotherapy, such as with phentermine, has not been shown to produce long-term weight or health benefits and can not be generally recommended.

Timing: Avoid evening administration (stimulant = insomnia)

Dose Escalation: Use lowest dose possible, esp. HTN, DM, Geriatrics

Monitor: BP, HR, Glucose (in diabetics)

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6
Q

What is the generic for Xenical

A

Orlistat

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7
Q

Xenical: MOA

A

Binds gastric and pancreatic lipases in lumen of the stomach and small intestine and thereby REDUCES FAT ABSORPTION into the body

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8
Q

Xenical: Contraindications, Precautions, Medication contraindications, Adjustments

A

CI: Pregnancy, malabsorption, cholestasis, oxalate kidney stones

Precautions: Severe liver disease, cholelithiasis, fat soluble vitamin deficiency
Medication Considerations: Warfarin (↑ effect), anti-seizure (↓ effect), levothyroxine (↓ effect), cyclosporine (↓ effect)

Renal Adjustments: None
Liver Adjustments: Avoid in severe liver disease

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9
Q

Xenical: dosing & efficacy

A

OTC = 60 mg p.o. T.I.D, Rx = 120 mg p.o. T.I.D

Total Body Weight Loss vs. Placebo:
1-year: -4.0%
4-years: -2.6%

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10
Q

Xenical: Indication, side effects, discontinuation rate

A

Indication: BMI >30 or 27 w/comorbs. Chronic. ≥12 yo

Side Effects: Fatty stools, fecal urgency or incontinence, oily spotting, abdominal pain (increase with >30% kcal from fat)

Discontinuation: Rate is high due to side effect : weight loss

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11
Q

What is the generic for Qsymia?

A

phentermine + topiramate

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12
Q

Qsymia: MOA

A

Topiramate:

Inhibits NPY/AgRP synaptic release of GABA that plays a role in Inhibiting POMC Neurons.
- NPY/ AgRP: stimulates appetite

Inhibiting the release of GABA reduces the suppression of POMC neurons and thereby increases Appetite Suppression

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13
Q

Qsymia: Dosing & Efficacy

A

Dosing (p.o. once a day):

  • Starter (Titration): 3.75 / 23 mg x 2-weeks
  • Recommended (Treatment): 7.5/46 mg or 15/92 mg
  • Escalation (Titration): 11.25/69mg
  • High Dose (Treatment): 15/92 mg

Total Body Weight Loss vs. Placebo:
1-year: -8.6% (high dose), 6.6% (treatment dose)
2-year: -8.7% (high dose), 7.5% (treatment dose)

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14
Q

Qsymia: Indication, dynamic dosing schedule, side effects

A

Indication: BMI >30 or 27 w/comorbs. Chronic. Age >18 (16, off-label)

  • Dynamic Dosing Schedule: Starter to Treatment Dose, evaluate:
    • Not at 3% weight loss after 12-weeks on Treatment Dose:
      • Stop or Escalate to 11.25/69 x 14d → 15/92 mg
        • Not at 5% after 12-weeks on High dose = Stop
          • Every other day x 1-week to avoid seizures

Side Effects:
Paresthesia, concentration/memory loss, depression, low bicarb

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15
Q

What is the generic for Belviq?

A

Lorcaserin

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16
Q

Belviq: Efficacy

A

Withdrawn form U.S. market due to increased rate of cancer diagnosis

17
Q

What is the generic for contrave?

A

Bupropion + Nalterxone

18
Q

Contrave: MOA

A

Bupropion: Increases the release and inhibits the reuptake of Dopamine (and to lesser extent Norepinephrine) thereby STIMULATING POMC NEURONS to SUPPRESS APPETITE

Naltrexone: Opiate receptor blockade prevents β-endorphin binding that tonically inhibits POMC Neurons. Reduction of Dopamine in reward centers influences desires, palatability

19
Q

Contrave: Contraindications, precautions, major DDI, Adjustments

A

Absolute CI: Pregnancy, breastfeeding, uncontrolled HTN, seizure disorder, anorexia/bulimia, severe depression, MAOI, chronic opiate use, acute opiate need, drug or alcohol withdrawal

Precautions: Cardiac arrhythmias, glaucoma, migraines, anxiety, bipolar disorder, seizure (bupropion lowers threshold)

Major DDI: MAOI, Pimozide, Thioridazine

Renal Adjustments: CrCl 30-49 = Max 8/90 B.I.D (Avoid <30)

Liver Adjustments: Child Pugh B = Max 8/90 B.I.D (Avoid C

20
Q

Contrave: Dosing & Efficacy

A

Dosing: Only supplied as an 8/90 tablet

  • Week 1: 8 (Naltrexone)/90 (Bupropion) once a day in a.m.
  • Week 2: 8/90 mg twice a day
  • Week 3: 16/180 mg a.m. + 8/90 mg p.m.
  • Week 4: 16/180 mg a.m. + 16/180 mg p.m.

Total Body Weight Loss vs. Placebo:

•1-year: -4.2%No data available beyond 1-year

21
Q

Contrave: Indication, evaluation of efficacy, side effects, opiate free, monitor

A

Indication: BMI >30 or 27 w/comorbs. Chronic. Age >18.

Evaluation of Efficacy: If not >5% wt loss at week 16 = Stop

Side Effects: Generally mild: N/V, headache, dizzy, dry mouth

Opiate Free: 7-10 days before initiating

Monitor: HR, BP, depression, suicidal ideation, migraine, hypoglycemia w/ insulin or secretagogue, seizures, LFT’s

Lab Error: May cause false + for amphetamines

22
Q

What is the generic for Saxenda

A

Liraglutide

23
Q

Saxenda: MOA

A

GLP-1

Stimulates POMC NEURONS to SUPPRESS APPETITE

Decreases GASTRIC EMPYTING thereby stimulating VAGAL AFFERENTS for MEAL TERMINATION

24
Q

Saxenda: CI, Precautions, Major DDI, Adjustments

A

Absolute CI: Pregnancy, breast feeding, MEN2, pancreatitis medullary thyroid cancer, acute gall bladder

Precautions: Pancreatitis hx, gastroparesis, gall stones, dehydration

Major DDI: None (modestly lowers blood pressure, glucose)

Renal Adjustments: None

Liver Adjustments: None

25
Q

Saxenda: Dose & efficacy

A

Dosing: Injection - Daily

•Week 1: 0.6 mg once a day•Week 2-5: 0.6 mg weekly increase to reach 3 mg•

Total Body Weight Loss vs. Placebo:

  • 1-year: -5.6%
  • No data available beyond 1-year
26
Q

Saxenda: Indication, Age, Evaluation of efficacy, Side effects, monitor

A

Indication: BMI >30 or 27 w/comorbs. Chronic.

Age: Adult dosing, 12-17 yo dosing, 7-11 yo dosing (off-label)

Evaluation of Efficacy: Not >4% weight at week 16 = Stop

Side Effects: N/V (may cause dehydration), constipation, diarrhea, indigestion, increased heart rate, gall stones, hypoglycemia (with insulin or secretagogue only)

Monitor: Pancreatitis, Improving Glucose (T2DM approved!)

27
Q

Generic for Ozempic/ WeGovy

A

Semaglutide

28
Q

Ozempic/ WeGovy: CI, Precautions, Major DDI, Adjustments

A

Absolute CI: Pregnancy, breast feeding, MEN2, pancreatitis medullary thyroid cancer, acute gall bladder

Precautions: Pancreatitis hx, gastroparesis, gall stones, dehydration

Major DDI: None (modestly lowers blood pressure, glucose)

Renal Adjustments: None

Liver Adjustments: None

29
Q

Ozempic/ WeGovy: Dosing & Efficacy

A

Dosing: Injection - weekly

  • Week 1: 0.25 mg once a week
  • Monthly: Increase 0.25 mg to reach 2.4 mg (week 16)

Total Body Weight Loss vs. Placebo:

•1-year: -12.4% (more than twice that seen with SAXENDA)

No data available beyond 68-wee

30
Q

Ozempic/ WeGovy: Indication, age, evaluation of efficacy, side effects, monitor

A

Indication: BMI >30 or 27 w/comorbs. Chronic.

Age: Adult dosing, 12-17 yo dosing, 7-11 yo dosing (off-label)

Evaluation of Efficacy: Not >4% weight at week 16 = Stop

Side Effects: N/V (may cause dehydration), constipation, diarrhea, indigestion, increased heart rate, gall stones, hypoglycemia (with insulin or secretagogue only)

Monitor: Pancreatitis, Improving Glucose (T2DM approved!)

Foundation exam 4 (4 decks)

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