Obesity

Question 1

BMI Definitions

Answer 1

> 25 overweight ( > 23 for asian)

> 30 obesity

Question 2

Drug-induced

Answer 2

-Tricyclic AD
-Contraceptives
-Antipsychotics
-Anticonvulsants
-GC
-Sulfa, glitazones
-Beta blockers

CAT BAGS

Question 3

Non-Pharmacological Treatment

Answer 3

Diet
-High protein (25 protein, 30 fat)
-Lacto ovo veg diet
-Low CHO diet < 20
-Low fat, vegan
-Mediterranean

Question 4

Phentermine
(Ionamin®, Adipex-P®, Lomaira) (C-IV)

Answer 4

Controlled, C IV

SHORT TERM

AE: DM, insomnia, constipation, HTN, tachy, psychosis (HIP CDT)

Avoid in HTN, CV disease, anxiety, substance disorder, CASH

DDI: clonidine, methlydopa, thyroid, stimulants

NO MAOI (2 wks)

Caution in TCA/SSRI

Question 5

Diethylpropion
(Tenuate, Tenuate Dospan) (CIV)

Answer 5

Controlled, C IV

SHORT TERM

AE: constipation, HA, insomnia, xerostomia

DDI: MAOI (2 wk), TCA, SSRI, sibutramine, Na oxybute, sympathomimetics

Question 6

Phentermine-Topiramate (Qsymia) (C-IV)

Answer 6

Controlled, C IV

AE:
-constipation
-HA
-infection
-paresthesia
-pharyngitis
-xerostomia
X CHIPP

CI:
-pregnancy, TERATOGEN

-2 wk of MAOI

AVOID IN LD/ESRD

DDI: spotting in contraceptives, CNS depres effects

Only available through pharmacies enrolled in Qsymia certified network

Question 7

Naltrexone-Bupropion Extended-Release (Contrave®)

Answer 7

AE:
-HTN, HR
-suicidality
-psych sx
-hypoglycemia

PS HH SOA

BBW:
-suicidal thoughts, psych rxns

CI:
-seizure
-anorexia/bulimia
-opioid tx

Evaluate in 12 wks
-If pt has not lost 5% of baseline weight, D/C

Question 8

Orlistat (Xenical®, AlliTM)

Answer 8

Long term

AE:
-HA
-GI
-resp inf
-back pain
-malabs of ADEK
-liver related events

MLB GHR get the W

DI: warfarin

Take MV 2 hrs before med

CI in pregnancy

Question 9

GLP1s

Answer 9

Question 10

Pharmacotherapy Recommendation for Obesity

Answer 10

Women seeking contraceptive: suggest oral contras over injectables

If on AD: make decision with pt

Antiretroviral: monitor weight

Inflammation diseases: NSAIDS +antirhematic drugs

Question 11

Bariatric Surgery

Answer 11

BMI ≥ 40

BMI 35-39.9 kg/m2 with obesity-related comorbidity

BMI of > 30 kg/m2 with difficult to control T2D or MS

Question 12

Monitoring

Answer 12

Monthly for first 3 months, then every 3 months

If ineffective (weight loss < 5 %) then D/C and choose alternative

Question 13

Guidelines

Answer 13

1. Without IA response to lifestyle mods, add pharm
2. Sema 2.4
3. Lira 3.0
4. Phen/TOP ER
5. Nalt/BUP ER

No orlistat (unless small weight loss and tolerate GI AE)

Question 14

Arteriosclerosis

Answer 14

Avoid Diethylpropion

Question 15

Glaucoma

Answer 15

Avoid

Phentermine-Topiramate (Qsymia)

Diethylpropion

Question 16

Hyperthyroidism

Answer 16

Avoid

Phentermine-Topiramate (Qsymia)

Diethylpropion

Question 17

Substance abuse disorder

Answer 17

Avoid

Diethylpropion

Phentermine
(Ionamin®, Adipex-P®, Lomaira)

Question 18

AVOID IN LD/ESRD

Answer 18

Avoid Phentermine
(Ionamin®, Adipex-P®, Lomaira)

Question 19

spotting in contraceptives

cns effects

Answer 19

Phentermine
(Ionamin®, Adipex-P®, Lomaira)