Obesity Drugs and Surgeries

Question 1

Most widely prescribed?

Answer 1

Phentermine (BUT only approved for 3 mos) - longer off labe, CHEAPEST
realted to amphetaimine but no abuse potential

Question 2

Phentermine Mech?

Answer 2

Acts on CNS to increase satiety thus decr intake

4-5 % weight loss

Question 3

Phentermine ADRs

Answer 3

INCREASE IN BP!!! (moitor BP after 1 week, contraindicated in HTN)
also; nervousness, insomnia, HA, dry mouth

Question 4

Safest weight loss drug?

Answer 4

Orlistat (Alli OTC, Xenical prescription)
FDA approved for long term use
Can prevent DM, and improve lipids and lowers HbA1c in DM pts

Question 5

Orlistat mech?

Answer 5

Pancreatic lipase inhib that block ~1/3 dietary fat absorption from GI tract

Question 6

Orlistat ADR

Answer 6

Oily stools, sense of urgency, diarrhea, oily leakage
No systemic side effects as not absorbed
DDI: increased INR with warfarin, decreased levels cyclosporine

Question 7

Lorcarsarin (cost/mech/ADR/% loss)

Answer 7

expensive $250 per month
LEAST SIDE EFFECTS
selective 5HT2C receptor agonist (2C receptor only in brain not heart)
being monitored for cardiac effects
4-5% loss

Question 8

Greatest drug weight loss? ADR?

Answer 8

Phentermine (increases satiety)/topiramamte (anti sz/anti migraine): Qsymia
10-12% loss
TERATOGEN (so preg test before use)
Also: MODERATE ADR dry mouth paresthesia, insomnia dizziness, psyc and attention probs

Question 9

Most effective surgery for weight loss?

Answer 9

RYGB (Roux en Y Gastric Bypass) 28-30%
ALSO most RISKY
Dramatic benefits in glucose control in DM

Question 10

How does RYGB work?

Answer 10

Food goes staight into intestine without hitting stomach –> increased satiety
Decrease in serum ghrelin = decr hunger

Question 11

Risks of RYGB

Answer 11

THROMBOEMBOLISM, LEAK, iNFX/PNA
Nutritional defic (B12, Vit D, Fe)

Question 12

Least weight loss but also least risk?

Answer 12

Laparascopic band 20-24%
Reversible - reduces size of stomach to increase satiety
Positive effect on glucose but less than other two surgery options

Question 13

Naltrexone with Bupropion

Answer 13

Naltrexone alters reward pathways
INTERMEDIATE in effect and Intermediate in ADR
ADR: incr BP, nausea, GI, dry mouth, not for pregnancy, expensive, black box for suicidality

Question 14

Laparascopic band problems

Answer 14

Requires follow up and adjustment

Risk of MECHANICAL FAILURE (slippage of erosion of band)

Question 15

Sleeve Gastrectomy

Answer 15

2nd best for glucose control in DM (RYGB best)
24-27% weight loss - so MOR for loss and MOR for risk
Increases satiety by removing part of the stomach
No risk for mech problems (band) or nutriotonal defic (RYGB)