Obesity management Flashcards
What is considered a high risk waist circumference?
men >40in
women >35in
What BMI range should waist circumference be measured?
25-34.9
What are people at a normal weight with a high risk waist circumference at increased risk for?
Cardiovascular diseases
HTN
T2DM
When should weight loss medications be considered in addition to lifestyle modifications?
> /= 30
How much of a calorie deficit is needed to lose 1 lb a week?
500 kcal/ day
What should be used in conjunction with diet?
physical activity
What is the standard recommendation for moderate-intensity physical activity per day?
30 min on 5 or more days of the week
What is the MOA of Phentermine (ADIPEX-P)?
sympathomimetic amine –> stimulates release of NE –> decreases hunger
How long should Phentermine be used for?
short-term; no more than 12 weeks
What are SEs with Phentermine?
- increased HR and BP
- restlessness/ insomnia
- headache
What are CIs to Phentermine?
- CVD
- coronary artery disease
- arrhythmias
- stroke
- congestive HF
- glaucoma
- seizures
What is the MOA of Orlistat?
gastrointestinal lipase inhibitor; blocks absorption of ~1/3 of dietary fat from the GI tract
What are the 2 brand names for Orlistat?
Rx: XENICAL
OTC: ALLI
What are SEs to Orlistat?
- gas
- oliy spotting
- oily/ fatty stool
- fecal incontinence, urgency, frequency
How are SEs with Orlistat managed?
adhering to low-fat diet that contains an average of 15g / meal
What are important patient counseling points for Orlistat?
- multivitamin containing ADEK taken > 2h before, after Orlistat, or at bedtime
- separate Orlistat and levothyroxine by 4 hours
- INR may increase when taking warfarin
What is the MOA of Phentermine/ Topiramate (QSYMIA)?
Topiramate: unknown nut appears to suppress appetite and enhance satiety
How must Qsymia be dosed?
start treatment with 3.75mg/ 23mg QD x 14 days then increase the dose slowly
Why should Qsymia be taken in the morning?
insomnia
What are CIs to Qsymia?
- pregnancy (birth defects)
- glaucoma
- hyperthyroidism
What is the MOA of Naltrexone/ Bupropion ER (CONTRAVE)?
affects the hypothalamus and mesolimbic dopamine circuit involved in regulation of food intake
What is the dosing schedule for Contrave?
Week 1: 1 tab qam
Week 2: 1 tab qam and 1 tab 2pm
Week 3: 2 tabs qam and 1 tab qpm
Week 4 and beyond: 2 tabs qam and 2 tabs qpm
What are the BBWs for contrave?
Suicidality
Neuropsychiatric events
What are CIs to Contrave?
- seizure disorders
- anorexia/bulimia
- abrupt D/C of alcohol, benzos, barbs, or antiepileptic drugs
- use of other bupropion products
- chronic opioid use (none in the last 7-10 days)
What are warnings for contrave?
- should not be taken with high-fat meals
- risk of hepatotoxicity
What is the MOA of Liraglutide (SAXENDA)?
GLP-1 receptor agonist; regulates appetite and calorie intake
How is SAXENDA administered?
SQ in abdomen, thigh, upper arm
How is saxenda dose increased?
4 week dosage escalation to minmize GI symptoms; max 3.0mg/day
What are common SEs with SAXENDA, WEGOVY, and ZEPBOUND?
- N/V/D
- constipation
- dyspepsia
- abdominal pain
What are CIs with saxenda, Wegovy, and Zepbound?
personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2
What BBW does Saxenda and Wegovy have?
risk of thyroid C-cell tumors , including medullary thyroid carcinoma
What are warnings with Saxenda?
acute pancreatitis
acute gallbladder disease
suicidal behavior/ ideation
What is different between Saxenda and Semaglutide (WEGOVY) dosing?
SAXENDA: daily dosing
WEGOVY: weekly dosing
How is WEGOVY dose increased?
over 16 weeks to minimize GI symptoms
What are warnings with WEGOVY and ZEPBOUND?
Acute pancreatitis
Acute gallbladder disease
What is the MOA of Tirzepatide (ZEPBOUND)?
GIP (glucose-dependent insulinotropic polypeptide) receptor agonist AND GLP-1 receptor agonist
How is Tirzepatide dosed?
weekly
What are BBWs with Tirzepatide?
- risk of thyroid C-cell tumors , including medullary thyroid carcinoma
- personal or family history of multiple endocrine neoplasia syndrome type 2
