Obesity medications

Question 1

Phentermine. Cost? Weight loss potential? How commonly prescribed?

Answer 1

CHEAPEST drug ($20/mo)
5-8% weight loss
Only effective as long as you take it
MOST COMMONLY PRESCRIBED (FDA approved for 3 months only, but ppl prescribe for life anyway b/c no harm)

Question 2

What are the side effects of phentermine? What is the mechanism?

Answer 2

Side effects relate to mechanism. PHentermine is a non-addictive stimulant.
HTN
Headache
Nervousness

Question 3

Orlistat. Mechanism? Cost? What is the MAIN BENEFIT? Weight loss expected?

Answer 3

Pancreatic Lipase inhibitor that inhibits fat absorption.
$100/month at a minimum.
SAFEST MEDICATION. SO SAFE CAN BUY OTC.
5-8% weight loss

Question 4

What are the side effects of orlistat?

Answer 4

Steatorrhea (urgency, diarrhea)

Question 5

Lorcasarin. Mechanism? MAIN BENEFIT? Cost? Weight loss potential?

Answer 5

Serotonin 2C receptor agonist (similar to fenfluramine [of phen-fen notoriety) but the 2C receptor is only present in the brain, not the heart.
FEWEST SIDE EFFECTS (dizziness, headache, nausea)
$220/mo
4-5% weight loss potential

Question 6

Phentermine/Topiramate combination. Efficacy? Cost? Other benefits besides weight loss?

Answer 6

$150/mo
Reduces HTN, glucose, triglycerides, raises HDL
10-12% WEIGHT LOSS. THIS IS THE MOST EFFECTIVE MEDICATION AVAILABLE.

Question 7

Side effects of phentermine/topiramate? MAIN RISK?

Answer 7

Paresthesias.

CONTRAINDICATED IN PREGNANCY. MUST USE BIRTH CONTROL CONCURRENTLY. Pregnancy test every month.

Question 8

Naltroxone SR/Bupropion SR. Mechanism? Cost? Efficacy?

Answer 8

Naltrexone blocks reward pathways. Buproprion stimulates POMC neurons reducing food intake.
$200/mo
Intermediate efficacy.

Question 9

Naltroxone SR/Bupropion SR. Side effects?

Answer 9

Increased BP
Decreased seizure threshold.
Category X pregnancy.

Question 10

What is the benchmark weight loss that should cue physicians to stop a medication?

Answer 10

Less than 5% weight loss at 3 months? Stop the medication. It’s not working.

Question 11

Efficacy of Lap band?

Answer 11

20% weight loss. Almost no mortality in the short term.

Question 12

Efficacy of sleeve gastrectomy?

Answer 12

25% weigh loss. Very few risks.

Question 13

Efficacy of Gastric bypass?

Answer 13

30% weight loss. Risk of mortality 0.2%.

Question 14

Who is a good candidate for bariatric surgery?

Answer 14

BMI >35 w/ comorbidities

BMI >40 w/o comorbidities

Question 15

Bariatric surgery may decrease your A1c. T/F

Answer 15

True

Question 16

Bariatric surgery may decrease your lifetime risk of cancer?

Answer 16

True

Question 17

What are the major EARLY risks of bariatric surgery?

Answer 17

PE, bowel perforation, Thiamine deficiency

Question 18

What are the major LATE risks of bariatric surgery?

Answer 18

B12 deficiency. JUST GIVE IT TO ANYONE with a surgery. 
Iron deficiency (particularly in women)
Vitamin C/D (osteoporosis)

Bottom line–> check these levels when you see them, and they likely need supplementation

Question 19

Surgery is the best treatment for type 2 diabetes. True or false.

Answer 19

True.