Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Obesity Medicine > Obesity Medications > Flashcards

Obesity Medications Flashcards

1
Q

What medication was discontinued in 1997? Why?

A

Fen-Phen combination pills which was discontinued due to rare but serious valvular heart disease and pulmonary HTN. However, these effects were isolated to the other component of the medication (Fenfluramine which had non selective 5-HT activity) and has not been reported with Phentermine alone. However, there remains significant unfounded stigma surrounding Phentermine due to its association with this medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Use of Metformin for weight loss in non-diabetics

A

Off label indication as not FDA approved

Study gave non-diabetic patients 2200-2500 mg per day total and average weight loss was ~6kg

Getting to that dose is a bit awkward. Could do 875 TID or add an extra half dose of 1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The difference between Alli and Xenical

A

Alli is OTC and 1/2 the dose of prescription strength Xenical

Xenical costs about 10 times as much

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Side effects with Topiramate

A 
Change in taste (primarily soda)
Dizziness
Drowsiness
Forgetfulness 
Paresthesias (transient and seen in ~30%of patients)
Nausea
Abdominal pain
Diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

1/2 life for Phentermine

A

Longer-acting medication. Half-life 20 hours, with peak effect at 4 hours. This is why it is typically dosed in the morning

Diethylpropion works similarly, but only lasts ~5 hours and has to be dosed multiple times a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

This med can cause false positive amphetamine testing

A

Contrave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Phentermine addiction potential? What level DEA schedule is it?

A

DEA schedule IV controlled substance (Need to review EFORSCE first), even though studies show no evidence of addictive potential, cravings, or withdrawal with this medication (unlike other medications in the class)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

This medication can cause emergent priapism

A

Lorcaserin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mechanism of action for Orlistat

A

Pancreatic lipase inhibitor, prevents absorption of about 30% of ingested fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What obesity med was recently pulled from the market by FDA due to concerns about cancer

A

Lorcaserin/Belviq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If patient is possible candidate for future bariatric surgery, what should you keep in mind when considering weight loss medications

A

People who are on the border of qualifying for weight loss surgery might lose enough weight with meds to no longer meet criteria for more effective bariatric surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The cheapest and most widely available form of phentermine is? How much does it cost?

A

37.5mg tablets with a score down the middle.

About $10 for 30 at Publix

Capsules r more expensive, hard to find, and can’t be cut in half

Lomaira costs about $30 for 90 8mg tabs

There is an ODT version that costs ~$300

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Weight loss meds that require titrating the dose

A

Qysmia
Contrave
Liraglutide

In some cases Phentermine and Metformin

Don’t need to titrations Belviq or Orlistat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

This medication can increase risk of seizures with abrupt withdrawal

A

Topiramate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

BMI criteria for starting weight loss medications?

A

BMI ≥ 30 or BMI ≥ 27 with co-morbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cost of Bupropion with Good Rx coupon

A

~$20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Weight loss med(s) which effect serotonin levels

A

Lorcaserin
Zonisamide
Fenfluramine (Taken off the market)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The best weight loss med for patients who also have Migraines

A

Topamax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Weight loss medication to avoid in patients with history of bulimia or anorexia

A

Bupropion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The best weight loss med for patients who also have Pre-diabetes/diabetes

A

Metformin

Liraglutide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Weight loss medications that are off label

A
  • Phentermine (and other sympathimemetics) for long term use
  • Topiramate by itself
  • Generic combination of Phen and Top rather than approved (more expensive) Qysmia
  • Metformin
  • Bupropion by itself
  • Generic combination of Naltrexone and Bupropion rather than approved (more expensive) Contrave
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

These medications are taken TID with meals

A

Orlistat
Lomaira
Diethylpropion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

This weight loss medication is free at Publix

A

Metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Preferred weight loss medication for patients with significant cravings

A

Contrave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
This oral weight loss medication does not have any dose titration
Lorcaserin
26
Preferred weight loss med in obese patients who smoke
Bupropion
27
Contraindications to Phentermine use
Relative contraindications = uncontrolled HTN, CAD, hyperthyroidism, substance abuse, glaucoma, pregnancy, renal disease, and seizure disorder
28
This medication has been shown to have ASCVD benefit (at least in diabetes)
Liraglutide
29
This medication is probably the least effective as far as average weight loss
Orlistat
30
Mechanism of Setmelanotide
MC4R agonist for treatment of POMC Def
31
This medication has the same mechanism as Phentermine
Diethylpropion. Rarely used now Way shorter half life than Phentermine so taken TID
32
Systemic absorption of this medication is minimal
Orlistat
33
This condition in female patients is a contraindication to all the weight loss medications
Pregnancy
34
Effect of Bupropion on anxiety
Can worsen anxiety and cause agitation, but not a clear contraindication
35
How do you treat POMC deficiency
Setmelanotide is an MC4R agonist for the treatment of POMC deficiency
36
Weight loss medications which are controlled substances
Phentermine/Qysmia Lorcaserin/Belviq Diethlpropion
37
If you start lower dose Phentermine and have some effect but don’t reach goal, what steps can you take to titrate up effect?
Can increase to a max dose of 37.5mg tab once per day Many like to start with generic Phentermine and then later add generic Topiramate if needed to mimic Qysmia. Effect is synergistic, not just additive
38
Dosage of Topiramate
In Qysmia is 23mg ER —> titrations up to 46 or 94 Topiramate ER QD is $400-700 per month Topiramate BID is available for about $10. Starting dose for other conditions is 25-50mg BID
39
Preferred med for sleep related eating disorder
Clonazepam
40
The only FDA approved weight loss medication that is available over the counter
Alli (Orlistat)
41
Titration and dosages of Qysmia
Phentermine-Topiramate 3.75-24 7. 5-46 (suggested dose) 11. 25-69 15-92 (high dose) All QD Spend at least 14 days at each dose before increasing
42
These weight loss medications may be best for patients with chronic constipation
Orlistat | Metformin
43
This weight loss medication can not be combined with antidepressants
Lorcaserin
44
Contraindications to Metformin
Severe heart failure and severe CKD Caution in liver disease and alcohol abuse
45
The medication that has the biggest average weight loss
Qysmia Liraglutide is prob second best
46
This weight loss medication causes nasopharingitis
Lorcaserin
47
Are Topamax neurological side effects self limited?
Tingling tends to be self limited and may not necessarily be an indication to stop the medication. Cognitive side effects are not self limited and therefore the Med should be stopped
48
Women with PCOS should be warned about this possible adverse effect of weight loss medications?
Pregnancy as become more regular
49
The bioavailability of this Med can be dangerously increased if taken with a high fat meal
Contrave
50
Injectable obesity medication
Liraglutide
51
The trade names for Orlistat
Alli and Xenical
52
Contraindications for Lorcaserin
Already on antidepressant, eGFR <30, on viagra, sickle cell (predisposed to priapism), or valvular heart disease
53
You should take this with Orlistat
Multivitamin (due to risk of fat soluble vitamin deficiency) Fiber/Psylium supplement (to decrease side effects)
54
These weight loss meds can cause seizures
Bupropion/Contrave Stopping Topamax suddenly can also cause seizures Book said Phentermine, but Epocrates doesn’t
55
Trade name for low dose Phentermine taken with each meal
Lomaira
56
Difference between Saxenda and Victoza
Saxenda is about double the dose, but same med
57
These weight loss medications are sympathomimetics that stimulate the sympathetic nervous system directly
Phentermine Diethylpropion Indirectly other meds activate the sympathetic nervous system through intermediates like POMC
58
Patients taking this weight loss medication should also take a multivitamin
Orlistat
59
At this point in time, patients weight loss tends to plateau on a given medications
6-9 months
60
These meds should not be taken alongside Phentermine
Linezolid MAOIs Other stimulants (such as ADHD meds)
61
Generic name for Saxenda
Liraglutide
62
The most teratogenic weight loss medication
Topamax/Qysmia
63
Saxenda dosing
Titrated over 5 weeks = 0.6mg SC x 7 days --> 1.2mg SC x 7 days --> 1.8mg SC x 7 days --> 2.4mg SC x 7 days --> 3.0mg SC maintenance dose
64
Preferred weight loss Med for patients with chronic migraines
Topamax
65
Naltrexone use for weight loss on its own
Not really done on its own. Thought to augment effects of other medications
66
The trade name for Lorcaserin
Belviq
67
Stimulant similar to Phentermine which is much less commonly used now
Diethylpropion
68
Dual Efficacy weight loss medications
* Bupropion for depression and smoking cessation * Metformin for pre-diabetes/diabetes and PCOS * Liraglutide for DM * Topiramate for seizures and migraines
69
Mechanism of Action for Liraglutide/Saxenda
GLP-1 agonist delays gastric emptying Activates POMC and inhibits NPY
70
These medications activate POMC
Liraglutide/Saxenda Lorcaserin/Belviq Bupropion (And combo Contrave) Phentermine (and combo Qysmia) Basically everything other than orlistat
71
Contrave side effects
Gastrointestinal symptoms are common with naltrexone/bupropion. Up to one in three patients will report nausea and 19% will experience constipation, especially early in treatment. Headache, dizziness, and sleep disorders are also common. In premarketing studies, about 20% of patients discontinued treatment because of adverse effects.
72
Long term use of this weight loss specific medication is off label?
Prescribing for more than three months of Phentermine is considered “off label.” Generic so nobody is gonna study it. There is abundant experience and observational literature demonstrating the safety and efficacy of these drugs well beyond twelve weeks and Qysmia is a combination medication with phentermine in it which. If that is safe long term, phentermine alone must be too
73
The best weight loss med for patients who also have PCOS
Metformin
74
Obesity medications to avoid in patients with Glaucoma
Phentermine | Bupropion
75
Effect of Naltrexone on POMC
Prevention of autoinhibition of POMC
76
Use of Bupropion for weight loss without mental health indication
Off label cuz not FDA approved. Have been studies that show about 10% weight loss
77
Mechanism of Phentermine
Reduced reuptake of catecholamines (mainly norepinepherine from hypothalamus) Activates POMC
78
Most common side effects with Loracaserin? Rare but severe adverse reactions?
Headache and dizziness Suicidal ideation/worsening depression, priapism, hypoglycemia when combined with insulin, and possibly increased risk of valvular regurg (debatable)
79
Mechanism of action for Topiramate
GABA receptor modulator
80
Weight loss med(s) which effect norepinepherine levels
Phentermine | Bupropion
81
Contrave dosing
Naltrexone-Bupropion 8 mg-90 mg ER in each tab. Titrate number of tabs, not the dose. 1 AM x 7 days --> 1 AM 1 PM x7 days --> 2 AM 1 PM x 7 days --> 2 AM 2 PM x 7 days
82
Med that should not be used in a patient at risk for abrupt opioid or alcohol withdrawal
Contrave/Bupropion due to lower seizure threshold But substance abuse is really a relative contraindication for all the weight loss meds
83
Trade name of Pranlintide
Symlin
84
Mechanism of Pranlintide (Symlin)
Amylin which Antagonize glucagons action in the liver Diabetic medication with some weight loss
85
Generally speaking, you can expect this % of weight loss with a weight loss medication
8-15% (this number doesn’t have placebo effect removed)
86
Weight loss med(s) which effect dopamine levels
Bupropion | Zonisamide
87
What is the most commonly used weight loss medication?
Phentermine
88
Contraindications for Saxenda/Liraglutide
Medullary Thyroid Cancer, personal or family history of MEN, history of pancreatitis
89
This medication used off label for weight lose is also sometimes used off label for tremor
Topiramate
90
Contraindications to Orlistat
Pregnancy, Malabsorptive syndromes, severe liver disease, history of oxalate kidney stones, and cholestasis
91
This medication should be taken in the morning
Phentermine
92
Expected weight loss for Phentermine?
Don’t have specific numbers for expected weight loss as it was only studied for short term, but appears to be in the ball park of other medications
93
Mechanism of Zonisamide
Activation of serotenergic and dopaminergic pathways
94
Risk Evaluation and Mitigation Strategy’s (REMS) is required for which meds
Saxenda (Pancreatitis and MEN1) Qysmia (teratogenic) Really optional not required
95
Saxenda adverse effects
Nausea and vomiting common (about 40%) Can have other GI side effects too such as abdominal pain, diarrhea/constipation ... Headache and dizziness less common Rare but severe side effects include medullary thyroid cancer and pancreatitis
96
Dosages and formulations of Belviq
Don’t titrate. Either get 10mg of Belviq (immediate release) BID or 20mg ER QD of Belviq XR
97
Preferred weight loss med for obese patient with depression
Bupropion Can’t use Lorcaserin/Belviq if already on another depression Med
98
Which FDA approved weight loss medication is probably the safest overall
Orlistat. Longer studies, less significant side effects, and fewer contraindications
99
Mechanism of action for Loracaserin
Selective serotonin 5-HT2C receptor agonist in the hypothalamus promoting satiety —> activates POMC Fenfluramine was non-selective
100
What medication is FDA approved for treating bulimia
Fluoxetine is FDA approved, while all SSRIs are effective Topamax and Trazadone are used off label to treat
101
Phentermine adverse reactions
Dry mouth (weak anticholinergic), Insomnia, palpitations, hypertension, tachycardia, and headaches (can worsen underlying migraines)
102
This medication is probably the least well tolerated
Orlistat
103
Only medication FDA approved for use in Binge Eating Disorder with obesity? Other options?
Lisdexamfetamine (FDA approved) Topamax or Zonisamide (antiepileptic)
104
This currently available medication is most similar to Fenfluramines mechanism of action
Lorcaserin/Belviq (is more selective than fenlfuramine) Phentermine was in combo with fenfluramine, but works differently
105
This is the only weight loss medication that is safe to use during pregnancy
Metformin
106
Timing of taking weight loss meds with and without food
Orlistat is with food Others doesn’t matter
107
Outcome changes with weight loss medications
Opponents of the use of weight loss meds argue that the studies on these meds have flaws including short duration, lack of head to head comparison, high attrition rates, and inadequate reporting of clinical outcomes such as cardiovascular outcomes. However, there is data to show clinically significant changes in BP, Lipids, HbA1c etc with many of the obesity medications.
108
Bupropion mechanism
Norepi and dopamine uptake inhibitor Activates POMC
109
The best weight loss med for patients who also have Seizures
Topamax
110
Treatment of night eating syndrome
Progressive Muscle Relaxation Sertraline. Topamax is also an option
111
Obesity Medicines which can worsen BP
Bupropion/Contrave | Phentermine/Qysmia
112
Per FDA, you should stop obesity medications after this amount time if weight loss is < than this %?
If 5% weight loss is not achieved at 12 weeks while at max dose the drug should be discontinued for lack of effectiveness.
113
Weight loss medications approved for pediatric patients
Orlistat is approved for ages 12 and up Phentermine is approved for ages 16 and up Metformin is approved for ages 10 and up, but not for obesity alone. Need insulin resistance or PCOS for it to not be “off label”
114
This weight loss medication is contraindicated for patients on chronic opioids
Contrave
115
These medications should be used with caution in patients with a history of nephrolithiasis
Topamax | Orlistat
116
This medication can lessen the Euphoric effects of alcohol
Contrave/Naltrexone

Obesity Medicine (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions