Obesity Pharm

Question 1

current FDA requirements for anti-obesity medications

Answer 1

decrease weight >5% in 12 months
OR
35% of participants must lose >5%
and need evidence for improvement in comorbidities

Question 2

pt criteria for prescribing anti-obesity medications

Answer 2

1. BMI >30
   OR
   BMI >27 and at least one concomitant obesity-related risk factor or disease
2. pts are willing to take medication in conjunction w/ overall weight management program (diet and exercise)
3. realistic expectations of medication therapy (10-15% weight loss is excellent)

Question 3

Orlistat

Answer 3

prevents absorption of fats; inhibits gastric and pancreatic lipases –> TGs excreted undigested
SE: GI, “adversion therapy”

Question 4

Phentermine

Answer 4

appetite suppressant: stimulates neurons to release dopamine and norepinephrine
catecholamine elevation –> increased leptin and decreased neuropeptide Y
SE: like an amphetamine

Question 5

Qsymia

Answer 5

amphetamine + topiramate

Reg cat X

Question 6

Lorcaserin

Answer 6

specific agonist of 5HT-2C serotonin receptor –> suppress appetite, increase satiety
mild weight loss (4-5% in a year)
SE: few, headache
- avoids side effects assoc w/ other serotonin agonists (5HT-2A - hallucinogenic; 5HT-2B - valvulopathy)

Question 7

Liraglutide

Answer 7

Saxenda
GLP-1 agonist: potentiates glucose-mediated insulin secretion, suppression of postprandial glucagon release, delays gastric emptying, CNS-mediated loss of appetite
Pros: 5-10% weight loss
Cons: SC injection, expensive, SEs nausea and diarrhea, bb warning for thyroid c-cell tumor risk

Question 8

contrave

Answer 8

bupropion + naltrexone

makes food less rewarding, decreases pleasure of food and alcohol

Question 9

empatic

Answer 9

bupropion + zonisamide
zonisamide: approved anticonvulsant similar to topiramate in MOA
in phase III trials