Obesity Pharmacotherapy Exam 3 Flashcards

1
Q

What are the medications associated with weight gain?

A
  • Anticonvulsants (e.g. carbamazepine, gabapentin, pregabalin, valproic acid)
  • Antidepressants (e.g. mirtazapine, tricyclics)
  • Atypical antipsychotics (e.g. clozapine, olanzapine, quetiapine, risperidone)
  • Conventional antipsychotics (e.g. haloperidol)
  • Hormones (e.g. corticosteroids, insulin, medroxyprogesterone)
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2
Q

What should be done with the patient before initiation pharmacotherapy of obesity?

A
  • Assess readiness to engage in weight loss efforts and identify potential barriers
  • Educate on potential health consequences of excessive body weight
  • Discuss risks of therapies
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3
Q

What are the different type of treatment options?

A

– Comprehensive lifestyle intervention
– Pharmacotherapy
– Implantable medical devices
– Bariatric surgery

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4
Q

When should pharmacotherapy of obesity be initiated?

A
  • have failed to achieve/sustain weight loss with lifestyle alone
  • BMI >= 30 kg/m2
  • BMI >= 27 kg/m2 with > 1 comorbidity
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5
Q

Phentermine brand name

A

Adipex-P

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6
Q

When should phentermine be discontinued?

A

if tolerance develops

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7
Q

What can happen if you d/c phentermine abruptly?

A
  • can cause caused extreme fatigue and depression

- will want to taper it off

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8
Q

CI to phentermine

A

– Cardiovascular disease
– Hyperthyroidism
– Substance abuse
– Glaucoma

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9
Q

Precautions in phentermine

A

– Renal impairment

– CNS depressants

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10
Q

phentermine drug interactions

A
  • do not use with SSRI’s

- interaction with MAOI

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11
Q

patient education for phentermine

A

administer before breakfast or 1-2 hours after breakfast

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12
Q

orlistat brand name

A
  • Xenical (Rx)

- Alli (OTC)

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13
Q

orlistat monitoring

A

s/s of liver toxicity and obtain LFTs if symptoms occur

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14
Q

orlistat patient education

A

– Take during or up to 1 hour after meal.
– Skip dose if meal skipped or contains no fat
– Supplement with MVI 2 or more hours before or after orlistat to prevent vitamin deficiency

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15
Q

lorcaserin brand name

A

Belviq (XR)

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16
Q

orlistat drug interaction

A
  • warfarin

- decrease absorption of oral drugs

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17
Q

lorcaserin precautions

A

– Moderate renal impairment and severe hepatic impairment
– Increased risk of serotonin syndrome if used with other serotonergic or dopaminergic medications
– Valvular heart disease

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18
Q

lorcaserin monitoring

A

– CBC
– depression or suicidal thoughts
– s/s serotonin syndrome
– s/s vavlular disorder (based on history with fenfluramine)

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19
Q

lorcaserin drug interactions

A

may increase levels of drugs metabolized by 2D6 (dextromethorphan, paroxetine, sertraline, risperidone, metoprolol)

20
Q

phentermine and topiramate brand name

A

Qsymia

21
Q

phentermine and topiramate dosing

A

– 3.75/23 mg PO daily x 14 days, then increase to 7.5/46 mg daily
– If 3% weight loss not achieve by week 12, increase to max dose of 15/92 mg PO daily
– If discontinue, gradually taper to prevent possible seizure

22
Q

phentermine and topiramate contraindications

A

– pregnancy (REMS program requires negative pregnancy test before initiation and monthly during therapy)
– glaucoma
– Hyperthyroidism
– Cardiovascular disease

23
Q

phentermine and topiramate precautions

A

Use reduced dose in moderate-severe renal and moderate hepatic impairment

24
Q

phentermine and topiramate drug interaction

A

– MAOI inhibitors
– CNS depressants
– Carbonic anhydrase inhibitors

25
Q

phentermine and topiramate monitoring

A

– Pregnancy
– check at baseline and monthly thereafter
– s/s of depression or suicidal thoughts, sleep disorders
– Heart rate
– Electrolytes and creatinine at baseline and during therapy

26
Q

phentermine and topiramate patient education

A

– Take in morning to avoid insomnia

– Ensure adequate fluid intake reduce risk of kidney stones

27
Q

bupropion and naltrexone brand name

A

Contrave®

28
Q

bupropion and naltrexone contraindications

A

– Chronic opioid or opiate agonist therapies
– Seizures
– MAO inhibitors

29
Q

bupropion and naltrexone precautions

A

– Use reduced dose in moderate-severe renal impairment and hepatic impairment
– Lowers seizure threshold
– Rare reports of hepatotoxicity

30
Q

bupropion and naltrexone titration

A
  • exists
  • 8/90 mg PO daily x 1 week, 8/90 mg PO BID x 1 week, 16/180 mg PO in AM and 8/90 in PM x 1 week, then 16/180 mg (2 tabs) PO BID
31
Q

bupropion and naltrexone drug interactions

A

– May increase levels of drugs metabolized by 2D6 (e.g. paroxetine, sertraline, risperidone, metoprolol)
– Inhibitors or inducers of 2B6 might increase or decrease levels of bupropion (e.g. rifampin, carbamazepine)

32
Q

bupropion and naltrexone monitoring

A

– Heart rate and blood pressure at baseline and periodically throughout
– s/s of seizures mania, suicidal thoughts

33
Q

bupropion and naltrexone patient education

A

do not take with a high-fat meal

34
Q

liraglutide titration

A

– exists
– 5-week titration schedule to reduce GI adverse effects
– 0.6 mg SC daily x 1 week, 1.2 mg x 1 week, 1.8 mg x 1 week, 2.4 mg x 1 week, then 3 mg daily thereafter

35
Q

liraglutide contraindication

A

personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2

36
Q

liraglutide precaution

A

Moderate and severe renal and hepatic impairment

37
Q

liraglutide brand name

A

Saxenda®

38
Q

liraglutide monitoring

A

– Monitor glucose and adjust diabetes medications as necessary
– s/s of thyroid tumors
– s/s of pancreatitis.
– Heart rate

39
Q

liraglutide patient education

A

Proper technique for injection into subcutaneous of abdomen, thigh, or upper arm

40
Q

What are usual things to monitor for for an obese patients especially on these medications?

A
  • BMI
  • Weight
  • WC
  • BP
  • Medication tolerability
  • Medication and lifestyle adherence
  • Glucose and A1c if have diabetes
  • Lipids
41
Q

What happens after bariatric surgery?

A
  • Monitor medications and medical conditions after surgery
  • For up to 2 months post-op, all meds should be given in a liquid dose form, a crushed tablet, an opened capsule, or non-oral dose form
  • Consider reducing or stopping meds for diabetes, hypertension, GERD
  • Avoid enteric coated or extended-release meds for all acutely and long-term after Roux-en-Y gastric bypass
  • Avoid sorbitol and other nonabsorbable sugar due to increased risk of dumping syndrome
  • Recommend contraception for 1-2 years after surgery
  • Avoid GI irritants such as oral NSAIDs and bisphosphonates
  • Increase monitor especially of narrow therapeutic index drugs and adjust dose as indicated
  • Watch for transition to other addictive behaviors
  • Empiric supplementation with MVI plus minerals, calcium, vitamin D, folic acid, thiamine, iron, B12
  • Emphasize lifelong adherence to vitamin and mineral supplements
42
Q

PPCP: Collect

A
  • Patient characteristics (e.g., age, race, sex)
  • Patient history (past medical, family, social—dietary habits, tobacco use)
  • Obesity-related conditions
  • Current medications including prescription, nonprescription, and herbal product use
  • Weight loss history and prior attempts to lose weight
  • Objective data
43
Q

PPCP: Assess

A
  • Presence of secondary obesity (e.g., hypothyroidism, Cushing syndrome)
  • Current medications that may contribute to weight gain
  • Presence of obesity-related comorbidities (e.g., hypertension, dyslipidemia, coronary artery disease, type 2 diabetes mellitus, sleep apnea, increased waist circumference)
  • Class of overweight and obesity determined by BMI, waist circumference, and obesity-related comorbidities)
  • Readiness to engage in weight loss efforts and potential barriers to success
  • Candidacy for treatment with implantable medical devices, bariatric surgery, or pharmacotherapy
44
Q

PPCP: Plan

A
  • Nonpharmacologic lifestyle intervention including low-calorie diet, physical activity, and behavioral modifications
  • Pharmacotherapy (if appropriate) including specific medication, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies
  • Initial weight loss goal of 5% to 10% over a 6-month time period
  • Monitoring parameters including efficacy (weight loss) and tolerability (medicationspecific adverse effects)
  • Patient education (e.g., purpose of dietary and lifestyle modification, drug therapy)
  • Self-monitoring of weight—when and how to record results
  • Referrals to other providers when appropriate (e.g., physician, dietician, psychologist)
45
Q

PPCP: Implement

A
  • Educate patient regarding health risks associated with overweight and obesity
  • Provide patient education regarding all elements of treatment plan
  • Use motivational interviewing and coaching strategies to maximize adherence
  • Schedule follow-up (e.g., monthly for first 3 months and every 3 months thereafter)
  • Collaborate with patient, caregiver, and health care providers
46
Q

PPCP: Follow-up: Monitor & Evaluate

A
  • Determine weight loss goal attainment
  • Presence of adverse effects
  • Patient adherence to treatment plan using multiple sources of information