Obesity tx Flashcards
indications for pharmacotherapy for weight loss
BMI 27-29.9 + Co morbidities
Antidiabetic medications
sulfonureas
insulin
TZDs
Meds that may promote weight gain
- anti-diabetic meds
- mood stabilizers, antipsychotics
- birth control pills (Depo)
- Glucocorticoids: prednisone
Phentermine
Increases NE content in brain
CHEAPEST
FDA aproved for only 3 mo use
5-8% weight loss
Side effects: HTN, headache, Nervousness
NO SERIOUS LONG TERM SIDE EFFECTS
Most widely prescribed med for anti obesity
Phentermine
Orlistat
pancreatic lipase inhibitor
inhibits fat absorption by 30%
- cost $100/mo
SAFEST
GI side effects: oily stools (1/3 of the fat in your meals goes out in your poo), urgency
Multivitamine recommended to prevent fat soluble vitamin deficiency
Lorcasarin
Serotonin 2C receptor agonist (only in brain, not heart)
LEAST SIDE EFFECTS
- min headache, dizziness, nausea
- Cost$220/mo
Phentermine/Topiramate
Combo gives greater efficacy w/ fewer side effects MOST EFFECTIVE (10-12%)
Side effects: dry mouth, paresthesias, insomnia, dizziness, anxiety, irritability and disturbance in attention
Associated with BIRTH DEFECTS - get preggo test
Naltrexone/Bupropion
Bupropion stimulates hypothalamic POMC neurons and reduces food intake
Naltrexone blocks opioid receptor - alters reward pathways
INTERMEDIATE IN EFFECTIVENESS AND SIDE EFFECTIVENESS
Worrisome side effects:
Increase BP + pulse
Lower seizure threshold
suicidal ideation (balck box)
CATEGORY X PREGNANCY
WEight loss drugs to avoid in pregnancy
Phentermine/Topiramate
Naltrexone/Bupropion
INTERMEDIATE IN EFFECTIVENESS AND SIDE EFFECTIVENESS
Naltrexone/Bupropion
MOST EFFECTIVE (10-12%) but cost alot
Phentermine/Topiramate
LEAST SIDE EFFECTS (modestly effective)
Lorcasarin
SAFEST, but limited weight loss and costly
Orlistat (xenical)
CHEAPEST, but not approved for long term use
Phentermine