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Pharmacotherapy 1 > Overweight and Obesity > Flashcards

Overweight and Obesity Flashcards

1
Q

What are some medical conditions that can contribute to overweight and obesity?

A

depression
growth hormone deficiency
Cushing syndrome
polycystic ovary syndrome

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2
Q

What are some medications categories that can contribute overweight and obesity?

A 
anticonvulsants
antidepressants
atypical antipsychotics
 conventional antipsychotics
hormones
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3
Q

What are some examples of antipsychotics that cause wt gain?

A

carbamazepine
gabapentin
pregabalin
valproic acid

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4
Q

What are ome examples of antidepressants taht cause wt gain?

A

mirtazapine

tricyclic antidepressants

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5
Q

What are som examples of atypical antipsychotics that cause wt gain?

A

clozapine
olanzapine
quetiapine
risperidone

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6
Q

What are some examples of conventional antipsychotics that cause wt gain?

A

haloperidol

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7
Q

What are some examples of hormones that cause wt gain?

A

corticosteroids
insulin
medroxyprogesterone

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8
Q

What are the waist circumference thresholds for abdominal fat content?

A

> 88 cm for females

>102 cm for males

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9
Q

What does an increased waist circumference indicate?

A 
elevated risk of:
HTN, 
dyslipidemia
type 2 DM
CVD
all-cause mortality
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10
Q

What are indications for weight loss?

A

obese BMI>30kg/m^2

overweight BMI>25kg/m^2 w/ at least one risk factor

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11
Q

What is the goal reduction in body wt for wt loss therapy?

A

initial goal is 5-10% over 6 mos

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12
Q

What are some appropriate prescribed calorie intake for wt loss?

A

1200-1500 kcal/d for women

1500-1800 kcal/d for men

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13
Q

What are the critera for bariatric surgery?

A

BMI >= 40 or >= 35 w coexisiting conditions AND motivated to lose wt AND have not responded to behavioral treatment w/ or w/o pharmacotherapy

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14
Q

What is the avg wt loss w bariatric surgery?

A

50% of BW

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15
Q

What are potential complications of bariatric surgery?

A 
wound infection
GI leaks
DVT
depression
cholecystitis
Fx
vitamin def
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16
Q

What are Rx therapy options for wt loss?

A 
CNS stimulants
lipase inhibitors
serotonin 5-HT2C REceptor agonists
sympathomimetic and anticonvulsants
opiod antagonist and dopamine norepinephrine reuptake inhibitor
GLP-1 agonist
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17
Q

What are CNS stimulants that can be used for short-term wt loss?

A 
Phentermine: Adipex-P, Lomaira
Methamphetamine: Desoxyn
Phendimetrazine: generic
Benzphetamine: Regimex
Diethylpropion; generic only
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18
Q

What are lipase inhibitors that can be used for wt loss?

A

orlistat: Xenical or Alli

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19
Q

What are serotonin 5-HT2C receptor agonists that can be used for wt loss?

A

lorcaserin: Belviq

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20
Q

What are sympathomimetics and anticonvulsants used for wt loss?

A

phentermine and topiramate: Qsymia

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21
Q

What are opiod antagonist and dopamine/norepinephrine reuptake inhibitors used for wt loss?

A

naltrexone & buproppion ER: Contrave

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22
Q

What are GLP-1 agonists used in wt loss?

A

liraglutide: Saxenda

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23
Q

What are indications for Rx wt loss therapy?

A

BMI >=30 kg/m^2 OR BMI >=27 kg/m^2 w other risk factors

risk factors: HTN, DM, dyslip, etc.

did NOT lose wt or maintin wt loss w behavior intervention

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24
Q

What are the indications for CNS stimulants in wt loss?

A

adjunct to exercise, behav mod, caloric restriction in SHORT-TERM management (wk) of exogenous obesity

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25
Q

What is the mechanism of action of CNS stimulants in wt loss?

A

incr conc of NE to stimulate receptors in hypothalamus–>appetite suppression

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26
Q

What are SEs of CNS stimulants in wt loss?

A 
palpitation
tachycardia
incr BP
overstimx
restlessness
insomnia
tremor
dizziness
HA
euphoria
dysphoria
xerostomia
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27
Q

What wt loss medications are aproved by the FDA for chronic management of obesity?

A 
orlistat
lorcaserin
phentermine & topiramate
naltrexone & bupropion ER
liraglutide
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28
Q

What are the brand names of orlisat?

A

Xenical

Alli

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29
Q

Which wt loss med is available OTC?

A

Alli

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30
Q

What is the moa of orlisat?

A

reversibly inhibits gastric and pancreatic lipases, which allow abs of long-chain TGs

decr dietary fat abs by 30%

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31
Q

What is the dosing of Xenical?

A

120 mg po tid, take w/in 1 h of eating fat-containing meal

approved for pts >=12 yoa

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32
Q

What is the dosing for Alli?

A

60 mg orally tid, taken w/in 1 hr of eating fat-containing meal

approved for pts >=18 yoa

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33
Q

What is an important counseling point for lipase inhibitors for wt loss?

A

dose should be omitted if a meal is missed or does not contain any fat

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34
Q

What is the avg wt loss w orlistat above diet and exercise?

A

2.9-3.4 kg after 1 yr

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35
Q

What are special considerations for using orlistat?

A

sugg’d for pts w CVD

rec’d standard MVI

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36
Q

what are common adverse rxns to orlistat?

A

GI: oily spotting, abdominal pain/discomfort, flat w discharge, fecal urgency, fatty/oily stool, increased defectation

decreased abs of fat-soluble vits

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37
Q

What are contraindications for orlistat?

A

pregnancy
chronic malabs syndrme
cholestasis

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38
Q

What are some precautions or warnings for orlistat?

A

rare hepatotoxicity (dark urine, lack of appetite, dark stools)

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39
Q

Orlistat interacts w which drugs?

A 
cyclosporine
levothyroxine
MVI
warfarin
OC
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40
Q

How should cyclosporine be admin’d w orlistat?

A

3 hr p orlistate, monitor pt

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41
Q

How should levothyroxine be admin’s w orlistat?

A

admin >4 hr apart, monitor

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42
Q

How should MVI be admin’d w orlistat?

A

> 2 hr apart

rec MVI at bedtime

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43
Q

How should warfarin be admin’d w orlistat?

A

monitor INR

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44
Q

How should OC be admin’d w orlistat?

A

recommend use of back up contraceptive if pt experiences severe diarrhea.

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45
Q

What is the brand name for lorcaserin?

A

Belviq

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46
Q

What is the moa of lorcaserin?

A

selective activation of serotonin 5-HT2c reeptors in the hypothalamus–>satiety and decr food intake

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47
Q

What is the dosing of lorcaserin?

A

Belviq: 10 mg po bid
Belviq XR: 20 mg po d

can be taken w or w/o food

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48
Q

How should lorcaserin be used in renal impairment?

A

mod: caution

sev, ESRD: not rec’d

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49
Q

What is the avg wt loss w lorcaserin above diet and exercise?

A

3.6 kg after 1 y

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50
Q

What schedule is lorcaserin?

A

C-IV

pot for abuse and psychodependence

51
Q

What are common ADR for lorcaserin?

A

depression, memory lapses
dizziness, fatigue
HA
nausea, dry mouth, constipation

52
Q

What are contraindications for lorcaserin?

A

pregnancy

53
Q

What are precautions and warnings for lorcaserin?

A

psychiatric disorder
cardiac valvular disease–> reported w agonist activity at receptors in interstitial cardiac cells
CVD
priapism
pulmonary HTN
elevated serum prolactin level
serotonin syndrome/neuroleptid malignant syndrome-like rxns

54
Q

What durg classes does lorcaserin interact w?

A

serotonergic agents

CYP2D6 substrates

55
Q

What are examples of serotonergic agents?

A 
MAOIs
linezolid
SSRIs, SNRIs, TCAs
bupropion
lithium
tramadol
triptans
SJW
56
Q

What are the recommendation for serotonergic agent use with lorcaserin?

A

concomitant use should be avoided

57
Q

What is the brand name for penthermine/topiramate ER?

A

Qsymia

58
Q

What is the moa of phentermine/topiramate ER?

A

phenterine–sympathomimetic amine: reducing appetite through CNS effects (hypothalamus stim–>NE)

topiramate–anticonvulsants: mech unknown, thought to cause appetite suppression and enhance satiety

59
Q

What is the dosing for phentermine/topiramate ER?

A 
start: 3.75/23 mg po d
after 14 d: 7.5/46 mg po d
*if <3% wt lost, d/c or incr dose
after 12 wks: 11.25/69 mg po d
after 14 days: 15/92 mg po q
**if 5% of bseline not lost after 12 wks, gradulaly d/c
60
Q

When shold phentermine/topiramate ER be taken?

A

in morning to avoid insomnia

61
Q

How should phentermine/topiramate ER be dose in renal imp?

A

CrCl <50 mL/min: do not exceed p/t ER 7.5/46 mg po d

dialysis: not rec

62
Q

How should phentermine/topiramate ER be dosed in hepatic impairemtn?

A

mod: do not exceed 7.5/46 mg po daily
sev: not rec’d

63
Q

How should phentermine/topiramate ER be d/c’d?

A

gradually decr by taking qod for >1 wk prior to d/cing

Sz risk

64
Q

What is the avg wt loss for phentermine/topiramate ER above diet and exercise?

A

6.6-8.6 kg after 1 yr

65
Q

What are special consideration for dispensing phentermine/topiramate ER?

A

C-IV

must be distriuted by REMS-certified pharmacies

66
Q

What are common ADRs of phentermine/topiramate ER?

A 
constipation
dry mouth
paraesthesia
dysgeusia
dizziness, lightheadedness
blurry vision
insomnia
67
Q

What are contraindications to phentermine/topiratmate ER?

A 
pregnancy 
hyperthyroidism
glaucoma
use during or w/in 14 d following MAOI 
known hypersensitivity or idiosyncrasy to the sympathomimetic amines
68
Q

what are precautions/warnings for phentermine/topiramate ER?

A 
incr HR
suicidal behavior/ideation
mood and sleep disorders
cog impairment
kidney stones
acute myopia and secondary angle closure glaucoma
incr sCr
metabolic acidosis
decr NaHCO3 and K
69
Q

What drug classes does phentermine/topiramate ER interact with?

A 
combination OC
CNS depressants
alcohol
non-potassium sparing diuretics
antiepileptic drugs
carbonic anhydrase ihbitions
70
Q

How should combination OCs be admin’d w phentermine/topiramate ER?

A

counsel on potential for breathrough bleeding

rec back-up method

71
Q

How should CNS depressants be admin’d w phentermine/topiramate ER?

A

avoid combination, when possible

72
Q

How should alcohol be admin’d w phentermin/topiramate ER?

A

avoid alcohol intake

73
Q

How should non-potassium sparing diuretics be admin’d w phentermine/topiramate ER?

A

monitor for risk of hypokalemia

74
Q

How should carbonic anhydrase inhibitors be admin’s w phentermine/topiramate ER?

A

avoid concurrent use

75
Q

What is the brand of naltrexone/bupropion ER?

A

Contrave

76
Q

What is the moa of naltrexone/bupropion ER?

A

naltrexone: opiod antag: decr food ccravings
buproprion: weakly inhib neuronal reuptake of dopamine and NE; may suppress appetite

exact wt loss effects not understood

77
Q

How should naltrexone/bupropion ER be dosed?

A 
8 mg/ ER 90mg
wk 1:  1 tab qam
Wk2: 1 tab qam+qpm
wk3: 2 tab qam + 1 tab qpm
wk4: 2 tab qam+qpm

if 5% wt loss not achieved by 12 wk pt titrated to appropriate dose then therapy should be d/c

78
Q

How should naltrexone/bupropion ER be taken?

A

not w high fat meal

not crushed, cut, or chewed

79
Q

How should naltrexone/bupropion ER be dosed in renal imp?

A

mild: caution
mod/sev: do not exceed 1 tab bid
dialysis: not rec

80
Q

How should naltrexone/bupropion ER be dosed in hepatic imp?

A

do not exceed 1 tab d

81
Q

What are special considerations for naltrexone/buproprion ER?

A

boxed warningf or suicidal behaivor and ideation.

potential to cause false positive urine tests for amphetamines

82
Q

What are common ADRs of naltrexone/bupropion ER?

A 
GI effects
HA
dizziness
dry mouth
insomnia
83
Q

What are contraindications for naltrexone/bupropion ER?

A

pregnancy
use of other bupropion procuts or chronic opiod use
acute opiods withdrawl
uncontrolled HTN
Hx of Sz
bulimia or anorexia nervosa
abrupt d/c of alcohol, benzodiazepines, barbiturates or antiepileptic drugs
use during or w/in 14 d of MAOI therapy
initiation of Contrave concurrently pt taking linezolid or IV methylene blue

84
Q

What are precautions/warning for naltrexone/bupropion ER?

A 
incr BP, HR
Sz risk
narrow-angle glaucoma
hepatotoxicity
suicidal behavior or idea (boxed warning)
85
Q

What are drug classes that interact w naltrexone/bupropion ER?

A 
opiods
CYP2B6 inducers/inhibitors
CYP2D6 substrates
MAOIs
drugs that lower Sz threshold
86
Q

How should opiods be admin’d w naltrexone/bupropion ER?

A

avoid

87
Q

How should CYP2B6 inhibitors be admin’d w naltrexone/bupropion ER?

A

do not exceed max dose of Contrave 1 tab bid

88
Q

How should MAOIs be admin’d w naltrexone/bupropion ER?

A

avoid concomitant use or use w/in 14 d

89
Q

What is the brand name for liraglutide?

A

Saxenda

90
Q

What is the moa of liraglutide?

A

glucagon-like peptide-1 (GLP-1) receptor agonist–>
reduction of food intake and slowed gastric emptying

(suppresses glucagon and stimulation insulin secretion)

91
Q

What is the dosing of liraglutide?

A

SQ inj
wk1: 0.6 mg
incr by 0.6 mg each wk for up to 3 mg

if cannot toleate dose incr, delay for 1 wk

d/c if 4% wt loss not achieved after 16 wks

92
Q

What are special considerations for liraglutide?

A

Boxed warning: thyroid C-cell tumors

REMS program

93
Q

What are common ADRs of liraglutide?

A

GI effects
redness, bruising, discomfort at inj site
hypoglycemia

94
Q

What are contraindications for liraglutide?

A

pregnancy
hx of medullary thyroid carcinoma
hx o multiple endocrine neoplasia syndrome type 2

95
Q

What are precautions/warnings for liraglutide?

A 
acute pancreatitis
acute gall bladder disease
suicidal behavior and ideation
incr HR
renal imp
thyroid C-cell tumors (boxed warning)
96
Q

What are notable drug-drug interactions with liraglutide?

A

abs or other concomitantly admin’d po meds may be delayed (delayed gastric emptying)

97
Q

What are common herbal/natural remedies used for wt loss?

A 
hoodia
green tea
citrus aurantium
fenugreek
caffeine
ephredrine
capsaicin
yohimbine
chitosan
guar gum
hydroxycitric acid
garcina cambogia
98
Q

How should secondary obesity be treated?

A

treat primary disease!
hypothyroidism
Cushing syndrome
ypothalmic causes

99
Q

What is appropriate wt therapy management for 25<=BMI <27?

A

<= 1 risk factor weight maintenance (lifestyle)

>=2 risk factors lifestyle therapy

100
Q

What is appropriate wt therapy management for 27<=BMI <30?

A

w/o risk factors: maintenance

w risk factor: lifestyle + drug

101
Q

What is appropriate wt therapy management for 30<=BMI <35?

A

lifestyle + drug

102
Q

What is appropriate wt therapy management for 35<=BMI <40?

A

<=1 risk factor drug + lifestyle

> =2 risk factors weight loss surgery

103
Q

What is appropriate wt therapy management for BMI>=40?

A

weight loss surgery

104
Q

How should wt loss patients in general be monitored?

A

closely during first 6 mos

follow-up q4wks

105
Q

Which chornic wt loss drugs can be used in T2DM?

A

all of them!

but monitor for hypoglycemia

106
Q

Which chronic wt loss drugs cannot be used in TN?

A

naltrexone/bupropion ER:

  • caution, monitor BP and HR
  • if HTN uncontrolled, avoid
107
Q

Which chronic wt loss drugs can be used with CAD/arrhythmias?

A

orlistat, lorcaserin

otherwise caution: monitor HR, rhythm, (BP for Contrave)

108
Q

Which chronic wt loss drugs can be used with CHF?

A

none of the them–not enough data

109
Q

Which chornic wt loss meds can be used with mild-mod CKD?

mild=50-79 mL/min
mod=30-49 mL/min

A

all of them!

for mod:

  • Qsymia can’t exceed 7.5mg/46 mg d
  • Contrave can’t exceed 8mg/90 mg BID
110
Q

Which chornic wt loss meds can be used with severe CKD? (<30 mL/min)

A

orlistat–> caution, watch for oxalate nephropathy
liraglutide–>caution, watch for volume depletion and vomiting

avoid others: cleared renally

111
Q

Which chornic wt loss meds can be used with mild-mod hepatic imp?

A

CAUTION ALL.
orlistat & liraglutide: monitor for gallstone

lorcaserin: hep metab

Qsymia: max 7.5mg/46 mg d
Contrave: max 8mg/90 mg qam

112
Q

Which chornic wt loss meds can be used with severe hepatic imp?

A

AVOID ALL

113
Q

Which chornic wt loss meds can be used with depression?

A

orlistat, liraglutide

Qsymia: avoid max dose (15mg/92mg)

Caution: lorcaserin (avoid concomitant serotonergic drug), Contrave (avoid in young people)

114
Q

Which chornic wt loss meds can be used with anxiety?

A

all of them :)

Qsymia: avoid max dose (15mg/92mg)

115
Q

Which chornic wt loss meds can be used with glaucoma?

A

orlistat, locaserin, liraglutide

116
Q

Which chornic wt loss meds can be used with Szs?

A

all except Contrave

remember to taper Qsymia

117
Q

Which chornic wt loss meds can be used with pancreatitis?

A

all
AVOID: liraglutide if Hx of pancreatitis
montiro: orlistat, liraglutide

118
Q

Which chornic wt loss meds can be used with opiods?

A

all except Contrave

119
Q

Which chornic wt loss meds can be used with pregnancy?

A

NONE

use contraception and stop if become pregnant

120
Q

Which wt loss med should do monthly preg tests?

A

Qsymia

121
Q

What wt loss meds can be used in peds?

A

lifestyle bigger focus

Xenical >=12 yoa

122
Q

Which chornic wt loss meds can be used with breasting?

A

none

123
Q

Which chornic wt loss meds can be used with alcoholism/additction

A

orlistat, liraglutide OK

CAUTION: lorcaserin (abuse), Qsymia

AVOID: Contrave

124
Q

When should wt loss pharmacotherapy be d/c’s?

A

lorcaserin, Qsymia, Contrave: <5% wt loss after 12 wks max dose therapy

liraglutide <4% wt loss not achieved after 16 wk therapy

Pharmacotherapy 1 (26 decks)

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