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
2
Q
What are some medications categories that can contribute overweight and obesity?
A
anticonvulsants antidepressants atypical antipsychotics conventional antipsychotics hormones
3
Q
What are some examples of antipsychotics that cause wt gain?
A
carbamazepine
gabapentin
pregabalin
valproic acid
4
Q
What are ome examples of antidepressants taht cause wt gain?
A
mirtazapine
tricyclic antidepressants
5
Q
What are som examples of atypical antipsychotics that cause wt gain?
A
clozapine
olanzapine
quetiapine
risperidone
6
Q
What are some examples of conventional antipsychotics that cause wt gain?
A
haloperidol
7
Q
What are some examples of hormones that cause wt gain?
A
corticosteroids
insulin
medroxyprogesterone
8
Q
What are the waist circumference thresholds for abdominal fat content?
A
> 88 cm for females
>102 cm for males
9
Q
What does an increased waist circumference indicate?
A
elevated risk of: HTN, dyslipidemia type 2 DM CVD all-cause mortality
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
11
Q
What is the goal reduction in body wt for wt loss therapy?
A
initial goal is 5-10% over 6 mos
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
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
14
Q
What is the avg wt loss w bariatric surgery?
A
50% of BW
15
Q
What are potential complications of bariatric surgery?
A
wound infection GI leaks DVT depression cholecystitis Fx vitamin def
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
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
18
Q
What are lipase inhibitors that can be used for wt loss?
A
orlistat: Xenical or Alli
19
Q
What are serotonin 5-HT2C receptor agonists that can be used for wt loss?
A
lorcaserin: Belviq
20
Q
What are sympathomimetics and anticonvulsants used for wt loss?
A
phentermine and topiramate: Qsymia
21
Q
What are opiod antagonist and dopamine/norepinephrine reuptake inhibitors used for wt loss?
A
naltrexone & buproppion ER: Contrave
22
Q
What are GLP-1 agonists used in wt loss?
A
liraglutide: Saxenda
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
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
25
What is the mechanism of action of CNS stimulants in wt loss?
incr conc of NE to stimulate receptors in hypothalamus-->appetite suppression
26
What are SEs of CNS stimulants in wt loss?
```
palpitation
tachycardia
incr BP
overstimx
restlessness
insomnia
tremor
dizziness
HA
euphoria
dysphoria
xerostomia
```
27
What wt loss medications are aproved by the FDA for chronic management of obesity?
```
orlistat
lorcaserin
phentermine & topiramate
naltrexone & bupropion ER
liraglutide
```
28
What are the brand names of orlisat?
Xenical
| Alli
29
Which wt loss med is available OTC?
Alli
30
What is the moa of orlisat?
reversibly inhibits gastric and pancreatic lipases, which allow abs of long-chain TGs
decr dietary fat abs by 30%
31
What is the dosing of Xenical?
120 mg po tid, take w/in 1 h of eating fat-containing meal
approved for pts >=12 yoa
32
What is the dosing for Alli?
60 mg orally tid, taken w/in 1 hr of eating fat-containing meal
approved for pts >=18 yoa
33
What is an important counseling point for lipase inhibitors for wt loss?
dose should be omitted if a meal is missed or does not contain any fat
34
What is the avg wt loss w orlistat above diet and exercise?
2.9-3.4 kg after 1 yr
35
What are special considerations for using orlistat?
sugg'd for pts w CVD
| rec'd standard MVI
36
what are common adverse rxns to orlistat?
GI: oily spotting, abdominal pain/discomfort, flat w discharge, fecal urgency, fatty/oily stool, increased defectation
decreased abs of fat-soluble vits
37
What are contraindications for orlistat?
pregnancy
chronic malabs syndrme
cholestasis
38
What are some precautions or warnings for orlistat?
rare hepatotoxicity (dark urine, lack of appetite, dark stools)
39
Orlistat interacts w which drugs?
```
cyclosporine
levothyroxine
MVI
warfarin
OC
```
40
How should cyclosporine be admin'd w orlistat?
3 hr p orlistate, monitor pt
41
How should levothyroxine be admin's w orlistat?
admin >4 hr apart, monitor
42
How should MVI be admin'd w orlistat?
>2 hr apart
| rec MVI at bedtime
43
How should warfarin be admin'd w orlistat?
monitor INR
44
How should OC be admin'd w orlistat?
recommend use of back up contraceptive if pt experiences severe diarrhea.
45
What is the brand name for lorcaserin?
Belviq
46
What is the moa of lorcaserin?
selective activation of serotonin 5-HT2c reeptors in the hypothalamus-->satiety and decr food intake
47
What is the dosing of lorcaserin?
Belviq: 10 mg po bid
Belviq XR: 20 mg po d
can be taken w or w/o food
48
How should lorcaserin be used in renal impairment?
mod: caution
| sev, ESRD: not rec'd
49
What is the avg wt loss w lorcaserin above diet and exercise?
3.6 kg after 1 y
50
What schedule is lorcaserin?
C-IV
| pot for abuse and psychodependence
51
What are common ADR for lorcaserin?
depression, memory lapses
dizziness, fatigue
HA
nausea, dry mouth, constipation
52
What are contraindications for lorcaserin?
pregnancy
53
What are precautions and warnings for lorcaserin?
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
What durg classes does lorcaserin interact w?
serotonergic agents
| CYP2D6 substrates
55
What are examples of serotonergic agents?
```
MAOIs
linezolid
SSRIs, SNRIs, TCAs
bupropion
lithium
tramadol
triptans
SJW
```
56
What are the recommendation for serotonergic agent use with lorcaserin?
concomitant use should be avoided
57
What is the brand name for penthermine/topiramate ER?
Qsymia
58
What is the moa of phentermine/topiramate ER?
phenterine--sympathomimetic amine: reducing appetite through CNS effects (hypothalamus stim-->NE)
topiramate--anticonvulsants: mech unknown, thought to cause appetite suppression and enhance satiety
59
What is the dosing for phentermine/topiramate ER?
```
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
When shold phentermine/topiramate ER be taken?
in morning to avoid insomnia
61
How should phentermine/topiramate ER be dose in renal imp?
CrCl <50 mL/min: do not exceed p/t ER 7.5/46 mg po d
dialysis: not rec
62
How should phentermine/topiramate ER be dosed in hepatic impairemtn?
mod: do not exceed 7.5/46 mg po daily
sev: not rec'd
63
How should phentermine/topiramate ER be d/c'd?
gradually decr by taking qod for >1 wk prior to d/cing
Sz risk
64
What is the avg wt loss for phentermine/topiramate ER above diet and exercise?
6.6-8.6 kg after 1 yr
65
What are special consideration for dispensing phentermine/topiramate ER?
C-IV
| must be distriuted by REMS-certified pharmacies
66
What are common ADRs of phentermine/topiramate ER?
```
constipation
dry mouth
paraesthesia
dysgeusia
dizziness, lightheadedness
blurry vision
insomnia
```
67
What are contraindications to phentermine/topiratmate ER?
```
pregnancy
hyperthyroidism
glaucoma
use during or w/in 14 d following MAOI
known hypersensitivity or idiosyncrasy to the sympathomimetic amines
```
68
what are precautions/warnings for phentermine/topiramate ER?
```
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
What drug classes does phentermine/topiramate ER interact with?
```
combination OC
CNS depressants
alcohol
non-potassium sparing diuretics
antiepileptic drugs
carbonic anhydrase ihbitions
```
70
How should combination OCs be admin'd w phentermine/topiramate ER?
counsel on potential for breathrough bleeding
| rec back-up method
71
How should CNS depressants be admin'd w phentermine/topiramate ER?
avoid combination, when possible
72
How should alcohol be admin'd w phentermin/topiramate ER?
avoid alcohol intake
73
How should non-potassium sparing diuretics be admin'd w phentermine/topiramate ER?
monitor for risk of hypokalemia
74
How should carbonic anhydrase inhibitors be admin's w phentermine/topiramate ER?
avoid concurrent use
75
What is the brand of naltrexone/bupropion ER?
Contrave
76
What is the moa of naltrexone/bupropion ER?
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
How should naltrexone/bupropion ER be dosed?
```
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
How should naltrexone/bupropion ER be taken?
not w high fat meal
| not crushed, cut, or chewed
79
How should naltrexone/bupropion ER be dosed in renal imp?
mild: caution
mod/sev: do not exceed 1 tab bid
dialysis: not rec
80
How should naltrexone/bupropion ER be dosed in hepatic imp?
do not exceed 1 tab d
81
What are special considerations for naltrexone/buproprion ER?
boxed warningf or suicidal behaivor and ideation.
potential to cause false positive urine tests for amphetamines
82
What are common ADRs of naltrexone/bupropion ER?
```
GI effects
HA
dizziness
dry mouth
insomnia
```
83
What are contraindications for naltrexone/bupropion ER?
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
What are precautions/warning for naltrexone/bupropion ER?
```
incr BP, HR
Sz risk
narrow-angle glaucoma
hepatotoxicity
suicidal behavior or idea (boxed warning)
```
85
What are drug classes that interact w naltrexone/bupropion ER?
```
opiods
CYP2B6 inducers/inhibitors
CYP2D6 substrates
MAOIs
drugs that lower Sz threshold
```
86
How should opiods be admin'd w naltrexone/bupropion ER?
avoid
87
How should CYP2B6 inhibitors be admin'd w naltrexone/bupropion ER?
do not exceed max dose of Contrave 1 tab bid
88
How should MAOIs be admin'd w naltrexone/bupropion ER?
avoid concomitant use or use w/in 14 d
89
What is the brand name for liraglutide?
Saxenda
90
What is the moa of liraglutide?
glucagon-like peptide-1 (GLP-1) receptor agonist-->
reduction of food intake and slowed gastric emptying
(suppresses glucagon and stimulation insulin secretion)
91
What is the dosing of liraglutide?
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
What are special considerations for liraglutide?
Boxed warning: thyroid C-cell tumors
| REMS program
93
What are common ADRs of liraglutide?
GI effects
redness, bruising, discomfort at inj site
hypoglycemia
94
What are contraindications for liraglutide?
pregnancy
hx of medullary thyroid carcinoma
hx o multiple endocrine neoplasia syndrome type 2
95
What are precautions/warnings for liraglutide?
```
acute pancreatitis
acute gall bladder disease
suicidal behavior and ideation
incr HR
renal imp
thyroid C-cell tumors (boxed warning)
```
96
What are notable drug-drug interactions with liraglutide?
abs or other concomitantly admin'd po meds may be delayed (delayed gastric emptying)
97
What are common herbal/natural remedies used for wt loss?
```
hoodia
green tea
citrus aurantium
fenugreek
caffeine
ephredrine
capsaicin
yohimbine
chitosan
guar gum
hydroxycitric acid
garcina cambogia
```
98
How should secondary obesity be treated?
treat primary disease!
hypothyroidism
Cushing syndrome
ypothalmic causes
99
What is appropriate wt therapy management for 25<=BMI <27?
<= 1 risk factor weight maintenance (lifestyle)
| >=2 risk factors lifestyle therapy
100
What is appropriate wt therapy management for 27<=BMI <30?
w/o risk factors: maintenance
| w risk factor: lifestyle + drug
101
What is appropriate wt therapy management for 30<=BMI <35?
lifestyle + drug
102
What is appropriate wt therapy management for 35<=BMI <40?
<=1 risk factor drug + lifestyle
>=2 risk factors weight loss surgery
103
What is appropriate wt therapy management for BMI>=40?
weight loss surgery
104
How should wt loss patients in general be monitored?
closely during first 6 mos
| follow-up q4wks
105
Which chornic wt loss drugs can be used in T2DM?
all of them!
| but monitor for hypoglycemia
106
Which chronic wt loss drugs cannot be used in TN?
naltrexone/bupropion ER:
- caution, monitor BP and HR
- if HTN uncontrolled, avoid
107
Which chronic wt loss drugs can be used with CAD/arrhythmias?
orlistat, lorcaserin
otherwise caution: monitor HR, rhythm, (BP for Contrave)
108
Which chronic wt loss drugs can be used with CHF?
none of the them--not enough data
109
Which chornic wt loss meds can be used with mild-mod CKD?
mild=50-79 mL/min
mod=30-49 mL/min
all of them!
for mod:
- Qsymia can't exceed 7.5mg/46 mg d
- Contrave can't exceed 8mg/90 mg BID
110
Which chornic wt loss meds can be used with severe CKD? (<30 mL/min)
orlistat--> caution, watch for oxalate nephropathy
liraglutide-->caution, watch for volume depletion and vomiting
avoid others: cleared renally
111
Which chornic wt loss meds can be used with mild-mod hepatic imp?
CAUTION ALL.
orlistat & liraglutide: monitor for gallstone
lorcaserin: hep metab
Qsymia: max 7.5mg/46 mg d
Contrave: max 8mg/90 mg qam
112
Which chornic wt loss meds can be used with severe hepatic imp?
AVOID ALL
113
Which chornic wt loss meds can be used with depression?
orlistat, liraglutide
Qsymia: avoid max dose (15mg/92mg)
Caution: lorcaserin (avoid concomitant serotonergic drug), Contrave (avoid in young people)
114
Which chornic wt loss meds can be used with anxiety?
all of them :)
| Qsymia: avoid max dose (15mg/92mg)
115
Which chornic wt loss meds can be used with glaucoma?
orlistat, locaserin, liraglutide
116
Which chornic wt loss meds can be used with Szs?
all except Contrave
remember to taper Qsymia
117
Which chornic wt loss meds can be used with pancreatitis?
all
AVOID: liraglutide if Hx of pancreatitis
montiro: orlistat, liraglutide
118
Which chornic wt loss meds can be used with opiods?
all except Contrave
119
Which chornic wt loss meds can be used with pregnancy?
NONE
| use contraception and stop if become pregnant
120
Which wt loss med should do monthly preg tests?
Qsymia
121
What wt loss meds can be used in peds?
lifestyle bigger focus
Xenical >=12 yoa
122
Which chornic wt loss meds can be used with breasting?
none
123
Which chornic wt loss meds can be used with alcoholism/additction
orlistat, liraglutide OK
CAUTION: lorcaserin (abuse), Qsymia
AVOID: Contrave
124
When should wt loss pharmacotherapy be d/c's?
lorcaserin, Qsymia, Contrave: <5% wt loss after 12 wks max dose therapy
liraglutide <4% wt loss not achieved after 16 wk therapy
