Overweight and Obesity Exam 3 Flashcards
When should you initiate pharmacological treatment?
- BMI >= 30 with no other risk factors
- BMI >= 27 with other risk factors / diseases (HTN, dyslipidemia, CHD, DM II, sleep apnea)
What are the drug classes that can be used for obesity?
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- Catecholaminergic, Stimulant, Sympathomimetic Medications
- Fat absorption inhibitor
- GLP-1 agonist
- Stimulant + anticonvulsant
- Opioid receptor antagonist + atypical antidepressant
- 5-HT2C receptor agonist
MOA of Catecholaminergic, Stimulant, Sympathomimetic Medications
increase levels of norepinephrine (and serotonin and dopamine to some extent) by inhibiting the reuptake
ADE of Catecholaminergic, Stimulant, Sympathomimetic Medications
- increased heart rate
- increased blood pressure
- insomnia
- nervousness / anxiety
- loss of appetite
- dry mouth, palpitation
- euphoria / dysphoria
Duration of use of Catecholaminergic, Stimulant, Sympathomimetic Medications
- not longer for more than 3 months
- high abuse potential
Catecholaminergic, Stimulant, Sympathomimetic Medications drug interactions
- may cause toxicity if taken with MAOI b/c can increase levels of dopamine, 5HT, NE
- takes 2-3 weeks to make new MAO
Catecholaminergic, Stimulant, Sympathomimetic Medications: brain or periphery? decreasing appetite or increasing energy expenditure?
- brain
- increasing energy expenditure
Catecholaminergic, Stimulant, Sympathomimetic Medication examples
- Benzphetamine
- Diethylpropion
- Phendimetrazine
- Phentermine
- Amphetamine / Amphetamine-like drugs
- Amphetamine
- Dextroamphetamine
- Methamphetamine
MOA of Fat absorption inhibitors
- lipase inhibitor
- inhibits fat from getting absorbed
Fat absorption inhibitors: brain or periphery? decreasing appetite or increasing energy expenditure?
- periphery
- neither; inhibiting fat from being absorbed
Fat absorption inhibitor example
Orlistat
Orlistat
- OTC: 60mg TID; Rx: 120mg TID (max effect seen at 120mg)
- not very effective
- take with fat-containing meal (during or up to 1 hr after)
ADE of Fat absorption inhibitor
- loose, greasy stool, diarrhea
- abdominal cramping
- bloating
- b/c the fat is fermenting
How can you manage the ADE of Fat absorption inhibitors?
- avoid eating super high fat containing meal; the more fat in the gut, the worst the effects
- if there are GI history, do not start with this drug
- dose dependent
MOA of Phentermine + Topiramate
- Phentermine: stimulant, increase in NE levels
- Topiramate: anti convulsant (decreases excessive neuron activity by stabilizing sodium channels in inactive state and increasing GABA activity)
Phentermine + Topiramate: brain or periphery? decreasing appetite or increasing energy expenditure?
- brain
- increase energy expenditure
- argument for decrease appetite b/c ADE of dry mouth
Duration of use of Phentermine + Topiramate
- can be used more than 3 months
- do not abruptly d/c b/c the topiramate can cause rebound seizures
ADE of Phentermine + Topiramate
- mood changes
- fatigue
- insomnia (take in a.m.)
- increased heart rate
- dry mouth (both topiramate and phentermine)
MOA of Naltrexone + Bupropion
- Naltrexone is an opioid receptor antagonist (nonspecific)
- Bupropion is an atypical antidepressant (Blocks norepinephrine and dopamine reuptake transporters)
- Combined use may block “reward” of food and increase mood
Naltrexone + Bupropion: brain or periphery? decreasing appetite or increasing energy expenditure?
- brain (?)
- decreasing appetite
ADE of Naltrexone + Bupropion
- Increased risk of suicidal thoughts/behaviors (boxed warning)
- Seizures
- Increased blood pressure and heart rate
- CNS depression (sedation)
- all due to bupropion
Naltrexone + Bupropion clinical concerns
- seizures
- heart conditions
- uncontrolled hypertension
Naltrexone + Bupropion drug interactions
- may cause toxicity if taken with MAOI b/c can increase levels of dopamine, 5HT, NE
- takes 2-3 weeks to make new MAO
MOA of Liraglutide
- GLP-1 agonist (gut-brain peptide)
- Decreases appetite through increase fullness / satiety
Liraglutide: brain or periphery? decreasing appetite or increasing energy expenditure?
- brain and periphery
- decrease appetite
How should the patient eat while being on liraglutide?
eat 1/3 of the plate and wait to see if pt is still hungry
ADE of liraglutide
- Pancreatitis
- Gallbladder issues
- Irritation of injection site
- Nausea / vomiting (eating too fast)
MOA of Lorcaserin
- 5-HT2C receptor agonist (specific receptor which bypasses other ADE’s)
- decreases hunger / increases satiety
- directly stimulates neurons in the hypothalamus that are known to regulate feeding
Lorcaserin: brain or periphery? decreasing appetite or increasing energy expenditure?
- brain
- decreasing appetite
Duration of use of Lorcaserin
- approved for long term use
- CIV due to perceived risk for dependence or abuse
What kind of patients should you be cautious with when using Lorcaserin? (not an objective)
- moderate renal impairment (not recommended in end stage renal disease)
- severe liver impairment
What are OTC meds that can be used?
- Stimulants: ephedra, caffeine, hoodia, bitter orange
- Chitosan
- pyruvate
- chromium
