Overweight/Obesity Lecture Flashcards
Common drug classes that cause obesity or overweight
Anticonvulsants; Antidepressants; Atypical antipsychotics; Conventional antipsychotics; Hormones
Examples of drugs that cause obesity - anticonvulsant drugs
carbamazepine; gabapentin; pregabalin; valproic acid;
Examples of drugs that cause obesity - antidepressants drugs
mirtazpine; tricyclic antidepressants
Examples of drugs that cause obesity - atypical antipsychotics drugs
clozapine; olanzapine; quetiapine; risperidone
Examples of drugs that cause obesity - conventional antipsychotics drugs
haloperidol
Examples of drugs that cause obesity - hormone drugs
corticosteroids; insulin; medroxyprogesterone
What criteria indicates a patient that would benefit from weight loss
- BMI over 30
- BMI over 25 and 1 + risk factors
Non-Pharmacological Therapy - what 3 things to do lose weight
1 - reduced calorie intake
2 - increased physical activity
3 - behavioral strategies
Appropriate kcal/day levels for women for weight loss
1200 - 1500 kcal/day
Appropriate kcal/day levels for men for weight loss
1500 - 1800 kcal/day
Appropriate amount calories to cut per day to lose weight
500 - 750 kcal
Specific ways to increase adherence/interventions and counseling to use
- onsite programs with trained professional
- encourage pts to BUILD UP exercise (up to 5 days a week of 30 minutes)
Criteria for bariatric surgery
BMI over 40 AND BMI over 35 + coexisting conditions AND motivated to lose weight AND has not responded to behavioral treatment (with or without pharmacotherapy)
Effects of bariatric surgery
- reduce calorie intake
- ensure behavior modification through eating small amounts of food slowly and throughly chewing each mouthful
Average weight loss with bariatric surgery = ___ %
50% of body weight
5 classes of drugs for Prescription drug therapy options - LONG TERM
- Lipase inhibitor
- Serotonin 5-HTC2 receptor agonist
- Symphathomimetic (CNS STIMULANT) and anticonvulsant
- opioid antagonist/dopamine and norepinepherine reuptake inhibitor
- GLP-1 agonist
Class of prescription drug that is for short term use for weight loss
CNS stimulants
Lipase inhibitor weight loss drug
Orlistat - Xenical or Alli
Orlistat is generic for ?
Xenical or Alli
Orlistat is apart of what kind of drug class
lipase inhibitor
Lorcaserin is generic for ?
Belviq
Belviq is apart of what kind of drug class
serotonin 5-HT2C Receptor agonist
Qsymia is brand for what?
Phentermine and topiramate
Qsymia is apart of what kind of drug class
sympathomimetic and anticonvulsant
Contrave is brand for what?
Naltrexone and bupropion extended release
Contrave is apart of what kind of drug class
opioid antagonist and dopamine/norepinephrine reuptake inhibitor
Saxenda is brand for ?
liraglutide
Saxenda is apart of what drug class
GLP-1 agonist
BMI equation
Kg/ m^2 or lbs/in^2 x 703
BMI ranges (for underweight, normal weight, overweight, obese)
under: < 18.5
normal: 18.5 - 24.5
over: 25 - 29.9
obese: over 30
Waist circumfrences for females and males that indicate they are at a higher risk for issues
female if over 35 INCHES
male if over 40 INCHES
(dont forget to convert to cm if relevant)
Potential complications from bariatric surgery
wound infections; GI leaks; DVT; depression; cholecystitis; fractures; vitamin deficiencies
Mechanism or Orlistat
reversibly inhibits gastric and pancreatic enzymes - lipids (long chain TGs) not absorbed!
Dosing of Xenical and Alli
Xenical - 120 mg TID
Alli - 60 mg TID
(Take within 1 hr of eating a fat-containg meal - dont take if you didnt eat)
Contraindications (other than pregnancy): for Orlistat
cholestatis; chronic malabsorption syndrome
Drug interactions with Orlistat
Levothyroxine; Warfarin (bc Vit.K); Cyclosporine; Multivitamins (bc fat soluble vitamins); Oral contraceptives (if lots of side effects of diarrhea)
Common Side effects of Orlistat
Oily spotting, abdominal pain/discomfort, flatus with discharge, fecal urgency, fatty/oily stool, oily evacuation, defecation increased
Mechanism of action for Belviq (Lorcaserin)
will ACTIVATE serotonin-5HT2C in the hypothalamus to result in satiety/decreased food intake
Dosing of Belviq (Lorcaserin)
10 mg BID
OR
20 mg QD (if Belviq XR)
Which drug is allowed by FDA for kids over 12 years old
Xenical - Rx only
Which drug is contraindicated with patients that have glaucoma
Qsymia - phentermine/topiramate
and
(Contrave - may cause narrow angle glaucoma - do not use either!!!)
Which weight loss drugs should not be used in patients with alcoholism or addictoin
Contrave - the bupropion part will lower seizure threshold
Which weight loss drugs can breastfeeding mothers use?
NONE - none recommended at all
Which weight loss drug should not be used by opioid users
Contrave - bc naltrexone component
Which drug should not be used by patients with a history of pancreatitis
Saxenda/ liraglutide
Which weight loss drug should patients with hypertension avoid
Contrave - (because of uncontrolled hypertension)
Which weight loss drugs can type 2 diabetics use?
All of them are ok!
Which weight loss drugs can SEVERE hepatic impairment patients use?
NONE - all bad for them
if just mild - to moderate impairment - use all with caution
Which weight loss drug should patients with seizure disorders avoid?
Contrave - because of bupropion portion
Which weight loss drug should not be used in patients with a history of thyroid cancer
Saxenda
Common adverse reactions with Saxenda
irritation at injection site and HYPOGLYCEMIA and GI effects
Mechanism of Saxenda
it is GLP-1 agonist - reduction of food intake/SLOWS gastric emptying
Main contraindications with Contrave
- opioid use or other bupropion use
- uncontroleld HTN
- seizure disorder
Dosing of Contrave and “how” to take it
- titrate up to 2 AM and 2 PM
- do NOT with a high fat meal
