Pharm

Question 1

What anti-obesity medication is contraindicated in patient on tramadol?

Answer 1

Buproprion/Naltrexone (contrave) - also in patients on benzos and opioids chronically

Question 2

Only anti-obesity medication which can be prescribed in patients with ESRD

Answer 2

Liraglutide

Question 3

Weight LOSING medications

Answer 3

DM: Metformin, GLP-1 agonists, SGLT inhibitors, acarbose, pramlintide (amylin mimetic)
Hormones: Testosterone in men with deficiency
Neuro: Topiramate, Zonisamide
Psych: Bupropion, Fluoxetine
HIV: Highly active antiretroviral protease inhibitors with HIV lipodystrophy
Others: Apremilast

Question 4

Weight NEUTRAL medications

Answer 4

Cards: ACE, ARB
DM: DPP4 inhibitors
Psych: Sertraline, Lamotrigine, Oxcarbazepine, Nortriptyline, Benzos
Antipsychotics: Aripipraozle, Haldol, Lurasidone, Ziprasidone
Others: NSAIDs, Tylenol, Capsaicin,

Question 5

Weight GAINING medications

Answer 5

Cardio: Beta blockers, Nifedipine, Amlodipine
DM: Insulin, Sulfonylureas, Thiazolidinediones, Meglitinides
Hormones: Steroids, combined OCP, Depo
Neuro: Carbamazepine, Gabapentin, Valproate, Pregabalin
Psych: TCAs, paroxetine, citalopram, venlafaxine, MAO-I, Trazodone, Mirtazapine, escitalopram, duloxetine, zonisamide, Lithium, Valproic acids,
Antipsychotics: Clozapine, Olanzpine. Quetiapine, Risperidone
Others: Benadryl, HAART, Tamoxifen, chemo/biologics

Question 6

Reasonable antipsychotic switch in a patient with schizophrenia on olanzapine

Answer 6

Zirprasidone

Question 7

Anti-obesity medication that is safe in patients with glaucoma

Answer 7

Liraglutide (GLP-1 agnoists); avoid Phentermine, bupropion, and topiramate

Question 8

FDA approved anti-obesity medications in adolescents

Answer 8

Liraglutide (12 and up); Phentermine (16 and up), and Orlistat (12 and up)

Question 9

GLP-1 Receptor Agonists (Liraglutide and Semaglutide)

Answer 9

Dosage: Lira 3.0 mg SC daily or sema 2.4 mg SC weekly; MOA: act on GLP-1 receptor in hypothalamus reducing food intake, increasing satiety, improving glucose metabolism; Contraindications: personal or fam hx of medullary thyroid carcinoma or MEN2; ADR: nausea, hypoglycemia, diarrhea, GI upset, fatigue, acute pancreatitis; Clinically significant weight loss (50-80% of patients)

Question 10

Setmelanotide

Answer 10

Indications: age >/= 6 years with obesity due to defects in POMC, PCSK-1, or LEPR; Dosage: 2 mg SC up to 3 mg (12 and up) or 1 mg up to 2 mg (6-11); MOA: reestablishes the MC4R pathway which reduces hunger and increases energy expenditure leading to weight loss; Weight loss: 80% with 10% weight loss in 1 study then 45.5% in another study; Contraindications: none (even with pregnancy if benefits > risks); ADR: spontaneous penile erection, depression, SI, injection site skin pigmentation, GI upset

Question 11

Plenity (Gelesis 100)

Answer 11

Dosage: 3 capsules with water followed by 16 oz 30 mins prior to lunch and dinner; MOA: occupy volume in the stomach and small intestine to create the sensation of fullness; Contraindications: pregnancy and allergy to ingredients; Precautions: patients with esophageal anatomic abnormalities, diverticuli, IBD diseaes, GERD, hx of GI surgery; ADR: abdominal pain, constipation, flatulence, diarrhea, abdominal distention; 59% had 5% WL; 26% had 10% WL

Question 12

The only FDA approved medication for binge eating disorder

Answer 12

Lisdexamfetamine (Vyvanse)

Question 13

Off-label Usage for Weight loss

Answer 13

Metformin, Topiramate, Sympathomimetics > 12 weeks, Generic combination medications

Question 14

Cost Effectiveness of anti-obesity medications

Answer 14

Phentermine is the most COST-EFFECTIVE for obesity treatment

Semaglutide is the MOST EFFECTIVE treatment, but not cost effective

Question 15

FDA approved for short-term usage

Answer 15

Phentermine, Diethylpropion, Phendimetrazine, Benzphetamine

Question 16

Naltrexone/Bupropion HCL ER

Answer 16

Dosage: 8 mg/90 mg increasing doses from 1 tablet to 2 tablets twice a day over 4 weeks; MOA: opioid antagonist + weak inhibitor of dopamine uptake leading to decreased appetite; Pharmacokinetics: metabolized and excreted by kidneys; 40-57% of 5 % WL and 20-35% of 10% WL; Contraindications: Uncontrolled HTN, seizures, eating disorder, alcohol use, chronic benzo or opioid use, increased risk of SI; ADR: HTN, nausea, constipation, headache, vomiting, dry mouth, diarrhea

Question 17

Phentermine/Topiramate ER

Answer 17

Dosage: 3.75/23 mg up to 15/92 mg; MOA: sympathomimetic + increased satiety induced by augmenting GABA; Pharmacokinetics: Phen -metabolized by the liver, Top - excreted by the kidney; Weight loss: 67% of 5%, 47% of 10% weight loss; Contraindication: glaucoma, hyperthyroidism, MAOI; ADR: paresthesias, dizziness, dry mouth, constipation

Question 18

Orilstat

Answer 18

Dosage: 60-120 mg TID with meals; MOA: pancreatic and gastric lipase inhibitor thus prevents absorption of 30% of ingested fat, Contraindications: chronic malabsorption, cholestasis; Common ADR: diarrhea, fecal incontinence, fat soluble vitamin def, rare hepatotoxicity, Weight loss: mild (21%)