PHARM: OBESITY

Question 1

what drugs are associated with weight gain?

Answer 1

antidepressants - tricyclic antidepressants

antipsychotics - 1st and 2nd gen.

corticosteroids - prednisone

anti-hyperglycemic - insulin

lithium

Question 2

what are appetite suppressants options approved in canada?

Answer 2

bupropion alone or with naltrexone

Question 3

adverse effects of bupropion

Answer 3

dry mouth, constipation, agitation, insomnia, anxiety

can cause seizures

caution in patients with hepatic impairment

Question 4

adverse effects of combination bupropion and naltrexone?

Answer 4

nausea, vomiting, constipation, headache, dizziness, insomnia, dry mouth.

contraindicated with concurrent opioid therapy (pt must be free from opioid 7 days)

Question 5

what cautions are indicated for bupropion and naltrexone?

Answer 5

• medications that lower seizure thresholds
• alcohol consumption
• high fat meals
• uncontrolled hypertension, seizure disorder, severe hepatic impairment, end stage renal failure

Question 6

what is the lipase inhibitor drug?

Answer 6

orlistat

Question 7

how does orlistat work?

Answer 7

pancreatic and gastric lipase inhibitor reduces dietary fat absorption by 30%

Question 8

adverse effects of orlistat?

Answer 8

oily spotting, flatus with discharge, fecal urgency

decreased absorption of fat-soluble vitamins

contraindicated in patients with chronic malabsorption syndrome or cholestatsis

Question 9

what cautions are indicated for orlistat?

Answer 9

take multivitamin daily over 2 hours before or after orlistat or at bedtime.

high fat diet in poorly tolerated.

less effective in patients on low fat diets or with irregular eating pattersns.

Question 10

what are the two major incretin hormones (incretin = derived hormones)

Answer 10

glucagon like peptide 1 (GLP-1)

glucose dependent insulinotropic polypeptide (GIP)

Question 11

what are the incretin mimetics responsible for?

Answer 11

most of the glucose induced insulin secretory response following ingestion.

Question 12

what enzyme metabolizes incretin mimetics?

Answer 12

dipetidyl peptidase 4 (DPP4)

Question 13

what is GLP-1 directly responsible for?

Answer 13

reduction of food intake and appetite, increased satiety, decreased gastric emptying.

note: related to reward systems in brain.

Question 14

What is Liraglutide?

Answer 14

GLP-1 agonist

so it mimics the actions of GLP-1 to produce a response when it binds to the receptor in brain

Question 15

how is liraglutide administered?

Answer 15

subcutaneous injection

Question 16

adverse effects of liraglutide?

Answer 16

nausea, vomiting, constipation or diarrhea.

GI effects can be reduced by a slow titration.

can cause pancreatitis

severe hypoglycemia observed in patients with T2DM

Question 17

caution for liraglutide?

Answer 17

heart rhythm disturbances, hepatic insufficienct, severe renal impairment.

DO NOT USE IN IBD

contraindicated in pregnancy, breastfeeding, or history of medullary thyroid carcinoma or multiple endocrine neoplasia (MEN 2)

Question 18

when should you discontinue use of liraglutide?

Answer 18

discontinue use after 12 weeks if body weight loss if under 5%

Question 19

what is the difference between semaglutide and liraglutide?

Answer 19

both GLP-1 agonist
semaglutide has longer half-life (165 hours vs 13-15)
also administered weekly subcutaneous injection

Question 20

adverse effects of semaglutide?

Answer 20

similar to liraglutide

also increase in amylase and lipase (suggesting possible pancreatitis)

Question 21

when should you assess efficacy of therapeutic dose?

Answer 21

after 3-6 months

Question 22

is weight loss during pregnancy recommended?

Answer 22

no, despite the risks.

consensus: weight gain target of no more than 5-9 kg (11 - 20 lbs) during.

Question 23

what obesity drug is specifically NOT recommended during pregnancy and why?

Answer 23

orlistat due to reduced fat-soluble vitamin absorption

Question 24

the Step trials investigated the use of Semaglutide at a dose higher than used for diabetes. What did they find?

Answer 24

drug group lost 12.6% more than than placebo

Question 25

which medication is expected to cause the greatest amount of weight loss?

Answer 25

Semaglutide (Ozempic)