PHARM: OBESITY Flashcards
what drugs are associated with weight gain?
antidepressants - tricyclic antidepressants
antipsychotics - 1st and 2nd gen.
corticosteroids - prednisone
anti-hyperglycemic - insulin
lithium
what are appetite suppressants options approved in canada?
bupropion alone or with naltrexone
adverse effects of bupropion
dry mouth, constipation, agitation, insomnia, anxiety
can cause seizures
caution in patients with hepatic impairment
adverse effects of combination bupropion and naltrexone?
nausea, vomiting, constipation, headache, dizziness, insomnia, dry mouth.
contraindicated with concurrent opioid therapy (pt must be free from opioid 7 days)
what cautions are indicated for bupropion and naltrexone?
- medications that lower seizure thresholds
- alcohol consumption
- high fat meals
- uncontrolled hypertension, seizure disorder, severe hepatic impairment, end stage renal failure
what is the lipase inhibitor drug?
orlistat
how does orlistat work?
pancreatic and gastric lipase inhibitor reduces dietary fat absorption by 30%
adverse effects of orlistat?
oily spotting, flatus with discharge, fecal urgency
decreased absorption of fat-soluble vitamins
contraindicated in patients with chronic malabsorption syndrome or cholestatsis
what cautions are indicated for orlistat?
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.
what are the two major incretin hormones (incretin = derived hormones)
glucagon like peptide 1 (GLP-1)
glucose dependent insulinotropic polypeptide (GIP)
what are the incretin mimetics responsible for?
most of the glucose induced insulin secretory response following ingestion.
what enzyme metabolizes incretin mimetics?
dipetidyl peptidase 4 (DPP4)
what is GLP-1 directly responsible for?
reduction of food intake and appetite, increased satiety, decreased gastric emptying.
note: related to reward systems in brain.
What is Liraglutide?
GLP-1 agonist
so it mimics the actions of GLP-1 to produce a response when it binds to the receptor in brain
how is liraglutide administered?
subcutaneous injection
adverse effects of liraglutide?
nausea, vomiting, constipation or diarrhea.
GI effects can be reduced by a slow titration.
can cause pancreatitis
severe hypoglycemia observed in patients with T2DM
caution for liraglutide?
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)
when should you discontinue use of liraglutide?
discontinue use after 12 weeks if body weight loss if under 5%
what is the difference between semaglutide and liraglutide?
both GLP-1 agonist
semaglutide has longer half-life (165 hours vs 13-15)
also administered weekly subcutaneous injection
adverse effects of semaglutide?
similar to liraglutide
also increase in amylase and lipase (suggesting possible pancreatitis)
when should you assess efficacy of therapeutic dose?
after 3-6 months
is weight loss during pregnancy recommended?
no, despite the risks.
consensus: weight gain target of no more than 5-9 kg (11 - 20 lbs) during.
what obesity drug is specifically NOT recommended during pregnancy and why?
orlistat due to reduced fat-soluble vitamin absorption
the Step trials investigated the use of Semaglutide at a dose higher than used for diabetes. What did they find?
drug group lost 12.6% more than than placebo
which medication is expected to cause the greatest amount of weight loss?
Semaglutide (Ozempic)
