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NMT200 midterm (wk1-6) > pharm wk 2 > Flashcards

pharm wk 2 Flashcards

1
Q

what are 2 examples of incretic mimetics

A

semaglutide and liraglutide

work on GLP1 or GIP

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2
Q

what is the example of appetite suppressant

A

buproprion

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3
Q

what is the lipase inhibitor example

A

orlistat

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4
Q

what is the goal of therapy for obesity

A

reduce excess body fat for health and not for cosmetic reasons; reducing weight by 5–10% can result in important health benefits

prevent weight regain

prevent and treat comorbidities

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5
Q

2 treatment phases of obesity

A

Induction of weight loss – achieved through caloric restriction

Prevention of weight regain – countering the neurobehavioural changes that seek to restore body weight to its original level

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6
Q

drugs associated with weight gain (5)

A

antidepressants - TCAs (amitriptyline)

antipsychotics (1st and 2nd generations)

corticosteroids (i.e. prednisone)

antihyperglycemic drugs (sulfonylureas. meglitinides, thiazolidinediones, insulin)

lithium (for mania)

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7
Q

what are the 2 appetite suppressants

A

bupropion and naltrexone (can combine)

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8
Q

what type of drug is bupropion

A

sympathomimetic (acts like NE/E and is stimulating)

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9
Q

what type of release does bupropion have

A

sustained release formula

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10
Q

other than appetite suppression, what else can bupropion be used for

A

antidepressant and smoking cessation aid

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11
Q

who is bupropion/naltrexone recommended for

A

Indicated for weight management alongside diet and exercise for those with a BMI of 30 or higher (27 if weight-related comorbidity present)

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12
Q

what hormones does bupropion/naltrexone mediate

A

Mediates hormones involved in appetite and reward

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13
Q

Adverse effects of bupropion

A

Dry mouth, constipation, agitation, insomnia, anxiety

Can cause seizures in rare instances with higher doses

Caution in patients with hepatic impairment

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14
Q

adverse effects of combining bupropion and naltrexone

A

Nausea, vomiting, constipation, headache, dizziness, insomnia, dry mouth

Contraindicated with concurrent opioid therapy (due to precipitation of opioid withdrawal)

Patients must be opioid free for 7 days prior to initiation of treatment

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15
Q

cautions for bupropion and naltrexone use

A

Avoid concurrent use of drugs that lower the seizure threshold.

Minimize or avoid alcohol consumption.

Avoid in patients with uncontrolled hypertension, seizure disorder, severe hepatic impairment, or end-stage renal failure.

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16
Q

what food should you take bupropion and naltrexone away from

A

high fat meal

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17
Q

orlistat îs a

A

lipase inhibitor

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18
Q

what does orlistat do ? by what %?

A

dont absorb fat

Pancreatic and gastric lipase inhibitor that reduces dietary fat absorption by 30%

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19
Q

adverse effects or orlistat

A

Oily spotting, flatus with discharge, fecal urgency.

Decreased absorption of fat-soluble vitamins

Contraindicated in patients with chronic malabsorption syndrome or cholestasis.

20
Q

cautions with orlistat

A

Advise patients to take a multivitamin daily ≥2 h before or after orlistat or at bedtime

A high fat intake is poorly tolerated

21
Q

who is orlistat less effective in

A

Less effective in patients on low-fat diets and is difficult to take for individuals with irregular eating patterns

22
Q

2 major incretin hormones in humans are

A

glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP)

23
Q

what do incretin hormones do

A

responsible for most of the glucose-induced insulin secretory response following glucose ingestion

24
Q

what are GLP-1 and GIP (incretins) metabolized by

A

by the enzyme dipeptidyl peptidase 4 (DPP4)

25
Q

what effects does GLP-1 have

A

GLP-1 is also responsible for the reduction of food intake and appetite, increased satiety, and decreased gastric emptying

GLP-1 also affects reward-related systems in the brain

26
Q

GIP effects on the body

A

GIP has less effect on other organs, but also delays gastric emptying and seems to play a role in fat deposition

27
Q

what is liraglutide

A

GLP-1 agonist

28
Q

how to administer liraglutide

A

subcutaneous injection

29
Q

what is liraglutide fro

A

Originally approved for type 2 diabetes and then rebranded for obesity

30
Q

adverse effects of liraglutide

A

Nausea, vomiting, constipation, and diarrhea are most common

Gastrointestinal side effects can be minimized by a slow titration.

Can cause pancreatitis in rare instances

Severe hypoglycemia observed in patients with type 2 diabetes; adjustment of diabetes medications may be required

31
Q

cautions for liraglutide

A

Caution in patients with heart rhythm disturbances, hepatic insufficiency, and severe renal impairment.

Should not be used in inflammatory bowel disease.

Contraindicated in pregnancy, breastfeeding, personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 (MEN 2).

Discontinue after 12 weeks if body weight loss <5%

32
Q

what is semaglutide

A

GLP-1 agonist

33
Q

what is the difference between semaglutide and liraglutide

A

GLP-1 agonist like liraglutide but with a longer half-life (165 hours compared to liraglutide’s 13 – 15 hours)

34
Q

how to administer semaglutide

A

weekly subcutaneous injections

35
Q

what is better at weight loss; semaglutide or liraglutide

A

semaglutide

36
Q

adverse effects of semaglutide

A

Similar to liraglutide

Nausea, diarrhea, abdominal pain, vomiting, constipation, digestive upset, fatigue, dizziness

Increase in amylase and lipase (suggesting possible pancreatitis)

37
Q

what is obesity during pregnancy associated with

A

gestational diabetes, gestational hypertension, preeclampsia, birth defects, caesarean delivery, fetal macrosomia, perinatal deaths, postpartum anemia and childhood obesity in offspring

Increased risk of complications following caesarean delivery

Labor is longer

38
Q

what is not recommended during pregnancy

A

Despite the increased risks of obesity and pregnancy, weight loss during pregnancy is not recommended

39
Q

what is the recommended weight targets for pregnancy

A

NOT WEIGHT LOSS

weight gain targets (to gain no more than 5 – 9.1 kg (11 – 20 lb) during pregnancy

40
Q

what drugs for pregnancy vs not

A

Orlistat is specifically not recommended during pregnancy due to reduced fat-soluble vitamin absorption

Evidence for bupropion is conflicting. It should not necessarily be withheld for continuation of therapy if patient is already taking it

41
Q

meta analysis of liraglutide, semaglutide and GLP-1 infusions

what do most studies show

A

evidence of appetite suppression, delayed gastric emptying, and changes in taste and food preferences

42
Q

high dose semaglutide in obesity STEP trail

A

drug group vs drug and calorie restriction and exercise

Additional mean change in weight for the drug group: 12.6%

43
Q

Which of the following medications is expected to cause the greatest amount of weight loss?
A. Liraglutide
B. Orlistat
C. Bupropion
D. Semaglutide

A

D. Semaglutide

44
Q

how much % weight is loss using bupropion / naltrexone

A

Net weight loss of 4.2% over 48 weeks

45
Q

how much weight loss % using orlistat

A

Compared to placebo: 2.9% additional weight loss over 1 year

46
Q

how much weight loss using liraglutide

A

3 mg SC can induce 8 kg of weight loss over 2 years of therapy in conjunction with lifestyle measures

47
Q

how much weight loss using semaglutide

A

Shown to reduce weight by approximately 16 kg over 2 years of therapy (double of that or liraglutide)

NMT200 midterm (wk1-6) (22 decks)

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