Pharmacology

Question 1

What are the 4 controlled substance AODs approved for short term use?

Answer 1

CIV- Diethylprorion, Phentermine, CIII-Phendimetrazine, Benzphetamine

Question 2

What are the 2 controlled substance AODs used long term?

Answer 2

CIV- Phentermine/topiramate

Question 3

What 3 AODs can be used in children and teens?

Answer 3

> 10 yo Metformin for DM2,PCOS,insulin resistance but off label for weight
12 yo Orlistat Long term
16 yo Phentermine short term

Question 4

what are the 3 key ways AOMs work?

Answer 4

1. Centrally acting meds that impair dietary intake
2. Medications act peripherally to impair dietary absorption
3. Medications that increase energy expenditure

Question 5

What are the 3 drug classes?

Answer 5

1. CNS stimulants/Anorexiants (Phentermine etc),
2. Anti-depressants/Dopamine reuptake inhibitors/opioid antagonists (Bupropion/naltrexone)
3. GI agents (GLP-1 agonists)

Question 6

Non-FDA approved agents (6)-4unique, 2 drug class and names

Answer 6

TMZ B AS
topiramate, metformin, zonisamide, bupropion,
Amylin agonist (pramlinitide),
SGLT2 inhibitors ( cana,empa,dapa)

Question 7

5 FDA agents approved for long term use

Answer 7

Orlistat, liraglutide, semaglutide, Phentermine/topiramate, Bupropion ER/naltrexone

Question 8

Most cost effective AOM

Answer 8

Phentermine

Question 9

Most effective treatment

Answer 9

Semaglutide

Question 10

Metformin can help treat complications of which other medications?

Answer 10

anti-psychotics and HIV protease inhibitor lipodystrophy

Question 11

Metformin can reduce cancer rate and improve treatment of which cancers?(5)

Answer 11

colon, ovarian, lung breast and prostate cancer

Question 12

Topiramate dosing for obesity

Answer 12

25-100 mg/day, usually divided BID

Question 13

Topiramate causes which fetal abnormality

Answer 13

oral clefts

Question 14

Off label medications for BED? check

Answer 14

duloxetine, fluoxetine

bupropion, topiramate

Question 15

Which plant based supplement shares MOAs with metformin

Answer 15

Berberine

Question 16

BED-How many episodes to be considered Moderate or Severe?

Answer 16

Moderate 4-7

Severe 8-13

Question 17

What is the dose escalation for Wegovy/semaglutide?

Answer 17

Start at 0.25 mg/week , increase to 0.5, 1.0, 1.7 then 2.4 every 4 weeks

Question 18

How does Metformin work? 3

Answer 18

Decreases hepatic glucose production, thus reducing the need for insulin secretion;
Decreases intestinal absorption of glucose.
Has an antilipolytic effect that lowers free fatty acid concentrations, thus reducing gluconeogenesis

Question 19

Metformin’s actions

Answer 19

Biguanide
Potentiates insulin
Inhibits enzymes involved in gluconeogenesis and glycogen synthesis in liver
Stimulates insulin signalling and glucose transport in muscles
Increases the peripheral glucose disposal through disposal into ske muscle

Question 20

Thiazolidinediones ie pioglitazone

Answer 20

PPAR pathway
Increases insulin sensitivity
Increase adiponectin
Decrease leptin
*heart failure

They bind avidly to peroxisome proliferator-activated receptor gamma in adipocytes to promote adipogenesis and fatty acid uptake (in peripheral but not visceral fat). By reducing circulating fatty acid concentrations and lipid availability in liver and muscle, the drugs improve the patients sensitivity to insulin. Thiazolidinediones favourably alter concentrations of the hormones secreted by adipocytes, particularly adiponectin. They increase total body fat and have mixed effects on circulating lipids

Question 21

What does a GLP-1 analog do in the pancreas?

Answer 21

Reduces blood glucose by stimulating insulin release and preventing glucagon release, as well as increasing Bcell mass

Question 22

DPP4 inhibitors ie;sitagliptins

Answer 22

Reduce GLP1 degradation

Question 23

SGLT2inhibitors ie empagliflozin

Answer 23

Increase glucose excretion via kidneys
SGLT2 proteins responsible for 90% of glucose reabsorption
Side benefit weight loss, lowering BP

Question 24

Which drug is contraindicated with cholelithiasis?

Answer 24

Orlistat - caution with liraglutide as well

Question 25

What is setmelanotide, and in which disease is it being used?

Answer 25

It is a MC4r agonist, being used in POMC deficiency

Question 26

What is metreleptin and what is it being used for?

Answer 26

A leptin analogue, indicated for leptin deficiency in patients with generalized lipodystrophy.

Question 27

Why do some patients with T2DM get post-prandial hyperglycemia?

Answer 27

Glucagon production may not be adequately suppressed after eating

Question 28

Green tea extract has side effects similar to those of excess caffeine. What is the mechanism of action and serious risk?

Answer 28

Decrease fat synthesis and increase fat oxidation

hepatotoxicity

Question 29

Chitosan is like Orlistat, how

Answer 29

Decreases fat absorption

Side effects - constipation,bloating,indigestion

Question 30

Glucosinolates side effects

Answer 30

Hypothyroidism,goitre

Question 31

Raspberry extract side effect, MOA

Answer 31

Burping

Increases Fat oxidation

Question 32

Mu Huang/Ephedrine side effects, MOA

Answer 32

Reduce appetite

Palpitations,MI,stroke,death

Question 33

What medications can mitigate weight gain associated with anti-psychotics? 3

Answer 33

Metformin
GLP1 agonists
Topiramate

Question 34

Antipsychotics with Variable/Neutral weight gain

Answer 34

aripiprazole
haloperidol
loxapine
lurasidone
perphenazine
ziprasidone
amisulpride