Pharmacology Flashcards
What are the 4 controlled substance AODs approved for short term use?
CIV- Diethylprorion, Phentermine, CIII-Phendimetrazine, Benzphetamine
What are the 2 controlled substance AODs used long term?
CIV- Phentermine/topiramate
What 3 AODs can be used in children and teens?
> 10 yo Metformin for DM2,PCOS,insulin resistance but off label for weight
12 yo Orlistat Long term
16 yo Phentermine short term
what are the 3 key ways AOMs work?
- Centrally acting meds that impair dietary intake
- Medications act peripherally to impair dietary absorption
- Medications that increase energy expenditure
What are the 3 drug classes?
- CNS stimulants/Anorexiants (Phentermine etc),
- Anti-depressants/Dopamine reuptake inhibitors/opioid antagonists (Bupropion/naltrexone)
- GI agents (GLP-1 agonists)
Non-FDA approved agents (6)-4unique, 2 drug class and names
TMZ B AS
topiramate, metformin, zonisamide, bupropion,
Amylin agonist (pramlinitide),
SGLT2 inhibitors ( cana,empa,dapa)
5 FDA agents approved for long term use
Orlistat, liraglutide, semaglutide, Phentermine/topiramate, Bupropion ER/naltrexone
Most cost effective AOM
Phentermine
Most effective treatment
Semaglutide
Metformin can help treat complications of which other medications?
anti-psychotics and HIV protease inhibitor lipodystrophy
Metformin can reduce cancer rate and improve treatment of which cancers?(5)
colon, ovarian, lung breast and prostate cancer
Topiramate dosing for obesity
25-100 mg/day, usually divided BID
Topiramate causes which fetal abnormality
oral clefts
Off label medications for BED? check
duloxetine, fluoxetine
bupropion, topiramate
Which plant based supplement shares MOAs with metformin
Berberine
BED-How many episodes to be considered Moderate or Severe?
Moderate 4-7
Severe 8-13
What is the dose escalation for Wegovy/semaglutide?
Start at 0.25 mg/week , increase to 0.5, 1.0, 1.7 then 2.4 every 4 weeks
How does Metformin work? 3
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
Metformin’s actions
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
Thiazolidinediones ie pioglitazone
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
What does a GLP-1 analog do in the pancreas?
Reduces blood glucose by stimulating insulin release and preventing glucagon release, as well as increasing Bcell mass
DPP4 inhibitors ie;sitagliptins
Reduce GLP1 degradation
SGLT2inhibitors ie empagliflozin
Increase glucose excretion via kidneys
SGLT2 proteins responsible for 90% of glucose reabsorption
Side benefit weight loss, lowering BP
Which drug is contraindicated with cholelithiasis?
Orlistat - caution with liraglutide as well
What is setmelanotide, and in which disease is it being used?
It is a MC4r agonist, being used in POMC deficiency
What is metreleptin and what is it being used for?
A leptin analogue, indicated for leptin deficiency in patients with generalized lipodystrophy.
Why do some patients with T2DM get post-prandial hyperglycemia?
Glucagon production may not be adequately suppressed after eating
Green tea extract has side effects similar to those of excess caffeine. What is the mechanism of action and serious risk?
Decrease fat synthesis and increase fat oxidation
hepatotoxicity
Chitosan is like Orlistat, how
Decreases fat absorption
Side effects - constipation,bloating,indigestion
Glucosinolates side effects
Hypothyroidism,goitre
Raspberry extract side effect, MOA
Burping
Increases Fat oxidation
Mu Huang/Ephedrine side effects, MOA
Reduce appetite
Palpitations,MI,stroke,death
What medications can mitigate weight gain associated with anti-psychotics? 3
Metformin
GLP1 agonists
Topiramate
Antipsychotics with Variable/Neutral weight gain
aripiprazole haloperidol loxapine lurasidone perphenazine ziprasidone amisulpride
