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Endocrine Module > Pharmacotherapy of Obesity > Flashcards

Pharmacotherapy of Obesity Flashcards

1
Q

What is obesity?

A

An imbalance between energy intake and expenditure leading to energy storage

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2
Q

What is BMI?

A

Measures how a patient’s TOTAL body weight compares to their height

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3
Q

What is the formula for BMI?

A

(Weight in kg)/(height in meters)^2

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4
Q

Why is BMI not perfect?

A

Overestimates adiposity in edema/masculinity
Underestimates adiposity in asians

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5
Q

What BMI is considered underweight?

A

<18.4

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6
Q

What BMI is considered normal?

A

18.5-24.9

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7
Q

What drugs can cause Unintended weight gain?

A

Anticonvulsants
Antidepressants
Antipsychotics
Hormones

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8
Q

What medications affect NT?

A

Serotonin, Dopamine, and Histamine

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9
Q

When prescribing drug therapy for obesity what must be included?

A

Lifestyle changes

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10
Q

What are the nonpharmacologic therapies for obesity?

A
  1. Reduced caloric intake
  2. Increased physical activity
  3. Behavior modification
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11
Q

What obesity meds can be used in Type 2 DM?

A

Orlistat, Phentermine/Toprimate, and Liraglutide/Semaglutide

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12
Q

What obesity meds can be used in HTN?

A

Orlistat
The others are cautioned

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13
Q

What obesity meds can be used in CAD?

A

Orlistat
The others are cautioned

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14
Q

What obesity meds can be used in Dysrhthmia?

A

Orlistat
The others are cautioned

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15
Q

What obesity meds can be used in HF?

A

AVOID ALL

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16
Q

What obesity meds can be used in CKD?

A

Cautioned for ALL

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17
Q

What obesity meds can be used in Kidney Stones?

A

Liraglutide/Semaglutide
AVOID others

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18
Q

What obesity meds can be used in Depression

A

Orlistat, Phentermine/Toprimate, and Liraglutide/Semaglutide

19
Q

What obesity meds can be used in Anxiety?

A

Orlistat, Phentermine/Toprimate, and Liraglutide/Semaglutide

20
Q

What obesity meds can be used in Glaucoma?

A

AVOID Phentermine/Topiramate
OK for others

21
Q

What obesity meds can be used in Women trying to Conceive?

A

Caution in ALL

22
Q

What obesity meds can be used in Elderly Patients?

A

Orlistat, Phentermine/Toprimate, and Liraglutide/Semaglutide

23
Q

Orlistat Brand?

A

Xenical Rx
Alli OTC

24
Q

What are the pearls of Orlistat?

A

Supplement with fat-soluble vitamins

25
Q

Phentermine Brand?

A

Adipex-P Rx

26
Q

When should you take Phentermine?

A

1-2 hrs post breakfast
37.5 mg usual dose

27
Q

What are the pearls of Phentermine?

A

Short term
AVOID with SSRIs
Do not admin at HS

28
Q

Phentermine-Topiramate Brand?

A

Qysmia Rx

29
Q

Qsymia pearls?

A

Decreased sweating (oligohydrosis)
Teratogen

30
Q

Naltrexone-Bupropion Brand?

A

Contrave

31
Q

What obesity medication has a REMS program?

A

Qysmia

32
Q

Qysmia Algorithm

A
  1. Start 3.75/23 QD for 14 days
  2. Increase to 7.5/46 QD for 12 weeks
  3. > 3% Weight Loss?
    4a. YES = continue or increase to 11.25/69 for 14 days
    4b. NO = DC
  4. After 11.25/69 increase to 15/92 for 12 weeks
  5. > 5% Weight Loss?
    7a. YES = Continue 15/92
    7b. NO = DC
33
Q

What is the MD of Qysmia for 3% weight loss?

A

7.5/46

34
Q

What is the MD of Qysmia for 5% weight loss?

A

15/92

35
Q

Liraglutide Brand?

A

Saxenda Rx

36
Q

What is the dosing for Saxenda?

A

0.6 mg SQ QD
Target 3 mg QD

37
Q

For Saxenda when do you DC?

A

After 16 weeks and weight loss <4%

38
Q

What are the warnings for Saxenda and Wegovy?

A

Black Box: thyroid tumor
Warn: pancreatitis

39
Q

Semaglutide Brand?

A

Wegovy Rx

40
Q

For Wegovy when do you DC?

A

After 12 weeks of therapy and weight loss <5%

41
Q

Cellulose and Citric Acid Brand? (superabsorbent hydrogel)

A

Plenity

42
Q

What is the dose for Plenity?

A

3 capsules with 16 oz water

43
Q

What prescription meds are used off label for obesity?

A

GLP Agonists, Topiramate, and Lamotrigine

44
Q

What are medication adjustments after Bariatric Surgery?

A
  1. 2 months post-op all meds should be in liquid form, crushed, or open cap
  2. Reduce meds for DM, HTN, and GERD
  3. Avoid enteric coated or ER
  4. Avoid Sorbitol
  5. Contraception for 1-2 yrs post-op
  6. Avoid NSAIDs and Bisphosphonates
  7. Supplement vitamins
  8. Increase monitoring
  9. LIFELONG vitamin and mineral supplements

Endocrine Module (16 decks)

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