Q5 Obesity Flashcards
Why are antihyperglycemic medications associated with weight gain?
Things like insulin help glucose enter the cells and be stored as fat.
GLP1 SE?
Thyroid cancer, pancreatitis
The adipose tissue becomes an endocrine organ itself. Very inflammatory. Increase leptin, TNF-alpha, low adiponectin, high mineralocorticoids. This leads to comorbidities like HTN, DM2, HLD, all this stuff. Fat MASS is an issue too with OA, OSA, GERD, depression, low self esteem.
Quetapine, cloazapine, Olanzapine, Risperidone, Mirtazapine, SSRIs, MAOIs, TCAs
Antipsychotics and antidepressants that are associated with weight gain.
Gabapentin, Pregablin, Carbamazepine, divalproex, lithium, depakote,
Mood stabilizers and anti epileptics associated with weight gain.
Beta-blockers associated with weight gain.
Metoprolol, atenolol, propanolol.
Weight should be reduced at about 1-2lbs/week (0.45-.9kg)
5-10% in 6months
Weight loss GLP1 is high dose (appetite suppression) where as Tx for DM is lower dose.
Metformin is a good medication to use with other meds that have SE of weight gain, and combined with GLP1 to further decrease appetite.
Phentermine MOA
SE?
CI?
Adrenergic agonist (sympathomimetic) - Stim of hypothalamus to release NE which = appetite suppression.
Affects sleep, anxiety. Monitor BP, HR, N/v, insomnia, restlessness, HA. Tolerance may develop in a few weeks.
CI: CVD (arrhythmias, HF, CAD, stroke, uncontrolled HTN, hyperthyroid, glaucoma, drug abuse, MAOI inhibitor, pregnancy, breastfeeding.
NOT in sz or Tourette’s.
Most efficacious PO med for weight loss.
#1counseling?
Qsymia - phentermine/topiramate ER
MUST Taper gradually if it’s not working. Abrupt DC may result in Seizure.
What is the MOA of Contrave?
(Naltrexone/bupropion)
Bupropion: DA/NE reuptake inhibitor -> modulates central reward pathways triggered by food
Naltrexone: opioid antagonist->antagonizes inhibitory feedback loop that would otherwise limit bupropion’s anorectic properties.
When should contrave be discontinued?
If 5% weight loss at 16wks (12wks at maintenance dose)
If a patient is wanting to start contrave, what medication must they have a free interval from?
Opioid-free interval of at least 7-10 days.
MOA of orlistat?
Inhibits pancreatic and gastric lipase -> fat not hydrolysis -> fecal fat excretion. Decrease fat absorption by 30%.
