Special Populations: Weight Loss

Question 1

Who are weight loss medications indicated for

Answer 1

BMI > 30 or BMI > 27 w/ at least one weight related condition (HTN, hyperlipeidemia, diabetes)

Question 2

When should weight loss medications be stopped?

Answer 2

when weight loss of 5% isn’t reached by 12 weeks

Question 3

Qysmia generic

Answer 3

Phentermine/ topiramate ER

Question 4

Why does Qysmia have REMS?

Answer 4

teratogenic risk
pregnancy test before and monthly during treatment

Question 5

Qysmia CI

Answer 5

pregnancy
glaucoma
MAOi last 14 days

Question 6

Qysmia side effects

Answer 6

Tachycardia
CNS = insomnia, vision problems
inc SCr

Question 7

how should Qysmia be stopped?

Answer 7

taper, due to seizure risk

Question 8

Contrave generic

Answer 8

Naltrexone = dec food cravings
Bupropion = dec appetite

Question 9

Contrave boxed warnings

Answer 9

not approve or MDD or psychiatric disorders, can inc suicidal thoughts

Question 10

Contrave CI

Answer 10

pregnancy
chronic opioid use or acute withdrawal
uncontrolled HTN
seizures
MAOi also 14 days
using other bupropion products

Question 11

Contrave warnings

Answer 11

use caution with psychiatric disorders
d/c if signs of hepatotoxicity

Question 12

Contrave side effects

Answer 12

N/V
Constipation
HA
dizziness
Dry mouth
insomnia
inc SCr

Question 13

GLP1 agonists

Answer 13

inc satiety

Victoza/Saxenda = Liraglutide = daily dosing
Ozempic/wegovy/Rybelsus (oral) = Semaglutide = weekly dosing

Question 14

GLP1 agonist boxed warnings

Answer 14

risk of thyroid C-cell carcinoma

Question 15

GLP1 agonist contraindications

Answer 15

personal or family hx of medullary thyroid carcinoma or pts with multiple edorcien neoplasia syndrome type 2 (MEN 2)

Saxenda = pregnancy

Question 16

GLP1 agonist warnings

Answer 16

pancreatitis
hypoglycemia
acute gallbladder disease
gastroparesis

Question 17

GLP1 agonist side effects

Answer 17

nausea
vomiting
diarrhea
constipation

Question 18

Orlistat mechanism

Answer 18

lipase inhibitor

dec absorption of dietary fats by ~30%

Question 19

Orlistat dosing

Answer 19

taken with each fat containing meal

Question 20

Orlistat contraindications

Answer 20

pregnancy

Question 21

Orlistat Warnings

Answer 21

liver damage = rare
cholelithiasis
inc kidney stones
hypoglycemia in diabetics

Question 22

Orlistat side effects

Answer 22

GI = flatus w/ discharge
fatty stools
fecal urgency

Question 23

Orlistat notes

Answer 23

take with multivitamin containing A,D,E,K & Beta carotene at bedtime or separate by > 2 hrs

have to stick with dietary plan for weight improvement

Question 24

Appetite suppressing medications

Answer 24

Stims

Phentermine = Adipex
Diethylpropion
Phendimetrazine
Benzphetamine

Question 25

Appetite suppressing med contraindications

Answer 25

Cardiovascular disease
uncontrolled HTN
hyperthyroidism
glaucoma
pregnancy
MAOi in last 14 days

Question 26

appetite suppressing med side effects

Answer 26

tachycardia
agitation
inc BP

** Monitor GR and BP **

Question 27

How long should stims be used for?

Answer 27

up to 12 weeks, to “jump start” diet

Question 28

Who should get bariatric surgery

Answer 28

BMI > 40 or BMI > 35 with an obesity related condition