Special Populations: Weight Loss Flashcards
Who are weight loss medications indicated for
BMI > 30 or BMI > 27 w/ at least one weight related condition (HTN, hyperlipeidemia, diabetes)
When should weight loss medications be stopped?
when weight loss of 5% isn’t reached by 12 weeks
Qysmia generic
Phentermine/ topiramate ER
Why does Qysmia have REMS?
teratogenic risk
pregnancy test before and monthly during treatment
Qysmia CI
pregnancy
glaucoma
MAOi last 14 days
Qysmia side effects
Tachycardia
CNS = insomnia, vision problems
inc SCr
how should Qysmia be stopped?
taper, due to seizure risk
Contrave generic
Naltrexone = dec food cravings
Bupropion = dec appetite
Contrave boxed warnings
not approve or MDD or psychiatric disorders, can inc suicidal thoughts
Contrave CI
pregnancy
chronic opioid use or acute withdrawal
uncontrolled HTN
seizures
MAOi also 14 days
using other bupropion products
Contrave warnings
use caution with psychiatric disorders
d/c if signs of hepatotoxicity
Contrave side effects
N/V
Constipation
HA
dizziness
Dry mouth
insomnia
inc SCr
GLP1 agonists
inc satiety
Victoza/Saxenda = Liraglutide = daily dosing
Ozempic/wegovy/Rybelsus (oral) = Semaglutide = weekly dosing
GLP1 agonist boxed warnings
risk of thyroid C-cell carcinoma
GLP1 agonist contraindications
personal or family hx of medullary thyroid carcinoma or pts with multiple edorcien neoplasia syndrome type 2 (MEN 2)
Saxenda = pregnancy
GLP1 agonist warnings
pancreatitis
hypoglycemia
acute gallbladder disease
gastroparesis
GLP1 agonist side effects
nausea
vomiting
diarrhea
constipation
Orlistat mechanism
lipase inhibitor
dec absorption of dietary fats by ~30%
Orlistat dosing
taken with each fat containing meal
Orlistat contraindications
pregnancy
Orlistat Warnings
liver damage = rare
cholelithiasis
inc kidney stones
hypoglycemia in diabetics
Orlistat side effects
GI = flatus w/ discharge
fatty stools
fecal urgency
Orlistat notes
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
Appetite suppressing medications
Stims
Phentermine = Adipex
Diethylpropion
Phendimetrazine
Benzphetamine
Appetite suppressing med contraindications
Cardiovascular disease
uncontrolled HTN
hyperthyroidism
glaucoma
pregnancy
MAOi in last 14 days
appetite suppressing med side effects
tachycardia
agitation
inc BP
** Monitor GR and BP **
How long should stims be used for?
up to 12 weeks, to “jump start” diet
Who should get bariatric surgery
BMI > 40 or BMI > 35 with an obesity related condition
