Test 3 Pharmacotherapy in Weight Loss

Question 1

Qualifiers for pharmacotherapy to treat obesity

Answer 1

• BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with ≥ 1 obesityassociated comorbidity
• Failed to achieve weight loss goal after ≥ 6 months of comprehensive lifestyle intervention
• No contraindications to therapy
• Currently enrolled in ongoing comprehensive lifestyle intervention as previously defined (adjunctive therapy)

Question 2

What are the two categories of pharmcotherapies?

Answer 2

• long term

- short term

Question 3

long term pharmcotherapies

Answer 3

• orlistat
• lorcaserin
• phentermine / topiramate ER
• bupropion / naltrexone

Question 4

short term pharmcotherapies

Answer 4

• phentermine

Question 5

orlistat initial dose

Answer 5

60 mg TID 1 hour prior to fat-containing meals

Question 6

orlistat maximum dose

Answer 6

60 mg TID 1 hour prior to fatcontaining meals

Question 7

orlistat special comments

Answer 7

• Omit if meal skipped or does not contain fat

- Consider multivitamin during therapy to prevent vitamin deficiency

Question 8

orlistat monitoring

Answer 8

• BMI
• serum glucose in diabetic patients
• thyroid function in patients with hypo- or hyperthyroidism
• liver function tests if symptoms of hepatic dysfunction

Question 9

orlistat adverse reactions

Answer 9

• Soft stools
• diarrhea
• abdominal pain/bloating
• flatulence
• fecal urgency
• incontinence
• hepatic injury (rare)

Question 10

lorcaserin initial dose

Answer 10

10 mg BID

Question 11

lorcaserin maximum dose

Answer 11

10 mg BID

Question 12

lorcaserin special comments

Answer 12

• Use w/ caution if CrCl 30-50 ml/min.
• Use is not recommended if CrCl<30 ml/min.
• Do not use if severe hepatic dysfunction

Question 13

lorcaserin monitoring

Answer 13

• BMI – discontinue if <5% weight loss achieved at 12 weeks
• Serum glucose in diabetic patients
• complete blood count
• depression and/or suicidal ideation
• signs/symptoms of serotonin syndrome
• signs/symptoms of valvular heart disease

Question 14

lorcaserin adverse reactions

Answer 14

• Headache
• dizziness
• fatigue
• nausea
• dry mouth
• constipation
• hypoglycemia in patients with diabetes
• psychiatric disorders
• priapism
• elevated serum prolactin

Question 15

phentermine / topiramate ER initial dose

Answer 15

3.75 mg phentermine and 23 mg topiramate once

daily in the morning -titrate to 7.5/46 mg after 14 days

Question 16

phentermine / topiramate ER maximum dose

Answer 16

15 mg phentermine and 92 mg topiramate

Question 17

phentermine / topiramate ER special comments

Answer 17

• Do not exceed 7.5/46 mg if CrCl<50 ml/min. or moderate hepatic impairment
• Gradually discontinue if on 15/92 mg dose to prevent precipitation of seizure
• Do not use within 14 days of MAOi use

Question 18

phentermine / topiramate ER monitoring

Answer 18

• BMI
• serum glucose in diabetic patients
• pregnancy
• depression or suicidal ideation
• mood/sleep disorders
• HR
• serum electrolytes and creatinine at baseline and during treatment

Question 19

phentermine / topiramate ER adverse reactions

Answer 19

• Constipation
• dry mouth
• paraesthesia
• dysgeusia
• insomnia
• hypoglycemia in individuals with diabetes

Question 20

when to discontinue phentermine / topiramate ER

Answer 20

• Discontinue or escalate dose if 3% weight loss not achieved by week 12 on 7.5/46 mg dose
• Discontinue if 5% weight loss not achieve by week 12 on 15/92 mg dose

Question 21

bupropion / naltrexone initial dose

Answer 21

1 tablet once daily x1 week, then 1 tablet BID x1 week, then 2 tablets qAM and 1 tablet qPM x1 week, then 2 tablets BID

Question 22

bupropion / naltrexone maximum dose

Answer 22

2 tabs BID

32 mg naltrexone and 360 mg bupropion per day

Question 23

bupropion / naltrexone special comments

Answer 23

• Moderate-severe renal impairment: max 1 tablet twice daily
• Hepatic impairment: max 1 tablet daily
• Do not use within 14 days of MAOi use

Question 24

bupropion / naltrexone monitoring; BOXED warnings

Answer 24

• NOT approved for depression or psychiatric disorders
• ↑↑suicidality and antidepressant drugs
• ↑↑ serious psychiatric effects seen in patients taking bupropion for smoking cessation
• contraindicated in uncontrolled HTN
• seizure disorder of history of seizures
• pregnancy

Question 25

bupropion / naltrexone adverse reactions

Answer 25

• ↑↑blood pressure
• ↑↑HR
• lowers seizure threshold
• anxiety
• suicidal thoughts/actions

Question 26

phentermine initial dose

Answer 26

• Adipex: 15 mg once daily (or in 2 divided doses) before meals or 1-2 hours after meals
• Suprenza: 15 mg once daily
• Lomaira: 8 mg TID

Question 27

phentermine maximum dose

Answer 27

• Adipex: 37.5 mg/day
• Suprenza: 37.5 mg/day
• Lomaira: 8 mg TID, 30 min before meals

Question 28

phentermine special comments

Answer 28

• Use with caution in severe renal impairment
• Do not use within 14 days of MAOi use
• Avoid abrupt discontinuation
• Discontinue if satisfactory weight loss has not occurred within 4 weeks

Question 29

phentermine monitoring

Answer 29

• Baseline cardiac evaluation
• cardiac echocardiogram during therapy
• blood pressure

Question 30

phentermine adverse reactions

Answer 30

• ↑↑blood pressure
• ischemic events (stroke/MI)
• palpitations
• tachycardia
• valvular disease
• urticarial
• agitation
• headache
• dizziness
• insomnia
• psychosis
• dry mouth
• thirst,
• diarrhea