Treating Obesity in Medication Non-Responders or Under-Responders

Question 1

if pt doesn’t respond to medications, what’s the next step?

Answer 1

refer to bariatric surgery

Question 2

two med notorious for weight gain

Answer 2

gabapentin and insulin

also in the q vanlafaxine

Question 3

pancreatitis and liraglutide

Answer 3

not abs contraindicated; can use if prior hx 2/2 defined cause, just be careful

Question 4

option to rx phentermine if someone has been on it it in the past

Answer 4

can prescribe 1-2 capsules daily with 2nd tab as needed

Question 5

med that results in a lot of acid reflux

Answer 5

liraglutide

Question 6

what do you do if people are having side effects of liragluide (GERD, nausea/vomiting, fatigue)

Answer 6

decrease rate of uptitration of liragultide in dosing

Question 7

a good alternative if can’t tolerate topomax side effects

Answer 7

zonisamide

Question 8

indications for bariatric surgery

Answer 8

bmi 40 or 35 with comorb (HTN, DM, OSA)

inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts (ASMBS)

Question 9

hwo to dose qsymia separately

Answer 9

1/4 (quarter) tab of 50 mg naltrexone = 12.5, sometimes just make it 25 if having hard time with quarter tab

150 XR bupropion (can go up to 300, and max 450)

Question 10

protocol for rx topiramate for women with child bearing age

Answer 10

she tells them abt birth defects in babies, and ensure they are on birth control; but if abstinent, or aware of risk; if they decide they attempt preg, they need to stop medicine; don’t mandate on brith control/iud/etc

Question 11

zonasamide dosing compared to topomax

Answer 11

topimarmate 25 = zonasamide 100

she never had success with 400 zonazamide, 300 genearlly highest dose, but she has gone up to 200 topiramate