treatment of obesity Flashcards
Orlistat (Alli/Xenical)
MOA: reversible gastric and pancreatic
AE: GI side effects (oily and loose stool); interference with absorption of fat soluble vitamins
DI: increases bioavailability and lipid lowereing affect of pravastatin
CI: chronic malabsorption of cholestasis
Precautions: GI events may increase when taken with a high fat diet
Efficacy: 45% lost >5% of body wt
Dose: 120 mg tid with each meal
Phentermine (Ionamin)
MOA: increases NE and DA; mild CNS stimulant
AE: CNS stim with restlesness, insomnia, tremor, dizziness, HA, euphoria
DI: do not use with other CNS stims or within 14 days of MAOI
CI: hypersens. severe HTN, sx CV disease, hyperthyroidism, glaucoma, concurrent MAOI use, EtOH or drug abuse
Precautions: insulin requirements may decrease for pts with DM
Dose: 15-30mg qam approved for short term use as adjunct in conjunction with caloric restriction
Diethylpropion
MOA: increases NE and DA; mild CNS stimulant
AE: CNS stim with restlesness, insomnia, tremor, dizziness, HA, euphoria
DI: do not use with other CNS stims or within 14 days of MAOI
CI: hypersens. severe HTN, sx CV disease, hyperthyroidism, glaucoma, concurrent MAOI use, EtOH or drug abuse
Precautions: may increase szs, limited amount dispensed to decrease possibility of OD
Efficacy: 3kg more than placebo
Phentermine/Topiramate (Qysmia)
MOA: increase NE and DA; mild CNS stimulant
AE: dizziness, insomnia, tingling in hands/feet, impaired cognition
DI: do not use with other CNS stim, do not use within 14 days of MAOI, topiramate is a CYP2C19 substrate and inducer
Phentermine/Topiramate (Qysmia)
MOA: increase NE and DA; mild CNS stimulant
AE: dizziness, insomnia, tingling in hands/feet, impaired cognition
DI: do not use with other CNS stim, do not use within 14 days of MAOI, topiramate is a CYP2C19 substrate and inducer
CI: pregnancy, glaucoma, hyperthyroidism
Precautions: may increase resting HR; suicidal behavior and ideation, mood and sleep disorders, cognitive impairment
Efficacy: 9kg/year
Dose: 3.75 mg/23mg qam
Lorcaserin
MOA: serotonin 2C agonist that targets the satiety center of the brain, helping pts feel full sooner and eat less
AE: HA, dizziness, fatigue, nausea, dry mouth, and C
DI: CYP2D6 inhibitor
CI; pregnancy
Precautions: may cause serotonin syndrome or neuroleptic malignant syndrome, valvular heart disease, cognitive impairment, euphoria, dissociation, depression, and priapism
Efficacy: 7 lbs more than placebo
Naltrexone/Buproprion
opiod antagonist/DA and NE reuptake inhibitor
AE: N/C/HA/V dizziness
CI: uncontrolled HTN, sz disorders, anorexia nervosa or bulimia, drug or alcohol withdrawal, MAOI inhibitors
Health risks associated with obesity
DM, HTN, hyperlipidemia,CHD, cancer (men: colorectal and prostate; women: endometrial, cervical, ovarian, breast, and gallbladder
OA, sleep apnea, complications of pregnancy, depression, gallbladder disease, gout, hirsutism, psych difficulties
Liraglutide
GLP-1 agonist; increases glucose dependent insulin secretion and decreases glucose dependent glucagon secretion, slows gastric emptying and increases satiety
Misc weight loss agents
antidiabetic agents: exenatide and pramlintide only recommended for DM
herbal: no evidence
Calcium: increasing calcium consumption increases weight reduction, lean body mass, and body fat loss
Misc weight loss agents
antidiabetic agents: exenatide and pramlintide only recommended for DM
herbal: no evidence
Calcium: increasing calcium consumption increases weight reduction, lean body mass, and body fat loss
Drugs contributing to weight gain
anticonvulsants and mood stabilizers (carbamazepine, gabapentin, VPA, and lithium)
antidepressants (MAOI, tricyclics)
Antidiabetics (insulin, meglitinides, sulfonylureas, TZDs)
antipsychotics
antihistimines
corticosteroids
hormonal contraceptive
