Weight Loss Flashcards
Overweight BMI
25-29.9 kg/m^3
Drugs that can cause weight gain
antipsychotics insulin sulfonylureas divalproex/valproic acid gabapentin lithium mirtazapine steroids TCS (amitriptyline, nortiptyline)
antipyschotics that cause major weight gain
clozapine
olanzapine
risperidone
quetiapine
What thyroid disorder can cause weightgain?
hypothyroidism
OTC weight loss supplements
bitter orange caffeine guarana green tea powder *ineffective, harmful in CVD patients
Indication for rx weight loss drugs
BMI >30
or
BMI>27 with at least 1 weight related condition (HTN, dyslipidemia, diabetes)
Long-term stimulant options
Qsymia
Contrave
Saxenda
Orlistat
When to dc weight loss drugs
If 5% of weight loss hasn’t been achieved at 12 weeks of use
Lorcaserin (Belviq)
withdrawn from US due to risk of cancer
What weight loss drugs are safe in pregnancy
NONE!
When should Contrave be avoided?
HTN, caution in YA (suicide risk), Seziures, pts taking opioids
*remember, contains buproprion (lowers seziure threshold) and naltrexone
When to use caution with Qsymia
HTN and seizures (taper off)
phentermine and topiramate
Which weight loss drug has a REMS program due to teratogenic risk
Qsymia
Qsymia MOA
phentermine: sympathomimetic (stimulant), releases norepi to stimulate satiety center and decrease appetite
topiramate: increases satiety and decreases appetite by increases GABA, blocks glutamate receptors and inhibits carbonic anhydrase
Contrave MOA
naltrexone: decreases cravings
buproprion: decreases appetite
Saxenda MOA
liraglutide (GLP-1 agonist) increases satiety
risk of thyroid carcinoma
warning for pancreatitis
GI side effects
What other drug is Saxenda like
Victoza (both are liraglutide)
Orlistat
OTC: Alli Rx: Xenical
must be used with a low fat diet plan (max 30% daily kcal)
GI effects including oily stool
Separate from multivitamins
List of stimulants
phentermine (adipex)
diethylpropion
phendimetrazine
benzphetamine
Longest time frame to use stimulants
12 weeks
CI for stimulants
CVD HTN Drug abuse hx hyperthyroidism glaucoma HF Arrthymias
Guidelines for bariatric surgery
BMI >40 or >35 with obesity related condition
What drug may be needed post-bariatric surgery unless gallbladder is removed
Ursodiol (actigall): dissolves gallstones which are a high risk after rapid weight loss
