Weight Loss Flashcards
1
Q
BMI Parameters
A
- Overweight = BMI: 25-29.9
- Obese = BMI >= 30
2
Q
Drugs/Conditions for Weight Gain
A
- Antipsychotics**
- Diabetic drugs: insulin, meglitinides, sulfonylureas, TZD**
- Divalproex/valproic acid**
- Gabapentin/pregabalin**
- Lithium
- Mirtazapine**
- Steroids**
- TCAs
- Conditions: Hypothyroidism
3
Q
Drugs/Conditions for Weight Loss
A
- ADHD drugs (amphetamines)
- Bupropion
- Diabetic Meds: GLP-1 agonists, Pramlintide, SGLT2i
- Roflumilast
- Topiramate
- Conditions: Hyperthyroidism, celiac disease, IBD
4
Q
OTC Supplements for Weight Loss
A
- Bitter orange - OTC stimulant
- Caffeine (AKA guarana and concentrated green tea powder) - OTC stimulant
- Generally ineffective and not helpful, can harm those with CV disease
5
Q
Rx Weight Loss Meds/Monitoring
A
- Only indicated for obese patients or those with BMI >= 27 with a weight-related condition
- Weight-related condition: diabetes, HTN, dyslipidemia
- Should only be used as an addition to a dietary plan/increased physical activity
- D/C meds if at least 5% weight loss hasn’t occurred in 12 weeks
6
Q
Belviq/Belviq XR
A
- Lorcaserin
- 5HT2C agonist
- Withdrawn from US market due to increased risk of cancer
7
Q
Newer Stimulant Drug Options
A
- Qsymia
- Contrave
- Saxenda
- Orlistat formulations
- *All can be used long-term for weight maintenance**
8
Q
Preggos should avoid…
A
ALL weight loss drugs
9
Q
HTN patients should avoid…
A
- Contrave (CI with uncontrolled HTN due to bupropion component)
- Caution with Qsymia (monitor HR due to phentermine)
10
Q
Depression patients should avoid…
A
- Caution in young adults and adolescents
- Contrave - suicide risk due to bupropion
11
Q
Seizure patients should avoid…
A
- Contrave (lowers seizure threshold)
- Qsymia (must be tapered slowly due to topiramate)
12
Q
Opioids patients should avoid…
A
-Contrave (blocks opioid receptors)
13
Q
Qsymia
A
- Contains phentermine and topiramate ER
- Phentermine - sympathomimetic (stimulant) that decreases appetite
- Topiramate: increases satiety and decreases appetite
- REMS drug due to teratogen risk
14
Q
Qsymia Information
A
- CI: pregnancy, glaucoma (MAOI use -HTN urgency, hyperthyroidism)
- SE: tachycardia, insomnia, vision problems, cognitive impairment (“Stupamax”)
- Taper off due to seizure risk
- REMS drug due to teratogen risk
- CIV
15
Q
Contrave
A
- Contains naltrexone and bupropion
- Naltrexone decreases food cravings
- Bupropion decreases appetite (increases NE/DA)
16
Q
Contrave Information
A
- CI: pregnancy, chronic opioid use, uncontrolled HTN, seizure disorder, use with other bupropion-products, MAOI use w/in 14 days
- Warning: Caution with psychiatric disorders
- Don’t take with high fat meals
- Naltrexone blocks opioid and buprenorphine receptors
17
Q
Saxenda
A
- Liraglutide (Victoza used for diabetes)
- Injected SQ daily
- Increases satiety, delays gastric emptying
18
Q
Saxenda Information
A
- CI: pregnancy
- Warning: pancreatitis and hypoglycemia
- SE: nausea, GI effects, pancreatitis
- REMS: medullary thyroid carcinoma and pancreatitis
19
Q
Xenical/Alli
A
- Orlistat
- Decreases absorption of dietary fats by ~30%
- Must be used with a low-fat diet plan
20
Q
Orlistat Information
A
- CI: Preggo
- SE: GI (flatus w/ discharge, fatty stool, etc)
- Take ADEK and beta-carotene supplement at bedtime or separated by drug by at least 2 hours
- Max of 30% kcals from fat while on medication
- Separate from cyclosporine and levothyroxine
21
Q
Adipex-P
A
- Phentermine
- Sympathomimetic that decreases appetite
- CIV
22
Q
Bariatric Surgery
A
- Recommended for adults with BMI >= 40 or when BMI >= 35 with a obesity-related condition
- Restricts food intake leading to weight loss
- Many nutrition and medication concerns
23
Q
Bariatric Surgery Nutrition Concerns
A
- Calcium absorption may be bypassed: recommend calcium citrate (non-acid dependent)
- Anemia from vitamin B-12 and iron deficiency can occur, supplement
- Take iron and calcium supplements at least 2 hours before or 4 hours after antacids
- Life-long ADEK supplementation may be required
24
Q
Bariatric Surgery Medication Concerns
A
- Meds may need to be crushed and put into liquid or transdermal form for 2 months post-surgery
- Pharmacists should assess which meds can safely undergo crushing and provide alternatives
- Gallstones can occur with rapid weight loss, use Ursodiol to dissolve gallstones PRN
25
Q
Phentermine Information
A
- CI: CVD (uncontrolled HTN), hyperthyroidism, MAOI use, glaucoma, preggo, and hx of drug abuse
- SE: tachycardia, agitation, increased BP
- Monitor: HR and BP
- Use short-term, only up to 12 weeks, to “jump-start” diet
- Stimulant so take in the morning! (insomnia)
