Weight Loss Flashcards
overweight BMI
25-29.9 kg/m2
obese BMI
> =30 kg/m2
risks of being overweight
coronary heart disease
hypertension
stroke
T2DM
2 things that make body use fat as resource
decreasing calories
increasing energy. expenditure
drugs/conditions that cause weight gain
antipsychotics: clozapine, olanzapine, risperidone, quetiapine
diabetes: insulin, meglitinides, sulfonylureas, TZDs
divalproex/valproic acid
Gabapentin/pregabalin
lithium
mirtazapine
steroids
TCAs (amitriptyline, nortripttyline, etc.)
beta-blockers
dronabinol
hormones (estrogen, megestrol, etc)
MAOIs
SSRIs (paroxetine, others could be weight neutral)
vasodilators (minoxidil, etc)
condition: hypothyroidism
Drugs/conditions that cause weight loss
ADHD drugs (amphetamine, methylphenidate, etc.)
Gupropion
GLP-1 (exenatide, liraglutide, etc.)
Pramlintide
Roflumilast
SGLT2i (canagliflozin, empagliflozin, etc.)
Topiramate
Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine)
antiepileptic drugs: zonisamide, ethosuxamide
Interferons
Thyroid drugs (levothyroxine, etc.)
conditions: hyperthyroidism, celiac, IBS, cystic fibrosis, GERD/peptic ulcer, lupus, TB (active)
physical activity for weight loss
> =150 minutes/week over 3-5 separate days
OTC supplements for weight loss
bitter orange - stimulant
caffeine (in things like guarana, green tea powder too)
when are prescription drugs for weight loss appropriate
BMI >=30 or >=27 with 1+weight-related condition (dyslipidemia, HTN, DM)
in addition to diet and inc physical activity
what to avoid/use with caution prescription weight loss drugs in pregnancy
avoid all
what to avoid/use with caution prescription weight loss drugs in hypertension
Contrave CI with untrolled BP (has bupropion)
Qsymia: caution; monitor hR (has phentermine)
what to avoid/use with caution prescription weight loss drugs in depression
Contrave - caution in young adults/adolescents (suicide risk; contains bupropion)
what to avoid/use with caution prescription weight loss drugs in seizures
avoid: Contrave; lowers seizures threshold (Bupropion included)
caution: Qsymia, taper off slowly if used (has topiramate)
what to avoid/use with caution prescription weight loss drugs when taking opioids
avoid: Contrave - blocks opioid receptions (has naltrexone)
newer drugs that can be continue long-term
Qsymia,Contrave, Saxenda, Wegovy
when should weight loss drugs be stopped
<5% weight loss at 12 weeks
phentermine MOA
sympathomimetic/stimulant
phentermine CI
pregnancy - REMS drug bc teratogenic risk
glaucoma
phentermine side effects
tachycardia
CNS effects (insomnia)
vision problems
phentermine notes
taper off bc seizure risk
Contrave MOA
naltrexone - dec food cravings
Bupropion - dec appetite
Contrave CI
pregnancy
chronic opioid use
uncontrolled HTN
seizure disorder
use of other bupropion-containing products
use of MAOIs within 14 days
Contrave warnings
caution with psychiatric disorders
Contrave notes
Naltrexone block opiois
GLP-1 MOA
Saxenda, Wegovy: inc satiety
Vicoza, Ozempic: for DM only
liraglutide/Saxenda dosing
SC daily injection
semaglutide/Wegovy disong
SC weekly injection
GLP-1 CIs
Saxenda: pregnancy
GLP-1 warnings
pancreatitis
hypoglycemia
GLP-1 side effects
nausea
lipase inhibitors MOA
Orlistat, Xenical (Rx), Alli (OTC)
dec abs of dietary fat by 30%
lipase inhibitor CI
pregnancy
lipase inhibitor side effects
GI (flatus with discharge, fatty stool
lipase inhibitor notes
take multivitamin with A, D, C, K, E and beta carotene at bedtime or separated by >=2 hrs from lipase inhibitors
sympathomimets/stimulants MOA
Phentermine/Adipex-P
sympathomimetics/stimulants
stick to diet according to iron tribe, max 30% of calories done in her practice
phentermine MOA
sympathomimetic/stimulant
phentermine CI
CV disease (uncontrolled HTN)
hyperthyroidism
glaucoma
pregnancy
drug abuse history
phentermine side effects
tachycardia
agitation
inc BP
phentermine monitoring
HR, BP
when to usephentermine
short-term, up to 12 seeks, “jump start”
when to use bariatric surgery
BMI >=40 kg/m2
BMI >=35 kg/m2 with obesity-related condition
bariatric surgery common nutrient deficiencies
calcium citrate (preferred calcium; non-acid dependent absorption)
vit b12
iron deficiency
iron and calcium - take 2 hrs before or 4 hrs after antacids
may need life-long of DEAK
bariatric surgery medication concerns
may need to crush or put in liquid or use transdermal for up to 2 months post-surgery
rapid weight loss: might need meds that get ride of gallstones; Ursodiol (Urso 250, UrsActigall, Urso Forte)
