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You're Passing the Exam Sis... This Isn't an Option > Weight Loss > Flashcards

Weight Loss Flashcards

1
Q

What BMI is considered overweight vs. obese

A

BMI 25-29.9 kg/m^2 = overweight
BMI >/= 30 kg/m^2 = obese

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2
Q

Being overweight puts you at higher risk for

A

Coronary heart disease*
T2DM*
Stroke*
HTN*

Certain cancers and premature death

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3
Q

Define energy deficit and what are some diet recommendations for weight loss by AACE/ACE

A

This is how weight loss is achieved. Decreasing calories or increasing energy expenditure

AACE/ACE (Clinical/College of Endocrinology) recommend diets that reduce calories by 500 - 750 cal (ex: mediterranean, DASH - dietary approaches to stop HTN, low carb, low fat, volumetric, high protein and vegetarian diets, or very low calorie diets)

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4
Q

Many weight loss drugs work by…

A

Increasing satiety or reducing appetite

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5
Q

Questions to ask when a patient experiences weight gain

A

Do any of their medications cause weight gain
Do any of their conditions cause weight gain
Did they discontinue a weight loss medication
Are they just edemic

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6
Q

Drugs that cause weight gain

A

Key Drugs
Antipsychotics (clozapine, olanzapine, risperidone, quietapine)
Diabetes meds (insulin, sulfonylureas, meglitinides, thiazolidinediones)
Divalproex/valproic acid
Gabapentin, Pregabalin
Lithium
Mirtazapine
Steroids
TCA’s (e.g. amitriptyline, nortriptyline)

Others:
Beta Blockers
Dronabinol
Hormones (e.g. estrogen, megesterol)
MAO Inhibitors
SSRIs (paroxetine, others may be weight neutral)
Vasodilators

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7
Q

Condition that causes weight gain

A

Hypothyroidism

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8
Q

Ideal amount of physical activity

A

at least 150 minutes of activity performed 3-5 days of the week + resistance exercises 2-3 times weekly

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9
Q

When is it okay to add weight loss medications

A

When patient has failed to achieve adequate weight loss, maintain it, or prevent continued weight gain with the lifestyle measures

If patients have complications related to their weight (diabetes, dyslipidemia, hypertension, sleep apnea) then they can start medications at the same time as their lifestyle factors.

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10
Q

OTC supplements for weight loss (generally not recommended because ?)

A

Bitter orange
Excessive caffeine (ex: guarana, yerba mate, concentrated green tea powder)

Generally not recommended because they can be harmful esp. in patients with cardiovascular disease.

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11
Q

Criteria for weight loss drugs

A

BMI >/= 30 kg/m^2 or
BMI >/= 27 kg/m^2 with at least one weight related condition (HLD, HTN, T2DM)

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12
Q

What must always be coupled with weight loss medications

A

Dietary plan and increased physical activity

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13
Q

Older stimulant drugs that were used short term to jump start a diet

A

Phentermine, diethylpropion

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14
Q

Newer, long term weight loss drugs

A

Qsymia, wegovy, contrave, saxenda, and the orlistat formulations

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15
Q

If weight loss meds don’t produce ____% weight loss within ____ weeks, they need to be discontinued

A

5% weight loss in 12 weeks

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16
Q

Drugs that cause weight loss

A

Key drugs:
ADHD Drugs (amphetamine, methylphenidate)
Bupropion
GLP1 agonists (exenatide, liraglutide)
Pramlintide
Roflumilast
SGLT2 inhibitors (canagliflozin, empagliflozin)
Topiramate

Others:
Acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine, galantamine)
Antiepileptic drugs (zonisamide, ethosuximide)
Interferons
Thyroid drugs (ex: levothyroxine)

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17
Q

Conditions that cause weight loss

A

Hyperthyroidism
Celiac disease
Inflammatory bowel disease

Conditions:
Cystic fibrosis
GERD or peptic ulcer disease
Lupus
Tuberculosis (active disease)

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18
Q

True or false: weight loss drugs can never be used in pregnancy

A

True

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19
Q

Which weight loss drugs should be avoided and which should be used with caution in pts with HTN

A

Contrave - contraindicated with uncontrolled HTN because it contains bupropion which can increase blood pressure.

Qsymia - use with caution and monitor HR because it contains phentermine which can elevate BP and HR

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20
Q

Which weight loss drug should be used with caution in young adults and adolescents and those with depression

A

Contrave because it contains bupropion, it comes with a suicide risk

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21
Q

Which weight loss drug should be avoided and which should be used with caution in people with seizure disorders

A

Contrave - avoid bc it contains bupropion which lowers the seizure threshold

Qsymia- use with caution and you must taper off slowly if used because it contains topiramate.

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22
Q

MOA of phentermine

A

A sympathomimetic stimulant that releases NE to stimulate the satiety center and decrease appetite

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23
Q

MOA of topiramate

A

Its complicated:
Increases satiety, decreases appetite, possibly increases GABA, blocks glutamate receptors and/or inhibits carbonic anhydrase

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24
Q

Qsymia generic name + control class

A

Phentermine/topiramate
Schedule 4 ! CIV

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25
Q

Qsymia (phentermine/topiramate) starting, max, and renal dosing

A

Start: 3.75mg /23 mg PO QAM x 14 days; then titrate up based on weight loss (taken in the morning due to insomnia SE)

Max dose: 15 mg /92 mg PO QAM

CrCl < 50 ml/min, then max dose is 7.5 mg/46 mg daily (half the normal max)

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26
Q

CI’s for Qsymia

A
  • Avoid if pregnant (REMS - pregnancy test needed before tx and for every month of treatment + use effective contraception)
  • Avoid in glaucoma
  • Hypothyroidism
  • MAO inhibitor use within the past 14 days
27
Q

Side effects of Qsymia

A

tachycardia
CNS effects (e.g. insomnia so take in AM, depression
anxiety, suicidal thoughts, headache, paresthesias)
vision problems
constipation
dry mouth
decrease HCO3-
URTI’s

Risk of seizures, so we NEED to TAPER off

28
Q

Contrave generic name and the MOA of each part

A

Naltrexone: decreases food craving
Bupropion: decreases appetite

29
Q

Contrave (naltrexone/bupriopion) dosing regimen and counseling when taking

A

ER tablet: 8 mg / 90 mg
Week 1: 1 tab PO QAM
Week 2: 1 tab PO BID
Week 3: 2 tabs PO QAM & 1 tab PO QPM
Week 4+: 2 tabs PO BID

NEVER crush or chew swallow whole (ER)
Don’t take with fatty meal because it increases drug levels

30
Q

Contrave boxed warning

A

Not approved for treatment of major depressive disorder, or psych disorders. Buproprion can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults, not approved for pediatrics

31
Q

Contraindications and warnings for contrave

A

CI: pregnancy, chronic opioid use or acute opioid withdrawal, uncontrolled HTN, seizure disorder, use of other bupropion containing products, bulimia/anorexia, abrupt discontinuation of alcohol, benzos, barbiturates, antiepileptic drugs, and use of MAOi’s within 14 days

Warnings: Use caution with psychiatric disorders, discontinue with s/sx of hepatotoxicity, can increase HR, BP, and glaucoma

32
Q

SE of contrave

A

N/V, constipation, HA, dizziness, dry mouth, insomnia, increased SCr

33
Q

Jenna is on buprenorphine and she wants to start taking contrave. What do we need to counsel her on?

A

The naltrexone component of Contrave blocks buprenorphine and opioids from working and producing analgesia and this can lead to withdrawal. We should make sure she stops buprenorphine 7-14 days before starting contrave

34
Q

GLP1s that can be used for weight loss and what is their boxed warning and contraindication.

A

Liraglutide (Saxenda or Victoza)
Semaglutide (Wegovy or Ozempic)

Ozempic and Victoza are specifically for DM pts

Boxed warning for Thyroid C cell carcinomas in animal studies, the risk to humans is unknown.

Contraindicated in patients with personal or family history of medullary thyroid carcinoma (MTC) or patients with multiple endocrine neoplasia syndrome type 2 (MEN2). Saxenda is contraindicated in pregnancy (i think all weight loss drugs are)

35
Q

MOA of GLP1s for weight loss

A

Increase satiety

36
Q

Dosing for Liraglutide (saxenda and Victoza) and how young can it be used

A

They are approved for children at least 12 years old who are >60 kg and BMI is corresponding to a BMI of at least 30kg/m^2 in adults

0.6 mg SC daily x 1 week, then titrate up by 0.6 mg SC daily at weekly intervals until you reach target dose of 3 mg SC daily (4 weeks about)

37
Q

How is Semaglutide (Wegovy and ozempic) dosed

A

0.25 mg SC weekly for 4 weeks, then titrate up every 4 weeks to target dose of 2.4 mg SC weekly

38
Q

What are some warning s for GLP1s and side effects

A

Pancreatitis, hypoglycemia, acute gallbladder disease, gastroparesis

Nausea**, vomiting, diarrhea, constipation, injection site reactions

39
Q

Orlistat Rx vs OTC name

A

Orlistat (Xenical) - Rx only
Orlistat (Alli) - OTC

40
Q

MOA of orlistat

A

decreases absorption of dietary fats by 30%

41
Q

Dosing of (Orlistat) Xenical and age

A

120 mg PO with each meal containing fat; can take with the meal or up to 1 hour after ; for ages 12 an above

42
Q

Dosing of (Orlistat) Alli

A

60 mg PO with each meal containing fat; MUST BE USED WITH a low fat diet plan

43
Q

Contraindications for Orlistat

A

Pregnancy, chronic malabsoprtion syndrome, cholestasis

44
Q

Warnings for orlistat

A

Liver damage (rare), cholelisthiasis, increased urinate oxalate/kidney stones,

45
Q

Side effects of Orlistat

A

GI (farting with discharge, fatty stool), fecal urgency

46
Q

Counseling points for patients on Orlistat

A

Take fat absorbed vitamins (KADE) and beta carotine at bed time or separate by at least. 2 hrs

Never use with cyclosporine or separate by at least 3 hours; separate levothyroxine by at least 4 hours

Patients MUST stick to the dietary plan for both weight improvement and to help reduce side effects (max of 30% of their kcals should be from fat)

47
Q

MOA of appetite suppressants like
Phentermine (Adipex-P, Lomaira) (CIV)
Diethylpropion (CIV)
Phendimetrazine (CIII)
Benzphetamine (CIII)

A

They are sympathomimetics (stimulants) releasing NE stimulates satiety center to decrease appetite

48
Q

Contraindications of appetite suppressants like
Phentermine (Adipex-P, Lomaira) (CIV)
Diethylpropion (CIV)
Phendimetrazine (CIII)
Benzphetamine (CIII)

A

Cardiovascular disease (uncontrolled HTN, arrythmias, heart failure, CAD,) hyperthyroidism, glaucoma, pregnancy, breastfeeding, history of drug abuse, MAO inhibitors in last 14 days

49
Q

Side effects of appetite suppressants like
Phentermine (Adipex-P, Lomaira) (CIV)
Diethylpropion (CIV)
Phendimetrazine (CIII)
Benzphetamine (CIII)

what should we monitor

A

Tachycardia, agitation, Increased BP, insomnia, dizziness, tremor, psychosis

MONITOR HR AND BP

50
Q

Counseling points for appetite suppressants

A

For short term use to help jump start a diet
stimulants should be taken early in the day to avoid insomnia
Potential for misuse/dependence

51
Q

Dosing for
Phentermine (Adipex-P, Lomaira) (CIV)

A

15-37.5 mg PO daily before or after breakfast or in divided doses

52
Q

Dosing for Diethylpropion (CIV)

A

IR: 25 mg PO TID , 1 hour before meals and mid evening
SR: 75 mg PO once in mid morning

53
Q

Dosing for Phendimetrazine (CIII)

A

IR 35 mg PO BID-TID 1 hr before meals
ER: 105 mg PO daily 30-60 min before the morning meal

54
Q

Dosing for Benzphetamine (CIII)

A

25-50 mg PO daily TID (avoid late afternoon administartion)

55
Q

When is bariatric weight loss recommended

A

for adults whos BMI is > 40 kg/m^2 OR WHEN BMI>35 kg/m^2 with an obesity related

56
Q

What does bariatric surgery do

A

Restricts the amount of food people eat because stomach is smaller and this leads to weight loss . This is a life time commitment to healthy eating and regular exercise to sustain the weight loss.

57
Q

Nutrient deficiencies related to bariatric surgery

A

Calcium - bc normally absorbed in duodenum and may be bypassed – > give calcium citrate because its a non acid dependent absorption supplement

Vitamin B12 and Iron - deficiency can result in anemia

Iron and calcium supplements must be taken 2 hours before or 4 hours after antacids

Life long supplementation of fat soluble vitamins (KADE) because of fat malabsoption

58
Q

Medication concerns related to bariatric surgery

A

Meds may need to be dose adjusted and crushed and put into liquid or used in transdermal form for up to TWO months post surgery. - BE SURE TO ASSESS WHICH DRUGS CAN BE CRUSHED/DOSAGE FORM CHANGED

59
Q

Weight loss helps to improve what comorbid conditions

A

HTN and DM
We should monitor these conditions well and also consider dose reductions for medications

60
Q

Which weight loss medication contains a stimulant that can increase HR and should also be taken in the morning to avoid insomnia

A

Phentermine/Topiramate (Qsymia)

61
Q

Which weight loss medication can increase BP and also should be avoided with opioids and with a history of seizures and cautioned in those with depression

A

Burpropion/Naltrexone (Contrave)

62
Q

What are the side effects of using GLP1’s and counseling points for patients using it for weight loss

A

Nausea, pancreatitis, hypoglycemia
Avoid taking with other GLP1’s for DM

63
Q

Counseling points for patients on Orlistat

A

Take one capsule at each meal or up to one hour after each meal that contains fat

Eating a healthy, low fat diet is an important way to reduce the GI SE

SE: stomach issues: oily stools, oily spotting, intestinal gas with discharge, urgency to booboo/poor control, increased frequency of booboo)

64
Q

What should we monitor while patients are on appetite suppressants

A

Monitor HR and BP

Avoid using if they have CVD like uncontrolled HTN, arrhythmias, etc. or hyperthyroidism, pregnancy, galucoma, breast feeding, or history of drug abuse or MAO in past 14 days

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