Weight loss Flashcards
Overweight BMI
25-29.9 kg/m2
Obese BMI
> = 30 kg/m2
Under weight BMI
<18.5 kg/m2
Normal weight BMI
18.5 - 24.9 kg/m2
Select drugs/conditions that can cause weight gain
Drugs:
- Antipsychotics (e.g., clozapine, risperidone, quetiapine)
- Diabetes drugs (insulin, SUs, meglitinides,
TZDs) - Divalproex/valproic acid
- Gabapentin, pregabalin
- Lithium
- Mirtazapine
- Steroids
- TCAs (amitriptyline, nortriptyline)
Conditions: Hypothyroidism
OTC drugs for weight loss
- Bitter orange
- Caffeine
- Guarana
- Green tea powder
Which medication was withdrawn from the market due to risk of cancer?
Lorcaserin (Belviq, Belviq XR)
Weight loss medications should be __ if they do not produce at least __ weight loss at __weeks
Fill in the blank
- Discontinued, 5%, 12
Select drugs/conditions that can cause weight loss
Drugs:
* ADHD drugs
- Bupropion
- GLP-1 agonists
- Pramlintide
- SGLT2 inhibitors
- Topiramate
Conditions: Hyperthyroidism, Celiac disease, IBD
Weight Loss drugs: Hypertension
Which medications to avoid/use caution if having HTN? Why?
Avoid: Contrave
* Contraindicated with uncontrolled BP, contains bupropion
Caution: Qsymia
* Monitor HR, contains phentermine
Weight loss drugs: Depression
Which medication to avoid/use caution if having depression? Why?
Caution: Contrave
* In young adults and adolescents; suicide risk, contains bupropion
Weight loss drugs: Seizures
Which medication to avoid/use caution if having seizures? Why?
Avoid: Contrave
* Lowers seizure threshold, contains bupropion
Caution: Qsymia
* Must taper off slowly if used, contains topiramate
Weight loss drugs: Taking opioids
Which medication to avoid/use caution when taking opioids? Why?
Avoid: Contrave
* Blocks opioid receptors, contains naltrexone
Qsymia: generic, indications safety/SEs/monitoring
- Phentermine/topiramate (C-IV)
- REMS initiated due to teratogenic risk
- CIs: pregnancy, glaucoma
- SEs: tachycardia, insomnia, vision problems
MOA:
* Phentermine: sympathomimetic (stimulant); release of NE stimulates the satiety which decreases appetite
- Topiramate: increase satiety and decrease appetite, possibly by increasing GABA
Contrave: generic, indications safety/SEs/monitoring
- Naltrexone/bupropion
- CIs: pregnancy, chronic opioid use, uncontrolled HTN, seizure disorder, use of of other bupropion containing products and MAO inhibitors
- Warnings: caution with psychiatric disorders
MOA:
* Naltrexone: decreases food cravings, blocks opioids
* Bupropion: decreases appetite
Which GLP-1 agonist can be used for weight loss? Provide safety/SEs/monitoring parameters
- Liraglutide (Saxenda); SC daily
- CIs: pregnancy
- Warnings: pancreatitis, hypoglycemia
- SEs: nausea
MOA: Increases satiety
Lipase Inhibitor: generic, indications safety/SEs/monitoring
MOA: Decreases absorption of dietary fats by ~30%
Orlistat
* Rx: Xenical, OTC: Alli
- Must be used with a low-fat diet plan
- CIs: pregnancy
- SEs: GI (flatus with discharge, fatty stool)
- Take multivitamin ADEK and beta carotene at bedtime or separated by more than or equal to 2 hrs
What is Phentermine used for?
Safety/SEs/Monitoring
Appetite supressant; sympathomimetic (stimulant)
Phentermine (Adipex-P): C-IV
* CIs: cardiovascular disease, hyperthyroidism, glaucoma, pregnancy, hx of drug abuse
- SEs: tachycardia, agitation, increased BP
- Used short-term, up to 12 weeks
When is bariatric surgery necessary?
When:
* BMI is >= 40 kg/m2
- BMI >= 35 kg/m2 with an obesity-related condition
Common nutrient deficiencies
- Calcium citrate is preferred as it has non-acid dependent absorption
- Anemia can result from vitamin B12 and iron deficiency
- Iron and calcium supplements should be taken 2 hrs prior or 4 hrs after antacids
- Patient may require life long ADEK vitamins
- Medications may be crushed and put in liquid or used in transdermal form up to two months post-surgery
- Ursodiol can be used in case of a gallstone
