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Weight Loss Flashcards

1
Q

What drugs/conditions can cause weight gain?

A
  1. Antipsychotics (clozapine, olanzapine, risperidone, quetiapine)
  2. Diabetes drugs (TZD, SUs, metaglinides, insulin)
  3. Divalproex/valproic acid
  4. Gabapentin/Pregabalin
  5. Lithium
  6. Mirtazapine/SSRIs (paroxetine)
  7. Steriods
  8. TCAs (amitriptyline, nortriptyline)/ MAOi
  9. Hypothyroidism
  10. Beta blockers/vasodialators (minoxidil)
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2
Q

What drugs/conditions cause weight loss?

A
  1. ADHD drugs
  2. Bupropion
  3. GLP-1 agonist/Tirzepitide
    4.Pramlintide (Symlin)
  4. Roflumast (phosphodiesterase-4 inhibitor)
  5. SGLT-2i
  6. Topiramate
  7. Acetylcholinesterase inhibitors (donepizil, rivastigmine, galantamine)
  8. Antiseizure medications (zonisamide, ethosuxamide)
  9. Interferons
  10. Tyroid drugs/ Hyperthyroidism
  11. Cystic fibrosis/ Lupus
  12. Inflammatory bowel disease/ Celiac disease/ GERD/PUD
  13. TB active
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3
Q

What are lifestyle modifications for weight loss

A
  1. 500-700cal caloric deficit
  2. ≥150 min/wk physical activity on 5 separate days + resistance exercises 2-3x/wk
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4
Q

When are weight loss medications indicated?

A
  1. BMI ≥30
  2. BMI ≥27 + dyslipidemia/HTN/DM/sleep apnea
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5
Q

What are OTC supplements for weight loss?

A
  1. Bitter orange
  2. Caffeine (guarana, green tea, yerba mate)
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6
Q

When should weight loss medications be D/C?

A

Not losing at least a 5% weight loss at 12 weeks

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7
Q

What patients should avoid Contrave (bupropion/naltrexone)?

A
  1. Pregnancy
  2. HTN
  3. Depression (suicide risk)
  4. Seizures- lowers threshold
  5. Taking opioids
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8
Q

What is the MOA of phentermine?

A

Simpathomimetic stimulant; NE stimulates satiety center, reduced appetite

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9
Q

What is the MOA of topiramate for weight loss?

A

Increases satiety and decreases appetite; possibly by increasing GABA or blocking glutamate and/or inhibition of carbonic anhydrase

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10
Q

Phentermine/Topiramate ER

A

Qsymia

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11
Q

What are CIs to using Qsymia?

A
  1. Pregnancy
  2. Glaucoma
  3. hyperthyroidism
  4. MAOi within the past 14 days
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12
Q

What are SEs with Qsymia?

A
  1. Tachycardia
  2. CNS effects (insomnia, depression, anxiety, suicidal thoughts, headache, parathesis)
  3. Vision problems
  4. constipation/dry mouth
  5. low bicarbonate
  6. URTI
  7. elevated SCr
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13
Q

How is Qsymia administered/ dosed?

A
  1. REMS program required; pregnancy test needed before treatment and monthly thereafter and use effective contraception
  2. Taper off due to seizure risk
  3. Take in the morning
  4. Start 3.75mg/23mg PO QAM x 14 days taper based on weight loss
  5. CrCL<50: max dose 7.5/46mg/day
  6. Max dose 15/92mg/day
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14
Q

What is the MOA of naltrexone/bupropion for weight loss?

A

Naltrexone: decreases food cravings
Bupropion: decreases appetite

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15
Q

Naltrexone/Bupropion

A

Contrave

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16
Q

What are BBWs with naltrexone/bupropion?

A

Not approved for tx of MDD or psychiatric disorders; can increase risk of suicidal thinking in children, young adults, and is not approved for pediatric use

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17
Q

What are CIs to using Contrave (naltrexone/bupropion)?

A
  1. Pregnancy
  2. MAO i use within 14 days
  3. Opioid use/withdrawal
  4. Uncontrolled HTN
  5. Other bupropion products
  6. bulimia/anorexia
  7. abrupt D/C of alcohol, benzos, barbs, or antiseizure medication
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18
Q

What are warnings with naltrexone/bupropion?

A
  1. Cuation with psychiatric disorders
  2. D/C if s/sx of hepatotoxicity
  3. can elevate HR/BP
  4. glaucoma
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19
Q

What are SEs with naltrexone/bupropion?

A
  1. N/V/constipation
  2. dry mouth
  3. headache
  4. dizziness
  5. insomnia
  6. elevated SCr
20
Q

How is Contrave (naltrexone/bupropion)
dosed/administered?

A
  1. D/C opioids 7-14 days prior to starting
  2. Fatty foods increase drug levels, do not take with high fate meal
  3. Do not chew, cut, crush; swallow whole
  4. Max dose: 2 tabs BID
21
Q

What are BBWs with GLP-1s?

A

Risk of C-cell thyroid cancer

22
Q

What are CIs to using GLP-1s?

A
  1. Personal/family hx of medullary thyroid cancer or multiple endeocrine neoplasia syndrome type 2
  2. Pregnancy (Saxsenda)
23
Q

What are warnings for GLP-1s?

A
  1. Pancreatitis
  2. Hypoglycemia
  3. AKI
  4. gallbladder disease
  5. Not recommended with severe GI diseases (gastroparesis); drug induced ileus reported
24
Q

What are SEs with GLP-1s?

A
  1. N/V/D/constipation
  2. hypoglycemia
  3. injection site reactions
  4. increased HR (tirzepatide)
25
What are DIs with GLP-1s?
Reduced oral absoprtion of PO drugs due to decreased gastric emptying; caution with narrow therapeutic drugs or required threshold concentrations for efficacy
26
How is liraglutide (Saxenda) dosed?
Start: 0.6mg SQ daily x 1 week; titrate by 0.6mg weekly Max dose: 3mg SQ QD
27
How is semaglutide (Wegovy) dosed?
Start: 0.25mg SQ weekly x 4 weeks, titrate every 4 weeks Max dose: 2.4mg SQ weekly
28
How is tirzepatide (Zepbound) dosed?
Start: 2.5mg SQ weekly x 4 weeks, increase to 5mg weekly Max dose: 15mg SQ weekly
29
Liraglutide
Saxenda Victoza (DM)
30
Semaglutide
Wegovy Ozempic (DM)
31
Tirzepatide
Zepbound Mounjaro (DM)
32
What is the MOA of orlistat?
decreased abs of fats by ~30%
33
What are CIs with orlistat?
1. Pregnancy 2. chronic malabsorption syndrome 3. cholestasis (reduced bile flow from liver to gallbladder)
34
What are warnings with orlistat?
1. liver damage (rare) 2. cholestasis 3. increased urinary oxalate/ kidney stones 4. hypoglycemia (DM)
35
What are SEs with orlistat?
1. GI (flatulence with discharge) 2. Fatty stool 3. fecal urgency
36
How is orilistat dosed/administered?
1. Must be used with low-fat diet plan, max 30% kcal from fat (Lessens GI SEs and helps weight loss) 2. Multivitamin containing ADEK and beta carotene at bedtime or separate by ≥2h from orlistat 3. Separate cyclosporine by ≥3h and Levothyroxine ≥4h 4. Take PO with each meal containing fat or up to 1 h after eating
37
Orlistat
Xenical (Rx) Alli (OTC)
38
What are CIs/warnings with sympathomimetics for weight loss?
1. CV disease (uncontrolled HTN, pulmonary HTN, arrhythmias, HF, CAD) 2. Hyperthyroidism 3. Glaucoma 4. Pregnancy/breastfeeding 5. Drug abuse history 6. MAOi within 14 days 7. Short-term use up to 12 weeks
39
What are SEs with phentermine/others?
1. Tachycardia 2. Agitation 3. High BP/Pulmonary HTN (use >3mo) 4. insomnia 5. dizziness 6. tremor 7. psychosis
40
What should be monitored with phemtermine/others?
1. HR/BP 2. sx of pulmonary HTN (dyspnea, edema)
41
Phentermine
Adipex-P Lomaria
42
What drugs used for weight loss are controlled substances?
1. Phentermine (CIV) 2. Qsymia (CIV) 3. Diethylpropion (CIV) 4. Phendimetrazine (CIII) 5. Benzphetamine (CIII)
43
When is weight loss/ bariatric surgery indicated?
1. BMI ≥35 2. BMI≥30 and T2DM 3. BMI≥30 who cannot achieve/ sustain a goal BMI or improve obesity related comorbidity with other methods
44
What vitamins/electrolytes must be supplemented after bariatric surgery?
1. Calcium citrate (non-acid dept absorption) 2. B12 and iron (anemia) 3. ADEK vitamins (fat malabsoprtion)
45
What are DIs after bariatric surgery?
1. Medications may require dose reduction 2. Medications may need to be administered crushed/ as a liquid/ or as a transdermal for up to 2 months post-surgery 3. Take Ca/Fe supplements 2 hours before or 4 hours after antacids 4. Rapid weight loss can cause gallstones; Urisodol dissolves gallstones
46
Urisodol
Actigall Urso 250 Urso Forte

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