Weight Loss Flashcards
What is the BMI for normal weight? What BMI is overweight? What BMI is obese?
Normal: 18.5 - 24.9
Overweight: 25-29.9
Obese: >30
What are some key drugs that cause weight gain (ADDLMS)
Antipsychotics (esp atypicals
Diabetic meds (insulin, sulfonylureas, TZDs)
Divalproex/valproic acid
Lithium
Mirtazapine (sometimes used for help with weight gain)
Steroids
What are some key drugs that can cause weight loss? (ADTB)
ADHD drugs
Diabetic meds (GLP1 agonists, pramlintide, SGLT2 inhibitors)
Topiramate
Bupropion
What are some general treatment principles for weight loss?
Goal: lose 1.5-2 pounds per week
Diet: 500kcal deficit per day -> 1 lb per week
Exercise: ≥ 150mins/week
Consider ADDING meds to lifestyle if still not meeting goals
What are 4 commons OTC products that people may use to lose weight?
These usually contain stimulants
- Bitter orange
- Green tea extract
- Yerba Mate
- Guarana
These are generally ineffective and can be harmful (esp in CV disease)
When is pharamcotherapy indicated for weight loss? When is bariatric surgery an option?
BMI ≥ 27 + a comorbid condition OR BMI of 30-39.9
If BMI ≥ 40 or BMI ≥35 + comorbid condition, could be candidate for bariatric surgery
What weight loss drugs should you avoid in pregnancy?
AVOID ALL WEIGHT LOSS DRUGS IN PREGNANCY!!
In what conditions/disease states should you avoid taking Contrave (naltrexone/bupropion)?
Hypertension (bupropion)
Depression (buproprion)
Seizures (bupropion)
Taking opiods (naltrexone)
In what conditions/disease states should you have caution when taking Qsymia (phentermine/topiramate ER)
Caution in hypertension (phentermine)
Caution if seizures (contains topiramate)
Qsymia (phentermine/topiramate ER) - MOA? Contraindications (4)? Side effects (3)? What dosing consideration is there?
Phentermine: similar effect to amphetamines
Topiramate: causes decreased appetite and satiety, unclear mechanism
Contraindications
- hyperthyroidism
- glaucoma
- MAO-I use within past 14 days
- pregnancy (REMS)
Side effects
- tachycardia
- insomnia
- vision problems
Need to taper off when stopping due to seizures
Contrave (naltrexone/bupropion) - MOA? Contraindications (5)?
MOA - appetite/craving suppression
Naltrexone: opioid antagonist
Bupropion: anti-depressant, increases norepinephrine and dopamine
Contraindications
- use w/ another form of bupriopion
- chronic opioid use
- uncontrolled HTN
- use of MAO-Is
- seizure disorder or hx of seizures
GLP1 agonists + dual GLP-1 and DIP agonist - MOA? Boxed warning? Frequency of injection for each?
MOA - increases satiety
Boxed warning - risk of thyroid C-cell carcinomas
Saxenda (liraglutide) - daily
Wegovy (semaglutide) - weekly
Zepbound (tirzepatide) - weekly
Orlistat (Xenical, Alli) - MOA? What type of diet does the patient need to be on? Contraindication (1)? Other considerations (2)?
MOA - inhibits lipase to prevent absorption of dietary fat
Diet - need to be on low-fat diet
Contraindication - pregnancy (like all the others)
Other considerations
- separate from fat soluble vitamins by at least 2 hours (vit ADEK)
- max 30% of calories from fat
phentermine (Adipex-P) - MOA? Contraindications (6)? Is this medication for short term or long term use?
MOA - acts as stimulant (releases noreinephrine) to decrease appetite
Contraindications
- MAO inhibitor in past 14 days
- avoid in CV disease (HTN, arrhythmias, HF)
- hyperthyroidism
- glaucoma
- pregnancy
- drug abuse history
Only for short term use (up to 12 weeks)!
At what point do we decide the weight loss medication is not working for the patient?
If they have not lost 5% of their weight in 3 months
