Weight Loss

Question 1

What BMI is considered overweight? Obese?

Answer 1

Overweight: 25-29.9
Obese: >30

Question 2

What drugs can cause weight gain

Answer 2

Antipsychotics (clozapine, olanzapine, risperidone, quetiapine)
Diabetes drugs (insulin, meglitinides, sulfonylureas, TZD)
Dialproex/valproic acid
Gabapentin, pregabalin
Lithium
Mirtazapine
Steroids
TCAs (amitriptyline, nortriptyline)

Question 3

Obesity guidelines

Answer 3

Daily deficit of 500-750 kcal or individualized diet
Physical activity >150 minutes/week on 3-5 days
Weight loss medications ONLY IF lifestyle measures have failed

Question 4

What OTC weight loss supplements are used?

Answer 4

Stimulants (bitter orange) and/or excessive amounts of caffeine

Question 5

When are weight loss medications indicated?

Answer 5

Only use in addition to a dietary plan and increased physical activity
BMI > 30
BMI > 27 AND one weight-related condition (dyslipidemia, HTN, or DM

Question 6

What agents are used to jump start a diet? What are used long-term?

Answer 6

Short term: phentermine, diethylpropion

Long term: Qsymia, Contrave, Saxenda, adn Orlistat

Question 7

Why was Lorcaserin (Belviq) withdrawn?

Answer 7

Increased risk of cancer

Question 8

When should weight loss drugs be discontinued?

Answer 8

If they do not produce 5% weight loss at 12 weeks

Question 9

What drugs can cause weight loss

Answer 9

ADHD drugs
Bupropion
GLP-1 agonists
Pramlintide
Roflumilast
SGLT2 inhibitors
Topiramate

Question 10

What weight loss drugs should be avoided in

Pregnancy

Answer 10

All of them

Question 11

What weight loss drugs should be avoided/used with caution in
HTN

Answer 11

Avoid: Contrave
Caution: Qsymia

Question 12

What weight loss drugs should be avoided in

patients taking opioids

Answer 12

Contrave

Question 13

What weight loss drugs should be used with caution in

Depression

Answer 13

Contrave

Question 14

What weight loss drugs should be avoided/used with caution in
patients with seizures

Answer 14

Avoid: Contrave
Caution: Qsymia

Question 15

Phentermine MOA

Answer 15

Sympathomimetic (Stimulant); releases NE which decreases appetite

Question 16

Topiramate MOA

Answer 16

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

Question 17

Phentermine/Topiramate ER (Qsymia) schedule, CI, SE, notes

Answer 17

Schedule: IV
CI: pregnancy
SE: Tachycardia, insomnia
Notes: REMS drug d/t teratogenic risk

Question 18

Naltrexone/Bupropion (Contrave) MOA, CI, warnings, notes

Answer 18

MOA: naltrexone decreases food cravings, bupropion decreases appetite
CI: pregnancy, opioid use, uncontrollable HTN, seizure disorder, use of other bupropion-containing products
Warnings: psychiatric disorders
Notes: naltrexone blocks opioids

Question 19

Liraglutide (Saxenda) class, CI, warnings, SE

Answer 19

Class: GLP-1 receptor agonist
CI: Pregnancy
Warnings: Pancreatitis, hypoglycemia
SE: Nausea

Question 20

Saxenda vs Victoza

Answer 20

Liraglutide
S - weight loss
V - diabetes

Question 21

Orlistat class, MOA, CI, SE, notes

Answer 21

Class: Lipase inhibitor
MOA: decreases absorption of dietary fats by ~30%
CI: pregnancy
SE: GI (flatus with discharge, fatty stool)
Notes: take MVI with ADEK

Question 22

What medications are appetite suppressants? What is their schedule

Answer 22

C-IV: Phentermine (Adipex-P) and diethylpropion,

C-III: phendimetrazine and benzphetamine

Question 23

Appetite suppressants CI, SE, monitoring, notes

Answer 23

CI: CV disease, hyperthyroidism, glaucoma, pregnancy, hx of drug abuse
SE: tachycardia, agitation, increased BP
Monitoring: HR, BP
Notes: used short-term up to 12 weeks to jump start a diet

Question 24

When is bariatric surgery recommended?

Answer 24

BMI 40 or higher or when BMI 35 or higher with an obesity-related condition

Question 25

Common nutrient deficiencies in someone who had bariatric surgery

Answer 25

Calcium
B12 and iron (anemia)
ADEK

Question 26

What is ursodiol (Actigall, Urso, Urso Forte) used for?

Answer 26

Dissolves gallstones that can form with rapid weight loss