Weight Loss Flashcards
What BMI is considered overweight? Obese?
Overweight: 25-29.9
Obese: >30
What drugs can cause weight gain
Antipsychotics (clozapine, olanzapine, risperidone, quetiapine) Diabetes drugs (insulin, meglitinides, sulfonylureas, TZD) Dialproex/valproic acid Gabapentin, pregabalin Lithium Mirtazapine Steroids TCAs (amitriptyline, nortriptyline)
Obesity guidelines
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
What OTC weight loss supplements are used?
Stimulants (bitter orange) and/or excessive amounts of caffeine
When are weight loss medications indicated?
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
What agents are used to jump start a diet? What are used long-term?
Short term: phentermine, diethylpropion
Long term: Qsymia, Contrave, Saxenda, adn Orlistat
Why was Lorcaserin (Belviq) withdrawn?
Increased risk of cancer
When should weight loss drugs be discontinued?
If they do not produce 5% weight loss at 12 weeks
What drugs can cause weight loss
ADHD drugs Bupropion GLP-1 agonists Pramlintide Roflumilast SGLT2 inhibitors Topiramate
What weight loss drugs should be avoided in
Pregnancy
All of them
What weight loss drugs should be avoided/used with caution in
HTN
Avoid: Contrave
Caution: Qsymia
What weight loss drugs should be avoided in
patients taking opioids
Contrave
What weight loss drugs should be used with caution in
Depression
Contrave
What weight loss drugs should be avoided/used with caution in
patients with seizures
Avoid: Contrave
Caution: Qsymia
Phentermine MOA
Sympathomimetic (Stimulant); releases NE which decreases appetite
Topiramate MOA
Increases satiety and decreases appetite, possibly by increasing GABA, blocking glutamate receptors and/or inhibition of carbonic anhydrase
Phentermine/Topiramate ER (Qsymia) schedule, CI, SE, notes
Schedule: IV
CI: pregnancy
SE: Tachycardia, insomnia
Notes: REMS drug d/t teratogenic risk
Naltrexone/Bupropion (Contrave) MOA, CI, warnings, notes
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
Liraglutide (Saxenda) class, CI, warnings, SE
Class: GLP-1 receptor agonist
CI: Pregnancy
Warnings: Pancreatitis, hypoglycemia
SE: Nausea
Saxenda vs Victoza
Liraglutide
S - weight loss
V - diabetes
Orlistat class, MOA, CI, SE, notes
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
What medications are appetite suppressants? What is their schedule
C-IV: Phentermine (Adipex-P) and diethylpropion,
C-III: phendimetrazine and benzphetamine
Appetite suppressants CI, SE, monitoring, notes
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
When is bariatric surgery recommended?
BMI 40 or higher or when BMI 35 or higher with an obesity-related condition
