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Weight Loss Drugs Flashcards

1
Q

when is pharmacologic therapy for weight loss approved

A
  1. BMI ≥30
  2. BMI ≥27 with one or more comorbidities (T2DM, HLD, HTN, sleep apnea)
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2
Q

FDA approved medications for weight loss are indicated to be used as ______

A

adjunct to behavior modifications (diet and exercise)

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3
Q

short term (12 weeks) medications for weight loss

A

phentermine (not recommended)

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4
Q

long term (>12 weeks) medications for weight loss

A

orlistat, phentermine/topiramate ER, naltrexone ER/bupropion ER, liraglutide and semaglutide

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5
Q

phentermine class

A

sympathomimetic amine

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6
Q

phentermine MOA

A

suppresses appetite and increases metabolic rate so you feel less hungry and burn more calories. raises noradrenaline levels with increasing sympathetic nervous system (fight or flight)

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7
Q

phentermine dosing

A

37.5 mg daily

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8
Q

phentermine schedule

A

CIV

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9
Q

phentermine adverse

A

Increased HR and BP, dry mouth, constipation

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10
Q

phentermine contraindications

A

known CV disease (uncontrolled HTN), hyperthyroidism, history of drug abuse, use of MAOI inhibitors in the last 14 days, agitation, pregnancy X, nursing

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11
Q

orlistat class

A

gastrointestinal lipase inhibitor

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12
Q

orlistat MOA

A

reversible inhibitor of gastrointestinal lipases in the stomach and small intestine preventing digestion of triglycerides

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13
Q

orlistat brands

A

xenical (rx) and alli (otc)

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14
Q

orlistat dosing

A

xenical: 120 mg PO TID with meals
alli: 60 mg PO TID with meals

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15
Q

timing with orlistat to meals

A

can be taken as early as 1 hour before or as late as 1 hour after meals

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16
Q

orlistat ADE

A

diarrhea, oily spotting, flatus with discharge, fecal urgency, fatty/oily stool, increased defecation and fecal incontinence

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17
Q

orlistat ADEs are related to ___

A

diet; more likely to occur with meal >15 gm fat

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18
Q

orlistat contraindications

A

chronic malabsorption syndrome, cholestasis, pregnancy X

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19
Q

orlistat counseling

A

due to decreased fat soluble vitamin absorption, take a multivitamin AT BEDTIME to make sure you get enough of vitamins ADEK that your body might not absorb from the foods you eat

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20
Q

orlistat drug interactions

A

cyclosporine, levothyroxine, warfarin, AED

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21
Q

when to assess orlistat

A

at 12 weeks, discontinue if weight loss not at least 5%

22
Q

phentermine/topiramate ER class

A

sympathomimetic/anti-seizure

23
Q

phentermine/topiramate ER mechanism

A

phentermine MOA + anti seizure possibly increases POMC activity

24
Q

phentermine/topiramate ER schedule

25
initial dose titration for phentermine/topiramate
Days 1-14: 3.75 mg/23 mg QAM Then 7.5 mg/46 mg QAM
26
when to assess for phentermine/topiramate ER
at 12 weeks if weight loss ≥3% continue recommended dose. If weight loss is <3% titrate to: Days 1-14: 11.25 mg/69 mg QAM Then 15 mg/92 mg QAM (top dose)
27
phentermine/topiramate ER ADEs
increased HR and BP, dry mouth, constipation, tingling of hands and feet, dizziness, altered taste, insomnia
28
phentermine/topiramate ER monitring
renal dose adjust for CrCL <50 mL/min hepatic dose adjust for Child Pugh Class B Mood disorders (suicidal ideation)
29
phentermine/topiramate ER contraindications
known CV disease (uncontrolled HTN), hyperthyroidism, use of MAOI inhibitors in the last 14 days, glaucoma, pregnancy, nursing
30
phentermine/topiramate ER REMS
pregnancy category X: topiramate is a known teratogen. hormonal contraceptives need additional form of birth control
31
naltrexone ER/bupropion ER class
combination opioid antagonist/aminoketone antidepressant
32
naltrexone ER/bupropion ER mechanism
aminoketone bupropion ER: dopamine and norepinephrine reuptake inhibitor--> increases POMC activity--> sensation of satiety opioid antagonist naltrexone ER: opioid receptor antagonist--> after increased POMC activity, the beta-endorphins feedback to inhibit POMC--> naltrexone blocks beta-endorphin activity, enhancing the action of bupropion
33
naltrexone ER/bupropion ER dosing
Week 1: 1 tablet AM Week 2: 1 tablet AM and 1 tablet PM Week 3: 2 tablets Am and 1 tablet PM Week 4 onward: 2 tablets AM and 2 tablets PM
34
counseling for naltrexone ER/bupropion ER
do not take with a high fat meal (increased exposure)
35
when to assess naltrexone ER/bupropion ER
assess at 12 weeks and discontinue if weight loss not at least 5%
36
naltrexone ER/bupropion ER ADEs
nausea, constipation, HA, vomiting
37
naltrexone ER/bupropion ER precautions
renal dose adjust CrCL <50 mL/min hepatic dose adjust dose adjust with CYP2B6 inhibitors (clopidogrel) can cause increased HR and BP cases of hepatitis reported with naltrexone
38
naltrexone ER/bupropion ER contraindications
uncontrolled HTN, chronic opioid use, recent discontinuation of alcohol, BZD, barbiturates, AED's, MAOI inhibitors in the last 14 days, pregnancy X
39
naltrexone ER/bupropion ER BBW
increased risk of suicidal ideation with antidepressants for ages 18-24: have family assist with monitoring
40
GLP-1 agonists FDA approved for weight loss and T2DM
liraglutide and semaglutide
41
how do GLP-1 agonists work for weight loss
endogenous GLP-1 is released by L cells in ileum and colon in response to food digestion -stimulates pancreas to increase insulin and decrease glucagon -stimulates the brain to reduce appetite -stimulates GI tract to slow gastric emptying
42
what is the brand name of liraglutide for weight loss
saxenda
43
saxenda (liraglutide) dosing
week 1: 0.6 mg daily week 2: 1.2 mg daily week 3: 1.8 mg daily week 4: 2.4 mg daily week 5 onward: 3 mg daily if patient cannot tolerate GI events, a dose increase may be delayed by a week. if the adult patient cannot tolerate the 3 mg dose at all, discontinue. if the pediatric patient cannot tolerate the 3 mg dose, they can have 2.4 mg dose. if the pediatric patient cannot tolerate the 2.4 mg dose, discontinue.
44
what is the brand name of semaglutide for weight loss
wegovy
45
wegovy dosing
WEEKLY (not daily) week 1-4: 0.25 mg weekly week 5-8: 0.5 mg weekly week 9-12: 1 mg weekly week 13-16: 1.7 mg weekly week 17 onward: 2.4 mg weekly if the patients do not tolerate 2.4 mg dose, temporarily decrease to 1.7 mg for a maximum of 4 weeks, then try 2.4 mg again and discontinue if they cannot tolerate it.
46
GLP-1 ADEs
n/v/d, constipation, decreased appetite, dizziness, abdominal pain, dyspepsia, fatigue, increased lipase
47
GLP-1 precautions
may increase chance of hepatitis, increase HR by 10-20 BPM, hypoglycemia if taking insulin or a sulfonylurea
48
GLP-1 contraindications
history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2, pregnancy X
49
GLP-1 BBW
thyroid C cell tumors, including MTC
50
GLP-1 counseling
saxenda: refrigerator, room temp once opened, for 30 days wegovy: refrigerator, each pen is single use
51
when to evaluate for saxenda
at week 16. if weight loss <4%, discontinue

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