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GI > Weight Loss Drugs > Flashcards

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

A

CIV

25
Q

initial dose titration for phentermine/topiramate

A

Days 1-14: 3.75 mg/23 mg QAM
Then 7.5 mg/46 mg QAM

26
Q

when to assess for phentermine/topiramate ER

A

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
Q

phentermine/topiramate ER ADEs

A

increased HR and BP, dry mouth, constipation, tingling of hands and feet, dizziness, altered taste, insomnia

28
Q

phentermine/topiramate ER monitring

A

renal dose adjust for CrCL <50 mL/min
hepatic dose adjust for Child Pugh Class B
Mood disorders (suicidal ideation)

29
Q

phentermine/topiramate ER contraindications

A

known CV disease (uncontrolled HTN), hyperthyroidism, use of MAOI inhibitors in the last 14 days, glaucoma, pregnancy, nursing

30
Q

phentermine/topiramate ER REMS

A

pregnancy category X: topiramate is a known teratogen. hormonal contraceptives need additional form of birth control

31
Q

naltrexone ER/bupropion ER class

A

combination opioid antagonist/aminoketone antidepressant

32
Q

naltrexone ER/bupropion ER mechanism

A

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
Q

naltrexone ER/bupropion ER dosing

A

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
Q

counseling for naltrexone ER/bupropion ER

A

do not take with a high fat meal (increased exposure)

35
Q

when to assess naltrexone ER/bupropion ER

A

assess at 12 weeks and discontinue if weight loss not at least 5%

36
Q

naltrexone ER/bupropion ER ADEs

A

nausea, constipation, HA, vomiting

37
Q

naltrexone ER/bupropion ER precautions

A

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
Q

naltrexone ER/bupropion ER contraindications

A

uncontrolled HTN, chronic opioid use, recent discontinuation of alcohol, BZD, barbiturates, AED’s, MAOI inhibitors in the last 14 days, pregnancy X

39
Q

naltrexone ER/bupropion ER BBW

A

increased risk of suicidal ideation with antidepressants for ages 18-24: have family assist with monitoring

40
Q

GLP-1 agonists FDA approved for weight loss and T2DM

A

liraglutide and semaglutide

41
Q

how do GLP-1 agonists work for weight loss

A

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
Q

what is the brand name of liraglutide for weight loss

A

saxenda

43
Q

saxenda (liraglutide) dosing

A

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
Q

what is the brand name of semaglutide for weight loss

A

wegovy

45
Q

wegovy dosing

A

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
Q

GLP-1 ADEs

A

n/v/d, constipation, decreased appetite, dizziness, abdominal pain, dyspepsia, fatigue, increased lipase

47
Q

GLP-1 precautions

A

may increase chance of hepatitis, increase HR by 10-20 BPM, hypoglycemia if taking insulin or a sulfonylurea

48
Q

GLP-1 contraindications

A

history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2, pregnancy X

49
Q

GLP-1 BBW

A

thyroid C cell tumors, including MTC

50
Q

GLP-1 counseling

A

saxenda: refrigerator, room temp once opened, for 30 days
wegovy: refrigerator, each pen is single use

51
Q

when to evaluate for saxenda

A

at week 16. if weight loss <4%, discontinue

GI (15 decks)

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