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Weight Loss > Weight Loss Drugs > Flashcards

Weight Loss Drugs Flashcards

1
Q

Phentermine MoA

A

Sympathomimetic (stimulant)*
- release of norepinephrine stimulates t the satiety center which decreases appetite

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2
Q

Topiramate MoA

A

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

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3
Q

Qsymia
- C?
- Why is a pregnancy test needed before tx and monthly thereafter/ and contraception used during tx?

A

Phentermine/Topiramate ER
- C-IV
- It is a REMS drug due to its teratogenic risk

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4
Q

Qsymia max dose
- max dose for CrCl < 50

A

15 mg/92 mg PO QAM
- if CrCl < 50, max dose is 7.5 mg/46 mg/day

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5
Q

Qsymia Contraindications*

A

Pregnancy* glaucoma* hyperthyroidism, MAO inhibitor use within past 14 days

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6
Q

Qsymia side effects*

A

Tachycardia* CNS effects (insomnia, take in morning, depression, suicidal thoughts, etc.), vision problems, constipation, dry mouth, decreased HCO3, upper respiratory tract infection, increased Scr

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7
Q

Why taper* off Qsymia when stopping?

A

taper off due to seizure risk

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8
Q

Naltrexone MoA?

Bupropion MoA?

A

Naltrexone decreases food cravings

Bupropion decreases appetite

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9
Q

Contrave

A

Naltrexone/Bupropion

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10
Q

Contrave max dose

A

2 tabs BID of 8 mg/90 mg

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11
Q

Contrave
- can you cut/chew or crush tablets?
- Why not take with a high-fat meal?

A
  • No. Swallow whole.
  • Fatty food increases drug levels so do not take with high-fat meal
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12
Q

Contrave BBW: not approved for use in?

A
  • not approved for tx of depression, psychiatric disorders as bupropion can increase the risk of suicide.
  • also not approved for use in pediatric pts.
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13
Q

Contrave Contraindications

A

(Pregnancy, opioid use, uncontrolled HTN, seizure disorder, use of other bupropion containing products, use of MAO inhibitors within 14 days)*, etc.

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14
Q

Contrave: discontinue use with s/sx of?

A

hepatotoxicity

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15
Q

Contrave can increase?
Contrave can also cause what eye condition?

A

HR & BP & cause glaucoma

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16
Q

Naltrexone blocks opioids*, which can induce withdrawal, so: (related to contrave)

A

discontinue opioids or buprenorphine 7-14 days prior to use of contrave

17
Q

GLP-1 agonists MoA
- Drugs in this class for weight loss

A

increase satiety
- Liraglutide (Saxenda)* injection
- Victoza is FOR DIABETES

  • Semaglutide (Wegovy) injection
  • Ozempic & rybelsus are for DIABETES
18
Q

Liraglutide (Saxenda)
- dosing & target dose
- Can you take in pregnancy?

A

0.6 mg (SC daily*) x 1 week, titrate up by 0.6 mg SC daily at weekly intervals

Target dose: 3 mg SC daily

  • no, contraindicated in pregnancy
19
Q

Semaglutide (Wegovy) dosing & target dose

A

0.25 mg SC weekly x 4 weeks, titrate up every 4 weeks

Target dose: 2.4 mg SC weekly

20
Q

Saxenda & Wegovy
- risk of which carcinoma?
-Pancreatitis?
-hypoglycemia?
- what other warnings?
- primary side effect?
- decrease what diabetes meds to lessen risk of hypoglycemia?

A
  • thyroid c-cell carcinoma
  • yes, warning of pancreatitis
  • yes, warning of hypoglycemia
  • other warnings: acute gallbladder disease, gastroparesis
  • primary side effect: nausea
  • may decrease insulin or sulfonylurea/meglitinide doses
21
Q

Lipase inhibitor MoA

A

Decreases absorption of dietary fats by about 30%

22
Q

What weight loss medication is a lipase inhibitor?
- Rx name?
- OTC name?

A

Orlistat
Rx - Xenical
OTC - Alli

23
Q

Orlistat must be used with what type of diet?

A

low-fat diet plan

24
Q

contraindications to Orlistat

A

pregnancy*, chronic malabsorption syndrome, cholestasis

25
Q

Orlistat: damage to what organ?

A

Liver, but rare

26
Q

Orlistat may increase:

A

urinary oxalate/kidney stones

hypoglycemia in patients with diabetes

27
Q

Orlistat side effects

A

GI: flatus with discharge, fatty stool, fecal urgency

28
Q

orlistat: separate out these meds:

A

MTV with ADEK, beta carotene, cyclosporine, levothyroxine

29
Q

what type of dietary plan with orlistat?

A

max 30% of kcals from fat*

30
Q

what drugs are appetite suppressants (sympathomimetic stimulants that release norepinephrine and stimulate satiety center)

A

Phentermine (Adipex-P, Lomaira)
(C-IV)

Diethylpropion
(C-IV)

Phendimetrazine
(CIII)

Benzphetamine
(CIII)

31
Q

Benzphetamine - avoid taking at what time?

A

Late afternoon, stimulants taken later in the day can cause insomnia

32
Q

Phentermine (Adipex-P, Lomaira)
(C-IV)

Diethylpropion
(C-IV)

Phendimetrazine
(CIII)

Benzphetamine
(CIII)

Contraindications to above drugs?
Side effects
monitor
How are these drugs used?

potential for?

A

CVD (ex: uncontrolled HTN, arrhythmias, HF, CAD, hyperthyroidism, glaucoma, pregnancy, breast feeding, history of drug abuse*, MAO inhibitors within the past 14 days

Tachycardia, agiation, increased BP*, insomnia, dizziness, tremor, psychosis
HR BP (monitor)

USed short-term up to 12 weeks to “jump-start” a diet

misuse/dependence

33
Q

When is bariatric surgery recommended

A

BMI 40 or more*

BMI 35 or more with an obesity related condition*

34
Q

Bariatric surgery

  • iron and calcium supplements should be taken ___ hours prior or ______ hours after antacids
  • may need life-long supplementation of fat-soluble vitamins ADEK due to:
  • rapid weight loss can cause gall-stones, what medication can help with gallstones?
A

2 hours prior

4 hours after

  • fat mal-absorption
  • Ursodiol (Actigall, Urso 250, Urso Forte)
35
Q

Counseling for Qsymia: take in the morning, avoid taking in the evening to prevent:

can cause increased

A
  • insomnia
  • HR
36
Q

Contrave counseling: do not take with opioids or with a history of:

Can increase:

A
  • seizures
  • BP
37
Q

GLP-1 agonists counseling
- can cause:

A
  • hypoglycemia, pancreatitis, nausea
38
Q

Orlistat (Xenical and Alli) counseling

A
  • take 1 cap at each meal or up to 1 h after a meal that contains fat
  • eat a healthy diet low in fat to reduce GI effects
  • can cause stomach issues (fatty/oily stool, poor bowel control, etc.)
39
Q

Appetite suppressants counseling:
- can cause increased:

A

BP & HR

Weight Loss (4 decks)

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