Weight Loss Drugs Flashcards by Hiba Hussain

Phentermine MoA

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

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Topiramate MoA

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

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

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

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Qsymia max dose
- max dose for CrCl < 50

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

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Qsymia Contraindications*

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

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Qsymia side effects*

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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Why taper* off Qsymia when stopping?

taper off due to seizure risk

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Naltrexone MoA?

Bupropion MoA?

Naltrexone decreases food cravings

Bupropion decreases appetite

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Contrave

Naltrexone/Bupropion

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Contrave max dose

2 tabs BID of 8 mg/90 mg

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

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

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Contrave BBW: not approved for use in?

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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Contrave Contraindications

(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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Contrave: discontinue use with s/sx of?

hepatotoxicity

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

HR & BP & cause glaucoma

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

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

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

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

Semaglutide (Wegovy) injection
Ozempic & rybelsus are for DIABETES

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

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

Semaglutide (Wegovy) dosing & target dose

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

Target dose: 2.4 mg SC weekly

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

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

Lipase inhibitor MoA

Decreases absorption of dietary fats by about 30%

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

Orlistat
Rx - Xenical
OTC - Alli

Orlistat must be used with what type of diet?

low-fat diet plan

contraindications to Orlistat

pregnancy*, chronic malabsorption syndrome, cholestasis

Orlistat: damage to what organ?

Liver, but rare

Orlistat may increase:

urinary oxalate/kidney stones hypoglycemia in patients with diabetes

Orlistat side effects

GI: flatus with discharge, fatty stool, fecal urgency

orlistat: separate out these meds:

MTV with ADEK, beta carotene, cyclosporine, levothyroxine

what type of dietary plan with orlistat?

max 30% of kcals from fat*

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

Phentermine *(Adipex-P*, Lomaira) (C-IV) Diethylpropion (C-IV) Phendimetrazine (CIII) Benzphetamine (CIII)

Benzphetamine - avoid taking at what time?

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

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?

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

When is bariatric surgery recommended

BMI 40 or more* BMI 35 or more with an obesity related condition*

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?

2 hours prior 4 hours after - fat mal-absorption - Ursodiol (Actigall, Urso 250, Urso Forte)

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

- insomnia - HR

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

- seizures - BP

GLP-1 agonists counseling - can cause:

- hypoglycemia, pancreatitis, nausea

Orlistat (Xenical and Alli) counseling

- 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.)

Appetite suppressants counseling: - can cause increased:

BP & HR