Weight management Flashcards

1
Q

What are some medical reasons for weight excess

A

Cushing syndrome, hypothyroidism

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2
Q

What are the goals of medication management for weight management?

A

reduce and maintain weight loss, improve health outcomes, minimize AEs

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3
Q

Who are candidates for medication management for weight

A

invidious with BMI above goals, or have not met weight loss goals with lifestyle interventions

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4
Q

Phentemine is an appetite ____ should be used in ___ and is contraindicated in ____

A

appetite suppressant, short term, HTN.

mech is sympathimometic

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5
Q

What is the MOA of phetemine/topirimate

A

sympathimometic and appetite suppressant

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6
Q

Orlistat îs a ____ (MOA), taken ___x daily, and has _____

A

GI lipase inhibitor, three times daily, GI SE

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7
Q

GLP-1 agonists (semaglutide, liraglutide) is _____ dose in DM and is an _____

A

higher, insulin analog

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8
Q

Why are naltrexone and bupropion used in weight management?

A

work on pleasure centers around eating and can be used in an overeater

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9
Q

What are the most extensive to least expensive meds for obesity

A

naltrexone/buproprion->GLP-1->orlistat->phetemine/topirimate->phentemine

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10
Q

MOA of orlistat

A

alter digestion of fat by inhibiting pancreatic lipases, increases fecal fat excretion. this is basically pooping fat
if you don’t have a high fat diet, there is not a huge reason for this

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11
Q

Should you ever prescribe orlistat?

A

no, 3x daily and not necessarily effective

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12
Q

GLP-1 agonists end in

A

tide

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13
Q

What is MOA of GLP-1 agonists?

A

incretin analogue-> stimulate glucose dependent insulin secretion, inhibit glucagon release, delay gastric emptying

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14
Q

What is the expected weight loss from GLP-1 agonists in 1 year

A

10-20%.

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15
Q

What are adverse effects of GLP-1 agonists?

A

GI SE, avoid in pregnancy, hx pancreatitis, fam hx of medullary thyroid cancer

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16
Q

Can GLP-1 be used in combination with metformin?

A

yes! this can help sustain weight loss

17
Q

GLP-1 agonists are given as ___. Rybelsus is ___ however

A

injections

oral, may not have good weight loss effectiveness

18
Q

Liraglutide will maintain weight loss at _____ and will see improvement in ___

A
3mg daily dose
CV outcomes (HTN, DM, HLD)
19
Q

the LEADER trial showed what?

A

liraglutide caused reduced CV events in patients with DM on GLP-1

20
Q

STEP clinical trial showed what?

A

semaglutide-> weight loss 15 percent at 68 weeks. 2.4mg weekly + lifestyle sustained the weight loss.

21
Q

Semaglutide should be started on a _____ and then ________

A

low dose, 0.25 mg weekly. increased every 2-4 weeks until 2.4 dose. tummy ache so go slowly.

22
Q

MOA of phentermine/topirimate

A

appetite suppression. topirimate enhance GABA activity which helps

23
Q

Phentermine/topirimate expected weight loss and AEs?

A

at beset 5%

AEs: depression, dry mouth, avoid in HTN or CV (bc the phentermine, its a stimulant)

24
Q

Phentermine/topiramate is good for patients in ____

A
portion control (helps to kickstart)
try not to keep patient on for too long
25
Q

What is MOA of bupropion/naltrexone for weight loss?

A

pleasure centers around eating

26
Q

Expected weight loss and AE in naltrexone/buproprion

A

maybe 5%

AE: nausea, avoid in CV or suicide risk

27
Q

When would naltrexone/bupriprion prescribed?

A

binge eating, night time eating, emotional eating

28
Q

Phentermine MOA

A

early satiety

29
Q

how much weight loss for phentermine? AEs?

A

not much, 3-5%

Contraindicated in CV disease. HTN. use only for 12 weeks

30
Q

Do GLP-1 works on fat distribution?

A

yes, probably

31
Q

Length of treatment for weight loss management medications

A

12 weeks-> reassess-> long term (phentermine containing things are12 weeks only, goal is 3% weight loss)
naltrexone/buproprion-> 5%
GLP-1 goal is 10%