Weight management Flashcards
What are some medical reasons for weight excess
Cushing syndrome, hypothyroidism
What are the goals of medication management for weight management?
reduce and maintain weight loss, improve health outcomes, minimize AEs
Who are candidates for medication management for weight
invidious with BMI above goals, or have not met weight loss goals with lifestyle interventions
Phentemine is an appetite ____ should be used in ___ and is contraindicated in ____
appetite suppressant, short term, HTN.
mech is sympathimometic
What is the MOA of phetemine/topirimate
sympathimometic and appetite suppressant
Orlistat îs a ____ (MOA), taken ___x daily, and has _____
GI lipase inhibitor, three times daily, GI SE
GLP-1 agonists (semaglutide, liraglutide) is _____ dose in DM and is an _____
higher, insulin analog
Why are naltrexone and bupropion used in weight management?
work on pleasure centers around eating and can be used in an overeater
What are the most extensive to least expensive meds for obesity
naltrexone/buproprion->GLP-1->orlistat->phetemine/topirimate->phentemine
MOA of orlistat
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
Should you ever prescribe orlistat?
no, 3x daily and not necessarily effective
GLP-1 agonists end in
tide
What is MOA of GLP-1 agonists?
incretin analogue-> stimulate glucose dependent insulin secretion, inhibit glucagon release, delay gastric emptying
What is the expected weight loss from GLP-1 agonists in 1 year
10-20%.
What are adverse effects of GLP-1 agonists?
GI SE, avoid in pregnancy, hx pancreatitis, fam hx of medullary thyroid cancer
Can GLP-1 be used in combination with metformin?
yes! this can help sustain weight loss
GLP-1 agonists are given as ___. Rybelsus is ___ however
injections
oral, may not have good weight loss effectiveness
Liraglutide will maintain weight loss at _____ and will see improvement in ___
3mg daily dose CV outcomes (HTN, DM, HLD)
the LEADER trial showed what?
liraglutide caused reduced CV events in patients with DM on GLP-1
STEP clinical trial showed what?
semaglutide-> weight loss 15 percent at 68 weeks. 2.4mg weekly + lifestyle sustained the weight loss.
Semaglutide should be started on a _____ and then ________
low dose, 0.25 mg weekly. increased every 2-4 weeks until 2.4 dose. tummy ache so go slowly.
MOA of phentermine/topirimate
appetite suppression. topirimate enhance GABA activity which helps
Phentermine/topirimate expected weight loss and AEs?
at beset 5%
AEs: depression, dry mouth, avoid in HTN or CV (bc the phentermine, its a stimulant)
Phentermine/topiramate is good for patients in ____
portion control (helps to kickstart) try not to keep patient on for too long
