Weight, smoking, alcohol, opioids Flashcards
How do you calculate BMI?
BMI = weight (kg)/ Height^2 (m)
What are the classifications according to BMI?
<18.5 underweight, 18.5-24.9 normal, >25 overweight
pre-obese 25-29.9
obese 1 30-34.9
obese 2 35-39.9
obese 3 >40
What waist circumference places you at risk?
> 88cm in women, >102cm in men
What medications can cause weight gain?
Benzodiazepines, anti-epileptics, antipsychotics, TCAs, corticosteroids, sulphonylureas (diabetes drug), insulin
What are the 3 categories of shakes used for weight loss?
Formulated supplementary foods, formulated meal replacements, VLCD
How does a VLCD help lose weight?
Induces mild ketosis.
What medications may need to be adjusted in a VLCD?
Diabetes drugs, antihypertensives and lipid disorder drugs; monitor lithium and warfarin.
How does phentermine work?
It is a sympathomimetic amine that works in the appetite control centre in the hypothalamus. It supresses appetite.
What precautions and drug interactions does phentermine have?
Only use for max 12 w
It may cause increase BP
May interact with SSRI, MAOI, urinary acidifiers and alkalisers (excretion increased with acidification, reduced with alkaline urine)
Can cause withdrawal symptoms - drowsiness, fatigue, nausea, trembling, insomnia
What are the clinical indications for orlistat?
BMI>30 or >27 with comorbidities
What are counterindications and precautions for orlistat?
Cholestasis
Major GI surgery
Chronic malabsorption syndrome
Pancreatic enzyme deficiency
Chronic pancreatitis
Pregnancy and lastation
Bulimia, laxative abuse, fat-soluble vitamin deficiency (ADEK), peptic ulcer disease
What S4 drug combination may work for weight loss?
Bupropion+naltrexone
How do liraglutide and semaglutide work?
Slow gastric emptying and supress hunger
What are some AEs of GLP-1 agonists?
Constipation, nausea, diarrhoea
What is smoking’s effect on metabolic enzymes?
Smoking induces CYP1A2 and CYP2B6 (not via nicotine , therefore nicotine replacement does not induce these enzymes)
What medicines should be monitored when a patient quits smoking? Give some examples?
Antipsychotics, benzos and zolpidem, some antidepressants, heparin and warfarin, insulin, theophylline
What are the most effective 1st line treatments for smoking cessation?
NRT combination and varenicline (S4)
How does varenicline work?
Nicotine receptor patial agonist - in the absence of nicotine it reduces withdrawals and cravings, in the presence of nicotine it blocks its ability to bind the receptor and produce pleasurable effects
Whare are important notes for varenicline?
Can exacerbate mental health conditions, needs to be started at least 1 week before the quit date, must be swallowed whole, can cause nausea (take with food), follow up with dr 2-3 weeks after starting
How does bupoprion work?
It is an antagonist of the ACh nicotinic receptor. reduces the urge to smoke and symptoms of nicotine withdrawal
What are some important points for bupropion?
Start 1 week before quitting, CI in history of seizures, anorexia/bulimia, do not use with MAOI; significant DIs with antidepressants and inhibits CYP2B6;
take in the morning to reduce sleep problems
swallow whole
avoid alcohol
can be used with NRT
caution in patients using drugs that lower seizure threshold (antipsychotics, antidepressants)
follow-up 2-3 weeks
What drugs are used for alcohol withdrawal?
Benzodiazepines (gold standard) + B1 supplements
Acamprosate - reduces cravings, preferred when taking opiods for pain - start 7 days after last drink
Naltrexone - monitor liver fct, care when restarting opioids
Disulfiram - prevents alcohol metabolism, px must BAC 0 when starting treatment; not in renal and hepatic disease
What is the pharmacist’s role in the Opioid Treatment Program?
Dispense daily and takeaway doses
Assess px for signs of intoxication and withdrawal
Supervise administration and compliance
Provide support
Maintain regular contact with the prescriber if the notice - intoxication/drug use, non-attendance for dosing, other problems
What opioid agonists are available for treatment of opioid addiction?
Methadone - full agonist, oral liquid, rapid onset of action , long half life; severe and prolonged withdrawal
Buprenorphine - partial agonist, sublingual (film and tablet), slower onset but still within 1 h, long half life; less severe but still prolonged withdrawal
What are the approaches when methadone or buprenorphine doses are missed?
1-2 - dose as normal
3 - consult prescriber and review dose
4 -5- consult prescriber and reduce dose
6 - refer to prescriber
What are double or triple dosing of buprenorphine?
Dosing every 2 or 3 days.
What is in Suboxone and what are the advantages for use?
buprenorphine and naloxone
makes dosing quicker and requires less supervision; comes in a sublingual film that sticks to the mucosa; less chance of misuse
What is the rationale for naltrexone use?
Antagonist of the mu opioid receptor. Blocks the effect of opioid drugs. Can be used to prevent a relapse as the px won’t get the pleasurable effects of opioids. Works for 24-72 h.
What dosage forms does naloxone come in?
Prefilled syringe and single use nasal spray.
