Wt Loss Flashcards
1
Q
Overwieght/Obesity treatment
- A combined intervention of behavior therapy, dietary changes and increased physical activity should be maintained fro at least 6 months before considering pharmacotherapy
A
- Behavior modification and lifestyle changes
- Nutritional counseling
- Exercise counseling
- Correcting endocrine imbalances (menapause)
- Supplements
- Prescription medications
2
Q
Use of obesity drugs
A
- BMI > 30 kg/m2 OR BMI > 27 kg/m2 with comorbid condition (or have tried all other diet options)
- Understand that drug therapy is adjunctive to lifestyle intervention
- Have realistic expectations abt wt loss goals and outcomes
- Demonstrate readiness for change
- Are unable to lose/maintain wt with lifestyle change alone
- Comply with medication use
- Have no medical or psychiatric contraindications
- Wt loss drugs should never be used w/o continued concomitant lifestyle modifications and as part of a comprehensive wt loss program
- Continual assessment of drug therapy for efficacy and safety is necessary
- If the drug is efficacious in helping the pt to lose and/or maintain wt loss and there are no serious adverse effects, it can be continued
- If not, it should be discontinued
3
Q
Contraindications/Cautions of obesity drugs
A
- Pregnancy/Lactation
- Unstable cardiac dz
- Uncontrolled HTN (>180/110)
- Unstable severe systemic illness
- Unstable psychiatric disorder or history of anorexia
- Other drug therapy, if incompatible (MAOi, migraine drugs, adrenergic agents, arrhythmic potential)
- Closed angle glaucoma (caution)
- General anesthesia
4
Q
Orlistat (Alli, Xenical)
- Obesity Management
- Wt loss/maintenance
A
- MOA: reversible gastric and pancreatic lipase inhibitor (inhibits absorption of up to 1/3 of dietary fat)
- Minimal systemic absorption; lowers plasma LDL cholesterol levels; lowers HbA1C in DM pts
- Diet must be
5
Q
Lorcaserin (Belviq)
A
- MOA: serotonin receptor agonist; exact mechanism unknown; decreases food intake; increases satiety
- ADR: HA, dizziness, fatigue, N/D/C, dry mouth/dry eye, cough, bradycardia, hyperprolactinemia
- WARNING: Serotonin syndrome, neuroleptic malignant syndrome like reactions; valvular heart dz; cognitive impairment; psychiatric disorders (euphoria, dissociation); Watch for depression/suicidal thoughts; Watch blood glucose; priapsm (seek emergency treatment if an erection lasts > 4 hrs)
- DRUG INTERACTIONS: Serotonin drugs (triptans, MAOIs (including linezolid), SSRIs/SNRIs, dextromethorphan, TCAs, bupropion, Li, tramadol, tryptophan, St John’s Wort); Inhibits CYP 2D6 (dextromethorphan)
- t1/2= 11 hrs
- CIV
6
Q
Naltrexone/Bupropion (Contrave)
- For wt loss in obesity or overwieght with comorbidity
A
- Naltrexone: opioid antagonist
- Bupropion: antidepressants/smoking cessation
- ADR: N/V/D/C, HA, dizziness, insomnia, dry mouth
- WARNING: suicidal ideation, seizure, HTN, tachycardia, liver dysfunction, angle closure glaucoma
- CONTRAINDICATION: uncontrolled HTN, seizures, chronic opioid use, use of MAOIs
7
Q
Qsymia (phentermine/topiramate combo)
A
- ADR: insomnia, kidney stones, shaking/dizziness (think topiramate ADR)
- WARNING: increase in HR, suicidal behavior and ideation, acute myopia and secondary angle closure glaucoma, mood and sleep disorders, cognitive impairment, metabolic acidosis, elevated creatinine, wt loss may cause hypoglycemia
- CONTRAINDICATION: pregnancy, glaucoma, hyperthyroid
- DRUG INTERACTION: OCP (may cause irregular bleeding, d/c if spotting occurs); CNS depressants; non-potassium sparing diuretics
- CIV
8
Q
Liraglutide (Saxenda)
A
- MOA: GLP 1 agonist; decrease GI motility
- ADR: Wt loss, medullary thyroid cancer, constipation, abd discomfort, nausea (GI stuff!!!)
- CONTRAINDICATION:??
- MONITORING:??
9
Q
Drugs approved for short term use
A
Phentermine
Diethylpropion
Phendimetrazine
10
Q
Phentermine
- FDA approved for short term use (12 wks) in adults (> 16 yrs old)
A
- MOA: sympathomimetic, stimulates CNS activity/catecholamine release, thereby decreasing hunger; appetite suppressant
- COMMON ADR: palpitation, tachycardia; restlessness, insomnia, D, xerostomia (dry mouth), HTN, euphoria, HA
- SERIOUS ADR: dependency, psychosis, tachycardia, HTN, pulmonary hypertension, valvular heart dz
- NOT for pts with h/o heart disease
- WARNING: primary pulmonary HTN, valvular hear dz
- CONTRAINDICATION: MAOI use, arteriosclerosis, CVD, hyperthyroidism, glaucoma, agitation, h/o drug abuse, pregnancy, breastfeeding
- DRUG INTERACTION: anorexiants/stimulants (increased risk of CV, CNS, stimulation); MAOIs (HTN crisis); Linezolid (increased risk of HTN); Venlafaxind (Effexor)– (additive effect)
- CIV
11
Q
Diethylpropion
- FDA approved for short term use (12 wks)
- PRN
A
- MOA: sympathomimetic
- COMMON ADR: dry mouth, D/C, restlessness, anxiety, insomnia, HA, HTN, palpitations, arrhythmias
- SERIOUS ADR: tachycardia, HTN, pulmonary hypertension, valvular heart disease, hallucinations, psychosis, leukopenia
- CONTRAINDICATION: pulmonary hypertension; severe HTN, agitation, valvular heart dz, heart murmur, CVD, seizure disorder, advanced arteriosclerosis
- Excretion: urine
12
Q
Phendimetrazine (Bontril)
- FDA approved for short term use (12 wks)
A
- Similar to phentermine, diethylpropion
- Similar ADR/indications
- ADR: palpitation, tachycardia, restlessness, HTN, insomnia, agitation, dizziness, HA, flushing, sweating, tolerance, D/C
- Preg Cat C
- Lactation possibly unsafe
- CV evaluation: ECG, BP, physical CV exam
- Consider echo periodically and after d/c
- CIII
13
Q
Drug used off label
A
Desvenlafaxine (Pristiq)
Spironolactone
Pindolol
14
Q
Desvenlafaxine (Pristiq)
A
- Antidepressant (SNRI)
- ADR: decreased appetite, wt loss
- Seems to decrease cravings
15
Q
Spironolactone
A
- Decreases CHO cravings
- Useful prior to menses
- Start the day premenstrual s/sx begin, stop when menstrual flow ceases
