PA510-Anaphylaxis, Obesity, Nutrition

Histamine effects?

Increased HR

Gastric acid secretion

Blood vessel dilation

Itchiness

Bronchoconstriction

Mechanism of Epinephrine (anaphylaxis)

1)Alpha-Adrenergic: vasoconstriction, stabilizes BP

2)Beta-Adrenergic: bronchodilation, reduces release of inflammatory mediators from mast cells

3) Improves heart function: increases HR to counteract shock

Stimulant (short term) weight loss drugs

1) Phentermine (Adipex-P) C-IV

2)Benzphetamine (Didrex, Regimex) C-III

Pancreatic Lipase Inhibitor (long term) drugs

1) Orlistat (xenical, Alli)

Combination Obesity drugs (long term)

1) phentermine/Topiramate (Qysmia)

2)Naltrexone/Bupropion (contrave)

Phentermine

MOA: Stimulates CNS adrenergic

Indication: short term obesity management (8-12 weeks)

Contraindication: No MAOI use w/i 14 days

CAUSES MUSCLE ATROPHY (LONG TERM)

Orlistat (Xenical, Alli)

MOA: lipase inhibitor, decreases triglyceride and cholesterol absorption

Dose: 60 mg (Alli) or 120 mg (xenical) TID with meals or up to 1 hr post meal

SE: GI, fecal incontinence, oily stool

• malabsorption of fat-soluble vitamins

GLP-1 Agonists

MOA: increases insulin, decreases glucagon, SLOWS GASTRIC EMPTYING

SE: nausea, constipation,

contraindications: pancreatitis, renal disease

Black box: Thyroid Cancer

Approved GLP-1 for Weight Loss

1) Semaglutide (wegovy/ozempic)

2.4 mg subQ weekly

CONSTIPATION

2) Liraglutide (saxenda)

3mg subQ daily

DIARRHEA

Off-Label GLP-1 Agonists

1) Semaglutide (ozempic) *1-2 mg subQ weekly

2) dulaglutide (trulicity) *4.5 mg subQ weekly

3) bydureon (ER) or Byetta (short acting)

4) Tirzepatide (montano)

GLP-1/GIP agonist