NAPLEX: Rxprep - Weight loss

BMI for overweight

25 - 29.9 kg/m2

BMI for obese

over 30 kg/m2

A person that is overweight is at higher risk for...

- coronary heart disease

- HTN

- stroke

- type 2 diabetes

What is an "energy deficit"

calories must be decreased and/or energy expenditure increased..in order to force the body to use fat as an energy source

wt loss:

goal wt loss of _______ pounds/week

~1.5-2lbs

wt loss: 500 kcal decrease/day = _____ pound of weight loss/week (aka ____kcal/___pound)

500 kcal decrease/day = 1 pound of weight loss/week (3500 kcal/pound)

Drugs that can cause weight gain

- Diabetes meds: insulin, sulfonylureas, thiazolidinediones, meglitinides

- Antipsychotics (clozapine, olanzapine, risperidone, quetiapine)

- steroids (cushing effect)

- mirtazapine (used for pts that hae depression, sleep, and trouble gaining weight)

- TCAs (amitriptyline, nortriptyline)

- Lithium

- gabapentin, pregabalin

- divalproex / valproic acid

Conditions: hypothyroidism

How much physical activity is recommended?

>150 minutes per week, divided by 3-5 days a week

w/ resistance 2-3 times/week

When are prescription drugs not appropriate

for patients with small amounts of weight to lose

When are prescription drugs indicated for weight loss?

- BMI >30

or

- BMI >/= 27 + dyslipidemia, HTN, or DM

Weight loss medications are only used in addition to

- dietary plan

- increased physical activity

Weight loss drugs that can be continued long-term for weight maintenance

- Qsymia

- Contrave

- Saxenda

- orlistat formulations

This drug has been withdrawn from the market due to an increased risk of cancer

Lorcaserin (Belviq, Belviq XR)

Drugs and conditions that can cause weight loss

Drugs:

- ADHD drugs

- Bupropion

- GLP-1 agonist (exenatide, liraglutide)

- Pramlintide (SymlinPEN) - DM

- Roflumilast (Daliresp) - COPD

- SGLT2 inhibitors (canagliflozin, empagliflozin)

- Topiramate - anticonvulsant / migraines

Conditions:

- HYPERthyroidism

- Celiac disease

- IBD

When should weight loss drugs be discontinued

if they do not produce at least 5% weight loss at 12 weeks

when should wt loss drugs be avoided or used with caution

preg - avoid all

htn- use with caution, some CI

depression in ya and adolescents

szs

taking opioids

Drugs to avoid or use caution with: pregnancy

avoid all drugs for weight loss

Drugs to avoid or use caution with: HTN

Avoid:

- Contrave = has bupropion CI w/ uncontrolled BP

Caution:

- Qsymia = has phentermine so monitor BP

Drugs to avoid or use caution with: Depression

Caution:

- Contrave = has bupropion so suicide risk

Drugs to avoid or use caution with: Seizures

Avoid:

- Contrave = lowers seizure threshold

Caution:

- Qsymia = has topiramate so must taper off

Drugs to avoid or use caution with: Taking Opioids

Avoid:

- Contrave = has naltrexone so block opioid receptors

Components of Qsymia

Phentermine / Topriamate

Qsymia (phentermine/topriamate)

moa

phent: sympathomimetic (stimulant) - release of NE increases satiety which decreases appetite

topiramate: increase satiety, decrease appetite

wt loss REMS drug due to teratogenic risk

Qsymia (phentermine/topriamate)

Qsymia (phentermine/topriamate) contraindications

- prego

- hyperthyroidism

- glaucoma

maoi use wi 14 days

Qsymia (phentermine/topriamate) side effects

- tachycardia

- insomnia - take in AM to decrease risk

-mental changes (anx, depression)

vision problems

cognitive impairment (trobule focusing, etc)

Qsymia (phentermine/topriamate)

how must it be stopped + why

taper off d/t sz risk

which wt loss drugs are controlled?

+ what schedule?

Qsymia (phentermine/topriamate) - c4

phentermine (adipex-P) c4

Components of Contrave

Naltrexone / Bupropion

Contrave (naltrexone/bupropion) MOA

Naltrexone: opioid antagonist -> decrease food cravings

Bupropion: anti-depressant, increase NE/dopamine -> decrease appetite

Contrave (naltrexone/bupropion) contraindications

- prego

- opioid use (mus tbe off 7-14 days)

- uncontrolled HTN

-use of MAOIs (w/i 14 days)

- seizure disorder

- use of other bupropion-containing products (eg. xyban for tobacco cessation)

bulimia/anorexia

Contrave (naltrexone/bupropion) caution of use in pts with _____ dxs, dc if hx of ______

caution with psychiatric disorders ( activating drug so NOOOO if BPD)

dc if hx of hepatotoxicity

Qsymia (phentermine/topriamate) BBW

not approved for treatment og MDD or psychiatric dx; antidepressants (bupropion) can increase the risk of suicidal thinking and behavior in children, adolescents, and YA; not approved for use in pediatric patients

How long must opioids or bupropion be discontinued prior to the use of Contrave?

maoi?

discontinue for 7 - 14 days prior to the use of Contrave

14 days

Qsymia (phentermine/topriamate)

side effects

increase hr/bp

glaucoma

n/v

constipation

insomnia

How should Qsymia (phentermine/topriamate) be taken?

AM

NO FATTY MEALS (decreases absorption)

Liraglutide (Saxenda) MOA for weight loss

GLP-1 receptor agonist = delays gastric emptying and increases satiety

pts taking liraglutide (saxenda) must first do what before taking?

register with rems programs

rems for meduallry thyroid cancer, pancreatitis

Liraglutide (Saxenda) warnings

- pancreatitis (rems)

- hypoglycemia (rare)

- gi sx (most common)

Liraglutide (Saxenda) most common side effect

nausea

liraglutide (saxenda) how is dose started/taken?

MUST titrate

Orlistat (Xenical - Rx, Alli - OTC) moa

lipase inhibitor = decreases absorption of fat ~30%

MUST BE USED WITH LOW FAT DIET PLAN (OILY POOPS AND RUNNY LEGS)

Orlistat (Xenical - Rx, Alli - OTC)

HOW MUST IT be taken?

taken with meals containg fat or up to 1 hr after

Orlistat (Xenical - Rx, Alli - OTC) side effect

- sharting (leaking)

- fatty stool

- fecal urgency

kidney stones

Orlistat (Xenical - Rx, Alli - OTC) patient counseling (must also take what)

take with multivitamin containing A, D, E, K, and beta carotene at bedtime or separated by >2 hours

MUST separate cyclosporine also if taaking

NOT at same time as drug

- max 30% of kcals from fat

Sympathomimetic (stimulants) for weight loss

- phentermine (Adipex-P) = C-IV

- diethylpropion = C-IV

- phendimetrazine = C-III

- benzphentamine = C-III

phentermine (Adipex-P) (stimulant) contraindication

- CV disease (uncontrolled HTN)

- hyperthyroidism

- glaucoma

- prego

- drug abuse

phentermine (Adipex-P) (stimulant) side effects

- tachycardia

- agitation

- increased BP

phentermine (Adipex-P) (stimulant) duration limitation

used short-term, for up to 12 weeks to "jump-start" diet only

When is bariatric surgery recommended?

- BMI >40

or

- BMI > 35 w/ an obesity-related condition

Preferred calcium supplement for patients with bariatric surgery

calcium citrate (non-acid-dependent absorption)

Drug administration for up to 2 months post bariatric surgery

crushed up and put in liquid or transdermal form

Drug to treat gallstones caused for bariatric surgery

Ursodiol (Actigall, Urso 250, Urso Forte)

wt loss - OTC:

usually contain ____.

are they rec'd?

what are common ones?

stimulants

no, generally not effective, can be harmful esp in heart pts

bitter orange

green tea extract

yerba mate

guarana

bariatric surgery: common deificiencys

calcium

anemia (vit b12/folate)

iron

a,d,e,k (fat soluble vitamins)

bariatric surgery: common deificiencys

when should iron and calcium supps NOT be taken (think drug interactions)

2 hrs prior or 4 hrs after ANTACIDS