MCPC Obesity, Hypothyroidism, GERD, problem solving

when do you use drugs to treat obesity?

BMI>30

BMI>27 with HTN, T2DM, DLD

orlistat brand name

Xenical, Alli

orlistat MOA

Inhibits lipase in the GI thus preventing breakdown of fat and fat absorption

orlistat AE

flatus with discharge, oily stool, fecal urgency, abdominal pain

orlistat CI

pregnancy, chronic malabsorption syndrome, cholestasis

phentermine brand name

Adipex-P

phentermine MOA

enhanced NE and dopamine neurotransmission

phentermine AE

palpitations, HTN

phentermine CI

hx of CVD/HTN/hyperthyroidism/glaucoma

qsymia

phentermine/topiramate

qsymia MOA

Phentermine: anorexigenic agent that promotes release of NE and DA through their transporters

Topiramate: potentiates GABA to inhibit NPY neuron

qsymia AE

altered taste, insomnia, tachycardia, seizures upon withdrawal

qsymia CI

pregnancy, glaucoma, use of MAOI

contrave

Naltrexone/Bupropion

contrave MOA

bupropion blocks reuptake of NE and DA and promotes release, which stimulates the release of a-MSH

Naltrexone blocks opioid receptors which blocks endorphin effects to decrease appetite

contrave AE

constipation

N/V

lower seizure threshold

contrave CI

chronic opioid or opiate agnoist use, uncontrolled HTN, seizures, use of BZDs, eating disorders

semaglutide brand name

wegovy

liraglutide brand name

saxenda

Tirzepatide

zepbound

GLP1 agonists

Liraglutide

Dulaglutide

Semaglutide

GLP1 agonists BBW

thyroid C cell tumors

PPIs

-prazole

omeprazole

Prilosec

esomeprazole

Nexium

pantoprazole

Protonix

lansoprazole

Prevacid

PPI MOA

irreversible block H/K ATPase pump in parietal cells

PPI BBW

osteoporosis with long term use

PPI administration

Most effective when taken 30-60 minutes before breakfast.

H2 receptor antagonists

Cimetidine

Ranitidine

Famotidine

Nizatidine

cimetidine

Tagamet

famotidine

Pepcid

rantidine

Zantac

monitoring for H2 receptor antagonists

renal function

calcium carbonate

Tums, antacid

magnesium hydroxide

milk of magnesia, mylanta

sucralfate MOA

binds to ulcers forming a protective barrier

sucralfate administration

Must be taken on an empty stomach; avoid with certain drugs due to binding.

metoclopramide

Reglan

metoclopramide MOA

Enhances upper GI motility by antagonizing dopamine and serotonin receptors

long term side effects of metoclopramide

tardive dyskinesia

normal TSH levels

0.4-4.0

hypothyroidism

condition of hyposecretion of the thyroid gland causing low thyroid levels in the blood that result in sluggishness, slow pulse, and often obesity

hypothyroidism symptoms

Fatigue, lethargy. Modest weight gain with anorexia. Dry, coarse skin and cold intolerance. Swelling of face, hands, and legs. Constipation. Weakness, muscle cramps, arthralgias, paresthesias, impaired memory and hearing.

hashimoto's

autoimmune hypothyroidism

drugs that can cause hypothyroidism

Contrast dyes, amiodarone, alpha-interferon, lithium, select antineoplastics, antithyroid drugs (methimazole, PTU) [makes sense]

hyperthyroidism

excessive activity of the thyroid gland

hyperthyroidism symptoms

Nervousness, weight loss despite increased appetite, excessive sweating and heat intolerance, palpitations, frequent bowel movements, muscular weakness of the proximal type and tremor

levothyroxine

Synthroid, Levoxyl

levothyroxine MOA

synthetic form of thyroxine (T4) hormone. Converted to T3 endogenously. Binds to thyroid hormone receptors and exert metabolic effects through control of DNA transcription and protein synthesis.

levothyroxine administration

same time each day on an empty stomach, preferably before breakfast

separate from PPIs by at least 4-6 hours

levothyroxine AE

-Dysrhythmias

-Palpitations

-Angina

-Hyperthyroidism

liothyroxine

Cytomel

liothyronine MOA

Synthetic T3

liothyronine indication

Hypothyroidism; myxedema coma

myxedema coma

extreme hypothyroidism(abrupt med cessation), rare with a high mortality rate = decreased cardiac output leads to decreased tissue perfusion which leads to brain and organ depletion leading to multi-organ failure

liothyronine AE

cardiac dysrhythmia, MI, tachycardia

liotrix

Thyrolar

Synthetic T4/T3 in 4:1 ratio

armour thyroid

desiccated thyroid

methimazole MOA

Blocks thyroid peroxidase inhibiting organification and coupling

PTU MOA

inhibits peripheral conversion of T4 to T3

methimazole AE

Agranulocytosis

PTU AE

severe hepatitis

DOC for grave's disease

methimazole

drug preferred for hyperthyroidism in pregnancy

Low dose PTU 1st trimester, MMI 2nd-3rd

OTC treatments for GERD

calcium carbonate (Tums)

magneium hydroxide (milk of magnesia)

Alka-seltzer

zantac

pepcid

tagamet

omeprazole (prilosec)

lansoprazole (prevacid)

esomeprazole (nexium)