weight loss

medications that cause weight gain

antiseizure (valproate, gabapentin, pregabalin)

diabetes drugs (insulin,su, meglitinides, TZDs)

psychiatric drugs (antidepressants: mirtazapine, antipsychotics: clozapine, olanzapinerisperisone, quetiapine)Lithium

other dolutegravir, prednisone, oral contraceptives

drugs that cause weight loss

antiseizure drugs (fenfluramine, topiramate)

diabetes drugs (glp1 tirzepatide)

psychiatric drugs (buproprion, ADHD drugs)

other roflumilast, apremilast

condition that causes weight gain

hypothyroidism

treatment principles 

energy deficit

low calorie meal plan 

physical activity (>150 mins per week0

behavioral techniques

what is a reasoable weight loss goal

5-10% decrease within 6 months

what do weightloss otc supplemtes typically contain

bitter orange and caffeine which can be packaged under guarana, green tea powder and are not recommended

when are medications recommended

BMI >27 and at least one weight related condition

which kinds of treatments are preferred

incretin based treatments

which antiobsesity drug is not recommended to be used long term

phentermine

liraglutide target dose

3mg daily

wegovy target dose

2.4 mg weekly

GLp1 warnings

pancreatitis, use with caution in gastroparesis

GLP1 SE

hypoglycemia, nausea

phentermine and topiramate moa

phentermine: sympathomimetic stimulant and decreases appetite

topiramate: increase satiety and decrease appetite

phentermine/topiramate (qsymia) contraindication

glaucoma

phentermine/topiramate (qsymia) SE

tachycardia, insomnia, vision problems

phentermine/topiramate (qsymia) notes (2)

taper off due to seizure risk

REMS drug due to teratogenic risk

naltrexone/bupropion (contrave) moa

naltrexone: reduces cravings

buproprion: reduced appetite

naltrexone/bupropion (contrave) boxed warning

suicidal thinking

naltrexone/bupropion (contrave) contraindications

chronic opioid use, uncontrolled hypertension, seizure, use of MAO inhibitors within 14 days

naltrexone/bupropion (contrave) SE

dry mouth and insomnia

Orlistat Rx brand name

xenical

orlistat otc brand name

alli

orlistat moa

lipase inhibitor, reduces absorption of dietary fat by 30%

orlistat notes (2)

must be used with low fat diet plan (max 30% of kcals from fat)

take multivitamin ADEK (Ffat soluble) and beta carotene at bedtime or separted by 2 hours

phentermine used

short term up to 12 weeks

phentermine contraindication

cardiovascular disease, hyperthyroidism, glaucoma, h/o drug abuse

phentermine brand name

adipex-p

phentermine SE

tachycardia, increased BP, pulmonary hypertension

phentermine monitoring

HR, BP

bariartric surgery patients may require life long

supplementation of A, D, E, K

nutrient deficiency in bariartiric surgery

calcium- take calcium citrate acid dependent absoprtion

vitamin b12 and iron- supplement

Vitamin ADEK

medication concerns in bariartric surgery 

medications may need to be crushed and put in liquid or udes in transdermal form for up to two months post surgery

ursodiol dissolces gallstones and may be needed (rapid weight loss can cause gallstones)