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Obesity pharm
Obesity pharmacotherapy
| Question | Answer |
|---|---|
| When should a weight loss medication be stopped? | If not at least 5% weight loss in 3 months |
| What BMI group has the lowest mortality | Overweight (BMI 25 to 30) |
| Medication no longer on the market that caused about 4% weight loss above placebo, lowered triglycerides, and raised HDL. It was withdrawn in 2010 due to increase in heart attacks and strokes. | Sibutramine (Meridia) |
| What was the MOA of sibutramine? | NE, dopamine, and serotonin reuptake inhibitor |
| Which trial showed that sibutramine actually increased risk of cardiovascular disease? | SCOUT trial |
| What were the limitations of the SCOUT trial? | Sibutramine (and placebo) were continued even if patients did not lose weight. Included patients that were high risk that would have not otherwise have been treated. |
| Who has relatively higher mortality the more obese you are, 30 year old individuals or 80 year old individuals? | 30 year old individuals |
| What is the typical range of weight loss percentage for current medications on the market | 5-12% weight loss |
| What is the starting dose and the max dose of phentermine per day? | Starting dose 15 mg daily, max dose 37.5 mg daily |
| How much weight loss can be expected beyond lifestyle with phentermine? | 4-6% (7-9 lbs in 2-14 weeks) |
| What is the effect of phentermine on pulse and blood pressure? | Pulse tends to rise or stay the same. Blood pressure tends to fall with the weight loss. |
| What should be told patients about prescribing phentermine long-term? | Can continue the medication if no serious cardiovascular or psych disease, if tell patient not FDA approved beyond 3 months, inform patient of long-term weight loss drugs, if pulse or BP does not go up, and lose at least 5% of baseline weight |
| Does high intensity or low intensity create more insulin sensitivity? | They are equal |
| What are two mechanisms by which glucose enters muscle cells? | Insulin receptor binding and muscle contraction during exercise |
| How often should people exercise to reduce insulin resistance? | At least every other day, because the effect of exercise on insulin sensitivity lasts about that long. |
| Which drug blunts the effect of exercise on insulin sensitivity and inflammatory markers? | Metformin |
| Where are the serotonin (5-HT 2C) neurons on which lorcaserin acts? | POMC neurons in the arcuate nucleus in the hypothalamus |
| What us the dose of lorcaserin used for weight loss? | 10 mg po bid |
| What are the three most common side effects of lorcaserin and percentage of patients who got the side effects in clinical trials? | Headache (16.8%), Dizziness (8.5%), Nausea (8.3%) |
| How often do women on topiramate have to check a home pregnancy test to avoid cleft lip and cleft palate in their baby if they do become pregnant? | Once a month |
| What are the top 6 side effects in patients on phentermine/topiramate ER? | Paresthesias, dry mouth, constipation, dysgeusia, nasopharyngitis, insomnia |
| According to the advance framework provided by AACE, what is considered the definition of obesity stage 1 and 2? | Stage 1 is BMI >25 with mild to moderate complications of obesity, Stage 2 is BMI >25 with severe complications |
| Two antidepressants that have weight loss properties. | Bupropion and protriptyline |
| Two SSRIs that are considered "weight neutral." | Sertraline (Zoloft) and fluoxetine (Prozac) |
| Name 4 antidepressants that likely will cause the most weight gain. | Paroxetine (Paxil), amitriptyline, nortriptyline, mirtazapine |
| Name 4 antiepileptic drugs that cause the most weight gain. | Valproic acid (5-10%), gabapentin (2.2 kg), divalproex, carbamazepine |
| Name 3 antiepileptic drugs that may result in weight loss. | Felbamate, Zonisamide, topiramate |
| Name how much weight gain can be expected with olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal) | Zyprexa = 30%, Seroquel = 16%, Risperdal = 14% |
| Name 3 antiepileptic drugs that are considered weight neutral. | Zonisamide (Zonegran), levetiracetam (Keppra), and phenytoin (Dilantin) |
| Name 2 antipsychotic drugs considered to have less weight gain than the others. | Aripiprazole (Abilify), Ziprasidone (Geodon) - 7% |
| Name two anti-histamines that cause weight gain. | Diphenhydramine, Cyproheptadine (both 1st generation) |
| Name 7 drugs or classes of drugs to treat diabetes that can cause weight loss or are weight neutral. | Metformin (-2.1kg), GLP-1s, SGLT2s, acarbose, DPP4 inhibitors, miglitol, pramlintide |
| Name three classes of diabetes drugs that cause weight gain | Insulin (10 kg), pioglitazone (3 kg), sulfonylureas (10 kg) |
| Which type of beta blockers are considered less likely to cause weight gain? | Non-selective beta blockers with a vasodilating component (nebivolol/Bystolic, carvedilol/Coreg) |
| What are the three mechanisms of action of topiramate | GABA receptor modulation, carbonic anhydrase inhibition, glutamate antagonism |
| How much weight loss can be expected with diethylpropion above lifestyle? | 6.6 lbs in 6 to 52 weeks |
| How much weight loss can be expected with orlistat above lifestyle? | 6.5 to 7.5 lbs (2.9-3.4%) in 1 year |
| How much weight loss can be expected with Qysmia 7.5/46 mg above lifestyle alone? | 14.5 lbs (6.6%) in 1 year |
| How much weight loss can be expected with Qysmia 15/92 mg above lifestyle alone? | 18.9 lbs (8.6%) in 1 year |
| How much weight loss can be expected with Belviq above lifestyle alone? | 7.9 lbs (3.6%) in 1 year |
| How much weight loss can be expected with Contrave at full dose above lifestyle alone? | 4.8% in 1 year |
| How much weight loss can be expected with Saxenda above lifestyle alone? | 12.8 lbs (4.5%) in 1 year |
| What are the proportions of patients achieving 5% and 10% weight loss, respectively, using Qysmia 7.5/46 mg? | 5% = 62%, 10% = 37% |
| What are the proportions of patients achieving 5% and 10% weight loss, respectively, using Qysmia 15/92 mg? | 5% = 67-70%, 10% = 47-48% |
| What are the proportions of patients achieving 5% and 10% weight loss, respectively, using Belviq 10 mg po bid? | 5% = 47.1%, 10% = 22.4% |
| What are the proportions of patients achieving 5% and 10% weight loss, respectively, using Contrave 32/360 mg? | 5% = 42-57%, 10% = 21-35% |
| What are the proportions of patients achieving 5% and 10% weight loss, respectively, using Saxenda 3.0 mg daily? | 5% = 62.3%, 10% = 33.9% |
| What are the contraindications/warnings for phentermine, diethylpropion, and phendimetrazine (9)? | pregnancy/breastfeeding, heart disease, uncontrolled hypertension, anxiety/bipolar, seizures, mao inhibitors, hyperthyroidism, glaucoma, h/o drug abuse |
| What are the contraindications/warnings for orlistat (7)? | pregnancy/breastfeeding, cyclosporine (take 2 hours before or after), chronic malabsorption, cholestasis, levothyroxine, warfarin, antiepileptic drugs |
| What are the contraindications/warnings for lorcaserin (3)? | pregnancy/breastfeeding, use with SSRI/SNRI/MAO/St. John's wort/bupropion/dextromethorphan (serotonin syndrome risk), 2nd degree or greater AV block |
| What are the contraindications/warnings for Contrave (7)? | Pregnancy/breastfeeding, uncontrolled hypertension, seizure disorder, anorexia/bulimia, MAO-I use, narcotic use |
| What are the contraindications/warnings for Saxenda (4)? | pregnancy/breastfeeding, medullary thyroid carcinoma or MEN-2, pancreatitis, gastroparesis |
| What are the side effects of the sympathomimetic amines (9)? | headache, increased blood pressure/heart rate, dry mouth, constipation, anxiety, CV (palpitations/ischemic events), CNS (overstimulation, dizziness, tremor), allergy, impotence/change in libido |
| What are the adverse side effects of orlistat (4)? | Decreased absorption of fat-soluble vitamins, steatorrhea, flatulence with discharge, fecal incontinence |
| What are the adverse side effects of Contrave (6)? | Nausea, constipation, headache, vomiting, dizziness, neuropsychiatric reactions |
| What are the adverse effects of liraglutide (3)? | Nausea, vomiting, pancreatitis |
| Which of the sympathomimetic amines is schedule III instead of schedule IV? | phendimetrazine |
| What is an average A1c reduction for both Qysmia and Belviq? | Both have about a 0.9 A1c reduction |
| Which weight loss medication causes an A1c reduction of 0.6 and is not a controlled substance? | Contrave |
| Which weight loss drug should you consider starting if a patient has at least 5% weight loss in 12 weeks preceding initiation of the medication? | Saxenda |
| Which weight loss medication is available in a very short acting 35 mg formulation, or a 105 mg ER version? | Phendimetrazine |
| What controlled substance schedule is lorcaserin? | Schedule IV |
| When should you consider increasing Qsymia from 7.5/45 mg to 15/92 mg? | If 3% weight loss is not achieved at 3 months |
| D/c liraglutide if you don't reach this weight loss target. | 4% at 16 weeks |
| How often should patients followup on weight loss medications? | At least every month for first 3 months, then every 3 months thereafter if on a stable dose |
| What are the dosages of diethylpropion and which is used most often? | 25 mg tid, or 75 mg CR daily (used most often, but ramp up slowly if had side effects on phentermine) |
| How much should insulin dosage be dropped if start a patient on a very low calorie diet with meal replacements? | 50% on day 1 |
| Which drug was pulled from the market for increased psychiatric effects, including suicidal ideation? | Rimonabant (was only previously approved in Europe) |
| Which drug can be used to help with psychotropic induced weight gain? | Metformin |
| What medications/substances should be avoided along with phentermine? | caffeine, energy drinks, decongestants |
| Weight loss medication to consider if patient has migraines? | Qsymia |
| What is the starting dose of Qsymia? | 3.75/23 mg usually for 14 days, then 7.5/46 mg |
| What conditions are topiramate useful for in addition to weight loss? | migraines, seizures, binge eating disorder, excess carbohydrate cravings, mood stabilization |
| Contraindications of topiramate (3) | Glaucoma, Nephrolithiasis, Renal failure |
| Side effects of topiramate | Paresthesias, somnolence, taste aversion, cognitive impairment (word finding difficulties) |
| Which mechanism of action for topiramate is responsible for modification of lipogenesis, taste aversion? | carbonic anhydrase |
| Which mechanism of action of topiramate is responsible for increased energy expenditure? | GABA modulation |
| What important drugs can topiramate interact with? | Metformin and oral contraceptives |
| What is the starting dose and max dose of topiramate monotherapy? | 25 mg, 150 mg |
| Who may be a good candidate for Beliviq? | unable to take phentermine, women of childbearing age, diabetes |
| In which conditions should Belviq be avoided? | CHF, depression |
| What special populations should be considered for Contrave? | Excessive hunger and cravings, smokers, Etoh dependency |
| What receptor does naltrexone block that is an autoinhibitor of POMC neurons? | beta-endorphin |
| What is the starting dose and max dose of Contrave? | 8/90 mg daily, 16/180 mg bid |
| Which of the FDA approved weight loss medications has been shown to increase blood pressure? | Contrave |
| What is the dose range of zonisamide? | 100 to 400 mg |
| In which patients should zonisamide be avoided? | nephrolithiasis, sulfa allergy |
| Which patient populations may benefit from zonisamide? | seizures, migraines, insomnia, excessive hunger, combination with bupropion (combination was studied years ago) |
| What are potential side effects of zonisamide? | somnolence, cognitive impairment, paresthesias |
| What is the MOA of zonisamide? | Enhances serotonin and dopamine activity |
| Which weight loss drug was studied with metformin in patients with type 2 diabetes and lost weight? | Topiramate |
Created by:
maa13
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