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Therapeutics II > Block 2: Obesity Medication > Flashcards

Block 2: Obesity Medication Flashcards

1
Q

Describe the assessment of obesity?

A
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2
Q

What are the metabolic complications of obesity?

A
  1. Prediabetes
  2. T2DM
  3. MS
  4. NAFLD/NASH
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3
Q

Obesity prevention is based on ___?

A

Staging and complication to determine weight loss and clinical goals

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4
Q

How do you stage weight loss?

A
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5
Q

What does primary diagnosis and prevention look like?

A
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6
Q

What does secondary diagnosis and prevention look like?

A
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7
Q

What does secondary diagnosis and prevention look like? *Slide 12-14

A
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8
Q

When should you initiate weight loss medication?

A
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9
Q

Phentermine?

Brand, MOA, Dosing, Indication ADR, CI, BBW

A

Adipex-P
MOA: Sympathomimetic amine anorectic similar to amphetamine; stimulations CNS, and elevates BP
Dosing: 14 day washout perioid post MAOI (antidepressant) therapy
* Only for short term use

Indications: Short-term adjunct to diet and exercise in patients
CI: CVD, MAOI, Hyperthyroidism, glaucoma, pregnant, lactation
ADRs: Dry mouth, restlessness, insomnia, tachycardia, HTN

BBW:
1. TX duration ≤12 weeks
2. Coadministration with other weight loss drugs is not recommended
3. Causes HTN

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10
Q

Orlistat

Brand, MOA, Dosing, Indications, CI, ADR, BBW

A

Alli-OTC, Xenical-Rx
MOA: : synthetic derivative of lipstatin, a reversible gastrointestinal lipase inhibitor -> bonds covalently -> unavailable to hydrolyze dietary triglycerides into absorbable fatty acids and monoglycerides
Dosing: 120 mg TID with each main meal containing fat, taken during or up to 1 hour after eating
* Taken with daily vitamins ADEK, and beta-carotene 2 hr defore or after Orlistat

Indication: Preferred for CVD Weight loss and weight maintenance in conjunction with a reduced calorie diet
* BMI >30 kg/m^2
* BMI≥27 kg/m^2 with≥1 weight-related comorbidity

CI: Pregnancy, Chronic malabsoprtion syndrome, cholestasis
ADR: Oily spotting, flatus with discharge, fecal urgency and incontinence

BBW: Multivitamin supplement containign fat-soluble vitamine recommend for nutrition

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11
Q

Phentermine/Topiramate ER

Brand, MOA, Dosing, CI, ADR, BBW

A

Qysmia (Sch IV)
MOA:
* Phentermine: sympathomimetic amine -> increase hypothalamic catecholamine release -> reduced appetite and decreased food consumption
* Topiramate ER: gabanergic, voltage-gated ion channel modulator, AMPA-kainite glutamate receptor inhibitor, and carbonic anhydrase inhibitor -> reduced appetite and enhanced satiety

Indications: Preffered in patients with depression on SSRI or SNRI
Dosing: Take in AM to avoid insomnia
CI: Pregnancy, glaucoma, hyperthyroidism, MOAIs, HD, Uncontrolled HTH
ADR: Dry mouth, tingling (paresthesia), constipation, insomnia, kidney stones

BBW: fetal tox, tachycardia, psychiatric disorders, Acute myopia and glaucoma

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12
Q

Naltrexone/Bupropion SR

Brand, MOA, Dosing, CI, ADR, BBW

A

Contrave
MOA:
* Naltrexone: opioid receptor antagonist
* Bupropion: aminoketone antidepressant

Dosing:
* 14 day washout between MAOI
* 7-10 day washout between opiod use

CI: Uncontrolled HTN, Seizures, anorexia, D/C alcohol, benzodiazepines, barbiturates, or antiepileptic drugs, chronic opioid use, use of other bupropion products or MAOIs, pregnancy
ADR: N/V/C/D

BBW: Suicidal thoughts, seizure, angle closure glaucoma

Avoid use in patients taking opioids since naltrexone will antagonize opioid

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13
Q

Liraglutide

Brand, MOA, CI, ADR, BBW

A

Saxenda
Daily SQ injection increasing to weekly increments
MOA: GLP-1 receptor agonist -> increases insulin release in the presence of elevated glucose, decrease glucagon secretion, and delaying gastric emptying, regulates appetite, and caloric intake

CI: Personal or family h/o MTC or MEN 2, Pregnancy
ADR: N/V/D/C, dyspepsia, abdominal pain

BBW: Pancreatitis risk increases with elevated TG, alcohol abuse, or gallstones

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14
Q

Semaglutide

Brand, MOA, CI, ADR

A

Wegovy
MOA: GLP-1 receptor agonist: SQ once weekly
CI: Personal or family h/o MTC or MENs, Pregnancy
ADR: N/V/D/C, dyspepsia, abdominal pain

BBW: Pancreatitis risk increases with elevated TG, alcohol abuse, or gallstones

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15
Q

Tirepatide

Brand, MOA, ADR, CI

A

Mounjaro (Off-label)
MOA: Glucose-dependent insulinotropic polypeptide (GIP)/GLP-1
ADR: N/V/D, constipation, dyspepsia, abdominal pain
CI: T1DM, thyroid carcinoma, MEN2

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16
Q

Setmelanotide

Brand, MOA, Indication

A

Imcivree
MOA: Melanocortin4 receptor agonist
Indication: genetic defiency

17
Q

When should you DC Naltrexone ER/bupropion ER and lorcaserin?

A

Patient has not lost at least 5% of BLBW at 12 weeks

18
Q

When should you DC Phentermine/topiramate ER?

A

Patient patient has not lost at least 3% of baseline body weight at 12 weeks

Max dose (15 mg/92 mg): if they havent lost 5% at 12 additional weeks -> DC

19
Q

When should you DC liraglutide?

A

Patient has not lost at least 4% of baseline body weight at 16 weeks

20
Q

When should semaglutides be DCd?

A

Least 5% of baseline body weight loss has not been achieved within 3 month

21
Q

How do you monitor obesity medications?

A
  1. Monthly for the first 3 months, every 3 months in all patients prescribed
  2. Monitor weight, BMI, waist, BP, HR
  3. Screen for comorbidities annually with BMI >30kg/m^2
22
Q
A
23
Q

Preferred Obesity TX of patient factors?

Uncontrolled HTN, Depression, Opioid use, Alcohol use, Preg/Lac, Old

A
24
Q

How does obesity med effect PK?

A
  1. Vd
  2. GFR
25
Q

Drug distribution is affected by ___?

A
  1. Amount of adipose tissue
  2. Magnitude of drug binding to adipose tissue
  3. Vascularization of adipose tissue
  4. Adipocyte tissue hypertrophy
26
Q

How do you calculate GFR?

A

Cockcroft-gault adjustments
* Underweight: use actual body weight
* Normal weight: use IBW
* Overweight/obese >20% of normal: use adjusted body weight

Adjusted body weight = IBW + 0.4 x (ABW-IBW)

27
Q

How do you treat Herpes Simplex Virus? Dosing?

A

Ganciclovir, Acyoclovir IV

  • Consider ABW when patient’s body weight is >20% IBW
  • Consider using actual weight when patient is <IBW
  • Elderly or low muscle mass patients who’s SCr is <0.8 is rounded to 1
28
Q

How do you drug dose in obestiy?

A
  1. Calculate BMI (classify obesity and adjusted weight indicated)
  2. Use serum creatine (CrCl)
  3. Use tertiary drug resources to dose meds

Therapeutics II (30 decks)

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