Which of the following are contraindications to the use of Qsymia? (Select ALL that apply.)
B. Pregnancy and lactation
C. Monoamine oxidase inhibitor use within the previous 14 days.
D. Morbid obesity, designated by a BMI > 40
A, B, C, E.
Mary is a 44 year-old female. Height 5'7", weight 197 pounds. Her blood pressure taken this morning was 134/78 mmHg. She had lab work done last month which reported an A1C of 8.7% and total cholesterol of 244 g/dL. Mary consumes a primarily carbohydrate-based diet with little vegetable intake because she claims that fresh vegetables "cost a lot of money and are hard to get in Wisconsin in the winter." She has been using over-the-counter weight loss products for years. She loses a little, then puts back on more weight. She went to her physician seeking help. The physician prescribed lorcaserin 10 mg PO ac TID #90, with 11 refills. Mary's other medications include fluoxetine 90 mg Q weekly, tramadol and sumatriptan PRN headaches and atorvastatin 10 mg daily. She refills the prescription for tramadol 1-2 Q 4-6 hours PRN #120 every month. The lorcaserin should not be filled for the following reasons. (Select ALL that apply.)
A. The dose schedule is incorrect.
B. Her weight does not qualify her for the use of this agent.
C. She could experience coordination problems, trouble thinking clearly, hallucinations and changes in her blood pressure.
D. Her medical conditions exclude the use of lorcaserin.
E. Lorcaserin is contraindicated in a patient with migraines.
A, C. Mary has a BMI is 30.9, which is obese. If she were overweight but not obese the use of lorcaserin would require that she had one weight-related condition, and she meets this condition as well. The dose is 10 mg twice daily. She is at risk for serotonergic toxicity with the use of lorcaserin. It should not be filled, even at the correct dose.
Choose possible side effects from the use of stimulants for weight loss: (Select ALL that apply.)
C. Low blood pressure
D. Difficulty sleeping
A, D. Tachycardia and increase in blood pressure should be expected to occur, and are dose-dependent.
In 2013 new weight loss guidelines were issued. Select a notable issue concerning the new guideline recommendations:
A. A variety of diet types can be used to lose weight; calorie counting is no longer the only recommended method for weight loss.
B. Calorie-counting is the only recommended method for weight loss.
C. Trained personnel such as "weight loss coaches" and "personal trainers" are useless and should not be encouraged.
D. Very low calorie diets should never be recommended.
E. Bariatric surgery is recommended for adults who are overweight (BMI > 24.9).
A. The guidelines recommend bariatric surgery for adults with a BMI >= 40 or BMI >= 35 with an obesity-related medical condition. Calorie restriction makes people hungry, and if you are hungry it is difficult not to eat. It is important to recommend plans in which patients feel satiated in order to have successful results. It is also important to consider which foods contribute to hunger (such as carbohydrates) in order to help our patients be successful.
Qsymia is a weight loss drug approved in 2012. What are the components of Qysmia?
A. Phentermine and fenfluramine
B. Phentermine and topiramate
C. Phentermine and lorcaserin
D. Phentermine and diethylpropion
E. Phentermine and pseudoephedrine
B. Qsymia is a combination of phentermine and topiramate in an extended-release formulation.
A patient beginning lorcaserin should be counseled on the following likely side effects: (Select ALL that apply.)
E. Dry mouth
A, B, C, E. Common side effects include headache, dizziness, fatigue, nausea, dry mouth, constipation and risk of hypoglycemia in patients with diabetes. There is a risk of cardiac effects; lorcaserin is being monitored in patients using it, as a requirement set by the FDA in order to approve the release of this drug.
A woman walks into the pharmacy and asks the pharmacist which over-the-counter product provides the most weight loss. The patient is 5 foot, 3 inches tall. She weighs about 150 pounds. Choose the correct advice that should be provided to the patient: (Select ALL that apply.)
A. Avoid refined carbohydrates, such as products made with white bread, and avoid products with added sugar; this will help eliminate many unhealthy food choices.
B. Activity counts; weight loss is maintained longer and people feel better when they are physically active.
C. Diet pills do not provide long-term benefit.
D. Increase your alcohol intake while dieting.
E. Start smoking if you do not already.
A, B, C.
What is the most common side effect of orlistat therapy?
C. Flatus with discharge, fatty stool
E. Vitamin deficiencies
C. The patient must stick to dietary plan for both weight improvements and to help moderate (control) the side effects such as flatulence and fatty stool.
Sheila is a 31 year old white female with asthma, diabetes type 2, hypertension and dyslipidemia. Lab results (taken this morning, fasting): Hemoglobin A1C 6.7%, LDL cholesterol 112 g/dL, triglycerides 168 g/dL and hCG+ Medications:Prevacid 30 mg daily, taken 30 minutes before breakfast ProAir HFA, Symbicort, twice daily as directed metformin 500 mg three times daily and lisinopril 20 mg daily. Sheila is asking for a prescription for the new weight loss drug Belviq that she read about in a magazine add. Which of the following statements are correct? (Select ALL that apply.)
A. Sheila can receive Belviq; she will need to be instructed to stick to a dietary plan.
B. Sheila can use Belviq but will need to stick to a dietary plan and exercise regimen.
C. The use of Belviq is contraindicated at this time in this patient.
D. Sheila's medications are unsafe at present and need to be changed.
E. Sheila should immediately discontinue the use of ProAir HFA.
C, D. The two newer weight loss agents Belviq and Qsymia are contraindicated in pregnancy. The ACE inhibitor should be discontinued; refer to an obstetrician who can also manage the diabetes control.
Counseling points for the use of prescription orlistat therapy should include the following: (Select ALL that apply.)
A. This medication must be used with a reduced-calorie diet, exercise, and behavior modification program.
B. The brand name for this medicine is Alli.
C. If you use medicine for a low thyroid you must take the orlistat at least one hour after taking the thyroid medicine.
D. Take a multivitamin that contains A, D, E and K at a different time of day than the orlistat (such as at bedtime).
E. In order to absorb this medicine your meal must contain at least 30 grams of fat.
A, D. Orlistat does not block the absorption of calories from sugar and other non-fat foods and the patient still needs to restrict the total calorie intake, and restrict the fat intake in order to limit the side effects. Orlistat's brand name for the prescription product is Xenical.
If a person has a stable weight and physical activity level, how many days would it take to lose one pound of fat if they decrease their caloric intake by 500 kcal per day?
A. One week
B. Two weeks
C. One month
D. One day
E. Three days
A. A 500 kcal decrease per day equals 1 pound weight lost per week (500 x 7 days = 3500 kcal/pound). By adding modest physical activity, this can be increased to 2 pounds weekly. A faster rate of weight loss typically reverses-often with more weight than at the start.
A patient gave the pharmacist a prescription for Xenical 120 mg #90, take one with each meal containing fat. Which of the following is an appropriate generic substitution for Xenical?
B. The generic name of Xenical is orlistat.
Lorcaserin is a newer drug approved for weight loss. Which of the following statements concerning lorcaserin are correct? (Select ALL that apply.)
A. The brand name is Qysmia.
B. Lorcaserin is Pregnancy Category X.
C. Lorcaserin is a serotonin (5-HT2c) receptor agonist.
D. The manufacturer is required to conduct Phase IV monitoring for cardiovascular effects in patients using lorcaserin.
E. Lorcaserin is a stimulant agent.
B, C, D. The brand name of lorcaserin is Belviq.
What is the scheduled (DEA) category of Qsymia?
A. C II
B. C III
C. C IV
D. C V
E. This drug is not controlled.
Which of the following agents are often present in over-the-counter weight loss products? (Select ALL that apply.)
A. Green tea
B. Mood relaxant herbals, such as valerian and melatonin
C. Fiber products, including psyllium
D. Caffeine containing products that are under different names, including yerba mate and guarana
E. Ephedra like products, including bitter orange
A, D, E. Tolerance develops quickly with the use of these agents, requiring higher doses. In patients with cardiovascular risk-which is often present in overweight patients-they carry significant risk.
Choose the safest and most practical use of prescription stimulant agents for weight loss?
A. Use only short-term, in addition to changes in diet and increased physical activity & only for patients with higher BMIs.
B. Useful in patients who will not engage in a regular diet and physical activity program.
C. Useful in patients with cardiovascular disease who require fast weight loss.
D. Useful long-term to help maintain weight loss in patients who cannot decrease caloric intake by other means.
E. Useful in patients who have less than ten pounds to lose.
A. The prescription drugs that are stimulants should be used only in addition to changes in diet and increased physical activity and only for use in patients with higher BMIs-above 27 with health complications or above 30 without.
Complications of being overweight include the following: (Select ALL that apply.)
A. Coronary heart disease
B. Type 2 diabetes
C. Increased quality of life
D. A higher BMI
E. Increased risk of certain types of cancer
A, B, D, E. Overweight puts patients at increased risk for coronary heart disease, hypertension, stroke, type 2 diabetes, certain types of cancer, and premature death. In addition to health risks, being overweight reduces the quality of life and causes social stigmatization and discrimination, including among children.