Obesity COPY Flashcards
(30 cards)
Generic name for Adipex
Phentermine
Adipex: MOA
Increases release and inhibits reuptake of norepinephrine and thereby stimulates POMC neurons to suppress appetite
Adipex: Contraindications, Medication considerations, Adjustments
CI: Cardiac disease (CAD, stroke, arrhythmias, heart failure, uncontrolled hypertension), glaucoma, hyperthyroidism, substance abuse, psychosis, pregnancy
Medication considerations: MAOIs (Level 1 DDI – CI, HTN Crisis), Antihypertensive or Caffeine, (↑HR, BP), Bupropion (↑Seizure Risk) Antidiabetics (↑Glucose), Geriatric (Start low dose)
Adjustments:
-Renal Adjustments: eGFR 15-29 = Max of 15 mg/day, Avoid <15
-Liver Adjustments: Unknown
Adipex: Dosing & Efficacy
Dosing (p.o. once a day):
- 15–37.5 mg: Q.D or in divided doses (15, 18.75, 37.5 mg)
- Lomaira (2016) = 8 mg T.I.D, 30 minutes before meals
Total Body Weight Loss vs. Placebo:
- Poor evidence base
- Rapid tolerance develops (8-12 weeks) and weight regain
- Intermittent Treatment = Continuous Treatment (36-weeks)
Adipex: Indication, AACE/ ACE, Timing, Dose escalation, Monitor,
Indication: BMI >30 or 27 w/comorbs. Short-term (few weeks), Age >17
AACE/ACE: Short-term pharmacotherapy, such as with phentermine, has not been shown to produce long-term weight or health benefits and can not be generally recommended.
Timing: Avoid evening administration (stimulant = insomnia)
Dose Escalation: Use lowest dose possible, esp. HTN, DM, Geriatrics
Monitor: BP, HR, Glucose (in diabetics)
What is the generic for Xenical
Orlistat
Xenical: MOA
Binds gastric and pancreatic lipases in lumen of the stomach and small intestine and thereby REDUCES FAT ABSORPTION into the body
Xenical: Contraindications, Precautions, Medication contraindications, Adjustments
CI: Pregnancy, malabsorption, cholestasis, oxalate kidney stones
Precautions: Severe liver disease, cholelithiasis, fat soluble vitamin deficiency
Medication Considerations: Warfarin (↑ effect), anti-seizure (↓ effect), levothyroxine (↓ effect), cyclosporine (↓ effect)
Renal Adjustments: None
Liver Adjustments: Avoid in severe liver disease
Xenical: dosing & efficacy
OTC = 60 mg p.o. T.I.D, Rx = 120 mg p.o. T.I.D
Total Body Weight Loss vs. Placebo:
1-year: -4.0%
4-years: -2.6%
Xenical: Indication, side effects, discontinuation rate
Indication: BMI >30 or 27 w/comorbs. Chronic. ≥12 yo
Side Effects: Fatty stools, fecal urgency or incontinence, oily spotting, abdominal pain (increase with >30% kcal from fat)
Discontinuation: Rate is high due to side effect : weight loss
What is the generic for Qsymia?
phentermine + topiramate
Qsymia: MOA
Topiramate:
Inhibits NPY/AgRP synaptic release of GABA that plays a role in Inhibiting POMC Neurons.
- NPY/ AgRP: stimulates appetite
Inhibiting the release of GABA reduces the suppression of POMC neurons and thereby increases Appetite Suppression
Qsymia: Dosing & Efficacy
Dosing (p.o. once a day):
- Starter (Titration): 3.75 / 23 mg x 2-weeks
- Recommended (Treatment): 7.5/46 mg or 15/92 mg
- Escalation (Titration): 11.25/69mg
- High Dose (Treatment): 15/92 mg
Total Body Weight Loss vs. Placebo:
1-year: -8.6% (high dose), 6.6% (treatment dose)
2-year: -8.7% (high dose), 7.5% (treatment dose)
Qsymia: Indication, dynamic dosing schedule, side effects
Indication: BMI >30 or 27 w/comorbs. Chronic. Age >18 (16, off-label)
- Dynamic Dosing Schedule: Starter to Treatment Dose, evaluate:
- Not at 3% weight loss after 12-weeks on Treatment Dose:
- Stop or Escalate to 11.25/69 x 14d → 15/92 mg
- Not at 5% after 12-weeks on High dose = Stop
- Every other day x 1-week to avoid seizures
- Not at 5% after 12-weeks on High dose = Stop
- Stop or Escalate to 11.25/69 x 14d → 15/92 mg
- Not at 3% weight loss after 12-weeks on Treatment Dose:
Side Effects:
Paresthesia, concentration/memory loss, depression, low bicarb
What is the generic for Belviq?
Lorcaserin
Belviq: Efficacy
Withdrawn form U.S. market due to increased rate of cancer diagnosis
What is the generic for contrave?
Bupropion + Nalterxone
Contrave: MOA
Bupropion: Increases the release and inhibits the reuptake of Dopamine (and to lesser extent Norepinephrine) thereby STIMULATING POMC NEURONS to SUPPRESS APPETITE
Naltrexone: Opiate receptor blockade prevents β-endorphin binding that tonically inhibits POMC Neurons. Reduction of Dopamine in reward centers influences desires, palatability
Contrave: Contraindications, precautions, major DDI, Adjustments
Absolute CI: Pregnancy, breastfeeding, uncontrolled HTN, seizure disorder, anorexia/bulimia, severe depression, MAOI, chronic opiate use, acute opiate need, drug or alcohol withdrawal
Precautions: Cardiac arrhythmias, glaucoma, migraines, anxiety, bipolar disorder, seizure (bupropion lowers threshold)
Major DDI: MAOI, Pimozide, Thioridazine
Renal Adjustments: CrCl 30-49 = Max 8/90 B.I.D (Avoid <30)
Liver Adjustments: Child Pugh B = Max 8/90 B.I.D (Avoid C
Contrave: Dosing & Efficacy
Dosing: Only supplied as an 8/90 tablet
- Week 1: 8 (Naltrexone)/90 (Bupropion) once a day in a.m.
- Week 2: 8/90 mg twice a day
- Week 3: 16/180 mg a.m. + 8/90 mg p.m.
- Week 4: 16/180 mg a.m. + 16/180 mg p.m.
Total Body Weight Loss vs. Placebo:
•1-year: -4.2%No data available beyond 1-year
Contrave: Indication, evaluation of efficacy, side effects, opiate free, monitor
Indication: BMI >30 or 27 w/comorbs. Chronic. Age >18.
Evaluation of Efficacy: If not >5% wt loss at week 16 = Stop
Side Effects: Generally mild: N/V, headache, dizzy, dry mouth
Opiate Free: 7-10 days before initiating
Monitor: HR, BP, depression, suicidal ideation, migraine, hypoglycemia w/ insulin or secretagogue, seizures, LFT’s
Lab Error: May cause false + for amphetamines
What is the generic for Saxenda
Liraglutide
Saxenda: MOA
GLP-1
Stimulates POMC NEURONS to SUPPRESS APPETITE
Decreases GASTRIC EMPYTING thereby stimulating VAGAL AFFERENTS for MEAL TERMINATION
Saxenda: CI, Precautions, Major DDI, Adjustments
Absolute CI: Pregnancy, breast feeding, MEN2, pancreatitis medullary thyroid cancer, acute gall bladder
Precautions: Pancreatitis hx, gastroparesis, gall stones, dehydration
Major DDI: None (modestly lowers blood pressure, glucose)
Renal Adjustments: None
Liver Adjustments: None
