Obesity management

Question 1

What is considered a high risk waist circumference?

Answer 1

men >40in
women >35in

Question 2

What BMI range should waist circumference be measured?

Answer 2

25-34.9

Question 3

What are people at a normal weight with a high risk waist circumference at increased risk for?

Answer 3

Cardiovascular diseases
HTN
T2DM

Question 4

When should weight loss medications be considered in addition to lifestyle modifications?

Answer 4

> /= 30

Question 5

How much of a calorie deficit is needed to lose 1 lb a week?

Answer 5

500 kcal/ day

Question 6

What should be used in conjunction with diet?

Answer 6

physical activity

Question 7

What is the standard recommendation for moderate-intensity physical activity per day?

Answer 7

30 min on 5 or more days of the week

Question 8

What is the MOA of Phentermine (ADIPEX-P)?

Answer 8

sympathomimetic amine –> stimulates release of NE –> decreases hunger

Question 9

How long should Phentermine be used for?

Answer 9

short-term; no more than 12 weeks

Question 10

What are SEs with Phentermine?

Answer 10

1. increased HR and BP
2. restlessness/ insomnia
3. headache

Question 11

What are CIs to Phentermine?

Answer 11

1. CVD
2. coronary artery disease
3. arrhythmias
4. stroke
5. congestive HF
6. glaucoma
7. seizures

Question 12

What is the MOA of Orlistat?

Answer 12

gastrointestinal lipase inhibitor; blocks absorption of ~1/3 of dietary fat from the GI tract

Question 13

What are the 2 brand names for Orlistat?

Answer 13

Rx: XENICAL
OTC: ALLI

Question 14

What are SEs to Orlistat?

Answer 14

1. gas
2. oliy spotting
3. oily/ fatty stool
4. fecal incontinence, urgency, frequency

Question 15

How are SEs with Orlistat managed?

Answer 15

adhering to low-fat diet that contains an average of 15g / meal

Question 16

What are important patient counseling points for Orlistat?

Answer 16

1. multivitamin containing ADEK taken > 2h before, after Orlistat, or at bedtime
2. separate Orlistat and levothyroxine by 4 hours
3. INR may increase when taking warfarin

Question 17

What is the MOA of Phentermine/ Topiramate (QSYMIA)?

Answer 17

Topiramate: unknown nut appears to suppress appetite and enhance satiety

Question 18

How must Qsymia be dosed?

Answer 18

start treatment with 3.75mg/ 23mg QD x 14 days then increase the dose slowly

Question 19

Why should Qsymia be taken in the morning?

Answer 19

insomnia

Question 20

What are CIs to Qsymia?

Answer 20

1. pregnancy (birth defects)
2. glaucoma
3. hyperthyroidism

Question 21

What is the MOA of Naltrexone/ Bupropion ER (CONTRAVE)?

Answer 21

affects the hypothalamus and mesolimbic dopamine circuit involved in regulation of food intake

Question 22

What is the dosing schedule for Contrave?

Answer 22

Week 1: 1 tab qam
Week 2: 1 tab qam and 1 tab 2pm
Week 3: 2 tabs qam and 1 tab qpm
Week 4 and beyond: 2 tabs qam and 2 tabs qpm

Question 23

What are the BBWs for contrave?

Answer 23

Suicidality
Neuropsychiatric events

Question 24

What are CIs to Contrave?

Answer 24

1. seizure disorders
2. anorexia/bulimia
3. abrupt D/C of alcohol, benzos, barbs, or antiepileptic drugs
4. use of other bupropion products
5. chronic opioid use (none in the last 7-10 days)

Question 25

What are warnings for contrave?

Answer 25

1. should not be taken with high-fat meals 2. risk of hepatotoxicity

Question 26

What is the MOA of Liraglutide (SAXENDA)?

Answer 26

GLP-1 receptor agonist; regulates appetite and calorie intake

Question 27

How is SAXENDA administered?

Answer 27

SQ in abdomen, thigh, upper arm

Question 28

How is saxenda dose increased?

Answer 28

4 week dosage escalation to minmize GI symptoms; max 3.0mg/day

Question 29

What are common SEs with SAXENDA, WEGOVY, and ZEPBOUND?

Answer 29

1. N/V/D 2. constipation 3. dyspepsia 4. abdominal pain

Question 30

What are CIs with saxenda, Wegovy, and Zepbound?

Answer 30

personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2

Question 31

What BBW does Saxenda and Wegovy have?

Answer 31

risk of thyroid C-cell tumors , including medullary thyroid carcinoma

Question 32

What are warnings with Saxenda?

Answer 32

acute pancreatitis acute gallbladder disease suicidal behavior/ ideation

Question 33

What is different between Saxenda and Semaglutide (WEGOVY) dosing?

Answer 33

SAXENDA: daily dosing WEGOVY: weekly dosing

Question 34

How is WEGOVY dose increased?

Answer 34

over 16 weeks to minimize GI symptoms

Question 35

What are warnings with WEGOVY and ZEPBOUND?

Answer 35

Acute pancreatitis Acute gallbladder disease

Question 36

What is the MOA of Tirzepatide (ZEPBOUND)?

Answer 36

GIP (glucose-dependent insulinotropic polypeptide) receptor agonist AND GLP-1 receptor agonist

Question 37

How is Tirzepatide dosed?

Answer 37

weekly

Question 38

What are BBWs with Tirzepatide?

Answer 38

1. risk of thyroid C-cell tumors , including medullary thyroid carcinoma 2. personal or family history of multiple endocrine neoplasia syndrome type 2