obesity pharmacotherapy Flashcards
candidates for pharmacotherapy
indication:
BMI >30kg/m2
or BMI >27kg/m2 w/ risk factors and did not lose weight OR maintains weight loss with with lifestyle intervention ( <5% loss in 3-6months of actively trying)
goals of pharmacotherapy
reduction of body weight
maintain body weight
prevent weight gain
improve obesity-related conditions
treatment followups
initiate pharmacotherapy
initial follow-up every month for first 3 months
3 month post initial follow-up: every 3 months
short-term pharmacotherapy
CNS stimulants:
phentermine
phendimetrazine
benzphetamine
diethylpropion
long-term pharmacotherapy
lipase inhib: orlistat
Sympathomimetic + anticonvulsant: phentermine/topiramate
Opioid antag: naltrexone/buproprion
GLP1: liraglutide/semaglutide
melanocortin R agonist:
setmelanotide
CNS stimulants
phentermine
phendimetrazine
benzphetamine
diethylpropion
MOA: increase NE to stimulate receptors
orlistat
lipase inhibitor
suggested for patients with CVD
MOA: reversibly inhibits gastric + pancreatic lipase to decrease absorption of dietary fats
take with meals
ADRs: GI
CI: pregnant, choletasis
Hepatotoxicity
Phentermine/topiramate (QSYMIA)
MOA: phentermine (sympathomimetic)
topiramate (anticonvulsant)
REMS drug due to teratogenicity
renal: not recommended on dialysis
hepatic: not recommended
naltrexone/buproprion (contrave)
MOA: naltrexone (opioid antagonist)
bupropion (weak inhibition of neuronal reuptake of dopamine)
renal: no use on dialysis
CI: pregnant
GLP1
semaglutide + liraglutide
common ADRs: GI, redness, bruising, hypoglycemia
warning: thyroid tumors
setmelanotide
MOA: MC4 receptor agonist
ADRs: back pain, GI, URI
monitoring parameters
close monitoring during first 6 months
followup every 4 weeks
