obesity pp pharm

Question 1

when should patients be screened

Answer 1

all adults annually
if BMI> 25, further evaluation

Question 2

associated with what coexisting conditions

Answer 2

HTN
HLD
DM
CVD
stroke
sleep apnea
certain cancers

Question 3

risk factors of CVD

Answer 3

smoking
HTN
elevated LDL
low HDL

Question 4

what parameters assess patients

Answer 4

BMI
waist circumference
comorbidities
readiness to lose weight

Question 5

BMI 25-29.9

Answer 5

overweight

Question 6

BMI <18.5

Answer 6

underweight

Question 7

BMI 35-39.9

Answer 7

obese 2

Question 8

BMI >40

Answer 8

obese 3
extreme obesity

Question 9

BMI 18.5-24.9

Answer 9

normal

Question 10

BMI 30-34.9

Answer 10

obese 1

Question 11

waist circumference high risk for men

Answer 11

> 40in

Question 12

waist circumference high risk for women

Answer 12

> 35

Question 13

sustained weight loss of 3-5% can

Answer 13

reduce BP
improve cholesterol
decrease risk of DM
improve DM control

Question 14

treatment goals

Answer 14

prevent additional weight gain
reduce body weight
control related risks
rate of 1-2 ponds per week
maintain weight loss

Question 15

treatment wise what is recommended for everyone?

Answer 15

lifestyle changes

Question 16

nonpharm therapy

Answer 16

reduced calorie diet ( 1200-1500 for women & 1500-1800 for men)
increased physical activity ( 3days/week for 30min/day)
self monitoring of food intake, physical activity, and weight
goal is 1-2lbs weight loss per week

Question 17

evidence based diets

Answer 17

Mediterranean (high protein) not good for pts with renal disease
DASH (low sodium)
Ornish (high protein and high fat, vegetarian based)

(do not use low fat diet with pts with hyperlipidemia)

Question 18

diet recommendations

Answer 18

eat breakfast
add dietary fiber
eat at regular intervals
limit sugary drinks
increase number of fruit and veggies
fiber and protein cause satiety

Question 19

exercise

Answer 19

30-60min for 3-5 days
at least 150min/week
key to maintenance of weight loss

Question 20

obesity associated conditions

Answer 20

degenerative joint disease
dyslipidemia
HTN
metabolic syndrome
non alcoholic fatty liver disease
obstructive sleep apnea
T2DM and prediabetes

Question 21

bariatric surgery

Answer 21

used as adjunct therapy for those with BMI>40 without comorbidities OR BMI>35 with comorbidity

Question 22

weight management meds (WMM) should be offered if

Answer 22

BMI>30
BMI>27 with obesity related conditions

Question 23

WMM should be discontinued when

Answer 23

if 3-5% weight loss is not achieved after 12 weeks of target dose therapy

Question 24

WMM is not appropriate for who

Answer 24

pregnant or lactating

Question 25

what WMM is approved for pts >12 y/o

Answer 25

orlistat

Question 26

all other WMM is approved for pts > than what age

Answer 26

18

Question 27

drugs contributing to weight gain

Answer 27

paroxetine amitriptyline insulin corticosteroids

Question 28

diabetes agents to use in obesity

Answer 28

metformin GLP1 SGLT2 if insulin required start with basal only and mitigate weight gain with those above

Question 29

HTN agents to use in obesity

Answer 29

ACE/ARB CCB

Question 30

depression

Answer 30

fluoxetine sertraline bupropion venlafaxine

Question 31

epilepsy

Answer 31

felbamate topiramate zonisamide lamotrigine

Question 32

phentermine warnings

Answer 32

tolerance in a few weeks do not d/c abruptly (seizure risk) avoid alcohol hypokalemia in combo with diuretic avoid in hepatic dysfunction do not use with SSRIs do not use with pts with cardiac disease

Question 33

phentermine/topiramate warnings

Answer 33

do do d/c abruptly avoid in hepatic dysfunction glaucoma avoid alcohol hyperthyroidism do not use MAO-! within 14 days pregnancy hx of suicidal ideation oligohidrosis

Question 34

phentermine/topiramate REMS

Answer 34

risk of congenital malformations monitor suicidality pregnancy test prior to start and monthly check electrolytes before and periodically risk of renal stones ensure adequate fluid intake

Question 35

bupropion/naltrexone warnings

Answer 35

do not take with high fat meals seizure disorders uncontrolled HTN eating disorder chronic opioid use MAO-I within 14 days

Question 36

bupropion/naltrexone interactions

Answer 36

clopidogrel increases concentrations of bupropion (decrease dose) bupropion can increase concentrations of antidepressants, antipsychotics, and BB induces opioid withdrawal

Question 37

orlistat warnings

Answer 37

take a MVI containing A,D,E and K ( fat soluble vitamins) cholestasis malabsorption CI in pts with gallbladder disease

Question 38

orlistat interactions

Answer 38

interferes with absorption of fat soluble vitamins (take 2 hours apart) separate levothyroxine by 4 hours may reduce absorption of AEDs may decrease amiodarone efficacy may decrease vitamin K absorption (watch INR if on warfarin) may affect absorption of COs and cyclosporine

Question 39

liraglutide warnings

Answer 39

hx of medullary thyroid cancer or endocrine neoplasia type 2 watch for signs of pancreatitis

Question 40

semaglutide warnings

Answer 40

CI in medullary thyroid carcinoma (MTC) and MEN-2

Question 41

tirzepatide warnings

Answer 41

CI in medullary thyroid carcinoma (MTC) and MEN-2