Weight Loss

Question 1

What diseases are associated with obesity

Answer 1

DM2, HTN, dyskinesia, stroke and CAD

Question 2

What receptors increase food intake?

Answer 2

Seratonin 1A subtype and noradrenegic alpha 2 receptors

Question 3

Stimulation of what receptors lower food consumption

Answer 3

Histamine types 1 & 3
Dopamine 1 &2

Question 4

Higher levels of what are associated with decreased food intake

Answer 4

Protein leptin

Question 5

Higher levels of what increases food intake

Answer 5

Neuropeptide Y

Question 6

How is BMI calculated

Answer 6

Kg divided by height in meters squared

Question 7

What BMI is considered overweight

Answer 7

25-29.9

Question 8

What BMI is considered obese

Answer 8

30-39
Class 1 30-34.9
Class 2 35-39

Question 9

What medical devices can be used for weight loss

Answer 9

Gastric banding, intranets balloon systems, gastric emptying systems, vagal blockade systems, or bariatric surgery

Question 10

What is the % goal of weight loss

Answer 10

5% of total body weight at 3-6 months at a rate of 1-2 pounds a week

Question 11

At what BMI is drug interventions not recommended

Answer 11

> 27

Question 12

What are the injectable GLP1

Answer 12

Liraglutide and semaglutide

Question 13

How does orlistat work

Answer 13

It acts on the GI tract by inhibiting pancreatic and gastric lipases and triglycerides. Leads to caloric deficit and weight loss

Question 14

Why does orlistat have minimal side effects

Answer 14

It acts locally in the GI tract and has minimal systemic absorption

Question 15

How is orlistat dosed

Answer 15

60 mg has less side effects but less effective
Recommended 120 mg TID within 1 hour of a fatty meal

Question 16

What should you supplement when dosing with orlistat

Answer 16

Fat soluble vitamins and multivitamins 2 hours before and after dosing

Question 17

When is orlistat contraindicated

Answer 17

Pregnancy, malabsorption syndrome, cholestasis

Question 18

What are the adverse effects of orlistat

Answer 18

Fatty or oily stools, abdominal pain, gas, nausea, fecal incontinence, URI , serious liver injury (monitor for jaundice)

Question 19

When should you stop orlistat

Answer 19

When patient developed jaundice like side effects

Question 20

What drugs does orlistat interact with

Answer 20

Cyclosporine, warfarin, amiodarone, fat soluble vitamins, levothyroxine, propafenone

Question 21

How should you does meds around orlistat that have interactions?

Answer 21

Cyclosporine 2 hours apart
All other meds 4 hours apart

Question 22

What med acts as a CNS stimulant and increases norepinephrine and dopamine release to decrease food intake and has a high abuse potential

Answer 22

Phentermine

Question 23

How is phentermine dosed

Answer 23

15-30mg a day as IR or ER. Max dose 37.5mg a day. Huge 1-2 hours before breakfast. Avoid dosing in evenings to avoid insomnia

Question 24

When is phentermine contraindicated

Answer 24

Unstable cardiac status, HTN, hyperthyroidism, agitation, glaucoma, drug abuse history

Question 25

What are the AEs of phentermine

Answer 25

Heart palpitations, tachycardia, elevated blood pressure, tremor, headache, euphoria, insomnia

Question 26

What is the combo med used for weight lost with phentermine

Answer 26

Topiramate ER

Question 27

What are the benefits of naltrexone/buproprion

Answer 27

Improved lipid profile, improved insulin sensitivity, improved HGA1C

Question 28

What are the adverse effects of naltrexone+bupropion

Answer 28

Nausea, constipation, headaches, vomiting, dizziness, insomnia, dry mouth, diarrhea

Question 29

What is the black box warning for naltrexone bupropion

Answer 29

Suicidal behaviors and ideation

Question 30

What meds cause an increased risk for hypersensitivity with naltrexone and bupropion

Answer 30

MAOIs

Question 31

Which patients should be monitored closely while on naltrexone

Answer 31

Patients with a history of depression

Question 32

Who should receive semaglutide or litaglutide

Answer 32

Adults with a BMI > 30 or >27 with a comorbidity

Question 33

What is the black box warning for GLP1

Answer 33

Thyroid cancer or METS

Question 34

What is tirzeptide?

Answer 34

Dual GLP1 agonist and GIP agonist to maximize benefits

Question 35

What weight loss drug is given 2nd line in T2DM

Answer 35

Tirzepatide

Question 36

How is tirzepatide dosed

Answer 36

Dose increased over 5-6 period starting at 5mg SC weekly and max dose 15 mg weekly. Monitor A1C and body weight.

Question 37

Patients with MEN 2 should avoid what drug?

Answer 37

Tirzepatide

Question 38

How does Diethylpropion work?

Answer 38

It is a sympathometic that causes CNS stimulation and appetite suppression

Question 39

What two weight loss meds have a high abuse potential

Answer 39

Diethylpropion and phentermine

Question 40

What does Diethylpropion metabolize as?

Answer 40

N dealkylation and reduction

Question 41

How is Diethylpropion dosed

Answer 41

ER tabs, TID before meals, DC if no response in 4 weeks

Question 42

What are the contraindications for Diethylpropion

Answer 42

Used > 3 months = pulmonary hypertension Advanced arteriosclerosis Severe hypertension Hyperthyroidism Glaucoma Agitated states

Question 43

What are the adverse effects of Diethylpropion

Answer 43

Constipation, diarrhea, anxiety, tachycardia, HTN, palpitation, dry mouth, impotence, decreased libido

Question 44

What drug should you not receive within 14 days of Diethylpropion to avoid hypertensive crisis

Answer 44

MAOIs (like phentermine)

Question 45

What medication is approved for short term weight loss management that is a sympathomemtic with extended release over 24 hours a day

Answer 45

Phendimettazine

Question 46

What med is used in weight management that reduces appetite and has secondary CNS effects used in addition to caloric restriction in exogenous obesity

Answer 46

Benzphetamine

Question 47

Use of phentermine is contraindicated in :

Answer 47

Cardiovascular disease, nursing mothers, and depression

Question 48

Naltrexone and bupropion work by:

Answer 48

CNS, and improves lipid profile and insulin sensitivity

Question 49

What SSRIs promote weight loss

Answer 49

Fluoxetine, sertraline

Question 50

What dietary supplements are banned for weight loss?

Answer 50

Ephedra

Question 51

What anti seizure meds are associated with weight gain

Answer 51

Carbamazepine, gabapentin, caloric acid, lithium

Question 52

What antidepressants are associated with weight gain

Answer 52

MOAI like phenelzine, presynaptic alpha 2 like mirtazapine, SSRI like paroxetine, Italian, escitalopram, and tricyclic antidepressant

Question 53

What anti diabetic drugs cause weight gain

Answer 53

Insulin, meglintinides, sulfonylureas, TZDs

Question 54

What antipsychotics cause weight gain

Answer 54

Clozapine, olanzapine, risperidone, quetiapine

Question 55

What “other drugs” cause weight gain

Answer 55

Antihistamine, corticosteroids, hormonal contraceptives