16 Questions
Who qualifies for weight loss medications?
BMI 30.0 + = Qualifies BMI 27.0 = Does Not Qualify BMI 27.0+ with HTN = Qualifies BMI 27.0+ with Dyslipidemia = Qualifies
If your patient loses __% of their body weight after 3 months of drug therapy, continue the therapy. If not, stop drug and consider a different therapy.
5%
What patients qualify for bariatric surgery
BMI 30-34.9 with DM or Metabolic Syndrome = Qualifies BMI greater than 35.0 = Does Not Qualify BMI equal/above 35.0 with obesity comorbidity = Qualifies BMI equal/above 40.0 = Qualifies
Match the ORAL weight loss drugs mechanism of action!
Phentermine (Adipex-P®) = Short-term stimulant that decreases appetite via norepinephrine and dopamine release Phentermine/Topiramate ER (Qsymia®) = Sympathomimetic/antiepileptic extended release combination that decreases appetite Naltrexone/Bupropion SR (Contrave®) = Opioid antagonist/dopamine and norepinephrine reuptake inhibitor that reduces cravings Orlistat (Xenical®, Alli®) = Inhibits gastric and pancreatic lipases and decreases fat absorption
Match the dosing with the oral drug for weight loss
Phentermine (Adipex-P®) = Twice daily for ages 17 and older Naltrexone/Bupropion SR (Contrave®) = 18+; once daily week one, twice daily week two, 2 in AM and 1 PM week three, 2 BID onwards Phentermine/Topiramate ER (Qsymia®) = Ages 12 and up; start low and increases every 14 days; renal dose of 7.5/46 Orlistat (Xenical®, Alli®) = TID before meals
Match the contraindications with the medication
Naltrexone/Bupropion SR (Contrave®) = Opioid use, uncontrolled HTN, seizure disorder, pregnancy Orlistat (Xenical®, Alli®) = Liver damage (rare), cholelithiasis, increased urinary oxalate/kidney stones Phentermine (Adipex-P®) = Cardiovascular disease (i.e., uncontrolled hypertension), hyperthyroidism, glaucoma, drug abuse, seizure disorder, Tourette’s, MAO inhibitors within the past 14 days Phentermine/Topiramate ER (Qsymia®) = Pregnancy Category X, hypertension, hyperthyroidism, glaucoma, MAO inhibitor within 14 days
Match the adverse effects with the medication for obesity.
Naltrexone/Bupropion SR (Contrave®) = Nausea/vomiting, headache, constipation, dizziness, anxiety Orlistat (Xenical®, Alli®) = Gastrointestinal (flatus with discharge, fatty stool, fecal urgency), Decreased absorption of vitamins ADEK Phentermine (Adipex-P®) = Increased heart rate, increased blood pressure (BP), headache, tremor, anxiety Phentermine/Topiramate ER (Qsymia®) = Tachycardia, CNS effects (i.e., insomnia), increased serum creatinine, hypokalemia, numbness, tingling, dizziness, xerostomia, dysgeusia, headache
What oral weight loss drug must be discontinued gradually
Phentermine/Topiramate ER (Qsymia®)
Which oral weight loss medication is category X for pregnancy?
Phentermine/Topiramate ER (Qsymia®)
Phentermine (Adipex-P®) is safe to use in a patient that is taking opioids, SSRIs or has alcohol abuse disorder.
False
A patient is wanting to start on weight loss medications but has a history of medullary thyroid cancer. What medications are contraindicated?
GLP + GIP (liraglutide,semaglutide,tirazepatide)
Match the drug with the dosing and classification
Liraglutide/Saxenda = Daily injection GLP Semaglutide Wegovy = Weekly GLP Tirazepatide Zepound = Weekly GIP :) = :)
What are contraindications for a patient starting GIP/GLT?
B and C
What DDI should you be aware of when starting a patient on GLP or GIP medications for weight loss since those drugs can increase drug concentrations?
Insulin, sulfonylureas, levothyroxine
What drug is a FDA approved medical DEVICE and acts as a gel matrix in the stomach and intestines but has major AE of abdominal pain, distention, and bloating?
Plenty
Special considerations. Match the special consideration with the medications that is safest for them.
CVD/HTN = GIP/GLT (monitor HR), orlistat Depression, Hx of seizures, Opioid use = AVOID naltrexone/bupropion DM2 = All are safe pregnancy = NONE
Study Notes
Weight Loss Medications
- Patients who qualify for weight loss medications: (no specific criteria mentioned)
- If a patient loses 5% of their body weight after 3 months of drug therapy, continue the therapy; if not, stop the drug and consider a different therapy.
Bariatric Surgery
- Patients who qualify for bariatric surgery: (no specific criteria mentioned)
Oral Weight Loss Drugs
Mechanism of Action
- Match the oral weight loss drugs with their mechanism of action (not specified)
Dosing
- Match the oral weight loss drugs with their dosing (not specified)
Contraindications
- Match the oral weight loss drugs with their contraindications (not specified)
Adverse Effects
- Match the oral weight loss drugs with their adverse effects (not specified)
- One oral weight loss drug must be discontinued gradually (not specified)
Specific Medications
- Phentermine (Adipex-P):
- Not safe to use in patients taking opioids, SSRIs, or with alcohol abuse disorder
- Category X for pregnancy
Contraindications
- Patients with a history of medullary thyroid cancer:
- Contraindicated medications (not specified)
- Patients starting GIP/GLP:
- Contraindications (not specified)
Drug Interactions
- GLP or GIP medications:
- Increase drug concentrations (specific DDI not specified)
FDA-Approved Medical Devices
- One FDA-approved medical device:
- Acts as a gel matrix in the stomach and intestines
- Major AE: abdominal pain, distension, and bloating
Special Considerations
- Match the special consideration with the safest medication (not specified)
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