What regulates food intake and energy expenditure?
Neuropeptide hormones
Cause of regained weight?
Non-adherence to diet
Decreased activity prescriptions
Increase in endogenous compensatory mechanisms
Orlistat MOA?
Pancreatic and gastric lipase inhibitor = fat malabsorption = reducing net energy intake
Lorcaserin MOA?
Selective 5HT2C agonist = satiety
Liraglutide MOA?
GLP-1 agonist = delays gastric emptying= reduces intake
Phentermine-topiramate MOA?
NE releasing agent (phen)
GABA modulation (top)
Reduced appetite= reduced intake
Naltrexone-bupropion MOA?
Opioid antagonist (Nal)
Dopa and NE reuptake inhibitor (bupropion)
Reduces food intake
Orlistat dose?
120 mg Before meals tds
Multivitamin at least 2 HR before/after
Lorcaserin dose?
10 mg BD
Liraglutide dose?
Initiate 0.6 mg SC
Increase by 0.6 mg
Max 3 mg
Phen-top dose?
Initiate 3.75 mg/23 mg 2 weeks
7.7/46 mg recommended
15/92 mg max
Nal-Bupro dose?
1 tab (8/90 mg) daily 1 week
Maintenance 2 tabs bd 1 month
Orlistat side effects?
Oily spotting, oily evacuation
Flatus with discharge
Faecal urgency, incontinence
*LOW FAT DIET TO MINIMIZE S/E
Lorcaserin side effects?
With diabetes:
Hypoglycaemia
Increased lipase levels
Liraglutide side effects?
Increased lipase levels
Phen-top side effects?
Insomnia
Dysgeusia (metallic taste in mouth)
Parethesias (burning, pins and needles)
Nal-burpro side effects?
Insomnia
Dry mouth
Orlistat contraindications?
Chronic malabsorption syndrome
Cholestasis
Liraglutide contraindications?
Medullary thyroid CA
Multi endocrine neoplasia T2
Phen-top contraindications?
Glaucoma
Hyperthyroidism
MAOI
Nal-Bupro contraindications?
UHT
Seizure
Anorexia
Bulimia
Drug/alcohol withdrawal
MAOIs
Log term opioid use
What is used for short term tx?
Suprenza
Sibutramine dose?
5- 10 mg
10 qd to start
Increased to 15 mg
Decreased to 5 mg
Sibutramine contraindications?
SSRIs
UHT
CAD
CHF
Arrythmia
Stroke
