PHARM

Question 1

How well do Metformin and Topirimate Go together?!

Answer 1

NOT well.

Avoid, due to potential for lactic acidosis (topirimate being a carbonic anhydrase inhibitor)

Question 2

Migraine Weight Positive Meds (3)?

Answer 2

Beta Blockers
Valproic Acid
TCA’s

Question 3

Weight Neutral Migraine Meds (4)?

Answer 3

-NSAID’s
-Triptans
-Botox
-Venlafaxine
-Erunab (CGRP) Antagonist

Question 4

Weight Negative Migraine Meds (2)?

Answer 4

Topirimate, Zonisamide

Question 5

What medication is approved for 6 yo and older?

Answer 5

Setmelanotide

melanocortin-4 (MC4) receptor agonist

Question 6

What medications are approved at 12 yo and older?

Answer 6

Semaglutide
Liraglutide
Orlistat
Qsymia (Phentermine/Topiramate ER)

Question 7

When are Contrave and Tirzepatide approved in kids?

Answer 7

at 18 yo

Question 8

Which anti-pyschotic is the least obesogenic?

Answer 8

Abilify

Question 9

Which mood stabilizers DON’T increase weight gain?

Answer 9

Lamictal, Oxcarbazepine

Question 10

Which mood stabilizers cause weight gain?

Answer 10

Depakote, Lithium, Carbamazepine

Question 11

Orlistat Contraindications? (3)

Answer 11

Chronic Malabsorption, Oxalate Nephrolithiasis, Pregnancy

Question 12

What Mediation is the first and only FDA Approved for Mod-Severe OSA Treatment?

Answer 12

Tirzepatide

Question 13

True or False? Semaglutide Can’t be taken concurrently with Insulin?

Answer 13

FALSE

A recent study showed improved weight, less insulin requirements, and no significant increase in hypoglycemia risks. Regardless, this should be orchestrated with his endocrinologist.

Question 14

Letrozole vs Oral Contraceptives?

Answer 14

an aromatase inhibitor, is the first-line pharmacologic treatment for ovulation induction for those who desire pregnancy.

Whereas COC is the first-line treatment for managing hyperandrogenism and menstrual irregularities in women with PCOS who are not trying to conceive

Question 15

Which Medication is FDA Approved for OSA?

Answer 15

Tirzepatide (Zepbound®) is the first and only FDA-approved medication for moderate to severe OSA in those with obesity.

Question 16

Weight Negative Anti-Seizure Meds (3)

Answer 16

Lamotrogine, Zonisadmine, Topiramate

Question 17

Weight Positive Anti-Seizure Meds (4)

Answer 17

Carbamazepine, Valproate, Pregabalin/Gabapentin, Depakote

Question 18

Topiramate Dual Indications (3)

Answer 18

Chronic Migraines, Epilepsy, Binge Eating Disorder

Question 19

Which Birth Control Options Cause Weight Gain?

Answer 19

Well Byron, Surprisingly, it’s just progesterone injections.

Question 20

Stepwise Treatment/Benefits in PCOS (4)

Answer 20

LIFESTYLE:
- Weight reduction… improving insulin resistance, hyperandrogenism, and fertility

OCP’s:
- Endometrial protection, Contraception, Improve Hyperandrogenism

METFORMIN:
- Improve ovulatory menses in ~50% of patients (no endometrial protection)
- Used in adjunct to OCP’s in overweight/obese people

SPIRONOLACTONE:
- If OCP response is suboptimal, caution / avoid in pregnancy

Question 21

Buproprion MOA & Contraindications

Answer 21

Enhances the release of norepinephrine /dopamine in the hypothalamus –> Stimulating POMC

Seizures. Uncontrolled HTN

Question 22

Topiramate MOA & Contraindications

Answer 22

Enhances satiety and reduces cravings via GABAergic modulation, glutamate inhibition, and altered taste perception.

Pregnancy, kidney stones, glaucoma

Question 23

Phentermine MOA

Answer 23

Suppresses appetite by increasing norepinephrine signaling in the hypothalamus.

Question 24

What is the only long-term, anti-obesity medication contraindicated in patients with eating disorders such as bulimia or anorexia nervosa?

Answer 24

Naltrexone/bupropion ER

Due to increased risk of seizure.

BLACKBOX warning for suicidal ideation in young adults

Question 25

What year was Phen-Fen DC'd and why?

Answer 25

The fenfluramine component (5-HT2B receptor agonist) caused both valvopathy and pulmonary arterial hypertension. 1997

Question 26

Which Medication used in combination anti-obesity medication for it's synergistic effects, but is ineffective alone in causing weight loss?

Answer 26

Naltrexone

Question 27

Which Anti-Obesity Meds Can Be Safely Used in ESRD?

Answer 27

All FDA-approved anti-obesity medications used for long-term weight loss should be avoided in the setting of end-stage renal disease, except for GLP-1 receptor agonists (Tirzepatide included) & Orlistat

Question 27

How much weight do patients gain on average after 1 year of coming off semaglutide?

Answer 27

The STEP 1 trial demonstrated that patients who discontinued semaglutide therapy (after 68 weeks of treatment) experienced significant weight regain over the following year. On average, patients regained approximately two-thirds of the weight they had lost during active treatment despite continuing with lifestyle interventions. In addition, their cardiometabolic risk factors returned to the pre-treatment baseline. Discontinuation of semaglutide often leads to a return of the body’s homeostatic mechanisms, emphasizing the importance of sustained treatment and close follow-up in obesity management.

Question 28

At What GFR is Metformin Contraindicated?

Answer 28

< 30 mL Min

Question 29

Mild, Moderate, Severe ESRD and Anti-Obesity Meds ?

Answer 29

Mild - GFR greater than/equal to 50 (no adjustment, all okay) Moderate - GFR 30 to 49 (Reduce Qsymia and Contrave) Severe - GFR < 30 - GLP1's ONLY (tirzpetide included) & Orlistat

Question 30

Class A, B, C Cirrhosis and Antiobesity

Answer 30

A okay B better reduce C better Cease Qsymia and Contrave Only

Question 31

GLP-1's / GIP Effects On Cardiovascular Biomarkers?

Answer 31

Increased HDL Decreased LDL, TG, A1C, BP

Question 32

Contrave Effects on CV Biomarkers?

Answer 32

Increased HDL, BP Neutral LDL Decreased TG, A1C

Question 33

Qsymia Effects on CV Biomarkers ?

Answer 33

Same As GLP's Increased HDL Decreased LDL, TG, A1C, BP

Question 34

Naltexone's Synergistic Effects On Buproprion?

Answer 34

BUPROPRION stimulates POMC neurons, leading to the release of alpha-melanocyte-stimulating hormone (a-MSH). This hormone binds to receptors that trigger appetite suppression. BETA-ENDROPHIN: When POMC neurons are activated, they also release beta-endorphin, an endogenous opioid. Beta-endorphin then binds to inhibitory mu-opioid receptors on the POMC neurons, creating a negative feedback loop that limits the appetite-suppressing effect. Naltrexone's role: As an opioid receptor antagonist, naltrexone blocks the mu-opioid receptors. This prevents beta-endorphin from inhibiting the POMC neurons. By removing this natural "brake," naltrexone allows the appetite-suppressing signal from bupropion to continue unimpeded, resulting in a more pronounced and sustained effect.

Question 35

Mouth Symptoms, Phentermine vs Topiramate?

Answer 35

Phentermine: Dry mouth Topiramate: Abnormal Taste

Question 36

Setmelanotide MOA & Indications

Answer 36

Setmelanotide is a medication that acts on the melanocortin-4 receptor (MC4R) for the treatment of severe obesity caused by genetic disorders.

Question 37

FDA Approved Meds in PEDS, by Ages

Answer 37

Setmelanotide (6 yo) Semaglutide / Liraglutide (12 yo) Qysymia Orlistat Phentermine (16 yo) 3 months max Contrave (18 yo) Zepbound

Question 38

Qsymia Titration Schedule (Phentermine Topiramate ER)

Answer 38

Start: 3.75/23 mg x2 weeks Increase: 7.5/46mg x2 weeks 3% WL at 12 weeks? - If Yes, continue dose - If No, Increase 11.25mg / 69 x 2 weeks 15 / 92 mg thereafter

Question 39

vBLOC (Vagotomy). Indications, Contraindications, WL Results, Common Side Effects

Answer 39

BMI of 40 or 35+ comorbidity. 18yo +, and failed one supervised WL program in last 5 years CI's: Cirrhosis, Portal HTN, Esophageal Varices, Hiatal Hernia WL: 8% at 2 years SE's: Dyspepsia, Pain at site of Implant

Question 40

Is a vBLOC MRI compatible?

Answer 40

No

Question 41

Minimum age for LAGB?

Answer 41

18 yo

Question 42

Low Density Foods?

Answer 42

Eating low-density, higher-weight foods, such as those high in fiber, including vegetables and fruits, promotes fullness, allowing patients to reduce their overall caloric intake and allowing them to obtain subsequent weight loss.

Question 43

In addition to weight negative effects, what other benefits do SGLT-2 Inhibitors have for diabetes?

Answer 43

Good for Kidneys and Heart Failure

Question 44

Acarbose

Answer 44

A complex disaccharide and an alpha-glucosidase inhibitor that delays carbohydrate digestion and absorption

Question 45

Orlistat and Levothyroxine?

Answer 45

When orlistat is taken without proper timing (e.g., spaced at least four hours apart from levothyroxine), it can reduce levothyroxine absorption, leading to symptoms of hypothyroidism such as brittle hair and cold intolerance.