Weight Loss

Question 1

overweight BMI

Answer 1

25-29.9 kg/m2

Question 2

obese BMI

Answer 2

> =30 kg/m2

Question 3

risks of being overweight

Answer 3

coronary heart disease
hypertension
stroke
T2DM

Question 4

2 things that make body use fat as resource

Answer 4

decreasing calories
increasing energy. expenditure

Question 5

drugs/conditions that cause weight gain

Answer 5

antipsychotics: clozapine, olanzapine, risperidone, quetiapine

diabetes: insulin, meglitinides, sulfonylureas, TZDs

divalproex/valproic acid

Gabapentin/pregabalin

lithium

mirtazapine

steroids

TCAs (amitriptyline, nortripttyline, etc.)

beta-blockers

dronabinol

hormones (estrogen, megestrol, etc)

MAOIs

SSRIs (paroxetine, others could be weight neutral)

vasodilators (minoxidil, etc)

condition: hypothyroidism

Question 6

Drugs/conditions that cause weight loss

Answer 6

ADHD drugs (amphetamine, methylphenidate, etc.)

Gupropion

GLP-1 (exenatide, liraglutide, etc.)

Pramlintide

Roflumilast

SGLT2i (canagliflozin, empagliflozin, etc.)

Topiramate

Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine)

antiepileptic drugs: zonisamide, ethosuxamide

Interferons

Thyroid drugs (levothyroxine, etc.)

conditions: hyperthyroidism, celiac, IBS, cystic fibrosis, GERD/peptic ulcer, lupus, TB (active)

Question 7

physical activity for weight loss

Answer 7

> =150 minutes/week over 3-5 separate days

Question 8

OTC supplements for weight loss

Answer 8

bitter orange - stimulant

caffeine (in things like guarana, green tea powder too)

Question 9

when are prescription drugs for weight loss appropriate

Answer 9

BMI >=30 or >=27 with 1+weight-related condition (dyslipidemia, HTN, DM)

in addition to diet and inc physical activity

Question 10

what to avoid/use with caution prescription weight loss drugs in pregnancy

Answer 10

avoid all

Question 11

what to avoid/use with caution prescription weight loss drugs in hypertension

Answer 11

Contrave CI with untrolled BP (has bupropion)

Qsymia: caution; monitor hR (has phentermine)

Question 12

what to avoid/use with caution prescription weight loss drugs in depression

Answer 12

Contrave - caution in young adults/adolescents (suicide risk; contains bupropion)

Question 13

what to avoid/use with caution prescription weight loss drugs in seizures

Answer 13

avoid: Contrave; lowers seizures threshold (Bupropion included)

caution: Qsymia, taper off slowly if used (has topiramate)

Question 14

what to avoid/use with caution prescription weight loss drugs when taking opioids

Answer 14

avoid: Contrave - blocks opioid receptions (has naltrexone)

Question 15

newer drugs that can be continue long-term

Answer 15

Qsymia,Contrave, Saxenda, Wegovy

Question 16

when should weight loss drugs be stopped

Answer 16

<5% weight loss at 12 weeks

Question 17

phentermine MOA

Answer 17

sympathomimetic/stimulant

Question 18

phentermine CI

Answer 18

pregnancy - REMS drug bc teratogenic risk

glaucoma

Question 19

phentermine side effects

Answer 19

tachycardia

CNS effects (insomnia)

vision problems

Question 20

phentermine notes

Answer 20

taper off bc seizure risk

Question 21

Contrave MOA

Answer 21

naltrexone - dec food cravings
Bupropion - dec appetite

Question 22

Contrave CI

Answer 22

pregnancy

chronic opioid use

uncontrolled HTN

seizure disorder

use of other bupropion-containing products

use of MAOIs within 14 days

Question 23

Contrave warnings

Answer 23

caution with psychiatric disorders

Question 24

Contrave notes

Answer 24

Naltrexone block opiois

Question 25

GLP-1 MOA

Answer 25

Saxenda, Wegovy: inc satiety Vicoza, Ozempic: for DM only

Question 26

liraglutide/Saxenda dosing

Answer 26

SC daily injection

Question 27

semaglutide/Wegovy disong

Answer 27

SC weekly injection

Question 28

GLP-1 CIs

Answer 28

Saxenda: pregnancy

Question 29

GLP-1 warnings

Answer 29

pancreatitis hypoglycemia

Question 30

GLP-1 side effects

Answer 30

nausea

Question 31

lipase inhibitors MOA

Answer 31

Orlistat, Xenical (Rx), Alli (OTC) dec abs of dietary fat by 30%

Question 32

lipase inhibitor CI

Answer 32

pregnancy

Question 33

lipase inhibitor side effects

Answer 33

GI (flatus with discharge, fatty stool

Question 34

lipase inhibitor notes

Answer 34

take multivitamin with A, D, C, K, E and beta carotene at bedtime or separated by >=2 hrs from lipase inhibitors

Question 35

sympathomimets/stimulants MOA

Answer 35

Phentermine/Adipex-P sympathomimetics/stimulants stick to diet according to iron tribe, max 30% of calories done in her practice

Question 36

phentermine MOA

Answer 36

sympathomimetic/stimulant

Question 37

phentermine CI

Answer 37

CV disease (uncontrolled HTN) hyperthyroidism glaucoma pregnancy drug abuse history

Question 38

phentermine side effects

Answer 38

tachycardia agitation inc BP

Question 39

phentermine monitoring

Answer 39

HR, BP

Question 40

when to usephentermine

Answer 40

short-term, up to 12 seeks, "jump start"

Question 41

when to use bariatric surgery

Answer 41

BMI >=40 kg/m2 BMI >=35 kg/m2 with obesity-related condition

Question 42

bariatric surgery common nutrient deficiencies

Answer 42

calcium citrate (preferred calcium; non-acid dependent absorption) vit b12 iron deficiency iron and calcium - take 2 hrs before or 4 hrs after antacids may need life-long of DEAK

Question 43

bariatric surgery medication concerns

Answer 43

may need to crush or put in liquid or use transdermal for up to 2 months post-surgery rapid weight loss: might need meds that get ride of gallstones; Ursodiol (Urso 250, UrsActigall, Urso Forte)