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33 Cards in this Set
- Front
- Back
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What BMI range qualifies as “overweight”?
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25 to 29.9
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What is the BMI cutoff at or above which an individual qualifies as “obese”?
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30
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What waist circumference is considered “high risk” for men? For women?
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For men, > 102 cm (40 in). For women, > 88 cm (35 in)
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By what standard is obesity in children ages 2 to 19 judged? [What is the cutoff for obesity?]
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The CDC 2000 Growth Chart [Children at or above the 95th percentile are considered obese.]
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What is considered an acceptable short term goal for weight loss as a percentage of baseline? How many pounds per week is considered a safe goal?
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5 to 10% of baseline weight, at a rate of 1 to 2 lbs per week
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What weight loss drug is available over-the-counter and as a prescription?
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Orlistat (Xenical)
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What three weight loss drugs are available by prescription?
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1) Phentermine, 2) Pentermine/ Topiramate (Qsymia), & 3) Lorcaserin (Belviq)
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What is the mechanism of action for Orlistat (Xenical)?
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Orlistat inhibits gastrointestinal lipases, thereby decreasing formation of free fatty acids (FFAs) from dietary triglycerides (TGs). Essentially, orlistat induces weight loss by lowering dietary fat absorption. Note that because of its mechanism, Orlistat is only effective if the meal with which it is consumed contains fat.
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Describe prescription and OTC dosing of Orlistat (Xenical). [How does the prescribed pediatric dose (for children 12 to 16 years of age) differ from that of adults?]
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The prescription strength is 120 mg orally, 3 times daily with meals. The OTC dose is 60 mg orally, 3 times daily with meals. [Pediatric dosing is the same as for adults, 120 mg po 3x/d w/ meals.]
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What are the common adverse effects of Orlistat (Xenical)?
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Soft stools, abdominal pain, flatulence, fecal urgency, incontinence (at least one of these occurs in up to 80% of individuals).
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What concern does taking Orlistat create with regards to vitamin absorption? What is the recommendation base on this concern?
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Malabsorption of fat soluble vitamins (A, D, & E) may occur. Encourage patients to take a multivitamin containing fat-soluble vitamins at least 2 hrs before or 2 hrs after taking Orlistat.
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What percentage of total calories coming from fat is considered “nutritionally balanced?”
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~30%
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For whom is Phentermine/Topiramate (Qsymia) indicated?
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Qsymia is indicated for 1) patients having a BMI of 30 or greater or 2) patients having a BMI of 27 or greater who have at least one weight-related comorbidity, such as hypertension, type-2 diabetes mellitus, or dyslipidemia.
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Describe dosing recommendations for Phentermine/Topiramate (Qsymia)?
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Initiate Qsymia 3.75 mg / 23 mg Extended Release daily for 14 days, then increase to 7.5 mg / 46 mg daily.
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When should Phentermine/Topiramate (Qsymia) be taken?
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Take Qsymia once daily in the morning. Avoid taking it in the evening to preclude insomnia.
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What is the maximum recommended dosage of Phentermine/Topiramate (Qsymia)?
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15 mg phentermine / 92 mg topiramate
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What are the recommendations regarding discontinuation of Phentermine/Topiramate (Qsymia)?
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Discontinue Qsymia if 3% weight loss is not achieved after 12 weeks on 7.5 mg / 46 mg dose (or 5% … on 15 mg / 92 mg)
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Why is an incremental dosage decrease recommended for discontinuation of Qsymia?
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To reduce the risk of seizure.
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What is the recommendation regarding safe dosing of Qsymia in patients having moderate renal or hepatic impairment?
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Do not exceed a 7.5 mg / 46 mg dose.
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What adverse effects are associated with Qsymia?
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Tingling sensation of hands and feet, dizziness, altered taste, insomnia, constipation, & dry mouth
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What drug interactions are associated with Qsymia? (3)
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1) With oral contraceptives, it may increase risk of bleeding but will not affect pregnancy risk (advise patients not to discontinue oral contraceptives), 2) Additive CNS effects with alcohol and other depressants (avoid taking w/ EtOH), & 3) May increase risk of hypokalemia with diuretics (except those that spare potassium). [Monitor serum potassium.]
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For whom is Lorcaserin (Belviq) indicated?
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Lorcaserin is indicated for 1) patients having a BMI of 30 or greater or 2) patients having a BMI of 27 or greater who have at least one weight-related comorbidity, such as hypertension, type-2 diabetes mellitus, or dyslipidemia.
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What is the mechanism of action for Lorcaserin (Belviq)?
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Lorcaserin is a Selective Serotonin 2C Receptor Agonist. It is thought to promote satiety and decrease food intake by activating 5-HT(2C) receptors on anorexigenic pro-opiomelanocortin neurons in the hypothalamus.
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Describe dosing recommendations (including max dose), for Lorcaserin (Belviq).
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10 mg orally twice daily (max dose 20 mg/day)
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What is the recommendation regarding discontinuation of Lorcaserin (Belviq)?
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Discontinue if a 5% weight loss is not achieved after 12 weeks.
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What monitoring is advised with Lorcaserin (Belviq)?
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1) Weight loss indicative of efficacy (particularly at the 12 wk mark), 2) Blood Glucuse Levels, 3) Complete Blood Count (CBC), 4) Prolactin levels, & 5) Changes in mood or behavior (including suicidal tendencies))
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What is the most concerning type of potential drug interaction with Locaserin (Belviq)?
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Increased risk of serotonin syndrome when used concurrently with SSRIs, such as paroxetine; SNRIs; TCAs, such as amitriptyline, clomipramine, desipramine, & imipramine; or the cough suppressant dextromethorphan.
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What are some of the signs and symptoms of serotonin syndrome?
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Agitation, confusion, diaphoresis (excess sweating), hallucinations, hyperreflexia, hypertension, tachycardia, hyperthermia, myoclonus (brief, involuntary twitching of muscles), and mental status changes.
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Of what three drugs is Locaserin (Belviq) said to increase the level?
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Locaserin is said to increase the level of atomoxetine, metoprolol, and propafenone in patients who use both concurrently.
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Which of the weight loss drugs carries a risk of priapism?
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Lorcaserin (Belviq)
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For how long is it recommended that patients attempt lifestyle modifications alone for weight loss before resorting to weight loss drugs as well?
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At least 6 months.
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For which patients might weight loss surgery be indicated?
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Weight loss surgery (gastric restriction or gastric bypass) is considered an option for patients having a BMI of at least 40 or for patients having a BMI of at least 35 plus comorbid conditions. It is reserved for patients in whom medication therapy has failed.
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How dramatically does a 10% reduction in weight reduce the severity of sleep apnea?
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A 10% reduction in weight is associated with a 50% reduction in the severity of sleep apnea.
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