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Weight Loss, Contraception, Infertility/PCOS
Questions With Complete Solutions
What are the recommendations for weight loss? (think physical activity) exercise 200-300 min/wk for weight LOSS
- muscle strengthening activities AT LEAST 2 days/wk What are the BASIC principles of common diets?
- LOW carb
- HIGH protein
- Decreased caloric intake Recommended daily calories for Women: 1,200 -1,500 kcal/day Recommended calories for Men: 1,500 - 1,800 kcal/day For pt's wanting to lose weight, they should decrease their daily caloric intake by, 500-750 kcal/day. Name the medications that can be used for weight loss:
- Tirzepatide (Zepbound)
- Naltrexone ER/Bupropion ER (Contrave)
- Orlistat (Alli, Xenical)
- Phentermine/Topiramate ER (Qsymia)
- Semaglutide (Wegovy) MOA- GIP + GLP-1 receptor AGONIST. binds and activates GIP & GLP-1 , helps regulate appetite & caloric intake. also increases satiety and slows gastric emptying. Tirzepatide MOA- pure opioid ANTagonist + weak inhibitor of DA and NE. possible action on hypothalamus to decrease appetite. Naltrexone ER/Bupropion ER MOA- reversible inhibitor of gastric and pancreatic lipases, inhibiting the absorption of dietary fats by 30%. Orlistat MOA- stimulates hypothalamus to release NE, reducing appetite. also blocks voltage dependent Na+ channels, enhances GABA and antagonizes glutamate -> suppress appetite and enhance satiety. Phentermine/Topiramate ER MOA- SELECTIVE GLP-1 agonist. increases glucose dependent insulin secretion to decrease inappropriate glucagon secretion, which slows gastric emptying. may also act in the part of the brain that regulates appetite and caloric intake. Semaglutide
- potassium
- glucose
- SCr
- BP
- s/s glaucoma and acute acidosis
- mood/sleep disorders Safety Monitoring for Semaglutide includes: SOS as tirzepatide and liraglutide (BG, pancreatitis, gallbladder, depression)
- SCR and HR Which of the two weight loss meds have the most weight loss efficacy? Tirzepatide and Semaglutide Follow-up is MONTHLY for 3 months, and then q3 months:
- Liraglutide
- Naltrexone ER/Bupropion ER
- Orlistat
- Phentermine/Topiramate ER Follow-up in monthly for 5 months with... semaglutide (wegovy) Follow-up monthly for 6 months with... tirzepatide (zepbound)
When can we D/C Contrave and Qsymia? if they have < 5% baseline weight loss at 12 weeks D/C Liraglutide if... < 4% weight loss at 12 weeks D/C semaglutide if... pt CANNOT tolerate 1.7mg or 2.4mg weekly dose Which of the weight loss meds is REQUIRED to have a REMS program?
- Qsymia (P/T) D/C med immediately if pregnancy occurs as there is an increased risk for congenital malformations Which medications must be dose adjusted for renal impairment?
- Contrave (N/B)
- Qsymia (P/T) Drug Interactions for Orlistat:
- Vitamins A, D, E, and K (separate by 2 hrs before or after administration)
- Levothyroxine (separate by 4 hours)
- Warfarin Drug Interactions for Contrave (N/B):
BMI 18.5 -
normal BMI > 25 - 30 overweight BMI >/= 40 Obesity 3 BMI > 30- Obesity 1 BMI >35- Obesity 2 What is the equation for % change in weight? ((original weight - current weight) / original weight) x 100 Which diets are considered low carb?
- Atkins
- Keto
- Zone Which diets are considered moderate energy deficient?
- DASH
- Jenny Craig
- Mediterranean
- Vegan
- WW What diets are considered healthy eating?
- DASH
- Mediterranean
- Vegan Describe 5-2-1-0: 5 servings of fruits/veggies per day, 5% weight loss </2 hours of non-work screen time/day, or alcoholic drinks/ day for men 1 hour of activity/day or </= 1 alcoholic drink/day women 0 sweetened drinks and NO SMOKING Describe the phases of the menstrual cycle in the ovary: 1- Follicular Phase (Estradiol), preovulatory days 1- 2- Ovulation, day 14 3- Luteal phase (progesterone), postovulatory days 15- Describe the phases of the menstrual cycle in the uterus: Menstrual phase, days 1- Proliferative phase, days 6- Secretory phase, days 14- GnRH- gonadotropin releasing hormone. released by hypothalamus to stimulate anterior pituitary
- Combined Oral Contraceptives
- Combined hormonal contraceptive TD patches
- Combined hormonal Contraceptive Vaginal Rings MOA- progesterone ONLY. suppress ovulation, thickens cervical mucus, alters FSH and LH concentrations, slows movement of ovum through fallopian tubes and alters endometrium. Progestin ONLY Oral Contraceptives ADRs of the TD patches:
- breast tenderness
- APPLICATION SITE RXNS
- increased BP
- DVT/PE
- acne
- weight GAIN
- abdominal pain
- dysmenorrhea ADRs of Vaginal Rings:
- intermenstrual bleeding
- vaginitis
- acne
- amenorrhea
- weight GAIN, abdominal pain
- pain w/ intercourse
- breast tenderness ADRs of POC's:
- bleeding irregularities (amenorrhea)
- CV events: DVT/PE
- acne
- alopecia
- pruritis/rash
- abdominal pain
- dysmenorrhea ALL of the hormonal contraceptives interact w/ ... CYP 3A4 inhibitors and inducers CHC, POC's, TD patches and Vaginal rings are .... 91% effective! How effective are the injectable contraceptives? 94% Which estrogens are the MOST androgenic?
- Mesantrol
- EE < 20mcg, then < 30 mcg Which progestins are the MOST androgenic? levonorgestrel and norgestrel
- breakthrough bleeding
- dysmenorrhea
- heavy flow
- bloating, N/V, edema, weight gain When should the previously mention s/s get better? within 3 months, if they do NOT then switch oral contraceptives ACHES A- abdominal pain C- chest pain, SOB H- headache E- eye problems S- severe pain in leg or swelling if these s/s occur, GO TO THE ED. not ovulating or lack of ovulating Anovulation disease of male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular, unprotected sex. Infertility female unable to bear a child due to inability to get pregnant or inability to carry pregnancy to live birth. Primary Infertility
female previously been pregnant/carried to live birth, who is now unable to bear a child/carry to live birth. Secondary Infertility painful menstruation of uterine origin Dysmenorrhea What are the ADRs of IUD's? P- period late A- abdominal pain, pain w/ intercourse I- infection, abnormal discharge N- not feeling well S- string (missing, shorter, longer) if these occur GO TO THE DR Do Pharmacists have the right to refuse to fill a prescription for emergency contraception? yes Ella EC repeat dose if... vomit w/in 3hrs of taking Levonorgestrel EC, repeat dose if... vomit w/in 2hrs of taking How long do you have to wait to resume hormonal contraceptive after Ella use?
- balanced diet
- stress reduction
- caffeine reduction
- smoking
- avoidance of illicit drugs What are the S/S of PCOS?
- hirsutism and acne
- polycystic ovaries
- insulin resistance
- overweight/obese What are the labs associated w/ PCOS? AMH- antimullerian hormone, elevated 2-3x above normal AFC- antral follicle count, elevated 20-30+ Increased LH LOW FSH Testosterone Name the medications used to treat PCOS:
- Metformin
- Pioglitazone
- Spironolactone
- Clomiphene Citrate
- Letrozole MOA- decreases glucose production and absorption to improve insulin sensitivity. also direct effect on steroidgenesis.
Metformin MOA- improves insulin sensitivity at target tissues (muscle adipocytes) and direct effect on steroidgenesis. Pioglitazone MOA- inhibits androgens from binding androgen receptors Spironolactone MOA- increase GnRH from hypothalamus to increase LH and FSH production. Clomiphene Citrate MOA- aromatase inhibitor. decreases estrogenic negative feedback on hypothalamus and pituitary that increases FSH. Letrozole Use Metformin for... infertility and weight loss. MUST have PCOS + infertility Use spironolactone for ... hirsutism and acne Use Clomiphene and Letrozole for ... infertility ADRs of Metformin:
- symptom control, contraception, CVD/DM risk (whatever patient wants)
- decrease body weight (helps w/ infertility)
- treatment does NOT reverse PCOS What do we screen for at every visit for PCOS?
- BMI
- BP
- waist circumference What do we screen for every 2 years in PCOS?
- lipids
- OGTT Name the things we screen for to assess CVD risk in PCOS patients:
- FH
- smoking
- IGT/T2DM
- HTN
- dyslipidemia
- OSA
- obesity Which medications have evidence for weight loss in PCOS? Xenical (Orlistat) Liraglutide (Victoza or Saxenda)
abnormal activity of H-P-O axis, includes PCOS and hyperprolactinemai WHO group 2 of PCOS Can use any class of contraceptive in bariatric surgeries.. RESTRICTIVE Can't use ... in Malabsorptive bariatric surgeiers.. POPs or CHCs Can use any class except ... in Migraines w/ or w/o aura.. CHC (can use them in migraines w/o aura IF benefits > risk)
