DDSEP® 8 Quick Quiz

Question 1

Publish date: August 31, 2022

Q1. A 54-year-old male is referred to you for advice on weight-loss management. His body mass index is currently 37 kg/m2; he exercises regularly and is interested in starting medications for weight loss. He is a chronic alcoholic who has a history of pancreatitis in the past and a few admissions for management of alcohol withdrawal, which included seizures. However, he has maintained his job as a cook at the local diner. The only other history is kidney stones as a teenager. He recently visited his primary care physician who "cleared" him. He remembers going for a sonogram of the heart, which was normal. He claims that he has been depressed about his brother's recent diagnosis of thyroid cancer and has vowed to stop drinking and lose weight.

Which of the following medications is the best option for him?

Naltrexone/bupropion (Contrave)

Liraglutide (Saxenda)

Phentermine/topiramate (Qsymia)

Lorcaserin (Belviq)

Q1. Correct answer: D. Lorcaserin (Belviq).

Rationale
Lorcaserin may cause valvulopathy, attention, or memory disturbance. This patient has normal ECHO and does not work with heavy machinery. Given his other history, this may be the best choice for him. Naltrexone/bupropion extended release is contraindicated in patients with seizure disorder, chronic opioid use, anorexia nervosa, bulimia, and abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs because bupropion lowers the seizure threshold. Liraglutide is contraindicated with personal or family history of medullary thyroid carcinoma or MENII. In addition, GLP1 receptor agonists can increase the risk of pancreatitis in patients with a history of pancreatitis. Phentermine/topiramate can increase the risk of nephrolithiasis. All of these medications are contraindicated in pregnancy and in patients with hypersensitivity to the drug and drug class.

References
Bays HE et al. Obesity algorithm, presented by the Obesity Medical Association. 2016-2017. https://cmcoem.info/pdf/curso/evaluacion_preoperatoria/oma_obesity-algorithm.pdf.
Steelman M and Westman E. Obesity: Evaluation and Treatment Essentials. Boca Raton: CRC press, 2016. https://www.abom.org/wp-content/uploads/2016/06/Obesity-Evaluation-and-Treatment-Essentials.pdf.
Liraglutide Prescribing Information (Saxenda). https://www.novo-pi.com/saxenda.pdf.
Lorcaserin (Belviq) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/022529lbl.pdf.
Naltrexone HCl/Bupropion HCl Extended Release Prescribing Information (CONTRAVE). https://contrave.com/contrave-pi/.
Phentermine HCl/Topiramate Extended Release Prescribing Information (Qsymia). https://qsymia.com/patient/include/media/pdf/prescribing-information.pdf

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