1. Complications of being overweight include the following: (Select ALL that apply.)

    A Coronary heart disease
    B Type 2 diabetes
    C Premature death
    D Stroke
    E Increased risk of certain types of cancer
    • A Coronary heart disease
    • B Type 2 diabetes
    • C Premature death
    • D Stroke
    • E Increased risk of certain types of cancer

    Being overweight (BMI 25-29.9 kg/m^2) or obese (BMI >/= 30 kg/m^2) puts patients at increased risk for coronary heart disease, hypertension, stroke, type 2 diabetes, certain types of cancer, and premature death. In addition to health risks, being overweight/obese reduces the quality of life and causes social stigmatization and discrimination, including among children.
  2. SG is a 31 year old white female with asthma, type 2 diabetes, hypertension and dyslipidemia. Lab results (taken this morning, fasting): Hemoglobin A1C 6.7%, LDL cholesterol 112 g/dL, triglycerides 168 g/dL and hCG+. Medications: Prevacid 30 mg daily, taken 30 minutes before breakfast, ProAir HFA PRN, Symbicort twice daily as directed, metformin 500 mg three times daily and lisinopril 20 mg daily. SG is asking for a prescription for Xenical because she read about it in a magazine advertisement. Which of the following statements is correct? 

    A The use of Xenical is contraindicated at this time in SG.

    Xenical (and all weight loss drugs) should be avoided in pregnancy. Of note, the ACE inhibitor should be discontinued and SG should be referred to an obstetrician who can manage hypertension,  diabetes and weight gain during pregnancy.
  3. What are the components of Qsymia?

    B Phentermine and topiramate

    Qsymia is a combination of phentermine and topiramate extended-release formulation.
  4. What is the scheduled (DEA) category of Qsymia?

    E C IV

    Refer to the 2018 RxPrep Course Book, page 1075.
  5. Which scenario best describes if BH is a candidate for a prescription weight loss drug? 

    E Her BMI is > 30 kg/m^2; she is a candidate if she is willing to engage in a dietary plan and physical activity program.

    The prescription drugs should be used only in addition to changes in diet and increased physical activity and only in patients with higher BMIs (above 27 if there are other health complications or above 30 without). BH has a BMI of 30.9. Prescription drugs should not be used in patients unable to engage in a dietary plan and physical activity program and if a small amount of weight loss is needed (less than 10 pounds).
  6. BH receives a prescription for lorcaserin. Which of the following statements concerning use of lorcaserin in BH is correct?

    A It can increase her risk for serotonin syndrome.

    Refer to p. 1076 of the 2018 RxPrep Course Book. BH is using an SSRI for her depression. Use of lorcaserin could increase her risk for serotonin syndrome due to additive effects of these medications.
  7. The physician calls the pharmacy to ask if Contrave would be a good choice to treat both depression and weight loss in BH. The pharmacist should respond: 

    D No, Contrave should be avoided in BH due to her allergy history.

    Refer to the 2018 RxPrep Course Book, page 1076. Contrave contains naltrexone (which decreases food cravings) and bupropion (which decreases appetite). It is not indicated for major depressive disorder and is contraindicated in patients with a history of seizure disorder since bupropion lowers the seizure threshold (BH developed seizures on Wellbutrin, which also contains bupropion).
  8. BH is prescribed orlistat for weight loss. Which of the following statements is true?

    C BH must take a multivitamin that contains A, D, E and K at a different time of day than the orlistat (such as at bedtime).

    Orlistat is a lipase inhibitor that decreases the absorption of dietary fats. Patients much be on a low-fate diet (maximum of 30% calories from fat) while using this drug. Orlistat's brand name for the OTC product is Alli.
  9. Which of the following weight loss drugs can cause hypoglycemia as a side effect? (Select ALL that apply.)

    E Belviq

    C Saxenda

    Lorcaserin and liraglutide can cause hypoglycemia. (Orlistat causes hypoglycemia according to the NAPLEX book. May be an error.)
  10. What are the two most important monitoring parameters for a patient taking a stimulant weight loss drug (e.g., phentermine or phentermine/topiramate)?

    A Heart rate and blood pressure

    Refer to p. 1077 in the 2018 RxPrep Course Book.
  11. All of the following are contraindications to the use of Adipex-P except:

    B Hypothyroidism

    Refer to the 2018 RxPrep Course Book, page 1077.
  12. OP is a 42 year-old male, height 5'10", weight 198 pounds. He has a past medical history of hypothyroidism, seizure disorder and depression. He takes the following medications: valproic acid, olanzapine, topiramate, levothyroxine, aspirin, omeprazole, mirtazapine, and ibuprofen as needed. Which of his conditions or medications can cause weight loss?

    B Topiramate

    Refer to the study tips on page 1074 of the 2018 RxPrep Course Book. Topiramate can cause weight loss. All of the other options cause weight gain.
  13. It would be considered safe (or not harmful) to use the weight loss drug Contrave in which of the following patients?

    B A patient who has orthostatic hypotension.

    Refer to p. 1076 of the 2018 RxPrep Course Book.
  14. Which of the following agents are likely to be found in over-the-counter weight loss products? (Select ALL that apply.)

    D Green tea

    D Caffeine 

    E Guarana

    OTC weight loss products often contain stimulant products, such as caffeine, ephedra (or bitter orange), green tea and guarana.
  15. All of the following weight loss drugs can be used long-term for weight maintenance with the exception of:

    E Adipex-P

    Phentermine (Adipex-P) is a short term stimulant appetite suppressant that can jump start weight loss but it should not be used long-term.
  16. TY is a 32 year-old female who is interested in a prescription weight loss agent. Her physician reviews her medical history and medication profile and discusses the various weight loss drugs with TY. For one of the agents, he says it is a "REMS drug" that is only available through special pharmacies due to the risk of birth defects. Which drug is the physician referring to?

    C Qsymia

    Qsymia is a REMS drug that is only available through a certified pharmacy network due to the risk of teratogenicity.
  17. MS is a 44 year-old female. Height 5'7", weight 178 pounds. Her blood pressure taken this morning was 134/78 mmHg. She had lab work done last month which reported an A1C of 8.7% and total cholesterol of 244 g/dL. MS consumes a primarily carbohydrate-based diet with little vegetable intake because she claims that fresh vegetables "cost a lot of money and are hard to get in Wisconsin in the winter." She has been using over-the-counter weight loss products for years. She loses a little, then puts back on more weight. She went to her physician seeking help. Which of the following drugs could help MS lose weight and help reduce her A1C?

    B Liraglutide

    Liraglutide is a GLP-1 agonist marketed under the brand name Saxenda for weight loss and Victoza for diabetes. Of note, insulin, sulfonylureas and pioglitazone cause weight gain.

    (Doesn’t Metformin have weight loss benefit?)
  18. What is the most common side effect of orlistat therapy?

    E Flatus with discharge

    The patient must stick to a dietary plan for both weight improvements and to help moderate (control) the side effects such as flatulence and fatty stool.
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