Question

A.P. is a 34-year-old woman who comes into your clinic looking for a medication to help her lose weight. She states that she has tried several times to lose weight but seems to gain it back within months after stopping her dieting. Your workup reveals a normal, young, well-developed woman in no acute distress. She is 66 inches tall and weighs 200 lb. Pertinent labs include A1c 5.9%. Her blood pressure is 128/88 and heart rate is 80. She has a history of monthly migraine headaches for which she takes sumatriptan 50 mg PO PRN headache and may repeat dose in 2 hours if there is no relief; she also has hypothyroidism for which she takes levothyroxine 112 mcg PO daily. She does not smoke or drink alcohol. She works as a secretary in an office. She has a BMI of 32.3 kg/m2. Diagnosis: Obesity Answer the following questions. I

1-List specific goals for treatment for A.P.

2-What drug therapy would you prescribe? Why?

3-The patient was prescribed phentermine ER/topiramate. What are the parameters for monitoring success of the therapy?

4-Discuss specific patient education based on the prescribed therapy.

5-Describe one or two adverse reactions for the selected agent that would cause you to change therapy.

6-What would be the alternative therapy?

7-What over-the-counter and/or alternative medications would be appropriate for A.P.?

8-What lifestyle changes would you recommend to A.P.?

9-Describe one or two drug–drug or drug–food interactions for the selected agent.

Answer 1

1). The patient was diagnosed with obesity. So, the treatment goals include,

• A gradual weight loss, approximately 0.5 kg per a week
• A permanent weight loss of about 5 to 10% of body weight
• Preventing the regaining of body weight soon after the termination of treatment
• Making permanent lifestyle modifications

2). In the given case, the patient reported quick regaining of body weight after termination of dieting. The patient is not a candidate for surgery because she has no serious co-morbidities and her BMI is not greater than 40. So, she must be put on a low-calorie diet and prescribed with appetite suppressants.

3). Phentermine ER (extended release) is an appetite suppressant used in the weight loss therapy. The useful parameters for monitoring the success of therapy is permanent or non-recurrent weight loss and reduced appetite in the patient.

4). The patient must be educated to take nutritious food instead of high-calorie food. Calculating the calories in the food consuming and planning the food intake according to the caloric needs and regular exercise are the key factors determining the output. The patient must also be explained about the importance of continuing the changes in food after cessation of therapy to avoid a quick weight gain.