Weight Loss
Obesity Management Update 2023
As a nutrition support pharmacist, you can help obese patients manage obesity as New Year’s resolutions kick in. Continue to emphasize lifestyle changes, and review medication lists for possible causes of weight gain (antipsychotics, steroids, etc). Updated Canadian guidelines recommend considering medications for patients with …
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Vitamin-E
Guide to manage NONalcoholic fatty liver disease
As a clinical pharmacist, you will see more focus on managing nonalcoholic fatty liver disease (NAFLD) , partly due to new guidelines. It’s being called a “sleeper epidemic” About 1 in 4 patients have this steatosis, but most don’t have symptoms. NAFLD often goes hand in hand with cardiovascular (CV) risk factors, such as insulin resistance or diabetes , obesity an…
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Weight Loss
Explaining the role of Mounjaro for Type 2 Diabetes
As a pharmacy doctor, you will hear buzz about new injectable Mounjaro (tirzepatide), the first "twincretin" for type 2 diabetes . Think of Mounjaro as similar to a glucagon-like peptide-1 (GLP-1) agonist, BUT it’s also a glucose-dependent insulinotropic polypeptide (GIP) agonist. More twincretins are in the works. GL…
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Weight Loss
MEDICATIONS can cause weight gain
As a nutrition support pharmacist, patients often ask you if their MEDICATIONS can cause weight gain. And alternatives to these medications may need to be considered, especially for patients who are overweight or obese with diabetes , etc... Atypical antipsychotics are notorious for causing weight gain, which might increase the risk of diabet…
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Weight Loss
Insulin resistance is a BIG problem
Metabolic syndrome is a BIG problem and growing. It affects over 25% of adults and 4% of adolescents. It's also called "insulin resistance syndrome" or "syndrome X" or "dysmetabolic syndrome" and even has its own ICD-9 code (see table 1) . New treatment guidelines will focus even more attention on it... …
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Weight Loss
Wegovy for weight loss
As a nutrition support pharmacist, you will hear buzz about Wegovy for weight loss. It’s injectable semaglutide, the same GLP-1 agonist as injectable Ozempic or oral Rybelsus for type 2 diabetes. READ OUR NOTE, " Weight LOSS medications don't always work ". Wegovy starts at the same 0.25 mg weekly dose as Ozempic…
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Weight Loss
Reduce insulin if SAXENDA is used for weight loss
As a nutrition support pharmacist, you will hear more about using Saxenda for weight loss in adolescents 12 and up, not just in adults. Saxenda will be the first GLP-1 agonist for obesity, that in addition to stimulating insulin release and inhibiting glucagon secretion, slows gastric emptying and increases satiety after eating, (see our Note about Saxenda for weigh…
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Weight Loss
L-carnitine for weight loss
As a nutrition support pharmacist, you will see L-carnitine, an amino acid, listed as an ingredient in some supplements and energy drinks. The debate's heating up on the safety and benefits of L-carnitine... The body can make L-carnitine (It is synthesized by the liver and kidneys from lysine and methionine. In fact, the body can synthes…
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Weight Loss
Weight LOSS medications don't always work
New guidelines will encourage using weight loss drugs to control obesity and weight-related conditions in some patients. We know that lifestyle changes are still first-line and adding medications may help patients adhere to their diet. But weight loss medications don't always work and there's no proof yet that they improve long-term outcomes. …
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Weight Loss
Adjusting medications after bariatric surgery
More patients will need help adjusting medications after bariatric surgery. More of these procedures are being done to help patients lose weight, control diabetes, and improve cardiovascular risk. Gastric banding (Lap-Band) and the Roux-en-Y gastric bypass are the most common procedures. Banding uses an inflatable ring to squeeze the neck of the stomach to reduce sto…
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Pediatric
Treating metabolic syndrome in kids
As a clinical pharmacist, you should know how to treat metabolic syndrome in PEDIATRIC patients. There will be more focus on treating metabolic syndrome in kids. This combination of obesity, insulin resistance , dyslipidemia , and hypertension is becoming more common in kids as well as adults. It's especially important to control these factors in kids, to preven…
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Weight Loss
Consider alternatives to medications that can lead to significant weight gain
T he management of obesity is a multifaceted endeavor. Diet, exercise, and behavioral modification are all recommended, in addition to pharmacotherapy when indicated (i.e., individuals with BMI ≥ 27 kg/m² with comorbidity or BMI ≥ 30 kg/m²) or surgical intervention when indicated (i.e., individuals with BMI ≥ 35 kg/m² with comorbidity or BMI ≥ 40 kg/m²). Unfortunat…
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Obesity
How to dose low-molecular-weight heparin (Clexane, etc) in very obese patients
There's still controversy about how to dose low-molecular-weight heparin (Clexane, etc) in very obese patients. Some physicians worry that doses based on total body weight will be too high for patients over 150 kg. This leads them to cap the dose to try to prevent overdosing. In fact, dalteparin labeling recommends a maximum treatment dose, the other low-molecula…
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