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Chapter 32: Weight Management Drugs

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Chapter 32: Weight Management Drugs

12 problems · 0 figures

Case Study 32.4.1 §32.4 source ↗

Read the following clinical scenario to answer the questions that follow.

Ellen Normandy is a 58-year-old female client who has been “watching” her diet and exercising at the local fitness club for the past 12 months to lose weight. She has lost 6.7 pounds. Frustrated, she arrives at her health care provider’s office to ask for medication. The provider takes vital signs and a fasting capillary blood glucose (CBG) level.

History
Laparoscopic cholecystectomy due to cholelithiasis
Laparoscopic total hysterectomy and oophorectomy
Mild hyperlipidemia

Current Medications
Multivitamin daily

Based on the information above, the nurse anticipates which primary medical diagnosis by the health care provider?
  1. a.
    Type 2 diabetes mellitus
  2. b.
    Metabolic syndrome
  3. c.
    Overweight
  4. d.
    Obesity
Table 32.7 in the book ↗
Vital Signs Physical Examination
Temperature: 97.9°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: No jugular vein distention; no peripheral edema bilaterally; S1, S2 noted; no extra sounds or murmurs

• Respiratory: Lungs clear upon auscultation to all fields; no use of accessory muscles

• GI: Abdomen soft, nontender, slightly distended, obese

• GU: Reports normal urine output—every 2–4 hours based on water intake; complains of constipation; last bowel movement 3 days ago

• Neurological: Within normal limits

• Integumentary: No wounds noted; skin appropriate for age
Blood pressure: 148/96 mm Hg
Heart rate: 88 beats/min, regular
Respiratory rate: 16 breaths/min, regular
Oxygen saturation: 99% on room air
Height: 5'9"
Weight: 278 lb
BMI: 41.1 kg/m2
CBG: 157 mg/dL

Answer

B. Metabolic syndrome
Metabolic syndrome is a collection of risk factors such as hyperglycemia, hyperlipidemia, hypertension, and overweight/obesity.

Case Study 32.4.2 §32.4 source ↗

Read the following clinical scenario to answer the questions that follow.

Ellen Normandy is a 58-year-old female client who has been “watching” her diet and exercising at the local fitness club for the past 12 months to lose weight. She has lost 6.7 pounds. Frustrated, she arrives at her health care provider’s office to ask for medication. The provider takes vital signs and a fasting capillary blood glucose (CBG) level.

History
Laparoscopic cholecystectomy due to cholelithiasis
Laparoscopic total hysterectomy and oophorectomy
Mild hyperlipidemia

Current Medications
Multivitamin daily

Which of the following indicates Ellen’s BMI classification?
  1. a.
    Overweight
  2. b.
    Class I obesity
  3. c.
    Class II obesity
  4. d.
    Class III obesity
Table 32.7 in the book ↗
Vital Signs Physical Examination
Temperature: 97.9°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Cardiovascular: No jugular vein distention; no peripheral edema bilaterally; S1, S2 noted; no extra sounds or murmurs

• Respiratory: Lungs clear upon auscultation to all fields; no use of accessory muscles

• GI: Abdomen soft, nontender, slightly distended, obese

• GU: Reports normal urine output—every 2–4 hours based on water intake; complains of constipation; last bowel movement 3 days ago

• Neurological: Within normal limits

• Integumentary: No wounds noted; skin appropriate for age
Blood pressure: 148/96 mm Hg
Heart rate: 88 beats/min, regular
Respiratory rate: 16 breaths/min, regular
Oxygen saturation: 99% on room air
Height: 5'9"
Weight: 278 lb
BMI: 41.1 kg/m2
CBG: 157 mg/dL

Answer

D. Class III obesity
Class III obesity is 40+ kg/m2.

32-1 §32.RQ source ↗

A nurse is presenting a workshop on weight management. The nurse explains overweight and obesity are determined by:
  1. a.
    Weight in pounds
  2. b.
    Height in centimeters
  3. c.
    Genetics
  4. d.
    Body mass index (BMI)

Answer

D. Body mass index (BMI)
Overweight and obesity are determined by BMI. The BMI is calculated using height and weight.

32-2 §32.RQ source ↗

A nurse performs an initial assessment of a client with a height of 5’9” and a weight of 278 pounds. What BMI does the nurse calculate for this client?
  1. a.
    51.2 kg/m2
  2. b.
    41.1 kg/m2
  3. c.
    31.2 kg/m2
  4. d.
    21.1 kg/m2

Answer

B. 41.1 kg/m2
BMI is calculated by dividing the client’s weight by their height in inches squared and multiplying by 703: 278 ÷ 69 2 = 278 ÷ 4761 = 0.0584 × 703 = 41.05 , rounded to 41.1.

32-3 §32.RQ source ↗

A nurse is providing education to a group of adults about the differences between overweight and obesity. Which statement by one of the participants demonstrates an accurate understanding of these terms?
  1. a.
    “Overweight and obesity are essentially the same, just different terms for having excess body fat.”
  2. b.
    “Overweight refers to having a BMI between 25 and 29.9, whereas obesity is defined as a BMI of 30 or higher.”
  3. c.
    “Obesity is a medical condition, whereas overweight is merely a cosmetic concern.”
  4. d.
    “Being overweight is a more severe health condition than obesity due to the increased risk of cardiovascular diseases.”

Answer

B. “Overweight refers to having a BMI between 25 and 29.9, whereas obesity is defined as a BMI of 30 or higher.”
Obesity and overweight are not the same; the distinguishing factor is a person’s client’s BMI. Overweight, with a BMI of 25–29, may lead to obesity. Obesity has a higher BMI ( ≥ 30) and is associated with serious consequences.

32-4 §32.RQ source ↗

The clinic nurse is teaching a 25-year-old female client about her new prescription for benzphetamine. What statement by the client indicates understanding?
  1. a.
    “It is best to use a method of birth control because the medication can be harmful to a fetus.”
  2. b.
    “This medication will make me very sleepy.”
  3. c.
    “I will be hungry on this medication.”
  4. d.
    “This medication is best taken right before bed.”

Answer

A. “It is best to use a method of birth control because the medication can be harmful to a fetus.”
Benzphetamine should not be given to clients who are pregnant; clients of childbearing age should be counseled to practice strict birth control methods to avoid pregnancy while on the medication.

32-5 §32.RQ source ↗

A provider at a weight-loss clinic is considering starting phentermine for a 35-year-old client. The nurse is performing a medication reconciliation for the client. Which medication would the nurse have concerns about?
  1. a.
    Acetaminophen
  2. b.
    Omeprazole
  3. c.
    Zinc
  4. d.
    Phenelzine

Answer

D. Phenelzine
Concurrent use of phenelzine, an MAOI, is contraindicated with phentermine. MAOIs should not be used 14 days before or after phenelzine use.

32-6 §32.RQ source ↗

While counseling a client on different anorexiants, the nurse advises them that office visits may be required every 14 days to assess progress and evaluate the effectiveness of the weight-loss medication. The nurse is referring to which medication?
  1. a.
    Phentermine
  2. b.
    Phendimetrazine
  3. c.
    Phentermine/topiramate
  4. d.
    Benzphetamine

Answer

C. Phentermine/topiramate
The dosage of phentermine/topiramate is usually readjusted every 14 days based on effectiveness.

32-7 §32.RQ source ↗

The nurse is aware that which lipase inhibitor is available by prescription from a provider and also over the counter at a lower dose?
  1. a.
    Orlistat
  2. b.
    Phentermine
  3. c.
    Bupropion naltrexone
  4. d.
    Benzphetamine

Answer

A. Orlistat
The drug orlistat is available by prescription under the brand name Xenical or OTC under the brand name Alli.

32-8 §32.RQ source ↗

The nurse is providing client education on the drug orlistat. The nurse explains common adverse effects of orlistat that subside within 4 weeks are:
  1. a.
    Palpitations (tachycardia)
  2. b.
    Headache and dizziness
  3. c.
    Diarrhea and fatty stool (steatorrhea)
  4. d.
    Itchiness and high blood pressure

Answer

C. Diarrhea and fatty stool (steatorrhea)
Orlistat is not systemically absorbed and does not affect the cardiovascular and neurological systems. Common side effects are specific to the GI system—abdominal discomfort, flatus, nausea, oily rectal discharge, fecal urgency, fatty stool, and diarrhea.

32-9 §32.RQ source ↗

The nurse is aware that a combination medication of an antidepressant and an opioid antagonist may be prescribed for weight loss. Which medication is it?
  1. a.
    Chromium picolinate and naltrexone
  2. b.
    Phentermine and topiramate
  3. c.
    Phenelzine and naloxone
  4. d.
    Bupropion and naltrexone

Answer

D. Bupropion and naltrexone
Bupropion is an antidepressant, and naltrexone is an opioid antagonist; when combined, they have been effective in weight management.

32-10 §32.RQ source ↗

A nurse is providing education to a client who has been prescribed orlistat (Alli) for weight loss. The client asks the nurse how this medication works to help with weight loss. Which response by the nurse is most accurate?
  1. a.
    “Orlistat suppresses appetite, making you feel less hungry and eat fewer calories.”
  2. b.
    “This medication increases your metabolism, helping you burn more calories.”
  3. c.
    “Orlistat blocks the absorption of dietary fat, reducing calorie intake from fat and promoting weight loss.”
  4. d.
    “It works by reducing water retention in the body, leading to weight loss.”

Answer

C. “Orlistat blocks the absorption of dietary fat, reducing calorie intake from fat and promoting weight loss.”
Orlistat works by inhibiting the action of pancreatic lipase, an enzyme responsible for breaking down dietary fat in the small intestine. By blocking fat absorption, it reduces the number of calories absorbed from dietary fat, thus promoting weight loss.

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Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.