RxCe - Medications That May Lead to Weight Gain Materials

COMMONLY USED MEDICATIONS THAT MAY LEAD TO WEIGHT GAIN

AMANDA MAYER, PharmD

Amanda Mayer is a graduate of the University of Montana, Skaggs School of Pharmacy. She has clinical experience as a pharmacist in the inpatient mental health setting, which is her passion. She has also done fill-in work at retail pharmacies throughout her career. Amanda appreciates the wide variety of professional opportunities available to pharmacists. Amanda loves spending time with her family and spends most of her free time exploring new restaurants, hiking in the summer, snowboarding, and cross-country skiing in the winter.

Topic Overview:

The prevalence of adult obesity in the United States is over 40%. There are a wide variety of health conditions that may be associated with or be worsened by being overweight or obese. Medications, including some agents used to treat diabetes, neurologic disorders, psychiatric illness, inflammatory conditions, blood pressure, and HIV, can be a contributing factor to weight gain and obesity. This course will give a brief overview of medications that have been known to cause weight gain and potential alternatives that may be used to avoid weight gain in susceptible patients.

Accreditation Statement

RxCe.com LLC is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.

Universal Activity Number (UAN): The ACPE Universal Activity Number assigned to this activity is

Pharmacist 0669-0000-24-019-H01-P

Pharmacy Technician 0669-0000-24-020-H01-T

Credits: 2 contact hour(s) (0.2 CEU(s)) of continuing education credit

Type of Activity: Knowledge

Media: Internet/Home study Fee Information: $6.99

Estimated time to complete activity: 2 contact hour(s) (0.2 CEU(s)), including Course Test and course evaluation

Release Date: March 6, 2024 Expiration Date: March 6, 2027

Target Audience: This educational activity is for pharmacists and pharmacy technicians

How to Earn Credit: From March 6, 2024, through March 6, 2027, participants must:

Read the “learning objectives” and “author and planning team disclosures;”

Study the section entitled “Educational Activity;” and

Complete the Course Test and Evaluation form. The Course Test will be graded automatically. Following successful completion of the Course Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)

Credit for this course will be uploaded to CPE Monitor®.

Learning Objectives:

Upon completion of this educational activity, participants should be able to:

Recognize common medications that may lead to weight gain.

Discuss negative long-term impacts that may be associated with weight gain.

Identify alternative or adjunctive treatments that may be used instead of or with medications that may cause weight gain.

Outline nonpharmacologic strategies for weight reduction.

Disclosures

The following individuals were involved in developing this activity: Amanda Mayer, PharmD, and Pamela Sardo, PharmD, BS. Pamela Sardo was an employee of Rhythm Pharmaceuticals until March 2022 and has no conflicts of interest or relationships regarding the subject matter discussed. There are no financial relationships or commercial or financial support relevant to this activity to report or disclose by any of the individuals involved in the development of this activity.

Educational Activity

Commonly Used Medications That May Lead to Weight Gain Introduction

Many widely used drugs may cause a patient to gain weight, which can then contribute to the patient being overweight or obese. For example, medications used to treat diabetes, neurologic disorders, psychiatric illnesses, hypertension, HIV, or inflammatory conditions are among the drugs that may contribute to weight gain. Excess weight is associated with poor health and can also impact a person’s mental health. Determining whether a drug is causing a patient to gain weight can be challenging because weight gain may be the result of other factors. Patients look to their healthcare providers to manage their weight within their treatment plans and help them identify the cause. Pharmacy teams can participate in this planning either independently or in collaboration with other healthcare providers.

Obesity and its Prevalence in the United States

Obesity is defined as a weight that is higher than what is considered healthy for an individual, given their height, using a formula known as the Body Mass Index (BMI).1 Body Mass Index is a screening tool for determining if someone is overweight or obese, with a high BMI potentially indicating high body fat.1

Body Mass Index uses a person’s weight in kilograms and divides it by the square of the person’s height in meters.1,2 A patient with a BMI in the 25.0 to <30 range is classified as overweight. If BMI is over 30.0 (>30 kg/m2), the individual is considered obese.1,2 In children, BMI is adjusted for age (BMI- for-age) and gender.3 Charts are used for boys and girls, ages 2 to 20 years.3 It should be noted that although BMI is a screening tool, it does not diagnose body fatness or health. This means that, in some instances, BMI can be misleading. Therefore, providers should perform appropriate assessments to

determine an individual's health status.1 Table 1 shows a simplified BMI table for adults.

Table

Body Mass Index

BMI Range	Category
< 18.5	Underweight
18.5 - 24.9	Normal Weight
25.0 - 29.9	Overweight
≥ 30.0	Obesity

Center for Disease Control and Prevention4

Using statistics from 2017 to 2020, the prevalence of adult obesity in the United States is estimated to be 41.9%.5 The prevalence of obesity for children and adolescents aged 2-19 years is estimated to be 19.7%, which equates to about 14.7 million children and adolescents.6

Excess weight is associated with poor health.7 Being overweight or obese may contribute to type 2 diabetes, high blood pressure, liver disease, stroke, osteoarthritis, sleep apnea, gallstones, gout, high cholesterol, and certain types of cancer.6 Obesity may lead to an increased risk of early death and commonly makes medical issues more difficult to treat.7 In addition, being overweight or obese can impact a person’s mental health. Obesity can also lead to stigmas that can affect a person’s quality of life.7

Drug Classes That May Cause Weight Gain

Drugs that may cause a patient to gain weight include medications used to treat diabetes, neurologic disorders, psychiatric illnesses, hypertension, HIV, or inflammatory conditions.8 Weight gain caused by medications can impact patient outcomes and lead to medication nonadherence. Addressing

this issue can be challenging for clinicians since a patient’s weight gain may have multiple causes.9 Weight gain may also be associated with a treatment’s duration (e.g., weight gain associated with long-term use, not short-term use). Prescribers and pharmacists may overcome these obstacles if they know how medications can affect weight and counsel patients accordingly. In some cases, patients may choose not to begin taking a medication that may cause them to gain weight or inquire about an alternative treatment that is more weight-neutral.8

Before commencing treatment with any of the following medications, the patient should be weighed and the patient’s BMI calculated. The patient should be weighed again at each follow-up visit to identify weight changes.8,10

Atypical Antipsychotics

Atypical antipsychotics, also referred to as second-generation antipsychotics, were developed to help decrease the movement side effects (extrapyramidal symptoms) of first-generation antipsychotics.11 Atypical antipsychotics mainly block serotonin and norepinephrine and have a lower affinity to dopamine receptor antagonism than typical antipsychotics.11 Atypical antipsychotics are considered first-line treatment options for schizophrenia and bipolar mania.11

Atypical Antipsychotics and Weight Gain

Atypical antipsychotics are the drug class associated with the most weight gain.8,12 Weight gain due to antipsychotics is highest during the first six months of treatment but can continue through the duration of treatment.12

The hypothesis behind antipsychotic-induced weight gain stems from the drug altering glucose metabolism and increasing cholesterol and triglyceride levels.11 This leads to an increase in the chance of insulin resistance. Antipsychotics may also affect neuropeptides that are linked with appetite control and energy metabolism.11

Clozapine and olanzapine have been associated with the highest amount of weight gain, followed by quetiapine and risperidone.12 Antipsychotics with a lower risk of weight gain include aripiprazole, lurasidone, and ziprasidone.12

Aside from antipsychotic medication use, other factors can contribute to weight gain in psychiatric patients.12 These may include paranoia or hospitalization that may cause an individual to be more sedentary and gain weight.10 In addition, other medications a patient is taking may be contributing to weight gain. For example, atypical antipsychotic drugs may be combined with antidepressant drugs, such as selective serotonin reuptake inhibitors (SSRIs), to treat conditions such as unipolar depression.12 As will be discussed below, antidepressants may also contribute to weight gain.9 The clinician is particularly challenged when a patient is gaining weight, and there may be multiple causes.

Managing Antipsychotic-induced Weight Gain

Metformin, an antidiabetic medication, has been used in several studies to help with the management of antipsychotic-induced weight gain.12 Metformin can help by improving the action of insulin and leading to decreased hepatic glucose production, increased peripheral utilization of glucose, and decreased appetite. Although metformin may be an option to help with antipsychotic-induced weight gain, using agents such as aripiprazole may be preferred due to its low risk of increasing weight.12

Antidepressants

Antidepressant medications are commonly used to treat depression.13 In addition to treating depression, medications classified as antidepressants are often used for other on-label and off-label uses, such as a treatment for neuropathic pain or anxiety.9

Antidepressant Medications and Weight Gain

Antidepressant medications may cause weight gain in patients.9 Weight gain can be seen in the following antidepressant classes and medications: tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAOI), and mirtazapine.9

Tricyclic antidepressants, including amitriptyline, nortriptyline, imipramine, desipramine, doxepin, and clomipramine, can cause weight gain primarily as a result of increased appetite.14 These agents are associated with the highest risk of weight gain among the antidepressants. Possible mechanisms for the increased appetite include the blocking of histamine and serotonin receptors.14

The SSRI most likely to cause weight gain is paroxetine, which is possibly related to an alteration in serotonin receptor activity.14 Patients who use SSRIs for less than six months are less likely to have weight gain, with differing opinions on weight gain for patients using SSRIs for longer than one year.

Monoamine oxidase inhibitors, such as phenelzine, can typically cause weight gain that may be caused by inhibiting the metabolism of norepinephrine, epinephrine, dopamine, serotonin, tyramine, ephedrine, and phenylephrine.14

Mirtazapine is classified as a tetracyclic antidepressant. It has been associated with weight gain with long- and short-term use due to the blockade of histamine and serotonin receptors.14

Antidepressants are important agents that many individuals need. Weight gain or increased appetite in some patients may cause them to discontinue use, resulting in poorly treated depression. As with antipsychotics, it may be difficult to determine the cause of weight gain. Antidepressants may

be prescribed in combination with other drugs (e.g., antipsychotics) that lead to weight gain, and it may take greater effort to identify the culprit.9,14

Managing Antidepressant-induced Weight Gain

Weight gain should be managed in patients with depression. This can be done through caloric restrictions and increased exercise. Prescribing agents with a lower risk of weight gain is recommended.14 If a patient has gained weight while taking an antidepressant, it may be advisable to switch to an antidepressant with a lower likelihood of causing weight gain. Agents that have shown to be likely weight-neutral include venlafaxine, duloxetine, escitalopram, trazodone, and nefazodone. Bupropion is an agent that does not show many antihistamine effects and has been associated with slight weight loss.9,14

Lithium

Lithium is a mood stabilizer. It is FDA-approved for use in bipolar disorder and mania.15

Lithium and Weight Gain

Whether lithium use is a material cause of weight gain is the subject of an ongoing debate.16 Earlier studies have suggested that lithium use can lead to significant weight gain. These studies reported that approximately one-third of patients taking lithium experienced this side effect.16 Another review estimated that up to 50% of patients may gain an average of 5 to 10 kg with chronic lithium treatment.17 However, Gomes-da-Costa, et al. (2022), disagreed and suggested that lithium use does not lead to substantial weight gain, especially when compared to alternative drugs.18

Moreover, the weight effects of lithium may be deceiving as patients may initially see weight loss at the start of therapy, but long-term treatment may lead to weight gain. Patients with high baseline weight, younger age,

and/or female are at higher risk for lithium-associated weight gain.19,20 Based on this conflicting evidence, Greil, et al. (2023) concluded that even if lithium performs better than some other medications, the patient should be monitored for weight and metabolic parameters.16

The mechanism of action is still unknown but may be due to the direct effect on hypothalamic centers that control appetite. Lithium may also cause increased thirst, leading to the patient consuming higher calorie drinks.19,20 Lithium also has an increased incidence of hypothyroidism, which may be associated with weight gain.19,20

Lithium is similar to the drugs already discussed above when it comes to identifying the cause of weight gain in patients taking lithium. Again, this can be difficult since patients may be taking other agents that may be the cause of weight gain. Additionally, the underlying affective disorder may be the primary cause of weight gain.16 Patients with bipolar disorders are at increased risk for weight gain regardless of the pharmacological treatment prescribed.16

Managing Lithium-induced Weight Gain

Patients should be advised of possible weight gain at the start of therapy. Healthcare providers can counsel patients to make lifestyle changes for more positive therapy outcomes.19,20

Antiepileptic Agents

Many antiepileptics have multiple FDA-approved indications that include but are not limited to seizure prophylaxis, neuropathic pain, migraine prophylaxis, bipolar disorder, and mania.21

Antiepileptic Agents and Weight Gain

Antiepileptic agents that have been associated with weight gain include valproate, gabapentin, pregabalin, vigabatrin, and possibly carbamazepine.10 Antiepileptics that are considered weight-neutral include lamotrigine, levetiracetam, and phenytoin. Antiepileptics that have been associated with a decrease in weight include felbamate, topiramate, and zonisamide.10

Valproate is thought to cause weight gain due to interactions with appetite regulation in the hypothalamus and effects on energy expenditure. Longer duration of treatment often leads to increased weight gain; however, most weight gain can be observed within the first year. Weight gain has not been associated with particular doses or levels; however, women, post- pubertal adolescents, and individuals who are overweight before treatment have a greater risk of weight gain.22 Weight gain with gabapentin and pregabalin appears to be related to dose and duration of drug exposure, with most patients treated with pregabalin for a year maintaining weight within 7% of their baseline weight.23 Prescribing information for vigabatrin states that in randomized controlled trials, 47% of patients on active medications versus 19% of patients on the placebo gained ≥7% of their baseline body weight.24

The Endocrine Society recommends considering the potential for weight gain when choosing antiepileptics for patients.25 The Endocrine Society also recommends providing patients with quantitative estimates of the expected weight gain to help make informed decisions about therapy.25

Managing Weight Gain Caused by Antiepileptic Therapy

While weight should be considered when choosing an antiepileptic, therapeutic efficacy should not be sacrificed.10 As discussed above, providers can counsel patients to make lifestyle changes, including exercise and physical activity, for more positive therapy outcomes.19,20,25,26

Medications for Diabetes

Diabetes management includes lifestyle intervention, pharmacological therapy, and routine blood glucose monitoring.27-29 Insulin, sulfonylureas, and thiazolidinediones are among the medications used to manage diabetes.27 These drugs will be discussed here because of their potential link to weight gain.

Diabetes Medications and Weight Gain

Insulin, sulfonylureas, and thiazolidinediones may cause weight gain.27 Other medications used to manage diabetes are generally considered weight- neutral or associated with some weight loss.28 Examples of sulfonylureas include glimepiride, glipizide, and glyburide. Examples of thiazolidinediones include rosiglitazone and pioglitazone.29

The mechanism of action for weight gain in patients managing diabetes may vary. There are multiple mechanisms by which insulin can cause weight gain, including but not limited to a reduction of blood glucose to levels below the renal threshold without reduction in caloric intake or experiencing or trying to avoid hypoglycemia by increasing caloric intake.29 Sulfonylureas can cause weight gain by increasing endogenous insulin levels, with weight gain being highest during the first months of therapy.27,30 Thiazolidinediones can cause weight gain by fluid retention, promoting lipid storage and adipogenesis.31-33

Managing Weight Gain Caused by Diabetes Medications

Medications that are associated with weight loss and those that are weight-neutral are recommended by the Endocrine Society as first- and second-line agents for the management of type 2 diabetes in a patient who is overweight or obese.25 These medications include metformin, dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose cotransporter 2 (SGLT2), and glucagon-like peptide 1 (GLP-1) receptor analogs.27,28

Antihypertensive Agents

Beta-blockers have been used to treat hypertension for decades.34 They are used as a first-line therapy in young patients with uncomplicated hypertension. They have been shown to be effective in reducing cardiovascular morbidity and mortality.34

Antihypertensive Agents and Weight Gain

Beta-blockers are important drugs, but they have been shown to have a variable effect on weight gain, with most weight gain seen within the first few months in patients taking beta-blockers.34 Beta-blockers are thought to affect body weight by reducing total energy expenditure.35 Beta-blockers can also cause fatigue, which may result in decreased patient activity, leading to weight gain.36

Managing Weight Gain Caused by Antihypertensive Agents

The Endocrine Society currently recommends the use of angiotensin- converting inhibitors, angiotensin receptor blockers, and calcium channel blockers over the use of beta blockers for first-line therapy in patients with hypertension and type 2 diabetes who are obese.25

Corticosteroids

Corticosteroid therapy can be used for a range of conditions, including but not limited to asthma, psoriasis, eczema, chronic obstructive pulmonary disease, ocular diseases, and auto-immune diseases.37

Corticosteroids and Weight Gain

Long-term glucocorticoid therapy has long been associated with weight gain.38 Up to 70% of patients taking long-term glucocorticoid therapy have self-reported substantial weight gain.38 Dose-dependent weight gain can be

seen with significant increases in patients taking the equivalent of oral or parenteral 5 mg prednisone daily. Fortunately, inhaled corticosteroids have not been shown to affect body weight significantly.39

High cortisol levels can lead to increased appetite.40 Corticosteroids may increase food intake through changes in the activity of AMP-activated protein kinase in the hypothalamus.41 Corticosteroids can influence metabolic rate by decreasing thermogenesis and uncoupling protein 1 (UCP-1) expression in brown adipose tissue.42 Chronic therapy has also been associated with activating the endocannabinoid system, which regulates food intake and can decrease energy expenditure.43

Managing Weight Gain Caused by Corticosteroids

The Endocrine Society recommends the use of nonsteroidal anti- inflammatory drugs and disease-modifying antirheumatic drugs over corticosteroids, when possible, for patients with chronic inflammatory diseases due to the potential weight gain caused by corticosteroids.25

Antiretroviral Therapy

Initiation of antiretroviral therapy for the treatment of human immunodeficiency virus (HIV) has been shown to cause weight gain in some patients.44 Weight gain can be a positive outcome in patients who are underweight at the time of antiretroviral therapy initiation; however, there is an increased risk of cardiovascular and metabolic disease in patients who start antiretroviral therapy in the normal or overweight category. One mechanism that is hypothesized is the return-to-health phenomenon, which is not completely understood but may result from the alleviation of HIV-associated inflammation and accelerated catabolism, where weight is returning to a pre- illness baseline, especially in patients with advanced HIV.45 Low baseline CD4 cell count and high baseline HIV RNA were correlated with more weight gain than those with higher CD4 cell counts and lower HIV RNA. Treating HIV may

help gastrointestinal dysfunction and decrease opportunistic infections that could have adverse effects on appetite and nutrient absorption.44

Integrase strand transfer inhibitors (INSTIs) regimens have been cited in more studies as being a cause of weight gain during treatment than regimens that do not include INSTIs; however, it is possible with all classes.44 Dolutegravir (DTG), bictegravir (BIC), and elvitegravir (EVG) were all included in regimens that were associated with weight gain, with DTG and BIC associated with more weight gain than EVG. Weight gain in patients taking antiretroviral therapy is greatest during the initial 48 weeks of therapy.44

It should be noted that while antiretroviral therapy has been shown to cause weight gain in some patients, other patients will lose weight while receiving these medications.44 The Endocrine Society suggests monitoring the weight and waist circumference of patients on antiretroviral therapy.25

Preventing Weight Gain with Lifestyle and Diet

Lifestyle changes are an important tool to help prevent an individual from becoming overweight or obese.46 Spending at least 30 minutes a day in moderate physical activity is one way to help prevent weight gain.46 This physical activity may be as simple as a brisk walk for some. Increasing the amount of physical activity in everyday life may also be helpful. Examples of physical activity in everyday life may include taking the stairs, parking further away from your destination, walking a pet, and doing housework.46 Benefits of exercise include improved blood glucose levels, reduced cardiovascular risk factors, weight loss, and improved well-being.47 Sedentary behavior should be decreased, and prolonged sitting should be interrupted every 30 minutes for blood glucose benefits.48 This may be challenging for some individuals, depending on their line of work. If a patient has a sedentary job, setting a timer to know when to get up and walk around may be helpful. Baseline physical activity and sedentary time should be evaluated. Patients should be given ideas for non-sedentary activities such as walking, yoga, housework, gardening, swimming, and dancing.48

Eating whole foods that are dense in nutrients is recommended.46 Whole foods may include fruit, vegetables, legumes, beans, nuts and seeds, and healthy plant-based fats. Reducing the consumption of foods that are high in sugar or calories and highly processed has been shown to be beneficial.46 Individuals should avoid sugar-sweetened beverages as much as possible. Portion control can also greatly help individuals with weight control.46

The Role of the Pharmacy Team

Pharmacy teams can be involved in lifestyle and weight-loss management either independently or in collaboration with other healthcare providers. Pharmacists and pharmacy technicians often make frequent contact with patients, making them a good source of information and support. Pharmacy technicians can be an integral part of the team by collecting information from patients that may suggest they are gaining weight and may need further assistance from pharmacists or other healthcare providers. Pharmacy technicians also recognize possible medication side effects. A patient may arrive at the pharmacy counter sharing that they do not understand why they have gained 10 pounds while requesting their high-dose prescription refill of amitriptyline. The patient then retrieves an over-the- counter container of orlistat to purchase for weight loss. The pharmacy technician is ideally positioned to provide words of encouragement to the patient during their interaction. The pharmacy technician should also refer this patient to the pharmacist for counseling due to possible association of high dose antidepressant with weight gain and patient selection of an over-the- counter weight loss medication.

Pharmacists should be on the lookout for medications that may induce weight gain and be sure to counsel patients to keep them informed and contact providers regarding therapy if indicated. Counseling and education aimed to help decrease obesity can be done with patients, even during short interactions. Pharmacists may have a large impact on patients with education that may include counseling on increased physical activity and healthy nutrition. Pharmacy teams can play a significant role in drug therapy and

disease state management; however, several barriers may exist, including lack of time, space, education, or reimbursement.

Summary

Weight gain caused by medications can be very frustrating for both patients and providers. Obesity may lead to an increased risk of early death and commonly makes medical issues more difficult to treat. Patients should be monitored for increased weight, and agents that are less prone to cause weight gain should be selected when possible.

Of the atypical antipsychotics, clozapine and olanzapine have the highest chance of causing increased weight gain. Weight gain can be seen with antidepressant medication, including some TCAs, SSRIs, MAOIs, and mirtazapine. Lithium may cause weight loss initially but often causes weight gain with long-term use of the drug. Antiepileptic agents, including valproate, gabapentin, pregabalin, vigabatrin, and carbamazepine, which can also be used for other indications, have been associated with weight gain. Medications used to manage diabetes, including insulin, sulfonylureas, and thiazolidinediones, may cause weight gain. Angiotensin-converting inhibitors, angiotensin receptor blockers, and calcium channel blockers are recommended over the use of beta blockers for first-line therapy in patients with hypertension and type 2 diabetes who are obese. Long-term glucocorticoid therapy has been associated with weight gain. Integrase strand transfer inhibitors (INSTIs) regimens have been cited in more studies as being a cause of weight gain during treatment of HIV than regimens that do not include INSTIs.

Pharmacy teams can be a great resource for patients to help prevent weight gain, provide education, and promote healthy habits. Pharmacists should look for medication therapies that may cause weight gain, while technicians can help collect data and motivate patients.

Course Test

Which of the following statements regarding obesity is false?

Obesity may be associated with type 2 diabetes, high blood pressure, sleep apnea, and high cholesterol.

Obesity may lead to an increased risk of early death.

Obesity makes medical issues easier to treat as patients are seen by providers more often.

Obesity can be associated with a stigma that may affect a person’s quality of life.

Which of the following atypical antipsychotics has been most frequently associated with weight gain?

Aripiprazole

Olanzapine

Risperidone

Lurasidone

Psychiatric patients may have factors that contribute to weight gain including:

A more active lifestyle than those without psychiatric disorders.

Psychiatric patients are physically unable to stop eating when they are full.

All antipsychotics cause significant weight gain.

Paranoia or hospitalization may cause an individual to be more sedentary than desired.

Which medication used to manage diabetes has been used to help patients with antipsychotic-induced weight gain?

Glyburide

Metformin

Pioglitazone

Insulin

Which of the following statements is true regarding antidepressants and weight gain?

Tricyclic antidepressants do not typically cause weight gain.

Weight gain is not a barrier to compliance with antidepressant medications.

Bupropion is associated with the largest amount of weight gain of all antidepressants.

Patients who use SSRIs for less than six months are less likely to have weight gain.

Which of the following is correct about weight gain and corticosteroid therapy?

High cortisol levels can lead to decreased appetite.

Chronic corticosteroid therapy activates the endocannabinoid system and INCREASES energy expenditure.

Inhaled corticosteroids are the corticosteroid form that is most likely to increase body weight significantly.

Long-term glucocorticoid therapy has long been associated with weight gain.

The Endocrine Society currently recommends:

Weight-losing and weight-neutral medications as first- and second- line agents for the management of type 2 diabetes in patients who are overweight.

All patients with diabetes should be on high-dose insulin regimens.

All patients with type 2 diabetes who have hypertension and are obese should be on beta blockers.

Long-term corticosteroids should be used first-line in all patients with chronic inflammatory disease.

In which of the following situations for patients with HIV has there been a correlation between antiretroviral treatment and higher increased weight gain?

Low baseline CD4 cell count and low baseline HIV RNA.

Low baseline CD4 cell count and high baseline HIV RNA.

High baseline CD4 cell count and low baseline HIV RNA.

High baseline CD4 cell count and high baseline HIV RNA.

Lifestyle changes can help patients to prevent medication-related weight gain. Which of the following suggestions may be helpful when counseling patients?

Eating a diet high in carbohydrates and processed food is an efficient way to avoid weight gain.

Physical movement and working out are the only factors that can help to prevent weight gain or reduce weight.

Small daily activities should be considered, like parking the car further from the destination to walk more or taking the stairs instead of the elevator.

Once medications are discontinued, all gained weight is lost within two months.

Pharmacy teams can help patients prevent medication-related weight gain in the following ways except:

Working individually or as a collaborative practice team to provide education and consults.

Screening for patients who are at increased risk of weight gain at the start of therapy may lead to weight gain.

Providing support and motivation to patients who are struggling with medication-related weight gain.

Recommending a patient stop a medication immediately if they notice weight gain.

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DISCLAIMER

The information provided in this course is general in nature, and it is solely designed to provide participants with continuing education credit(s). This course and materials are not meant to substitute for the independent, professional judgment of any participant regarding that participant’s professional practice, including but not limited to patient assessment, diagnosis, treatment, and/or health management. Medical and pharmacy practices, rules, and laws vary from state to state, and this course does not cover the laws of each state; therefore, participants must consult the laws of their state as they relate to their professional practice.

Healthcare professionals, including pharmacists and pharmacy technicians, must consult with their employer, healthcare facility, hospital, or other organization, for guidelines, protocols, and procedures they are to follow. The information provided in this course does not replace those guidelines, protocols, and procedures but is for academic purposes only, and this course’s limited purpose is for the completion of continuing education credits.

Participants are advised and acknowledge that information related to medications, their administration, dosing, contraindications, adverse reactions, interactions, warnings, precautions, or accepted uses are constantly changing, and any person taking this course understands that such person must make an independent review of medication information prior to any patient assessment, diagnosis, treatment and/or health management. Any discussion of off-label use of any medication, device, or procedure is informational only, and such uses are not endorsed hereby.

Nothing contained in this course represents the opinions, views, judgments, or conclusions of RxCe.com LLC. RxCe.com LLC is not liable or responsible to any person for any inaccuracy, error, or omission with respect to this course, or course material.

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