Endocrine and

Metabolic Disorders
Muhammad Ammar Zahid
Pharm.D., M.Phil., BCPS
Ph.D. candidate, College of Pharmacy, Qatar University
I have no conflicts of interest to disclose.

01/25/2022 BCPS Preparatory Class 2

Learning Objectives
• Identify a patient of endocrine and metabolic disorder based on diagnostic
criteria and classify according to classification criteria
• Review therapeutic agents used for the management of endocrine and
metabolic disorders
• Compare and contrast different treatment options available for the given
patient
• Select appropriate treatment option and ways to monitor the outcome of the
treatment according to the established practice guidelines
• Recommend management to avoid long-term complications of diabetes

01/25/2022 BCPS Preparatory Class 3

Presentation Focus
 Thyroid Disorders
 Hypo and Hyperthyroidism

 Adrenal Disorders
 Cushing’s Disease

 Diabetes Mellitus
 Obesity

01/25/2022 BCPS Preparatory Class 4

Thyroid Disorders
01/25/2022 BCPS Preparatory Class 6
Thyroid disorders - Pathophysiology
Hyperthyroidism - Graves Disease Hypothyroidism - Hashimoto Disease
 Autoimmune Disorder /  Autoimmune mediated

Antibodies stimulate thyrotropin  Iatrogenic: Surgery / Ablative Therapy

receptors on thyroid gland  Iodine Deficiency
 TSH-secreting pituitary tumors  Pituitary Insufficiency – Lack of TSH

 Autonomous thyroid nodule (toxic secretion

adenoma)  Drug-Induced (lithium)

 Multinodular goiter

 Thyroiditis (viral inflammation)

 Drug-Induced (amiodarone, thyroid

replacement tx)

01/25/2022 BCPS Preparatory Class 7

Thyroid disorders - Clinical
Presentation
Hyperthyroidism - Graves Disease Hypothyroidism - Hashimoto Disease
• Weight loss • Weight gain
• Heat intolerance • Cold intolerance
• Warm moist skin • Cold dry skin
• Fine hair • Corse hair
• Increased bowel movements • Decreased bowel movements
• Palpitations/tachycardia • Bradycardia
• Anxiety, nervousness, Insomnia • Depression, lethargy, fatigue
• Exophthalmos (Graves disease) • Preorbital puffiness
• Thyromegaly

01/25/2022 BCPS Preparatory Class 8

Case 1
S.S. is a 38-year-old schoolteacher who presents to the clinic today with noticeable dark
circles under her eyes. She has difficulty with sleep, mainly with staying asleep. It takes her
about 20 minutes to fall asleep, but after about 2 hours, she wakes up and cannot fall asleep
again for several hours. She took diphenhydramine for sleep but didn't continue due to
drowsiness in the morning. Her other medical problems include hypothyroidism
(levothyroxine 125 mcg at bedtime), hypertension (hydrochlorothiazide 25 mg in the
morning), chronic back pain (ibuprofen 800 mg three times daily), and MDD (citalopram 20
mg in the morning). Which agent is most likely contributing to S.S.’s insomnia?
a. Citalopram.
b. Hydrochlorothiazide.
c. Ibuprofen.
d. Levothyroxine

01/25/2022 BCPS Preparatory Class 9

Case 1
S.S. is a 38-year-old schoolteacher who presents to the clinic today with noticeable dark
circles under her eyes. She has difficulty with sleep, mainly with staying asleep. It takes her
about 20 minutes to fall asleep, but after about 2 hours, she wakes up and cannot fall asleep
again for several hours. She took diphenhydramine for sleep but didn't continue due to
drowsiness in the morning. Her other medical problems include hypothyroidism
(levothyroxine 125 mcg at bedtime), hypertension (hydrochlorothiazide 25 mg in the
morning), chronic back pain (ibuprofen 800 mg three times daily), and MDD (citalopram 20
mg in the morning). Which agent is most likely contributing to S.S.’s insomnia?
a. Citalopram.
b. Hydrochlorothiazide.
c. Ibuprofen.
d. Levothyroxine

01/25/2022 BCPS Preparatory Class 10

Thyroid disorders - Diagnosis

Free T4 Total T3 TSH

Total T4
Normal 4.5–10.9 mcg/dL 0.8–2.7 ng/dL 60–181 ng/dL 0.5–4.7 milli-
international
units/L
Hyperthyroid ↑↑ ↑↑ ↑↑↑ ↓↓*
Hypothyroid ↓↓ ↓↓ ↓ ↑↑*

Primary thyroid disease

*

01/25/2022 BCPS Preparatory Class 11

Goals of Treatment
• Eliminate/Normalize excess thyroid hormone
• Minimize or eliminate symptoms and long-term consequences
• Provide individualized therapy based on
• The type and severity of disease
• Patient age and gender
• Existence of nonthyroidal conditions
• Response to previous therapy

01/25/2022 BCPS Preparatory Class 12

Hyperthyroidism – Treatment
Ablative therapy by radioactive iodine (RAI) is treatment of choice (due to
low remission by pharmacotherapy). Pregnancy is an absolute
contraindication to use RAI
• Surgery is preferred if:
• Large gland (>80 g)
• Severe ophthalmopathy
• Lack of remission on antithyroid drug treatment
• Pharmacotherapy is reserved for patient:
• Awaiting ablative therapy or surgery (depletes stored hormone)
• Not a surgical or ablative candidate (or refuses)
• If ablative therapy or surgery fails to normalize thyroid function
01/25/2022 BCPS Preparatory Class 13
Hyperthyroidism – Treatment
Pharmacologic Therapy – Methimazole and propylthiouracil (PTU)
• Takes time to produce maximum effects (4-6 weeks) due to reserves of
hormone. Taper monthly and treat for 1 to 2 years
• Because of the risk of serious hepatotoxicity, PTU should not be considered
first-line therapy in either adults or children. Exceptions to this
recommendation include
(1) the first trimester of pregnancy (when the risk of methimazole-induced
embryopathy may exceed that of PTU-induced hepatotoxicity)
(2) intolerance to methimazole
(3) thyroid storm

01/25/2022 BCPS Preparatory Class 14

Hyperthyroidism – Treatment
Pharmacologic Therapy – Iodides
• Blocks thyroid hormone release and decreases size and vascularity of the
gland
• Symptom improvement occurs within 2–7 days and hormone reduced for few
weeks
• Shot term use (1-2 weeks)
• Adjunctive therapy to:
• Prepare a patient with Graves’ disease for surgery
• Acutely inhibit thyroid hormone release in severely thyrotoxic patients
• Inhibit thyroid hormone release after RAI therapy

01/25/2022 BCPS Preparatory Class 15

Hyperthyroidism – Treatment
Pharmacologic Therapy – Adrenergic blockers

• Adjunctive therapy to control symptoms (palpitations, anxiety, tremor, and

heat intolerance) specifically
• In elderly with symptoms
• Heart rates >90 bpm
• History of CVD
• Beta-blocker (Propranolol, metoprolol)

01/25/2022 BCPS Preparatory Class 16

Case 2
84-year-old woman complaints of feeling anxious and warm. She refused to
undergo ablative therapy. TSH = 0.22 mIU/L (0.5-4.5), free T4 = 3.2 ng/dL (0.8-
1.9). Diagnosis of Graves disease was made.
Which is the most appropriate initial option?

a. Potassium iodide
b. Propylthiouracil
c. Atenolol
d. Methimazole

01/25/2022 BCPS Preparatory Class 17

Case 2
84-year-old woman complaints of feeling anxious and warm. She refused to
undergo ablative therapy. TSH = 0.22 mIU/L (0.5-4.5), free T4 = 3.2 ng/dL (0.8-
1.9). Diagnosis of Graves disease was made.
Which is the most appropriate initial option?

a. Potassium iodide
b. Propylthiouracil
c. Atenolol
d. Methimazole

01/25/2022 BCPS Preparatory Class 18

Case 3
M.S. is a 68-year-old woman with a history of angina and hypertension and was
recently received a diagnosis of Graves disease (TSH = 0.2 mIU/L). She
experiences fatigue, heat intolerance, sweating and tachycardic. Initiation of
which regimen is likely to reduce her symptoms?
a. Propylthiouracil 100mg 3times daily.
b. Methimazole 10mg twice daily.
c. Propranolol 40mg 4times daily.
d. Lugol’s solution 10 drops 3times daily.

01/25/2022 BCPS Preparatory Class 19

Case 3
M.S. is a 68-year-old woman with a history of angina and hypertension and was
recently received a diagnosis of Graves disease (TSH = 0.2 mIU/L). She
experiences fatigue, heat intolerance, sweating and tachycardic. Initiation of
which regimen is likely to reduce her symptoms?
a. Propylthiouracil 100mg 3times daily.
b. Methimazole 10mg twice daily.
c. Propranolol 40mg 4times daily.
d. Lugol’s solution 10 drops 3times daily.

01/25/2022 BCPS Preparatory Class 20

Hypothyroidism – Treatment
• Levothyroxine (L-thyroxine, T4) is drug of choice (chemically stable, relatively
inexpensive, active when given orally, free of antigenicity, uniform potency)
• Average adult maintenance dose 125mcg/day
• Patients with longstanding disease and older individuals 50 mcg daily,
increase after 1 month if required
• Older patients with known cardiac disease 25 mcg/day titrated upward in
increments of 25 mcg at monthly intervals to prevent stress on the
cardiovascular system
• ADRs: Hyperthyroidism / angina / MI / bone fracture risk

01/25/2022 BCPS Preparatory Class 21

Case 4
63-year-old woman has Hashimoto’s disease. Recent TSH = 10.6 mIU/L (0.5-4.5)
and free T4 = 0.5 ng/dL (0.8-1.9). Complains of dry skin and being rundown.
What is the best drug for initial treatment?

a. Levothyroxine
b. Liothyronine
c. Desiccated thyroid
d. Methimazole

01/25/2022 BCPS Preparatory Class 22

Case 4
63-year-old woman has Hashimoto’s disease. Recent TSH = 10.6 mIU/L (0.5-4.5)
and free T4 = 0.5 ng/dL (0.8-1.9). Complains of dry skin and being rundown.
What is the best drug for initial treatment?

a. Levothyroxine
b. Liothyronine
c. Desiccated thyroid
d. Methimazole

01/25/2022 BCPS Preparatory Class 23

Case 5
A patient was recently initiated on thyroid replacement therapy to treat
hypothyroidism. When would be the best time to recommend checking thyroid
lab studies to assess maximum effects of this therapy?
a. 1 or 2 days
b. 1–2 weeks
c. 2–3 weeks
d. 4–6 weeks

01/25/2022 BCPS Preparatory Class 24

Case 5
A patient was recently initiated on thyroid replacement therapy to treat
hypothyroidism. When would be the best time to recommend checking thyroid
lab studies to assess maximum effects of this therapy?
a. 1 or 2 days
b. 1–2 weeks
c. 2–3 weeks
d. 4–6 weeks

01/25/2022 BCPS Preparatory Class 25

Case 6
60 years old patient complaining of fatigue, gained about 3-4 Kg in weight and
suffers from depressed mood. T4 reduced and TSH mildly elevated.
Which of the following is an appropriate treatment?
a. Liothyronine
b. Levothyroxine 50 mcg daily and monitoring TSH 4-6 W
c. No treatment is required
d. Levothyroxine 100 mcg daily and monitoring TSH 4-6W

01/25/2022 BCPS Preparatory Class 26

Case 6
60 years old patient complaining of fatigue, gained about 3-4 Kg in weight and
suffers from depressed mood. T4 reduced and TSH mildly elevated.
Which of the following is an appropriate treatment?
a. Liothyronine
b. Levothyroxine 50 mcg daily and monitoring TSH 4-6 W
c. No treatment is required
d. Levothyroxine 100 mcg daily and monitoring TSH 4-6W

01/25/2022 BCPS Preparatory Class 27

Adrenal Gland
Disorders
Pathophysiology
• Hyperfunction
• Cortisol overproduction  Cushing’s syndrome
• ACTH dependent (Cushing’s disease)
• ACHTH independent
• Aldosterone overproduction  Hyperaldosteronism

• Hypofunction ACTH Dependent

• Primary  Addisons disease Cushing Syndrome

ACTH Independent
Cushing Syndrome
01/25/2022 BCPS Preparatory Class 29
Cushing’s Disease - Presentation
 Central obesity / facial rounding
 Peripheral obesity / fat accumulation
 Myopathies
 Osteoporosis / back pain / fracture
 Glucose intolerance / diabetes
 HTN

01/25/2022 BCPS Preparatory Class 30

Cushing’s Disease - Treatment Goal
• Limit morbidity and mortality
• Return the patient to a normal functional state by removing the source of
hypercortisolism
• Minimizing pituitary or adrenal deficiencies

01/25/2022 BCPS Preparatory Class 31

Cushing’s Disease - Treatment
• Treatment of choice  Surgical resection of offending tumor
• Pharmacotherapy  patients who are not surgical candidates / preoperatively /
adjunctive therapy in postoperative patients
Block production of Cortisol – Osilodrostat (Approved in 2020)
• ADRs: QT prolongation (baseline EKG after initiating treatment)
Block ACTH secretion from pituitary - Pasireotide 
• Approved for treatment of adults with Cushing disease for whom pituitary surgery
is not an option or has not been curative.
• ADRs: Nausea, diarrhea, cholelithiasis, increased hepatic transaminases Baseline
LFTs), hyperglycemia (Baseline A1c), sinus bradycardia, and QT prolongation
(Baseline EKG).
01/25/2022 BCPS Preparatory Class 32
Cushing’s Disease - Treatment
Block steroidogenesis – Ketoconazole and Etomidate
Etomidate
• Only parenteral formulation
• Use is limited to patients with acute hypercortisolemia requiring emergency treatment
or in preparation for surgery
• Monitor cortisol levels closely, may undergo hypocortisolemia
Cytotoxic for adrenal gland – Mitotane
Glucocorticoid-Receptor Blocking Agents – Mifepristone
• Patients who have type 2 diabetes or glucose intolerance 

01/25/2022 BCPS Preparatory Class 33

Diabetes Mellitus
Classification and Pathophysiology
• Type 1 DM (5%–10% of cases) usually results from autoimmune destruction of
pancreatic β-cells, leading to absolute deficiency of insulin
• Type 2 DM (90%–95% of cases) is characterized by multiple defects:
• Impaired insulin secretion
• Reduced incretin effect
•  Insulin resistance
• Excess glucagon secretion
• Sodium-glucose cotransporter-2 (SGLT-2) upregulation in the kidney
• Gestational diabetes (GDM)
• Maturity onset diabetes of the young (MODY)
• Medications (eg, glucocorticoids, thiazides, niacin, atypical antipsychotics)
01/25/2022 BCPS Preparatory Class 35
Diabetes - Diagnosis
• Criteria for diagnosis of DM include any one of the following:
1. A1C ≥6.5%
2.FPG ≥126 mg/dL
3.OGTT ≥200 mg/dL (2 hrs after 75g oral glucose)
4.Random plasma glucose ≥200 mg/dL (11.1 mmol/L) with classic symptoms
of hyperglycemia or hyperglycemic crisis
• In the absence of unequivocal hyperglycemia, a diagnosis using
criteria 1 through 3 requires two abnormal test results from the
same sample or in two separate test samples.

01/25/2022 BCPS Preparatory Class 36

Prediabetes - Diagnosis (high-risk population)

• Impaired fasting glucose: FPG 100–125 mg/dL

• Impaired glucose tolerance: 2-hour plasma glucose after OGTT (75 g) of 140–
199 mg/dL c.
• A1C 5.7%–6.4%
• Screen yearly for T2D if positive for prediabetes

01/25/2022 BCPS Preparatory Class 37

Goals of Treatment
• Primary goal
• Prevent or delay progression of long-term microvascular (retinopathy, neuropathy,
nephropathy and macrovascular (CVS, PVD) complications.
• Additional goals
• Alleviate symptoms of hyperglycemia
• Minimize hypoglycemia and other adverse effects
• Minimize treatment burden
• Maintain quality of life

01/25/2022 BCPS Preparatory Class 38

Glycemic targets
Parameter American Diabetes Association American Association of
(ADA) Clinical Endocrinologists
(AACE)
A1C <7.0% ≤6.5%
Fasting plasma glucose (FPG) 80–130 mg/dL <110 mg/dL
Postprandial glucose (PPG) <180 mg/dL <140 mg/dL

Glycemic targets should be individualized. More stringent or less stringent goals may be appropriate
for some patients.

Evaluate after 3 months if uncontrolled

Evaluate after 6 months if controlled

01/25/2022 BCPS Preparatory Class 39

Case 7
96-year patient is diabetic and hypertensive, A1C 7.5 ,taking metformin 750mg
twice, atorvastatin, lisinopril. What adjustment does the patient need?
a. Add glyburide
b. Increase metformin to 1000mg
c. Metformin + glyburide
d. Do nothing

01/25/2022 BCPS Preparatory Class 40

Case 7
96-year patient is diabetic and hypertensive, A1C 7.5 ,taking metformin 750mg
twice, atorvastatin, lisinopril. What adjustment does the patient need?
a. Add glyburide
b. Increase metformin to 1000mg
c. Metformin + glyburide
d. Do nothing

01/25/2022 BCPS Preparatory Class 41

Treatment of Hyperglycemia in Type 1
Diabetes
• All patients with type 1 DM require exogenous insulin
• Regimens designed to provide insulin in a manner that mimics normal
physiologic insulin secretion
• Basal (consistent secretion of insulin throughout the day to manage glucose
levels overnight and in between meals ) + Bolus (bursts of insulin in response
to glucose rises after ingestion of carbohydrates (prandial insulin)

01/25/2022 BCPS Preparatory Class 42

Basal + Bolus Insulin
• Multiple daily injections or use of
continuous subcutaneous insulin
pump
• Common MDI regimen  One
injection long-lasting + Three
injections rapid-acting

01/25/2022 BCPS Preparatory Class 43

Starting Insulin Dose
• 0.4–1 units/kg/day
• 50% as basal insulin and 50% as prandial insulin 
• The insulin doses would then be adjusted based on SMBG data.
• For example, an 80-kg patient started on 0.5 units/kg/day would start with a
total daily dose of 40 units, with 20 units given as a long-
acting insulin (eg, insulin detemir, glargine) and 7 units of rapid-
acting insulin (eg, insulin aspart, lispro, or glulisine) with breakfast, lunch, and
dinner.

01/25/2022 BCPS Preparatory Class 44

Assessment and Adjustment
Ideally the adjustments should be done using SMBG data

 Know your goal fasting and post-prandial blood glucose

 Identify where in the day problems occur
 Determine which insulin(s) can affect blood glucose at that time
 Adjust medication or behavior

01/25/2022 BCPS Preparatory Class 45

Treatment of Hyperglycemia in Type 2
Diabetes
Very high A1C levels
Initial A1C is >1.5%
Initial A1C is close to (>10%, symptoms of
higher than the target
goal eg, чϳ ͘ ϱй hyperglycemia, or
A1C
evidence of catabolism

Initiate metformin as Consider two

Consider early
first-line therapy medications
introduction of basal
OR Metformin plus a
insulin
Life style modifications second agent
alone if patient is
motivated

• For patients maximized on metformin therapy but with A1C levels above the target, add a
second-line antihyperglycemic agent.
01/25/2022 BCPS Preparatory Class 47
Adding a second agent – without comorbidity

A1C above individualized target, No ASCVD risk, HF OR CKD

Need to minimize
Compelling need to
weight gain or Cost is a major issue
minimize hypoglycemia
promote weight loss

GLP1-RA or SGLT-2
inhibitor. If these
agents cannot be used,
DPP-4 inhibitor, GLP1- use a weight-neutral
RA, SGLT-2 inhibitor, or medication such as a SU, TZD
TZD DPP-4 inhibitor. Avoid
sulfonylureas, insulin,
and TZDs due to
weight gain.

01/25/2022 BCPS Preparatory Class 48

Adding a second agent – with comorbidity
A1C above individualized target and comorbidities

Established ASCVD HF CKD

SGLT-2 inhibitor (eg, SGLT-2 inhibitor with SGLT-2 inhibitor (eg,

empagliflozin) or GLP1- proven benefit in empagliflozin) or GLP1-
RA (eg, liraglutide) with reducing HF RA (eg, liraglutide) with
proven CV benefit progression. proven CV benefit

01/25/2022 BCPS Preparatory Class 49

Case 8
A 66-year-old man has had type 2 DM for 4 years. His A1C today is 7.7%. He has
altered his diet, and he states that he has been exercising regularly for months
now. He is taking metformin 1000 mg twice daily. Which would be the best
choice to help optimize his glycemic control?

a. Continue current medications and counsel to improve his diet and

exercise.
b. Discontinue metformin and initiate exenatide 5 mcg twice daily.
c. Add bromocriptine 0.8 mg at bedtime.
d. Add sitagliptin 100 mg once daily to his metformin therapy.

01/25/2022 BCPS Preparatory Class 50

Case 8
A 66-year-old man has had type 2 DM for 4 years. His A1C today is 7.7%. He has
altered his diet, and he states that he has been exercising regularly for months
now. He is taking metformin 1000 mg twice daily. Which would be the best
choice to help optimize his glycemic control?

a. Continue current medications and counsel to improve his diet and

exercise.
b. Discontinue metformin and initiate exenatide 5 mcg twice daily.
c. Add bromocriptine 0.8 mg at bedtime.
d. Add sitagliptin 100 mg once daily to his metformin therapy.

01/25/2022 BCPS Preparatory Class 51

Case 9
A 55-year-old with T2DM for 6 months (metformin 1000 mg twice daily since
diagnosis) A1c = 8.2%, Fasting BGs are at goal. His after-meal BGs average 210-
230 mg/dl. He is worried about his weight and doesn’t want any medications
that may increase it. Which is the most appropriate option?
a. Glyburide.
b. Liraglutide.
c. Pioglitazone.
d. Insulin glargine.

01/25/2022 BCPS Preparatory Class 52

Case 9
A 55-year-old with T2DM for 6 months (metformin 1000 mg twice daily since
diagnosis) A1c = 8.2%, Fasting BGs are at goal. His after-meal BGs average 210-
230 mg/dl. He is worried about his weight and doesn’t want any medications
that may increase it. Which is the most appropriate option?
a. Glyburide.
b. Liraglutide.
c. Pioglitazone.
d. Insulin glargine.

01/25/2022 BCPS Preparatory Class 53

Triple therapy
• Add drug from different class if:
• The A1C target is not achieved after 3 months of dual therapy
• If the patient did not tolerate the selected drug(s)

01/25/2022 BCPS Preparatory Class 54

Adding insulin
• Insulin is recommended for extreme (A1C >10%) or symptomatic hyperglycemia.
• Otherwise, GLP-1 RAs are preferred over basal insulin.
• Basal insulin is started at a low dose (10 units once daily or 0.1–0.2 units/kg/day) and
titrated slowly over time to a target FPG range (ie, 80–130 mg/dL] for patients targeting an
A1C <7%).
• If the A1C target is not reached by maximally titrating basal insulin, PPG is raised.
• GLP1-RA or SGLT-2 inhibitor should be considered if the patient is not already taking
one.
• Prandial insulin is also an option, starting with 4 units or 10% of the basal dose with
the largest meal of the day.

01/25/2022 BCPS Preparatory Class 55

Avoiding Chronic Complications
• BP management
• Goal < 140/90, more stringent if existing CVD
• If nephropathic, ACE inhibitors are ARBS are preferred for BP managment
• Lipid management
• ASCVD or ASCVD risk > 20%  High-intensity statin
• 40+ and No ASCVD  Moderate intensity statin (With growing age be cautious)
• <40 but ASCVD risk  Moderate intensity statin
• Antiplatelet therapy
• Low dose (75-125mg) aspirin for primary prevention in all ASCVD patients

01/25/2022 BCPS Preparatory Class 56

Case 10
56-year-old man with recent type 2 DM diagnosis receiving metformin 1000
mg twice daily. Has no other chronic diseases or h/o CVD. BP = 148/78 mm Hg,
pulse 74 bpm, A1c = 6.9%. If added, which agent has the most potential to
reduce both macro- and microvascular outcomes?

a. Insulin glargine
b. Lisinopril
c. Glyburide
d. Niacin

01/25/2022 BCPS Preparatory Class 57

Obesity
Not so recent guidelines
• American College of Cardiology/American Heart Association (ACC/AHA) and
The Obesity Society – 2013
• Most therapeutic agents approved after the guideline
• Endocrine Society – 2015
• No recommendation of one agent over other
• American Association of Clinical Endocrinology (AACE)/American College of
Endocrinology - 2016
• No recommendation of one agent over another, comprehensive review of treatment
options

01/25/2022 BCPS Preparatory Class 59

Classification based on BMI

Classification BMI
Normal 18.5-24.9
Overweight 25.0-29.9
Class I 30.0-34.9
Class II 35.0-39.9
Class III 40+

01/25/2022 BCPS Preparatory Class 60

Obesity – Treatment
• Nonpharmacologic therapy, including reduced caloric intake, increased physical
activity, and behavior modification, is the mainstay of obesity management.
• Pharmacotherapy is an adjunct for patients:
• Failed to achieve or sustain weight loss with lifestyle change alone
• Have a BMI ≥30 kg/m2
• BMI ≥27 kg/m2 with at least one weight-related comorbidity

• Long-term pharmacotherapy may have a role for patients who have no

contraindications to approved drug therapy
• Loss of at least 5 percent of total body weight at three to six months is a success

01/25/2022 BCPS Preparatory Class 61

Case 11
F.A. is a 55 years old female. Her BMI is 32 kg/mm2 and Weight = 120 lb. What
is the minimal weight loss expected in 6 months to decide the continuation of
therapy?
a. 6 lb
b. 12 lb
c. 17 lb
d. 26 lb

01/25/2022 BCPS Preparatory Class 62

Case 11
F.A. is a 55 years old female. Her BMI is 32 kg/mm2 and Weight = 120 lb. What
is the minimal weight loss expected in 6 months to decide the continuation of
therapy?
a. 6 lb
b. 12 lb
c. 17 lb
d. 26 lb

01/25/2022 BCPS Preparatory Class 63

Obesity - Pharmacotherapy
• Liraglutide
• Orlistat
• Phentermine/topiramate
• Naltrexone/bupropion
• Lorcaserin has been removed from the market

01/25/2022 BCPS Preparatory Class 64

• If you have any questions or feedback you can write to me

ammarzahid@gmail.com

01/25/2022 BCPS Preparatory Class 65