FINAL

OBESITY

LIPASE INHIBITORS
Example: Orlistat (Alli, Xenical)

Pharmacokinetic:
Absorption: Minimally absorbed in the gastrointestinal tract (acts locally)
Distribution: Limited systemic distribution
Metabolism: Minimal hepatic metabolism
Excretion: Excreted in feces (unabsorbed fat)
Half-life: Not clinically significant (nonsystemic)

Pharmacodynamics
Binds to gastric and pancreatic lipases in the intestine
Inhibits hydrolysis of triglycerides into fatty acids and monoglycerides
Prevents absorption of dietary fat (~30%)
Undigested fat is eliminated in feces

Result: decreased fat absorption → weight loss

Decreases cholesterol, LDL, glucose, and insulin levels
May improve blood pressure

Nursing Responsibilities
Before Administration:
Check baseline weight and BMI
Monitor blood pressure
Assess laboratory values (lipids, glucose, liver function tests)
Assess for contraindications (malabsorption syndrome, gallbladder disease, pregnancy)
Review medications (levothyroxine, HIV drugs, fat-soluble vitamins ADEK)
Identify high-risk patients (elderly, children <12, vitamin deficiencies, GI disorders)

During Administration:
Administer with meals containing fat (up to 3 times daily, within 1 hour before meals)
Ensure patient follows low-fat, balanced diet
Monitor for GI side effects (oily stool, flatulence, fecal urgency, diarrhea)
Monitor diabetic patients for hypoglycemia
Monitor hypertensive patients for possible medication adjustment

After Administration:
Monitor weight every 3 months
Monitor blood pressure and lab values regularly
Assess for vitamin deficiencies (A, D, E, K)
Educate patient on proper multivitamin use (2 hours before or after drug)
Instruct patient to avoid high-fat meals
Advise separation of dosing with levothyroxine (4 hours apart)
Document therapeutic effects (weight loss) and adverse effects
2. GLUCAGON-LIKE PEPTIDE-1 (GLP-1) RECEPTOR AGONISTS
Example: Liraglutide (Saxenda, Victoza), Semaglutide, Dulaglutide, Exenatide

Pharmacokinetic:
Absorption: Subcutaneous injection (rapid absorption); oral semaglutide has GI absorption with
low bioavailability
Distribution: Low volume of distribution; remains mainly in bloodstream targeting metabolic
tissues
Metabolism: Proteolytic degradation into amino acids by serum and tissue proteases
Excretion: Renal elimination of inactive metabolites
Half-life: Variable; short-acting (hours) to long-acting (up to 1 week for semaglutide/dulaglutide)

Pharmacodynamics
Activates GLP-1 receptors in pancreas, brain, and GI tract
Stimulates glucose-dependent insulin secretion
Suppresses glucagon release during hyperglycemia
Delays gastric emptying → prolonged satiety
Acts on hypothalamus → decreases appetite
Enhances insulin sensitivity and glucose uptake

Result:
↓ blood glucose levels
↓ appetite and food intake
↓ body weight
Improved glycemic control in Type 2 Diabetes Mellitus

Nursing Responsibilities
Before Administration:
Assess weight, BMI, and baseline blood glucose (HbA1c)
Check renal and hepatic function
Assess history of pancreatitis, thyroid cancer, or MEN 2
Evaluate gastrointestinal disorders (gastroparesis, IBD)
Review current antidiabetic medications (risk of hypoglycemia)
Confirm pregnancy status in females of reproductive age

During Administration:
Administer subcutaneously (abdomen, thigh, or upper arm)
Rotate injection sites to prevent lipodystrophy
Monitor for GI effects (nausea, vomiting, diarrhea)
Monitor blood glucose levels regularly
Observe for signs of pancreatitis (severe abdominal pain radiating to back)
Monitor injection-site reactions (redness, pruritus)
After Administration:
Monitor weight loss and HbA1c every 3 months
Evaluate therapeutic response (decreased glucose, improved satiety, weight reduction)
Monitor for hypoglycemia (especially with insulin or sulfonylureas)
Assess for thyroid-related symptoms (neck swelling, hoarseness)
Educate patient on long-term lifestyle modification (diet + exercise adherence)
Document adverse effects (GI symptoms, pancreatitis, allergic reactions)

Sympathomimetic agents
Example: Phentermine, Diethylpropion

Pharmacokinetic:
Absorption:Well absorbed orally; onset within a few hours.
Distribution:Widely distributed; crosses the blood-brain barrier to act on CNS.
Metabolism:Metabolized in the liver.
Excretion:Excreted primarily in urine.
Half-life:Phentermine: ~19–24 hours
Diethylpropion: ~4–6 hours

Pharmacodynamics
Stimulates release of norepinephrine in the hypothalamus
Activates adrenergic receptors (mainly α and β receptors)
Enhances sympathetic nervous system activity
Suppresses appetite (anorexigenic effect)
May increase heart rate and blood pressure
Result: decreased appetite → reduced caloric intake → weight loss
May cause CNS stimulation (insomnia, alertness)
May elevate blood pressure and pulse rate

Nursing Responsibilities
Before Administration:
Assess baseline weight, BMI, BP, and pulse.
Screen for contraindications (CVD, uncontrolled hypertension, hyperthyroidism, glaucoma, MAOI use).
Assess history of drug abuse.
• Educate patient on short-term use and possible side effects.
During Administration:
• Monitor BP and heart rate regularly.
• Observe for CNS effects (restlessness, insomnia).
• Administer in the morning to avoid sleep disturbances.
• Avoid concurrent use with other stimulants.
After Administration:
• Monitor weight loss and therapeutic response.
• Assess for adverse effects (dry mouth, constipation, palpitations).
• Reinforce diet and exercise modifications.
• Monitor for dependence or misuse.

DUAL INCRETIN RECEPTOR AGONISTS

Example: Tirzepatide (Zepbound, Mounjaro) (GLP-1/GIP dual agonist)
Pharmacokinetic:
Absorption: Subcutaneous injection with slow, sustained absorption
Distribution: Low to moderate volume of distribution; circulates in plasma targeting metabolic
tissues
Metabolism: Proteolytic degradation into amino acids via serum and tissue enzymes
Excretion: Renal elimination of inactive metabolites
Half-life: ~5 days (weekly dosing effect)

Pharmacodynamics
GLP-1 Action:
Activates GLP-1 receptors in the brain and GI tract
↓ appetite via hypothalamic satiety centers
Slows gastric emptying → prolonged fullness
GIP Action:
Stimulates glucose-dependent insulin secretion
Improves fat metabolism in adipose tissue
Enhances insulin sensitivity in fat and muscle cells
Synergistic Effect:
Dual receptor activation improves glycemic control and weight reduction more than GLP-1 alone
Reduces energy intake and improves metabolic efficiency
May reduce severity of GI side effects compared to high-dose GLP-1 therapy
Result:
↓ appetite and food intake
↑ insulin response (glucose-dependent)
↑ fat metabolism and energy regulation
Significant weight loss (~15–25% body weight in clinical trials)
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3. Nursing Responsibilities
Before Administration:
Assess baseline weight, BMI, and waist circumference
Check HbA1c and fasting blood glucose
Evaluate renal and hepatic function
Screen for history of pancreatitis or severe GI disease
Assess thyroid cancer/MEN 2 risk
Review current antidiabetic medications (risk of hypoglycemia)
Confirm pregnancy status in patients of reproductive age
⸻
During Administration:
Administer subcutaneously (abdomen, thigh, or upper arm) once weekly
Rotate injection sites to prevent skin irritation
Monitor for GI symptoms (nausea, vomiting, diarrhea, constipation)
Monitor blood glucose regularly (especially if combined with insulin or sulfonylureas)
Observe for signs of pancreatitis (severe abdominal pain radiating to back)
Monitor hydration status due to GI side effects
⸻
After Administration:
Monitor weight loss progress and metabolic parameters (HbA1c, lipids)
Evaluate therapeutic response (reduced appetite, improved glycemic control, weight reduction)
Monitor for hypoglycemia in combination therapy patients
Assess for gallbladder disease symptoms (RUQ pain, jaundice)
Educate patient on lifestyle modification (diet + exercise adherence)
Instruct on adherence to weekly dosing schedule and injection technique
Document adverse effects and therapeutic outcomes
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SSRI
DIABETIC
1. SULFONYLUREAS
Examples:
First-generation: Chlorpropamide (Diabinese), Tolazamide (Tolinase), Tolbutamide (Orinase)
Second-generation: Glimepiride (Amaryl), Glipizide (Glucotrol), Glyburide (Diabeta, Micronase)
Pharmacokinetic:
Absorption: Well absorbed orally; slow onset
Distribution: Highly protein-bound in plasma
Metabolism: Hepatic metabolism (liver)
Excretion: Urine (renal) ± bile (some second-generation drugs)
Half-life: ~6–17 hours (drug-dependent)
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2. Pharmacodynamics
Stimulates insulin release from pancreatic beta cells
Closes ATP-sensitive potassium channels → cell depolarization
Increases calcium influx → insulin secretion
Enhances insulin sensitivity at receptor sites
May increase number of insulin receptors
May enhance antidiuretic hormone (ADH) effect on renal cells
Result:
↓ blood glucose levels through increased insulin secretion
Risk of insulin secretion even without food intake → hypoglycemia
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3. Nursing Responsibilities
Before Administration:
Assess fasting blood glucose and HbA1c
Check renal and hepatic function
Assess allergy history to sulfonylureas
Evaluate nutritional intake and meal patterns
Assess risk factors (elderly, irregular meals, pregnancy status)
Establish baseline vital signs and neurologic status
⸻
During Administration:
Administer orally 30 minutes before meals (or as prescribed)
Ensure patient eats meals after medication intake
Monitor for hypoglycemia (sweating, tremors, confusion, dizziness)
Monitor blood glucose levels regularly
Avoid alcohol intake (increases hypoglycemia risk)
Monitor for GI side effects (nausea, epigastric discomfort)
⸻
After Administration:
Continue regular blood glucose monitoring
Evaluate therapeutic response (stable glucose levels)
Monitor for hypoglycemia episodes and intervene promptly
Assess nutritional status and dietary adherence
Monitor renal and liver function tests for toxicity
Educate patient on recognizing and managing hypoglycemia
Instruct patient to maintain consistent meal timing and carry fast-acting glucose
Evaluate patient understanding of drug use, side effects, and compliance
⸻
THIAZOLIDINEDIONES
1. THIAZOLIDINEDIONES
Examples: Pioglitazone (Actos), Rosiglitazone (-glitazone drugs)
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Pharmacokinetic:
Absorption: Well absorbed orally (PO)
Distribution: Highly protein-bound; widely distributed to peripheral tissues (fat, muscle, liver)
Metabolism: Hepatic metabolism (CYP450 system)
Excretion: Mainly in urine and feces (metabolites)
Half-life: ~3–7 hours (active metabolites may prolong effect)
⸻
2. Pharmacodynamics
Activates peroxisome proliferator-activated receptor-gamma (PPAR-γ) in adipose, muscle, and liver
tissues
Increases insulin sensitivity in peripheral tissues
Enhances glucose uptake in muscle and fat cells
Decreases hepatic glucose production (gluconeogenesis)
Improves lipid metabolism and insulin response
Result:
↓ insulin resistance
↓ blood glucose levels
Improved peripheral glucose utilization
No hypoglycemia when used alone
⸻
3. Nursing Responsibilities
Before Administration:
Review blood glucose and HbA1c levels
Assess liver function tests (risk of hepatotoxicity)
Check cardiac status (risk of heart failure)
Assess renal function
Evaluate history of bladder cancer or hematuria
Assess for osteoporosis risk (fracture risk)
Establish baseline weight, edema status, and vital signs
⸻
During Administration:
Administer orally once daily (with or without food)
Monitor for fluid retention (edema, sudden weight gain)
Monitor blood glucose levels regularly
Observe for signs of heart failure (dyspnea, fatigue, swelling)
Monitor liver function abnormalities (abdominal pain, jaundice, dark urine)
Observe urinary changes (hematuria, urgency → possible bladder cancer)
⸻
After Administration:
Evaluate therapeutic response (improved glucose control, reduced insulin resistance)
Monitor HbA1c periodically
Continue monitoring liver and renal function tests
Assess for long-term adverse effects (fractures, edema, heart failure)
Educate patient on lifestyle support (diet, exercise, weight-bearing activities)
Encourage calcium and vitamin D intake to reduce fracture risk
Instruct patient to report symptoms of heart failure, liver damage, or urinary abnormalities immediately
Document therapeutic outcomes and adverse reactions
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1. BIGUANIDES
Example: Metformin (Glucophage, Glucophage XR, Fortamet, Glumetza, Riomet)
⸻
Pharmacokinetic:
Absorption: Well absorbed orally; incomplete GI absorption
Distribution: Not significantly protein-bound; widely distributed in tissues
Metabolism: Not metabolized by the liver (excreted unchanged)
Excretion: Renal excretion (urine)
Half-life: ~4–8 hours (can be prolonged in renal impairment)
⸻
2. Pharmacodynamics
Decreases blood glucose levels by:
• Inhibiting hepatic gluconeogenesis (↓ liver glucose production)
• Increasing insulin sensitivity in muscle and fat cells
• Enhancing peripheral glucose uptake
• Improving insulin receptor response
Result:
↓ blood glucose levels without stimulating insulin secretion
No hypoglycemia when used alone
Improved insulin sensitivity and glucose utilization
⸻
3. Nursing Responsibilities
Before Administration:
Review blood glucose and HbA1c levels
Assess renal function (creatinine, eGFR)
Assess liver function tests
Check for history of alcohol use disorder
Assess risk for lactic acidosis
Review need for radiographic contrast procedures (hold drug 48 hours before/after)
Establish baseline weight and vital signs
⸻
During Administration:
Administer with meals to reduce GI upset (IR: twice daily; ER: once daily with evening meal)
Monitor for gastrointestinal effects (nausea, diarrhea, anorexia, metallic taste)
Monitor blood glucose levels regularly
Observe for signs of lactic acidosis (malaise, muscle pain, hyperventilation)
Avoid alcohol intake during therapy
Monitor vitamin B12 status with long-term use
⸻
After Administration:
Evaluate therapeutic response (stable or decreased blood glucose levels)
Monitor renal and hepatic function regularly
Assess for GI tolerance and adherence
Monitor for vitamin B12 deficiency (fatigue, neuropathy)
Educate patient on symptoms of lactic acidosis and when to seek immediate care
Reinforce lifestyle modifications (diet, exercise, glucose monitoring)
Document effectiveness and adverse effects
⸻
1. DPP-4 INHIBITORS
Examples: Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta), Alogliptin (Nesina,
Vipidia)
⸻
Pharmacokinetic:
Absorption: Well absorbed orally (PO); once daily administration
Distribution: Widely distributed; moderate protein binding (drug-dependent)
Metabolism: Hepatic metabolism (variable; linagliptin minimal hepatic metabolism)
Excretion: Renal excretion (majority of agents); some via bile/feces (linagliptin)
Half-life: ~12–24 hours (allows once-daily dosing)
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2. Pharmacodynamics
Inhibits dipeptidyl peptidase-4 (DPP-4) enzyme
Prevents breakdown of incretin hormones (GLP-1 and GIP)
Increases incretin levels → stimulates glucose-dependent insulin secretion
Decreases glucagon secretion from pancreatic alpha cells
Reduces hepatic glucose production
Result:
↓ blood glucose levels (glucose-dependent action)
↑ insulin secretion only when glucose is elevated
↓ glucagon release → ↓ liver glucose output
Low risk of hypoglycemia when used alone
⸻
3. Nursing Responsibilities
Before Administration:
Assess fasting blood glucose and HbA1c
Review renal function tests (important for dose adjustment)
Assess liver function tests
Check history of pancreatitis or hypersensitivity reactions
Evaluate risk for diabetic ketoacidosis (DKA)
Assess pregnancy and breastfeeding status
Establish baseline vital signs and symptom history
⸻
During Administration:
Administer orally once daily, with or without food
Monitor blood glucose levels regularly
Observe for signs of hypoglycemia (especially if combined with insulin or sulfonylureas)
Monitor for GI effects (nausea, vomiting, diarrhea, constipation)
Assess for respiratory or urinary tract infections
Watch for signs of pancreatitis (severe abdominal/back pain)
Monitor for allergic reactions (rash, angioedema, anaphylaxis)
⸻
After Administration:
Evaluate therapeutic response (improved glycemic control, lower HbA1c)
Continue monitoring renal and hepatic function
Monitor for rare but serious adverse effects (pancreatitis, renal failure, SJS)
Assess for hypoglycemia episodes if on combination therapy
Educate patient on proper daily adherence and glucose monitoring
Teach recognition and immediate reporting of severe abdominal pain, swelling, or skin blistering
Document effectiveness and adverse drug reactions
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1. SGLT-2 INHIBITORS (Antidiabetic Drugs)
Example: Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin
Pharmacokinetic:
Absorption:
Well absorbed orally; peak plasma concentration reached within 1–2 hours.
Distribution:
Widely distributed; highly protein-bound in plasma.
Metabolism:
Primarily metabolized in the liver (glucuronidation via UGT enzymes; minimal CYP involvement).
Excretion:
Excreted via urine and feces (renal and biliary excretion).
Half-life:
Approximately 10–13 hours (varies slightly per drug).
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2. Pharmacodynamics
Blocks sodium-glucose transporter 2 (SGLT-2) in proximal convoluted tubules
Inhibits reabsorption of filtered glucose in the kidneys
Increases urinary glucose excretion (glycosuria)
Reduces renal glucose threshold
Promotes osmotic diuresis
Result: decreased blood glucose levels → improved glycemic control in type 2 diabetes
Decreases HbA1c levels
Promotes mild weight loss and reduction in blood pressure
Provides cardiovascular and renal protective effects
⸻
3. Nursing Responsibilities
Before Administration:
• Assess baseline blood glucose, HbA1c, electrolytes, renal and hepatic function
• Check for contraindications (severe renal impairment, DKA, dehydration, pregnancy)
• Assess hydration status and blood pressure
• Review current medications (diuretics, ACE inhibitors, ARBs, NSAIDs)
During Administration:
• Monitor blood glucose levels regularly
• Observe for signs of hypovolemia (dehydration, hypotension)
• Monitor for urinary tract infections and genital infections
• Assess for signs of ketoacidosis (nausea, vomiting, abdominal pain)
After Administration:
• Evaluate therapeutic response (↓ blood glucose, ↓ HbA1c)
• Monitor renal function and electrolytes periodically
• Educate patient on adequate hydration, hygiene, and foot care
• Instruct patient to report adverse effects (UTI symptoms, decreased urine, swelling, infections)