MCQ Quiz: Pharmacology of Weight Loss Agents/Stimulants

The pharmacology of weight loss agents is a rapidly evolving field, offering new hope to patients struggling with obesity and its related comorbidities. As a pharmacist, understanding the mechanisms, side effects, and appropriate clinical use of these medications is paramount. The PharmD curriculum, through dedicated modules in courses like Patient Care 4, provides a comprehensive overview of the “Pharmacology of Weight Loss Agents/Stimulants.” This quiz will test your knowledge on the various drug classes used for weight management, from traditional stimulants to the newer GLP-1 receptor agonists, preparing you to counsel and manage patients effectively.

1. Phentermine is a sympathomimetic amine that promotes weight loss primarily by:

• a. Inhibiting lipase enzymes in the gut.
• b. Increasing the release of norepinephrine to suppress appetite.
• c. Acting as a GLP-1 receptor agonist.
• d. Blocking opioid receptors in the brain.

Answer: b. Increasing the release of norepinephrine to suppress appetite.

2. Orlistat (Xenical, Alli) works by which of the following mechanisms?

• a. It is a central nervous system stimulant.
• b. It increases metabolic rate.
• c. It inhibits gastric and pancreatic lipases, reducing the absorption of dietary fat.
• d. It modulates serotonin levels in the brain.

Answer: c. It inhibits gastric and pancreatic lipases, reducing the absorption of dietary fat.

3. Liraglutide (Saxenda) and semaglutide (Wegovy) belong to which class of medications?

• a. Lipase inhibitors
• b. Anorexiants
• c. GLP-1 Receptor Agonists
• d. Combination naltrexone/bupropion therapy

Answer: c. GLP-1 Receptor Agonists

4. A patient taking orlistat should be counseled to take which supplement, separated by at least 2 hours from the orlistat dose?

• a. Vitamin C
• b. A fat-soluble multivitamin (A, D, E, K)
• c. An iron supplement
• d. A B-complex vitamin

Answer: b. A fat-soluble multivitamin (A, D, E, K)

5. The combination product phentermine/topiramate (Qsymia) is contraindicated in patients with:

• a. Diabetes
• b. Hypertension
• c. Glaucoma
• d. Asthma

Answer: c. Glaucoma

6. The “Pharmacology of Weight Loss Agents/Stimulants” is a specific learning module in which course?

• a. PHA5784C Patient Care 4
• b. PHA5104 Sterile Compounding
• c. PHA5703 Pharmacy Law and Ethics
• d. PHA5878C Patient Care 3

Answer: a. PHA5784C Patient Care 4

7. GLP-1 receptor agonists promote weight loss by which mechanism?

• a. Increasing heart rate and metabolism.
• b. Increasing satiety (feeling of fullness) and slowing gastric emptying.
• c. Blocking fat absorption.
• d. Directly causing lipolysis.

Answer: b. Increasing satiety (feeling of fullness) and slowing gastric emptying.

8. A common and expected side effect of phentermine is:

• a. Drowsiness
• b. Bradycardia
• c. Increased heart rate and dry mouth
• d. Weight gain

Answer: c. Increased heart rate and dry mouth

9. Naltrexone/bupropion (Contrave) is contraindicated in patients:

• a. With hypertension.
• b. With diabetes.
• c. With an uncontrolled seizure disorder or who are taking chronic opioids.
• d. With high cholesterol.

Answer: c. With an uncontrolled seizure disorder or who are taking chronic opioids.

10. A common side effect that limits the tolerability of orlistat is:

• a. Insomnia
• b. Headache
• c. Gastrointestinal effects like flatus with oily discharge.
• d. Dry cough

Answer: c. Gastrointestinal effects like flatus with oily discharge.

11. Which weight loss medication is administered as a subcutaneous injection?

• a. Orlistat
• b. Phentermine/topiramate
• c. Liraglutide
• d. Naltrexone/bupropion

Answer: c. Liraglutide

12. The topiramate component of Qsymia is thought to contribute to weight loss through appetite suppression and altered taste perception, but it requires slow titration to minimize:

• a. Cardiovascular side effects.
• b. Gastrointestinal side effects.
• c. Cognitive side effects like memory impairment and paresthesia.
• d. Dermatological side effects.

Answer: c. Cognitive side effects like memory impairment and paresthesia.

13. A patient is prescribed naltrexone/bupropion. The pharmacist should confirm that the patient is not currently taking which class of medications for pain?

• a. NSAIDs
• b. Acetaminophen
• c. Opioids
• d. Muscle relaxants

Answer: c. Opioids

14. The primary indication for initiating pharmacotherapy for weight loss is:

• a. A desire to lose 5 pounds for cosmetic reasons.
• b. As an adjunct to diet and exercise for patients with a BMI ≥ 30 or ≥ 27 with comorbidities.
• c. As a replacement for diet and exercise.
• d. For any patient who asks for it.

Answer: b. As an adjunct to diet and exercise for patients with a BMI ≥ 30 or ≥ 27 with comorbidities.

15. GLP-1 receptor agonists carry a boxed warning for a risk of what, based on rodent studies?

• a. Myocardial infarction
• b. Stroke
• c. Thyroid C-cell tumors
• d. Severe liver injury

Answer: c. Thyroid C-cell tumors

16. The pharmacotherapy of weight loss agents is a specific lecture topic within the Patient Care 4 curriculum.

• a. True
• b. False

Answer: a. True

17. How long is phentermine monotherapy approved for?

• a. Lifelong use
• b. For 2 years
• c. For short-term use (e.g., up to 12 weeks)
• d. For one week only

Answer: c. For short-term use (e.g., up to 12 weeks)

18. What is the most common side effect when initiating a GLP-1 receptor agonist?

• a. Constipation
• b. Nausea
• c. Headache
• d. Insomnia

Answer: b. Nausea

19. A patient taking orlistat eats a very high-fat meal. What is the likely consequence?

• a. The patient will have increased absorption of the fat.
• b. The patient will experience more severe gastrointestinal side effects.
• c. The orlistat will be more effective.
• d. There will be no noticeable effect.

Answer: b. The patient will experience more severe gastrointestinal side effects.

20. The “Med Chem of Weight Loss Agents/Stimulants” is a topic within the Patient Care 4 curriculum.

• a. True
• b. False

Answer: a. True

21. Phentermine is classified as what schedule of controlled substance?

• a. Schedule II
• b. Schedule III
• c. Schedule IV
• d. Schedule V

Answer: c. Schedule IV

22. Which weight loss medication is available over-the-counter at a reduced strength?

• a. Phentermine
• b. Liraglutide
• c. Orlistat
• d. Bupropion

Answer: c. Orlistat

23. The bupropion component of Contrave works by:

• a. Inhibiting lipase.
• b. Acting as a GLP-1 agonist.
• c. Increasing dopamine and norepinephrine levels to reduce appetite.
• d. Blocking opioid receptors.

Answer: c. Increasing dopamine and norepinephrine levels to reduce appetite.

24. A patient taking naltrexone/bupropion should be advised to avoid taking their dose with what type of meal?

• a. A high-protein meal
• b. A high-carbohydrate meal
• c. A high-fat meal
• d. A low-sodium meal

Answer: c. A high-fat meal

25. Before dispensing phentermine/topiramate to a female of childbearing potential, the pharmacist must confirm:

• a. She has a negative pregnancy test and is on effective contraception.
• b. She has a history of diabetes.
• c. She is not taking any other medications.
• d. She can afford the medication.

Answer: a. She has a negative pregnancy test and is on effective contraception.

26. The role of the pharmacist in weight management includes:

• a. Identifying appropriate candidates for pharmacotherapy.
• b. Counseling on lifestyle modifications, side effects, and realistic expectations.
• c. Monitoring for efficacy and safety.
• d. All of the above.

Answer: d. All of the above.

27. Most “fat burner” supplements sold over-the-counter contain:

• a. A potent lipase inhibitor.
• b. A GLP-1 receptor agonist.
• c. A high dose of stimulants like caffeine.
• d. A prescription-strength anorexiant.

Answer: c. A high dose of stimulants like caffeine.

28. An active learning session covering nutrition and weight management is part of the Patient Care 4 course.

• a. True
• b. False

Answer: a. True

29. If a patient has not achieved at least a 5% weight loss after 12 weeks on the maximum tolerated dose of a weight loss agent, the medication should generally be:

• a. Continued indefinitely.
• b. Increased in dose.
• c. Discontinued.
• d. Switched to a different brand of the same drug.

Answer: c. Discontinued.

30. The “Introduction to Obesity” is a specific lecture in the Patient Care 4 curriculum.

• a. True
• b. False

Answer: a. True

31. The mechanism of GLP-1 agonists on weight loss involves effects on both the gut and which other organ?

• a. The liver
• b. The kidneys
• c. The brain (hypothalamus)
• d. The lungs

Answer: c. The brain (hypothalamus)

32. A patient with a history of pancreatitis should use which class of weight loss medications with caution?

• a. Lipase inhibitors
• b. Stimulants
• c. GLP-1 receptor agonists
• d. All weight loss medications are safe in pancreatitis.

Answer: c. GLP-1 receptor agonists

33. The primary benefit of using combination therapy like phentermine/topiramate is:

• a. It allows for lower doses of each component, potentially reducing side effects while achieving synergistic efficacy.
• b. It is cheaper than monotherapy.
• c. It has a faster onset of action.
• d. It can be used in all patient populations.

Answer: a. It allows for lower doses of each component, potentially reducing side effects while achieving synergistic efficacy.

34. Which of the following is NOT a mechanism of action for any FDA-approved weight loss drug?

• a. Increasing satiety.
• b. Suppressing appetite.
• c. Reducing fat absorption.
• d. Increasing the basal metabolic rate via thyroid hormone agonism.

Answer: d. Increasing the basal metabolic rate via thyroid hormone agonism.

35. A key counseling point for any weight loss medication is that it is an adjunct to, not a substitute for:

• a. Sleep
• b. Hydration
• c. Diet and exercise
• d. Vitamin supplements

Answer: c. Diet and exercise

36. Phentermine is structurally related to what other substance?

• a. Caffeine
• b. Nicotine
• c. Amphetamine
• d. Theophylline

Answer: c. Amphetamine

37. When counseling a patient on a self-injectable GLP-1 agonist, it is important to instruct them on:

• a. Rotating injection sites.
• b. Proper disposal of needles in a sharps container.
• c. How to prime the pen before first use.
• d. All of the above.

Answer: d. All of the above.

38. The naltrexone component of Contrave is an opioid antagonist. This means it will block the effects of:

• a. Ibuprofen
• b. Acetaminophen
• c. Hydrocodone
• d. Aspirin

Answer: c. Hydrocodone

39. Self-care supplements for weight loss are a topic within the Patient Care 4 curriculum.

• a. True
• b. False

Answer: a. True

40. The main safety concern with many unregulated herbal weight loss products is:

• a. Their high efficacy.
• b. The presence of undeclared stimulants or prescription drugs.
• c. Their pleasant taste.
• d. Their low cost.

Answer: b. The presence of undeclared stimulants or prescription drugs.

41. How does topiramate contribute to weight loss?

• a. Its exact mechanism is unknown, but may involve appetite suppression and altered taste.
• b. It is a potent lipase inhibitor.
• c. It increases the release of norepinephrine.
• d. It blocks fat absorption.

Answer: a. Its exact mechanism is unknown, but may involve appetite suppression and altered taste.

42. A patient with uncontrolled hypertension should not be prescribed which weight loss agent?

• a. Orlistat
• b. Phentermine
• c. A GLP-1 receptor agonist
• d. All are safe.

Answer: b. Phentermine

43. A realistic expectation for weight loss with pharmacotherapy is approximately what percentage of body weight?

• a. 1-2%
• b. 5-15%
• c. 25-30%
• d. Over 40%

Answer: b. 5-15%

44. Which of the following is a cardiovascular side effect of phentermine?

• a. Bradycardia
• b. Hypotension
• c. Tachycardia
• d. Normal sinus rhythm

Answer: c. Tachycardia

45. What is the role of the pharmacist when a patient asks about an OTC weight loss supplement they saw online?

• a. To encourage the patient to buy it immediately.
• b. To provide evidence-based information on its likely efficacy and potential for harm.
• c. To state that all supplements are safe and effective.
• d. To refuse to discuss it.

Answer: b. To provide evidence-based information on its likely efficacy and potential for harm.

46. A patient reports their orlistat capsules are causing very bothersome oily spotting. The pharmacist should advise the patient to:

• a. Stop the medication immediately.
• b. Double the dose.
• c. Reduce their dietary fat intake.
• d. Take the medication on an empty stomach.

Answer: c. Reduce their dietary fat intake.

47. The primary goal of managing obesity is to:

• a. Achieve a specific number on the scale.
• b. Improve health by reducing the risk and severity of weight-related comorbidities.
• c. Fit into a smaller size of clothing.
• d. Eliminate all fat from the diet.

Answer: b. Improve health by reducing the risk and severity of weight-related comorbidities.

48. An active learning session on pharmacotherapy for weight loss is part of the Patient Care 4 curriculum.

• a. True
• b. False

Answer: a. True

49. Why is a REMS (Risk Evaluation and Mitigation Strategy) program required for phentermine/topiramate?

• a. Due to the high cost of the medication.
• b. Due to the risk of abuse.
• c. Due to the significant risk of teratogenicity from the topiramate component.
• d. Due to its gastrointestinal side effects.

Answer: c. Due to the significant risk of teratogenicity from the topiramate component.

50. The ultimate goal of understanding the pharmacology of weight loss agents is to:

• a. Be able to recommend them to all patients.
• b. Help appropriate patients achieve and maintain a healthier weight as part of a comprehensive lifestyle plan.
• c. Memorize a list of side effects.
• d. Pass the final exam.

Answer: b. Help appropriate patients achieve and maintain a healthier weight as part of a comprehensive lifestyle plan.