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Pharmacology · chapter 32 · Weight Management Drugs

Other Drugs, Supplements, and Herbal Remedies

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Who semaglutide is for

    Semaglutide is intended for use in adults with an initial BMI of 30 kg/m 2 or greater (obesity) or an initial BMI of 27 kg/m 2 or greater (overweight) and at least one weight-related comorbidity such as hypertension, type 2 diabetes mellitus, or dyslipidemia (DailyMed, Wegovy, 2023).

  2. Delayed gastric emptying affects other drugs

    Note that because semaglutide delays gastric emptying, it may alter the absorption of other medications and supplements.

  3. Liraglutide raises heart rate

    This action also causes an ancillary increase in heart rate of 10–20 beats per minute above the client’s baseline.

  4. Protect yourself when giving liraglutide

    Double gloves and a protective gown (and goggles if necessary) should be worn during preparation and SQ administration to avoid unintentional absorption through the skin.

  5. Caution with insulin and sulfonylureas

    Caution should be exercised when used concurrently with insulin and insulin secretagogues like sulfonylureas.

  6. Signs of hypoglycemia to teach

    Teach clients to monitor for signs and symptoms of hypoglycemia that may occur from weight loss and/or the supplement such as headache, nervousness, irritability, sweating, clammy skin, shakiness, and palpitations.

  7. Avoid alcohol

    Avoid alcohol, which may interfere with weight-loss drugs and potentially cause hypoglycemia.

  8. Boxed warning: thyroid tumors in animals

    Semaglutide and liraglutide have been associated with thyroid tumors in animal studies; relevance to humans has not been established.

  9. Bupropion naltrexone serious effects

    Adverse effects of bupropion naltrexone include life-threatening anaphylactic reactions (pruritis, urticaria, hives, dyspnea, angioedema), homicidal/suicidal thoughts and behaviors, and seizures.

  10. Seizure risk with bupropion

    Use of other bupropion-containing products may increase the risk of seizures. Bulimia and anorexia nervosa may also increase the risk of seizures.

  11. Bupropion black box warning

    Bupropion has been shown to increase the risk of suicidal thoughts and behavior in short-term trials.

  12. Chromium and insulin

    Clients who are dependent on insulin should use it under medical guidance and monitor their capillary blood glucose levels (Balch, 2023).

  13. Guarana and the heart

    Due to the stimulant effects, guarana should not be used by clients with hypertension or cardiovascular conditions such as dysrhythmias.

  14. OTC products can interact

    Educate clients that some over-the-counter (OTC) products may not be safe and can interact with other prescribed medications, including increasing the risk of hypoglycemia.

Terms to know

Bupropion naltrexone
Bupropion naltrexone (Contrave) is a combination of an antidepressant (bupropion) and an opioid antagonist (naltrexone).
Glucomannan
Glucomannan is a dietary fiber extracted from the konjac (elephant yam), a Japanese root vegetable.
Guarana
Guarana is a seed with stimulant and phytochemical properties containing caffeine as the active ingredient.
Conjugated linoleic acid (CLA)
Conjugated linoleic acid (CLA) is a polyunsaturated fatty acid found naturally in animal food products such as beef, lamb, butter, and dairy products.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

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  1. A client asks about starting semaglutide for weight loss. Which finding in the history should the nurse report to the provider?

    1. Family history of medullary thyroid carcinoma
    2. BMI of 32
    3. Controlled hypertension
    4. Dyslipidemia

    Answer: Family history of medullary thyroid carcinoma

    Semaglutide and liraglutide are contraindicated with a personal or family history of medullary thyroid carcinoma. A BMI of 30 or more with comorbidities such as hypertension or dyslipidemia is an indication for the drug.

  2. A client on bupropion naltrexone tells the nurse they have been feeling hopeless and thinking about ending their life. What should the nurse do?

    1. Report it to the provider immediately.
    2. Tell the client this is a common side effect that will pass.
    3. Suggest the client take it with alcohol to relax.
    4. Increase the dose to improve mood.

    Answer: Report it to the provider immediately.

    Bupropion carries a black box warning for increased suicidal thoughts and behavior, and clients must immediately report increased depression or suicidal ideation. It should not be dismissed or treated by raising the dose, and alcohol is to be avoided.

  3. A nurse is preparing a liraglutide injection. Which precaution is recommended?

    1. Inject it intramuscularly.
    2. Mix it with the client's insulin in one syringe.
    3. Give it only with meals.
    4. Wear double gloves and a protective gown.

    Answer: Wear double gloves and a protective gown.

    Double gloves and a gown (and goggles if needed) are worn during preparation and subcutaneous administration to avoid absorption through the skin. Liraglutide is given subcutaneously once a day without regard to meals.

  4. A client with type 2 diabetes starts a GLP-1 drug for weight loss. Which signs of hypoglycemia should the nurse teach the client to watch for? Select all that apply.

    1. Nervousness
    2. Sweating and clammy skin
    3. Palpitations
    4. Shakiness
    5. Hot, dry skin

    Answer: Nervousness, Sweating and clammy skin, Palpitations, Shakiness

    Signs of hypoglycemia include headache, nervousness, irritability, sweating, clammy skin, shakiness and palpitations. Hot, dry skin is not listed as a sign of hypoglycemia.

  5. Which conditions are contraindications to bupropion naltrexone? Select all that apply.

    1. Anorexia or bulimia
    2. Chronic opioid use
    3. Well-controlled seasonal allergies
    4. Uncontrolled hypertension
    5. Seizure disorder

    Answer: Anorexia or bulimia, Chronic opioid use, Uncontrolled hypertension, Seizure disorder

    Bupropion naltrexone is contraindicated in seizure disorders, uncontrolled hypertension, anorexia or bulimia, and chronic opioid use, among others. Seasonal allergies are not listed.

  6. A client with atrial dysrhythmias wants to buy an energy drink containing guarana to help lose weight. What should the nurse advise?

    1. Guarana alone produces major weight loss.
    2. Guarana is safe for anyone because it is natural.
    3. Take it at bedtime to avoid side effects.
    4. Because of its stimulant effects, guarana should not be used with cardiovascular conditions such as dysrhythmias.

    Answer: Because of its stimulant effects, guarana should not be used with cardiovascular conditions such as dysrhythmias.

    Guarana contains caffeine and should not be used by clients with hypertension or cardiovascular conditions such as dysrhythmias. It does not significantly promote weight loss on its own.

Where every quote comes from

Section 32.4 Other Drugs, Supplements, and Herbal Remedies of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.