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NMSP Exam 3 > Eating Disorders and Refeeding Syndrome > Flashcards

Eating Disorders and Refeeding Syndrome Flashcards

1
Q

What are the suicide rates for Bulimia Nervosa

A

7x higher than general population

25-40% have attempted suicide in the past

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2
Q

What are the suicide rates for anorexia nervosa?

A

5x higher than general population

8-27% have a history of attempted suicide

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3
Q

What are teh DSM5 criteria for AN?

A

restriction of energy intake leading to low body weight

intense fear of gaining weight or becoming fat

distorted perception of body weight/shape

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4
Q

What are some questions in the Eating Disorder Screen for Primary Care?

A
  1. Are you satisified with your eating patterns
  2. Do you ever eat in secret
  3. Does your weight affect the way you feel about yourself?
  4. Have members of your family suffered with an ED?
  5. Do you currently or in the past suffered with an ED?
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5
Q

Describe the Restricting type of AN?

A

3 months of no binging or purging

-may see excessive exercising, fasting, and dieting

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6
Q

What is the Binge-Purging type of AN?

A

3 months of binging and purging

-may see self induced vomiting, misuse of laxatives, diuretics or enemas

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7
Q

Paradoxically, fear of weight gain may increase as what decreases?

A

As pt’s weight decreases and they become thinner, they fear weight gain even more

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8
Q

What are some cardiac complications of AN?

A

Bradycardia,

QT dispersion

Cardiac atrophy

hypotension

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9
Q

What are some GI and GU complications of AN?

A

Amenorrhea and decreased libido

Gastroparesis and constipation

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10
Q

What are some endocrine complications of AN?

A

Osteoporosis

hypotehermia

euthryoid

hypoglycemia

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11
Q

What are some electrolye complications of AN?

A

Dehydration

Hypokalemia

Hypophosphatemia

Hypomagnesemia

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12
Q

What are some Pulmonary and Hematologic complications of AN?

A

Resp. muscle atrophy and dyspnea

anemia, leukopenia, thrombocytopenia

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13
Q

What are some neurological and dermatologic complications of AN?

A

brain atrophy

xerosis

lanugo

carotenoderma

acrocyanosis

SD

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14
Q

What happens if a pt is rehydrated or fed beyond their current capacity?

A

Re-feeding syndrome-very serious, do not over feed

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15
Q

What is Re-Feeding Syndrome?

A

complication that occurs as a result of fluid and electrolyte shifts during aggressive nutritional rehabilitation of malnourished patients

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16
Q

What are some fatal outcomes of re-feeding syndrome?

A

hypophosphatemia

hypokalemia

CHF

Peripheral edema

Rhabdomyolysis

Sz

Hemolysis

17
Q

How can re-feeding syndrome be avoided?

A

carefully limit amount of calories and fluids in the early stages of refeeding

avoid very rapid increases in daily calories

closely monitor labs in first few weeks

18
Q

What other conditions are associated with AN?

A

OCD, OCPD

Perfectionism, compulsivity, narcissism

19
Q

What are the goals of nutritional rehab for AN patients?

A

work with a RD

2-3lbs per week for inpatient care

0.5-1lb per week for outpatients

start with 30-40kcal/kg and increase as needed

goal to bring t back to normal body weight and teach proper eating and self-care

20
Q

What are the therapy options for AN patients?

A

CBT

Specialist supportive clinical management

motivational interviewing

family therapy (good for adolescents)

*choice of therapy based on pt preference

21
Q

What are some considerations when chosing pharm agents for AN patients?

A

If therapy has not been helpful and pt willing to take meds, start at low dose

avoid bupropion due to sz risk

avoid TCA due to cardiotoxicity

Caution with antipsychotics or antidepressants that can prolong QT

22
Q

What are two good drug choices in AN and why?

A

Olanzapine can help with weight gain

Lorazepam can help with meal associated anxiety

23
Q

When should SSRIs be considered in AN treatment?

A

If anxiety/depression is inhibiting the pt from continuing care

may consider 2nd gen antipsychotic if depression is unresponsive to SSRIs

24
Q

What is the DSM 5 defintion of Bulimia Nervosa?

A

Binging without a sense of control in a short period of time

Followed by inappropriate compensatory behavior to prevent weight gain

Occurs at least 2x per week for 3 months

25
Q

While pt’s with AN are almost exclusively underweight, pt’s with BN can be

A

slightly underweight, overweight, normal weight or obese

26
Q

How do pt’s with BN tend to feel during and after purging and what is their goal?

A

They may feel out of control and ashamed during the binge

Often feel dysphoric after the binge

Typically don’t want to lose weight, but want to avoid gaining weight

27
Q

What are some electrolyte complications of BN?

A

Dehydration

Hypokalemia

Hypochloremia

Metabolic Alkalosis

28
Q

What are the cardiac complications of BN?

A

hypotension

orthostasis

sinus tachy

ECH changes

arrhythmias

29
Q

What are some GI complications of BN?

A

MW tear

Esophageal rupture

Parotid and submandibular gland hypertrophy

Abdominal pain/bloating/constpiation

30
Q

What are some dental and skin complications of BN?

A

tooth erosions/caries

scar/callus on dorsum of hand (Russel’s Sign)

xerosis

31
Q

What is the best treatment for BN?

A

nutritional rehab, CBT and pharm

32
Q

What drug should be avoided in BN treatment?

A

Bupropion due to increased Sz risk with binging and purging

33
Q

What is the first line drug agent for BN?

What is 2nd line treatment for BN?

What is 3rd line treatment for BN?

A

Fluoxetine

Other SSRIs (Sertraline or Fluvoaxamine)

TCA, Topiramate, Trazodone, MAOIs

34
Q

What is Binge Eating Disorder?

A

Same as binge-purge but without the purge part

35
Q

What is the first and only medication approved to treat moderate to severe BED in adults?

A

vyvanse

36
Q

What is the first line treatment for BED?

A

CBT and IPT

NMSP Exam 3 (21 decks)

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