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Therapeutics III > Eating Disorders - Block 3 > Flashcards

Eating Disorders - Block 3 Flashcards

1
Q

What are the types of eating disorders?

A
  1. Anorexia nervosa
  2. Atypical anorexia nervosa
  3. Bulimia nervosa
  4. Binge eating disorder
  5. ARFID
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2
Q

What is purging?

A

Compensatory behvaior:
1. Exercise
2. Vomiting
3. Laxatives
4. Diuretics

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3
Q

Bulimia involves both ___ and ___?

A

binging and purging

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4
Q

Why is vomiting who restrict calories dangerous?

A
  1. Less likely to replete electrolyes
  2. Exacerabte med complications
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5
Q

Is dieting an ED?

A

Not all patients who diet develop an eating disorder, but most patients with an eating disorder started by dieting

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6
Q

How do we assess Eating disorders?

A

APA recommends screeing as part of initial psych eval

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7
Q

What is the initial evaluation of a ED?

A
  1. Height/weight
  2. Patterns in eating or restiction
  3. patterns and changes in food repertoire
  4. Patterns of compensatory behavior
  5. percentage of time preoccupied with food, weight, and body shape
  6. prior treatment and response to treatment for an eating disorder
  7. psychosocial impairment
  8. Family hx
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8
Q

What is common ED assessment tools?

A

SCOFF questionaire

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9
Q

What does the SCOFF assess?

A
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10
Q

What are basic quetions you can incorporate in an ED assessment?

A
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11
Q

What are co-occurring conditions thatcan contribute to ED?

A
  1. Substance use hx
  2. Trauma hx
  3. Suicide risk
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12
Q

Physical examination of ED?

A

Abnormal vitals: HR <50, SBP <90, temp <36C
HEight, weight BMI

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13
Q

If purging behavior is present what do you do?

A
  1. Refer for dental evalv
  2. Instruct patient not to brush teeth after vomiting
  3. Oral rinse with water after vomiting and avoid igestion of carbonated drinks or citrus fruits to reduce dentination
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14
Q

Serum electrolyte abnormalities of ED?

A

NR: Hypokalemia, hyponatremia, hypomagnesemia, hypophosphatemia
P: with metabolic acidosis

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15
Q

Renal function tests of ED?

A

NR: Increased BUN, decreased GFR, decreased Cr because of low lean body mass (normal creatinine may indicate azotemia), renal failure (rare)
P: Increased BUN, CR

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16
Q

Serum glucose of ED

A

NR: Low

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17
Q

Liver function of EF?

A

NR: Elevated LFT

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18
Q

Lipid panel of ED?

A

NR: Hypercholesterolemia

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19
Q

Urinalysis of ED?

A

NR: Urinary specific gravity abnormalities
P: with high pH

20
Q

Serum gonadotropins and sex hormones of ED

A

NR: Decreased serum estrogen or serum testosterone; prepubertal patterns of LH, FSH

P: hypoestrogenemic, if menstrual irregularities are present

21
Q

Bone densitometry
(DXA scan) of ED?

A

NR and P: Reduced BMD, osteopenia, or osteoporosis in individuals with previous low weight and menstrual irregularity or amenorrhea

22
Q

Dental radiography of ED

A

P: erosion of dental enamel

23
Q

ECG ab of ED?

A

NR: Bradycardia or arrhythmias,
QTc prolongation
P: Increased P-wave amplitude and duration, increased PR interval, widened QRS complex, QTc prolongation, ST depression, T-wave inversion or flattening, U waves, supraventricular or ventricular tachyarrhythmias

24
Q

Whole body sx of ED?

A

NR, P

25
Q

CNS sx of NR and P?

A
26
Q

Oropharyngeal sx of NR and P?

A
27
Q

GI sx of NR and P?

A
28
Q

CV sx of NR and P?

A
29
Q

Reporductive sx of NR and P?

A
30
Q

Muscular sx of NR and P?

A
31
Q

Skeletal sx of NR and P?

A
32
Q

Derm sx of NR and P?

A
33
Q

What is anorexia nervosa?

A
  1. Restrictive food intake leading to significant low body weight
  2. Intense fear of gaining weight or becoming fat
    OR
  3. Restrictive food intake leading to significant low body weight
    Intense fear of gaining weight or becoming fat
  4. Body dysmorphia
34
Q

Non-pharm for anorexia nervosa?

A

Weight restoration: start with 1,500-2,000 kcal/day, rapidly advance to 3,000-4,000 kcal/day divided into meals and snacks and adjust further as needed
* Calorie dense liquid supplements can be given in between meals

35
Q

Pharm for anorexia nervosa?

A
  1. Olanzapine
  2. SSRI/AD
  3. Buproprion
  4. Citalopram, quetiapine, TD estradiol, hGh, cisapride
  5. Estrogen or bisphosphonated for bone health (not routinely recommended)
36
Q

What ED is not recommended to use bupropion?

A

Purging due to increased sz

37
Q

What is atypical anorexia?

A

Was the criteria of anorexia with normal weight

38
Q

What is bulimia nervosa?

A

Recurrent episodes of binge eating that is out of control, within 2 hr period, excessive eating
THEN
Recurrent inappropriate compensatory behaviors to prevent weight gain

39
Q

How often does Bulimia nervosa occur?

A

At least 1x/week for 3 months

40
Q

What are the recommened tx for bulimia nervosa?

A
  1. CBT
  2. SSRI (fluoxetine)
  3. Lithium (caution to avoid toxicity from dehydration from vomitting or purging using laxatives
41
Q

What drug is CI with BN?

A

Bupropion do to sz risk

42
Q

What constitutes a binge eating disorder?

A
  1. Recurrent episodes of bingeing: (2hr eating, 1/wk for 3 months, lack of control)
  2. 3 or more of the following:
    * Eating fast
    * Being uncomfortably full
    * Eating large amounts of food when not hungry
    * Eating alone
    * Feeling disgusted
43
Q

Tx for binge eating disorders?

A
  1. CBT
  2. antidepressant medication or lisdexamfetamine
44
Q

How would you dose Vyvanze for binge eating?

A

Initial: 30 mg QAM, increase 20 mg/wk to 50-70 mg
* No hepatic dose adj
* Renal impariment: Max, 50 mg/day
* Caution in HTN or CV patient

45
Q

Compare and contrast the different ED?

A
46
Q

what is ARFID?

A

Lack of interest in food or concern about adverse consequences of eating (no weight or body shape concerns)

Therapeutics III (40 decks)

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