4.6 pharmacotherapy of eating disorders Flashcards
What is DMS5, TR diagnostic criteria of anorexia nervosa?
Restriction of energy intake leading to a significantly low body weight
For the pt struggling w anorexia nervosa, what is the main fear?
Intense fear of gaining weight or becoming fat
What are sxs of anorexia nervosa?
Depression, obsessive compulsive disorder, suicidal ideation
How is the restricting type of anorexia nervosa defined?
- During last 3 months, pt has NOT engaged in recurrent episodes of binge eating or purging behavior
- Weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise
How is the binge-eating/purging type of anorexia nervosa defined?
- During last 3 months, pt has engaged in recurrent episodes of binge eating or purging behavior
What is the difference between the binge-eating/purging type of anorexia nervosa and bulimia nervosa?
The difference between the two subgroups is low body weight for AN
How is the mild severity of anorexia nervosa defined by the ICD-10?
BMI >17 kg/m^2
How is the moderate severity of anorexia nervosa defined by the ICD-10?
BMI 16-16.99 kg/m^2
How is the severe severity of anorexia nervosa defined by the ICD-10?
BMI 15-15.99 kg/m^2
How is the extreme severity of anorexia nervosa defined by the ICD-10?
BMI <15 kg/m^2
What does the CDC and WHO consider the low end of normal BMI?
18.5 kg/m^2
What are health consequences/sxs of anorexia nervosa?
- Abnormally slow HR, BP
- Decreased bone density
- Weakness
- Electrolyte abnormalities
- Hypoglycemia
- Dry skin, hair loss
- Severe dehydration
- Downy layer of hair (lanugo) all over body
- Cold intolerance, delayed gastric emptying, constipation
What is the tx focus of anorexia nervosa for inpatient hospitalization?
Tx of acute risks:
- Suicidality, psychosis, severe electrolyte abnormalities, cardiac irregularities
What is the tx focus of anorexia nervosa for outpatient hospitalization?
Tx of chronic sxs and relapse prevention:
- Psychotherapy, group therapy, nutritional counseling, family systems work
What does re-feeding syndrome of anorexia nervosa result in?
Re-feeding results in shift from fat metabolism to glucose metabolism
What are sxs of re-feeding syndrome?
Hypokalemia, water retention, severe edema
What is the health consequence of re-feeding syndrome?
Multiple organ failure
What is the general caloric tx for anorexia nervosa?
Increase calories slowly (often eating as low as 300-700 kcal/day)
What is the inpt tx for anorexia nervosa?
Increase by 500 kcal/day q4 days up to 3500 kcal/day
What is the outpt tx for anorexia nervosa?
Initial re-feeding 1200-1500 kcal/day (increase weekly by 500 kcal)
What is the non-pharm therapy for anorexia nervosa that has the best outcomes?
Cognitive behavioral
What are the pharmacotherapies for anorexia nervosa?
- No drug therapy is FDA approved
- Olanzapine: mod. weight gain
- Bupropion is CI
What is the diagnostic criteria for binge eating disorder by the DSM5, TR?
- Recurrent episodes of binge eating
- Occurs, on avg, at least once a week for 3 months
- NOT associated w recurrent use of inappropriate compensatory behavior
How is the mild severity of binge eating disorder defined?
1-3 episodes per week
How is the moderate severity of binge eating disorder defined?
4-7 episodes per week
How is the severe severity of binge eating disorder defined?
8-13 episodes per week
How is the extreme severity of binge eating disorder defined?
> = 14 episodes per week
What are the health consequences of binge eating disorder?
- HTN
- Elevated cholesterol
- CV disease
- T2DM
- Gallbladder disease
What is the pharmacotherapy for binge eating disorder?
Lisdexamfetamine (vyvanse)
What tx provides the best outcomes for treatment of binge eating disorder?
CBT + medication
What is the diagnostic criteria for bulimia nervosa by the DSM5, TR?
- Recurrent episodes of binge eating
- Recurrent inappropriate compensatory behaviors
- Occurs, on avg, at least 1/week for 3 months
How is the mild severity of bulimia nervosa defined?
1-3 episodes/week
How is the moderate severity of bulimia nervosa defined?
4-7 episodes/week
How is the severe severity of bulimia nervosa defined?
8-13 episodes/week
How is the extreme severity of bulimia nervosa defined?
> = 14 episodes/week
What are the health consequences of bulimia nervosa?
Amenorrhea, orthostatic hypotension, bradycardia, arrhythmias, osteopenia, osteoporosis
How does electrolyte imbalance happen in bulimia nervosa?
- Electrolyte imbalances due to dehydration and loss of electrolytes through purging
- Risk for irregular heartbeats, possibly HF and death
What are digestive tract health consequences of bulimia nervosa?
- Inflammation, gastric rupture, esophageal rupture from frequent vomiting (Mallory Weiss tears)
- Chronic irregular bowel movements
- Constipation from laxative abuse
What are dental health consequences of bulimia nervosa?
Tooth decay, staining, permanent loss of dental enamel from stomach acids
What diabetes related health consequence occurs from bulimia nervosa?
Diabetic ketoacidosis from withholding insulin in T1DM
What are the methods of purging of bulimia nervosa?
- Vomiting
- Laxatives
- Diuretics
- Excessive exercise
- Diabulimia
What is diabulimia?
Pts w T1DM and bulimia give themselves less insulin than needed or stop taking insulin to promote weight loss
What is the pharmacotherapy of bulimia nervosa?
Fluoxetine is FDA approved
What provides the best outcomes for treating bulimia nervosa?
CBT + med
