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PHRM 845 > 4.6 pharmacotherapy of eating disorders > Flashcards

4.6 pharmacotherapy of eating disorders Flashcards

1
Q

What is DMS5, TR diagnostic criteria of anorexia nervosa?

A

Restriction of energy intake leading to a significantly low body weight

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2
Q

For the pt struggling w anorexia nervosa, what is the main fear?

A

Intense fear of gaining weight or becoming fat

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3
Q

What are sxs of anorexia nervosa?

A

Depression, obsessive compulsive disorder, suicidal ideation

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4
Q

How is the restricting type of anorexia nervosa defined?

A
  • 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
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5
Q

How is the binge-eating/purging type of anorexia nervosa defined?

A
  • During last 3 months, pt has engaged in recurrent episodes of binge eating or purging behavior
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6
Q

What is the difference between the binge-eating/purging type of anorexia nervosa and bulimia nervosa?

A

The difference between the two subgroups is low body weight for AN

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7
Q

How is the mild severity of anorexia nervosa defined by the ICD-10?

A

BMI >17 kg/m^2

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8
Q

How is the moderate severity of anorexia nervosa defined by the ICD-10?

A

BMI 16-16.99 kg/m^2

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9
Q

How is the severe severity of anorexia nervosa defined by the ICD-10?

A

BMI 15-15.99 kg/m^2

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10
Q

How is the extreme severity of anorexia nervosa defined by the ICD-10?

A

BMI <15 kg/m^2

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11
Q

What does the CDC and WHO consider the low end of normal BMI?

A

18.5 kg/m^2

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12
Q

What are health consequences/sxs of anorexia nervosa?

A
  • 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
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13
Q

What is the tx focus of anorexia nervosa for inpatient hospitalization?

A

Tx of acute risks:
- Suicidality, psychosis, severe electrolyte abnormalities, cardiac irregularities

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14
Q

What is the tx focus of anorexia nervosa for outpatient hospitalization?

A

Tx of chronic sxs and relapse prevention:
- Psychotherapy, group therapy, nutritional counseling, family systems work

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15
Q

What does re-feeding syndrome of anorexia nervosa result in?

A

Re-feeding results in shift from fat metabolism to glucose metabolism

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16
Q

What are sxs of re-feeding syndrome?

A

Hypokalemia, water retention, severe edema

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17
Q

What is the health consequence of re-feeding syndrome?

A

Multiple organ failure

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18
Q

What is the general caloric tx for anorexia nervosa?

A

Increase calories slowly (often eating as low as 300-700 kcal/day)

19
Q

What is the inpt tx for anorexia nervosa?

A

Increase by 500 kcal/day q4 days up to 3500 kcal/day

20
Q

What is the outpt tx for anorexia nervosa?

A

Initial re-feeding 1200-1500 kcal/day (increase weekly by 500 kcal)

21
Q

What is the non-pharm therapy for anorexia nervosa that has the best outcomes?

A

Cognitive behavioral

22
Q

What are the pharmacotherapies for anorexia nervosa?

A
  • No drug therapy is FDA approved
  • Olanzapine: mod. weight gain
  • Bupropion is CI
23
Q

What is the diagnostic criteria for binge eating disorder by the DSM5, TR?

A
  • 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
24
Q

How is the mild severity of binge eating disorder defined?

A

1-3 episodes per week

25
Q

How is the moderate severity of binge eating disorder defined?

A

4-7 episodes per week

26
Q

How is the severe severity of binge eating disorder defined?

A

8-13 episodes per week

27
Q

How is the extreme severity of binge eating disorder defined?

A

> = 14 episodes per week

28
Q

What are the health consequences of binge eating disorder?

A
  • HTN
  • Elevated cholesterol
  • CV disease
  • T2DM
  • Gallbladder disease
29
Q

What is the pharmacotherapy for binge eating disorder?

A

Lisdexamfetamine (vyvanse)

30
Q

What tx provides the best outcomes for treatment of binge eating disorder?

A

CBT + medication

31
Q

What is the diagnostic criteria for bulimia nervosa by the DSM5, TR?

A
  • Recurrent episodes of binge eating
  • Recurrent inappropriate compensatory behaviors
  • Occurs, on avg, at least 1/week for 3 months
32
Q

How is the mild severity of bulimia nervosa defined?

A

1-3 episodes/week

33
Q

How is the moderate severity of bulimia nervosa defined?

A

4-7 episodes/week

34
Q

How is the severe severity of bulimia nervosa defined?

A

8-13 episodes/week

35
Q

How is the extreme severity of bulimia nervosa defined?

A

> = 14 episodes/week

36
Q

What are the health consequences of bulimia nervosa?

A

Amenorrhea, orthostatic hypotension, bradycardia, arrhythmias, osteopenia, osteoporosis

37
Q

How does electrolyte imbalance happen in bulimia nervosa?

A
  • Electrolyte imbalances due to dehydration and loss of electrolytes through purging
  • Risk for irregular heartbeats, possibly HF and death
38
Q

What are digestive tract health consequences of bulimia nervosa?

A
  • Inflammation, gastric rupture, esophageal rupture from frequent vomiting (Mallory Weiss tears)
  • Chronic irregular bowel movements
  • Constipation from laxative abuse
39
Q

What are dental health consequences of bulimia nervosa?

A

Tooth decay, staining, permanent loss of dental enamel from stomach acids

40
Q

What diabetes related health consequence occurs from bulimia nervosa?

A

Diabetic ketoacidosis from withholding insulin in T1DM

41
Q

What are the methods of purging of bulimia nervosa?

A
  • Vomiting
  • Laxatives
  • Diuretics
  • Excessive exercise
  • Diabulimia
42
Q

What is diabulimia?

A

Pts w T1DM and bulimia give themselves less insulin than needed or stop taking insulin to promote weight loss

43
Q

What is the pharmacotherapy of bulimia nervosa?

A

Fluoxetine is FDA approved

44
Q

What provides the best outcomes for treating bulimia nervosa?

A

CBT + med

PHRM 845 (48 decks)

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