61 - Pharmacotherapy of eating disorders Flashcards
anorexia nervosa
- ___ of energy intake leading to a significantly low body weight - intense fear of gaining weight or becoming fat
more prevalent in females
___ , OCD, and suicidal, ideation are common
- restriction
depression
Specifiers of Anorexia Nervosa
restricting type
- during last 3 months, the individual has ___ engaged in recurrent episodes of binge eating or purging behavior
- weight loss is accomplished primarily through diet and excessive exercise
NOT
Specifiers of Anorexia Nervosa
binge-eating/purging type
- during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior
- the difference between purging subgroup and bulimia nervosa disorder is the low ___ for AN
body weight
Specifiers of Anorexia Nervosa for ICD-10
___ kg/m2 is the low end of normal
18.5
anorexia nervosa - health consequences
- abnormally slow ___ and low ___
- decrease ___ density
- muscle loss, weakness
- ___ abnormalities and hypoglycemia
- dry skin, hair loss
- severe dehydration
- downy layer of hair ( ___ ) all over body
- ___ intolerance
- delayed ___ emptying
- constipation
- HR, BP
- bone
- electrolyte
- lanugo
- cold
- gastric
AN - inpatient
rationale:
- continued weight loss despite outpatient treatment
- SBP < ___ mmHg
- arrhythmia on ECG
- Na < ___ mmol/L
- K < ___ mmol/L
- suicidal ideation/self harm
treatmet intensity
- 24/7
treatment of ___ risks
- suicidality
- psychosis
- severe electrolyte abnormalities
- cardiac irregularities
increase weight by ___ - ___ lbs/week
- 80
- 125
- 3
- acute
- 2-3
AN - outpatient
rationale
- medically stable
- step down care from inpatient hospitalization
treatment intensity
- ___ - ___ hours/day, 5-7 days/week
treatment of ___ symptoms and ___ prevention
- psychotherapy
- group therapy
- nutritional counseling
- family systems work
increase weight by ___ - ___ lb/week
8-10
chronic, relapse
0.5-1
AN - re-feeding syndrome
in starvation, energy is principally derived from ___
- re-feeding results in shift from ___ to ___ metabolism
rapid ___ metabolism increases ___ secretion
rapid uptake of K, Mg, phosphate from serum goes into the cells
hypo___ , water retention, and severe ___
multiple organ failure
fat
- fat, glucose
glucose, insulin
hypokalemia, edema
AN - treatment
concern - re-feeding syndrome with initial treatment
correct - electrolyte and fluid deficits, thiamine, vitamin B complex, multivitamin supplements
increase calories ___
- inpatient - increase by ___ kcal/day every 4 days up to ___ kcal/day
- outpatient - initial re-feeding ___ - ___ kcal/day (increase weekly by ___ )
slowly
- 500, 3500
- 1200-1500, 500
AN - treatment
CBT
PCOL
- no drug therapy is FDA approved
- ___ modest weight gain
- ___ - little benefit for core symptoms
- ___ is CI
- olanzapine
- SSRI
- bupropion
binge eating disorder
- recurrent episodes of binge eating
- occurs, on avergae, at least ___ a week for __ months
- ___ associated with recurrent use of inappropriate compensatory behavior
once, 3
NOT
compensatory behavior - excessive exercise, laxatives, or purging
how many calories count as a binge
avg ___ kcal
can eat upwards of ___ - ___ kcal
3,500
6,000-10,000
binge eating disorder
gender ratio is far ___ skewed than AN F:M (1:0.7)
tends to run in families
depression, anxiety, BPD, and substance use disorders are more common in individuals with BED
less
severity specifiers for BED
- look at number of episodes per ___
week
Binge Eating Disorder - health consequences
similar to obesity
- HTN
- elevated ___
- ___ disease
- type ___ diabetes
- gallbladder disease
- cholesterol
- CV
2
serverity specifiers for BN
- measured in ___ per week
episodes
BN - health consequences
recurrent binging anf purging can affect the entire ___ tract
digestive
BN - outward signs of purging
___ tear
___ sign
Mallory-Weiss
Russell’s
