Eating disorders Flashcards
What is anorexia nervosa?
intense fear of gaining weight, significantly lower weight
What is bulimia nervosa?
recurrent episodes of binge eating then recurrent compensatory behaviour to prevent weight gain (vomit)
How long to get diagnosed with bulimia?
1x a week for 3 months
What is binge eating disorder?
binge eating with no compensatory behaviour (vomit)
MUST have 3 of :
eating rapidly
uncomfortably full
eatingg when not hungry
feeling guilty
IS AN or BN more connected to genetics?
AN
What does starvation do to the body?
increased cortisol causing HPA suppression which causes low hormones (amenorrhea and low libido
not a lot of tryptophan to make serotonin
What trigger most commonly causes HPA suppression?
stress
Which gender gets more eating disorders?
females
Which eating disorder has higher rates of mortality?
anorexia
What are the consequences from long term anorexia?
starvation, cardiac arrest, suicide
Do hospitalized pregnant women. or bulimic have higher heart attack risk?
bulimia
What mental disorder is common with eating disorders?
Anxiety, mood substance use
What is the general principle of treatment of eating disorders?
it is a coping mechanism so fix underlying and offer treatment for the symptoms
What happens if no estrogen?
osteoporosis, lowered growth, low libido, unexpected pregnancies
What event is a common relapse for eating disorders?
pregnancy
How can eating disorders effect pregnancy?
poor wight, miscarriage, nutrient deficiency, post partum depression
When will periods return?
in 6 months of achieving body weight of around 90%
What cardio complications can occur from AN?
prolonged QTc
Cardiac atrophy
bradycardia
arrhythmia
hypotension
At what QTc are you at risk of TDP?
> 470
What causes the arrhythmia in AN?
Low K
Will cardiac issues resolve?
with weight restoration yes
BUT
irreversible myocarditis with emetine toxicity
What does chronic ipecac use do?
induces vomitting
irreversible myocarditis
How can we lower refeeding risk?
refeed slow
phosphorus supplement
hospital
How can we treat gastroparesis?
Domperidone and metoclopramide
Why is domperidone better than metoclopramide?
doesn’t cross BBB= no EPS
Risks of domperidone?
QTc prolonging
How does domperidone work?
peripheral dopamine antagonist
What can we do for constipation?
Peg to retrain
if need bowel taper use sennosides
Any risk with sennosides?
be abused to Lose weight
What would show dehydration in eating disorders?
high BUN
What effects on liver does eating disorders cause?
low albumin, high high INR, LFT increase
Would you have metabolic acidosis or alkalosis if vomiting?
Alkalosis
Would you have metabolic acidosis or alkalosis if abusing laxative?
acidosis
When is most bone built?
adolescent
Which eating disorder has highest risk of OP?
AN
Does estrogen replacement help with bones?
NOPE
does not increase BMD
Do calcium and vitamin d supplementation help?
probably
Calcium 1200-1500mg and Vitamin D 1000 IU/day
Do bisphosphanates work?
no in teenagers
no studies for adults but can extrapolate
What is the best way to recover BMD?
weight recovery duh
How long does it take BMD to increase after restoring weight?
1-2 years
Is BMD always recoverable?
FU no
How to begin refeeding?
30-40kcal/kg/day then to 70-100
Which is better IV or NG to feed?
NG
What electrolytes must we monitor when feeding?
PO4, MG, K, NA, Ca daily for first 5 days
What is refeeding syndrome?
bloating, nausea, electrolytes rush into cells, retains fluid which causes more work for the heart, and this is bad
What electrolyte is crucial for the function of the heart?
PO4 as this is used in ATP
Non pharm for AN?
CBT
What is zinc used for?
zinc deficiency exhibit similar to AN
Does zinc help with BMI resting?
oof who knows perhaps??
Do antipsychotics help in AN?
only olanzapine showed weight increase BUT not benefit on eating disorder mentally
Risks with antipsychotics?
EPS, QTc, tardive
DO TCA help?
no
Do SSRI help?
help with comorbid conditions AFTER weight is restored
Does bupropion help?
NO, seizure risk
What are signs of bulimia?
dental caries, esophagus damage, parotid gland enlargement
What is usually the weight of a bulimic person?
upper end of normal or slightly overweight
Best psychotherapy for bulimia?
CBT
Is CBT better than drugs for bulimia?
OBV
AT what % weight does menses restart?
90% of normal
What drugs are good for bulimia?
SSRI- lower binge-purge episodes
Do you need to have depression in order to use SSRI’s for bulimia?
NO.
Benefit regardless
What SSRIs are good for bulimia and which has the indication?
FLUOXETINE-indication
citalopram
sertraline
Does topiramate help with bulimia?
it does decrease episodes BUT
side effects brutal- brain fog
