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PHAR 358 - Therapeutics (Dr. K. Halpape) > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

A BMI of < ____ kg/m2 is considered to be extreme Anorexia.

A

15mg/m2

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2
Q

Define Bulimia Nervosa according to the DSM-V.

A

Episodes of binge eating & compensation (ie. Laxatives, Vomiting, Diuretics, Drugs, Exercise, Diet) at least once weekly x 3mths

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3
Q

What body type do Bulimic patients most typically present with?

A

Normal - Slightly Overweight

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4
Q

Mild Bulimia is classified as 1-3 episodes per week… What constitutes Extreme Bulimia?

A

> /= 14 episodes weekly

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5
Q

Does Bulimia Nervosa diagnosis or severity ranking require a specific BMI?

A

Nope

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6
Q

How does Binge Eating Disorder (BED) differ from Bulimia?

A

No compensatory behaviors after excessive eating.

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7
Q

Explain the neurobiological dysfunction in Anorexia & Bulimia.

A

Chronic stress, starving, excess exercise = Increased Cortisol, which suppresses HPA, HPT & HPG axes.

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8
Q

What are the repercussions of HPG axis suppression in AN / BN?

A

Reduced estradiol, progesterone & LH production (which leads to amenorrhea & reduced libido).

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9
Q

5HT deficiency in AN / BN is due to a deficiency in what dietary AA?

A

Tryptophan

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10
Q

5HT deficiencies in AN / BN causes what to occur?

A

-Dysregulated satiety
-Anxiousness
-Disrupted Sleep / Mood
-OCD

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11
Q

DA deficiencies in AN / BN cause what to occur?

A

-Reduced energy
-Reduced pleasure
-Reduced reward feelings

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12
Q

NE deficiencies in AN / BN can cause what to occur?

A

-Hypotension
-Bradycardia

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13
Q

TSH inhibition in AN / BN reduces T4 to T3 conversion & leads to what?

A

Reductions in one’s resting metabolic rate

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14
Q

In terms of gendered prevalence, describe the rates of each eating disorder.

A

Anorexia: F > M
Bulimia: F > M
BED: Close to =

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15
Q

What is the typical peak age of onset for the various eating disorders?

A

Mid to late adolescence (14 - 20yrs)

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16
Q

What eating disorder demonstrates the highest mortality rates of any mental health illness?

A

Anorexia

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17
Q

What fraction of deaths amongst Anorexia Nervosa patients are due to suicide?

A

1/5 (20%)

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18
Q

What are the major risk factors predicting death amongst Anorexia patients?

A

-Low presenting wt
-Long duration illness
-Alc use

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19
Q

What types of disorders do Bulimic patients tend to develop at an increased rate (especially those with recurrent hospitalizations)?

A

CVD

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20
Q

How does the course of disease progression differ for Bulimia (in comparison to Anorexia)?

A

Anorexia: More chronically deteriorating course, no periods of remission.

Bulimia: Can be chronic or intermittent, with periods of remission & reoccurrence.

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21
Q

Why is amenorrhea in various eating disorders problematic?

A

-Increased Osteoporosis
-Reduced growth velocity
-Reduced sex drive

Unexpected Pregnancies

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22
Q

If somebody becomes pregnant with an eating disorder, what are some complications that can arise?

A

-Micronutrient Deficiencies for baby (developmental issues)

-Miscarriages

-Low birth wt / premature birth

-Troubles breastfeeding

-Postpartum depression

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23
Q

What percentage of women have relapses with their eating disorders during pregnancy?

A

22%

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24
Q

Once eating disorders are resolved, how long does it take for a woman to get her period back?

A

Usually within 6mths

25
Q

T or F: The return of a normal menstrual cycle is related to both the amount of total body fat & serum estrogen levels.

A

False… Estrogen levels yes, but body fat levels no.

26
Q

How might one’s body temperature present in a case of Anorexia?

A

Hypothermic with potential for cold intolerances

27
Q

How might an Anorexic patient’s cardiovascular assessment look?

A

-Prolonged QTc
-Bradycardia
-Ortho Hypotension
-Dizzy / Lightheaded
-Cardiac Muscle Atrophy

28
Q

A QTc interval of > ____ ms increases the risk for Torsades De Pointes & premature cardiac death.

A

470ms

29
Q

Cardiac arrythmias in AN are often preceded by what?

A

Hypokalemia (due to malnutrition & potential diuretic abuse)

30
Q

What are the proposed reasons for sinus bradycardia development in those with Anorexia?

A

Reduced energy utilization (due to vagal hyperactivity), decreased T3 levels.

31
Q

Chronic ingestion of ________ in Anorexia can lead to irreversible myocarditis.

A

Ipecac

32
Q

What drug can be used to reduce abdominal distention, pain & bloating in Anorexic patients?

A

Domperidone

33
Q

What is Domperidone’s MOA?

A

Dopamine Antagonist; delays gastric emptying, increases esophageal peristalsis & GI motility.

34
Q

Why is Domperidone favored over Metoclopramide in treating Anorexia GI symptoms?

A

Does not cross BBB (so no EPS symptoms).

35
Q

What limits Domperidone usage?

A

QT Prolongation

36
Q

How might Liver / Renal system reviews look in a patient with eating disorders?

A

Liver: Hypoalbuminemia, increased INR (by ~1.5 due to decreased clotting factor production), petechiae (microbleeds), increased GGT (if comorbid alc abuse).

Renal: Increased BUN (due to dehydration), decreased GFR.

37
Q

Patients with eating disorders who vomit profusely may demonstrate metabolic _________ (alkalosis / acidosis).

A

alkalosis

38
Q

Patients with eating disorders who abuse laxatives may present with metabolic _______ (alkalosis / acidosis).

A

acidosis

39
Q

What percentage of those with Anorexia present with osteoporosis?

A

40 - 66%

40
Q

T or F: Estrogen Replacement Therapies have shown zero promise with regards to increasing BMD in women with eating disorders.

A

True! Zero evidence of improvements.

41
Q

If we elect to supplement Anorexic / Bulimic patients with Ca2+ & Vit. D, what should we aim for in terms of a daily intake?

A

Ca2+: 1200 - 1500mg/d
Vit. D: 1000IU / day

42
Q

Is it advisable to give a teenage patient with an eating disorder Bisphosphonate drugs?

A

Nope… Can actually worsen their bone status (as these drugs reduce bone turnover & there is a high turnover rate as we go through puberty).

43
Q

What is the best strategy to address bone breakdown & recover BMD in those with eating disorders?

A

Wt Recovery!

44
Q

A systems review of the skin in those with eating disorders might show what?

A

-Dryness & scaling
-Back of the hand calluses
-Hair loss
-Lanugo hair

45
Q

When nutritionally rehabbing a patient, what kcal/kg/day target range should we aim to start at in order to avoid refeeding syndrome?

A

30 - 40kcal/kg/day

46
Q

How often should we monitor serum electrolytes (ie. PO4-, Mg2+, K+, Na+, Ca2+) when first initiating nutritional rehab?

A

1st 5d, then EOD x several wks

47
Q

What danger does ‘Refeeding Syndrome’ pose?

A

Precipitated CV changes / heart failure (as rapid cellular uptake of electrolytes from diet reduces serum levels & increases cardiac workload).

48
Q

Explain why PO4- should be supplemented (additionally to diet) to those initiating nutritional rehab.

A

Rapid cellular uptake of PO4- means less is available extracellularly for cardiac muscles to use… ATP depletion in cardiac myocytes = HF. Supplementation offsets this!

49
Q

In spite of its effects on wt gain, why is Olanzapine not a great agent to use in those with eating disorders?

A

Does not address negative thoughts around eating & increased drowsiness makes engaging with psychotherapies more challenging.

50
Q

What are the two primary reasons for initiating AD therapies AFTER weight restoration has occurred?

A

1) 5HT depletion = not much NT present for drug to act upon.

2) Reduced eating drive with most ADs (hence why we add on after as we want normal eating to commence).

51
Q

Which AD do we avoid (!!!) in eating disorders?

A

Bupropion (seizurrrrrrrrres)

52
Q

In Bulimic patients, what are some symptoms of “purging”?

A

-Parotid Gland enlargement

-Dorsal hand calluses

-Dental Caries

-Gastric / Esophageal ruptures

53
Q

What is the most effective treatment strategy for those with Bulimia (even more so than drugs)?

A

CBT (50 - 60% symptomatic remission)

54
Q

How many CBT sessions are needed for those who have Bulimia?

A

20hr long sessions over 6mth period

55
Q

90% of ideal BW is often a wt goal for those with Bulimia… What might be another treatment goal?

A

Menstrual re-initiation

56
Q

What is the drug of choice for Bulimic patients?

A

SSRIs (particularly Fluoxetine, with Citalopram & Sertraline also being studied)

57
Q

Fluoxetine is often initiated at starting doses of 10-20mg / day for Bulimia treatments… What is the target daily dose?

A

60mg / day

58
Q

How long is the typical treatment length for Bulimic patients on Fluoxetine?

A

6 - 12mths

59
Q

What are some signs in patients with eating disorders that indicate a medical emergency?

A

-Sudden onset delusions / hallucinations

-Self harming / suicidal thoughts

-Intense weakness / collapsing

-Blood in places it shouldn’t be

-Vomiting multiple x’s in a day

-Body temp < 35 degrees

PHAR 358 - Therapeutics (Dr. K. Halpape) (8 decks)

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