Eating Disorders - Block 3 Flashcards
What are the types of eating disorders?
- Anorexia nervosa
- Atypical anorexia nervosa
- Bulimia nervosa
- Binge eating disorder
- ARFID
What is purging?
Compensatory behvaior:
1. Exercise
2. Vomiting
3. Laxatives
4. Diuretics
Bulimia involves both ___ and ___?
binging and purging
Why is vomiting who restrict calories dangerous?
- Less likely to replete electrolyes
- Exacerabte med complications
Is dieting an ED?
Not all patients who diet develop an eating disorder, but most patients with an eating disorder started by dieting
How do we assess Eating disorders?
APA recommends screeing as part of initial psych eval
What is the initial evaluation of a ED?
- Height/weight
- Patterns in eating or restiction
- patterns and changes in food repertoire
- Patterns of compensatory behavior
- percentage of time preoccupied with food, weight, and body shape
- prior treatment and response to treatment for an eating disorder
- psychosocial impairment
- Family hx
What is common ED assessment tools?
SCOFF questionaire
What does the SCOFF assess?
What are basic quetions you can incorporate in an ED assessment?
What are co-occurring conditions thatcan contribute to ED?
- Substance use hx
- Trauma hx
- Suicide risk
Physical examination of ED?
Abnormal vitals: HR <50, SBP <90, temp <36C
HEight, weight BMI
If purging behavior is present what do you do?
- Refer for dental evalv
- Instruct patient not to brush teeth after vomiting
- Oral rinse with water after vomiting and avoid igestion of carbonated drinks or citrus fruits to reduce dentination
Serum electrolyte abnormalities of ED?
NR: Hypokalemia, hyponatremia, hypomagnesemia, hypophosphatemia
P: with metabolic acidosis
Renal function tests of ED?
NR: Increased BUN, decreased GFR, decreased Cr because of low lean body mass (normal creatinine may indicate azotemia), renal failure (rare)
P: Increased BUN, CR
Serum glucose of ED
NR: Low
Liver function of EF?
NR: Elevated LFT
Lipid panel of ED?
NR: Hypercholesterolemia
Urinalysis of ED?
NR: Urinary specific gravity abnormalities
P: with high pH
Serum gonadotropins and sex hormones of ED
NR: Decreased serum estrogen or serum testosterone; prepubertal patterns of LH, FSH
P: hypoestrogenemic, if menstrual irregularities are present
Bone densitometry
(DXA scan) of ED?
NR and P: Reduced BMD, osteopenia, or osteoporosis in individuals with previous low weight and menstrual irregularity or amenorrhea
Dental radiography of ED
P: erosion of dental enamel
ECG ab of ED?
NR: Bradycardia or arrhythmias,
QTc prolongation
P: Increased P-wave amplitude and duration, increased PR interval, widened QRS complex, QTc prolongation, ST depression, T-wave inversion or flattening, U waves, supraventricular or ventricular tachyarrhythmias
Whole body sx of ED?
NR, P
CNS sx of NR and P?
Oropharyngeal sx of NR and P?
GI sx of NR and P?
CV sx of NR and P?
Reporductive sx of NR and P?
Muscular sx of NR and P?
Skeletal sx of NR and P?
Derm sx of NR and P?
What is anorexia nervosa?
- Restrictive food intake leading to significant low body weight
- Intense fear of gaining weight or becoming fat
OR - Restrictive food intake leading to significant low body weight
Intense fear of gaining weight or becoming fat - Body dysmorphia
Non-pharm for anorexia nervosa?
Weight restoration: start with 1,500-2,000 kcal/day, rapidly advance to 3,000-4,000 kcal/day divided into meals and snacks and adjust further as needed
* Calorie dense liquid supplements can be given in between meals
Pharm for anorexia nervosa?
- Olanzapine
- SSRI/AD
- Buproprion
- Citalopram, quetiapine, TD estradiol, hGh, cisapride
- Estrogen or bisphosphonated for bone health (not routinely recommended)
What ED is not recommended to use bupropion?
Purging due to increased sz
What is atypical anorexia?
Was the criteria of anorexia with normal weight
What is bulimia nervosa?
Recurrent episodes of binge eating that is out of control, within 2 hr period, excessive eating
THEN
Recurrent inappropriate compensatory behaviors to prevent weight gain
How often does Bulimia nervosa occur?
At least 1x/week for 3 months
What are the recommened tx for bulimia nervosa?
- CBT
- SSRI (fluoxetine)
- Lithium (caution to avoid toxicity from dehydration from vomitting or purging using laxatives
What drug is CI with BN?
Bupropion do to sz risk
What constitutes a binge eating disorder?
- Recurrent episodes of bingeing: (2hr eating, 1/wk for 3 months, lack of control)
- 3 or more of the following:
* Eating fast
* Being uncomfortably full
* Eating large amounts of food when not hungry
* Eating alone
* Feeling disgusted
Tx for binge eating disorders?
- CBT
- antidepressant medication or lisdexamfetamine
How would you dose Vyvanze for binge eating?
Initial: 30 mg QAM, increase 20 mg/wk to 50-70 mg
* No hepatic dose adj
* Renal impariment: Max, 50 mg/day
* Caution in HTN or CV patient
Compare and contrast the different ED?
what is ARFID?
Lack of interest in food or concern about adverse consequences of eating (no weight or body shape concerns)
