Exam 4 lecture 6 Flashcards

1
Q

Anorexia Nervosa definition

A

Restriction of energy intake leading to a significantly low body weight.

Intense fear of gaining weight or becoming fat

depression is common comorbid diagnosis

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2
Q

Specifics of anorexia nervosa

A

Restricting type-
Binge eating/purging type

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3
Q

severity of anorexia nervosa

A

Mild<17 BMI
Moderate- 16-17 BMI
severe- 15-16
Extreme Below 15 BMI

18.5 is low end of normal BMI

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4
Q

health consequences of anorexia nervosa

A

-Abnormally slow HR, low BP
-decreased bine density
-weakness
-Electrolyte abnormalities, hypoglycemia
-Dry skin, hair loss
-severe dehydration
-downy layer of hair all over body
-cold intolerance
-delayed gastric emptying
-constipation

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5
Q

Inpatient vs outpatient treatment of anorexia

A

inpatient hospitalization- treatment of acute risks
outpatient hospitalization- Treatment of chronic symptoms and relapse prevention

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6
Q

What does anorexia nervosa lead to when refeeding

A

Re-feeding syndrome.

Refeeding results in shift from fat metabolism to glucose metabolism

leads to hypokalemia, water retention and severe edema

leads to multiple organ failure

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7
Q

How to treat anorexia nervosa

A

Increase calories slowly

CBT leads to best outcome

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8
Q

What medication is conraindicated in anorexia

A

Bupropion

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9
Q

What is binge eating disorder? How often? Is it associated with recurrent use of inappropriate compensatory behavior?

A

Recurrent episodes of binge eating.

Occurs atleast once a week for 3 months

NOT associated with recurrent use of inappropriate compensatory behavior.

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10
Q

binge eating disorder treatment

A

Lisdexamphetamine (Vyvanse) is FDA approved

CBT+medication provides best outcomes

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11
Q

what is bulimia nervosa

A

Recurrent episodes of binge eating. Recurrent inappropriate compensatory behaviors. At least once a week for 3 months.

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12
Q

treatment of bulimia nervosa

A

Fluoxetine is FDA approved

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13
Q

when do you have a higher rate of diagnosis for ADHD? What percent of adults will have it after childhood? Increased risk of what condition if you have ADHD?

A

If diagnosed in a first degree relative

Increased risk of substance use and antisocial disorder if ADHD is left untreated

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14
Q

ADHD types

A

Inattention
hyperactivity and impulsivity

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15
Q

Stimulant dosing? How fast are effets seen? Calculating doses in pediatric patients? When is IR preferred? When to give dose? Late afternoon symptoms? Two different stimulants?

A

Dose response effects seen in a short time

Calculating a dose in pediatric patients based on mg/kg not found to be helpful as variations in dosing not found to be due to height and weight

IR preferred for patients weighing <16 due to limited low dose availability

Avoid giving dose too late in the day, may give an after school dose

Late afternoon symptoms may require long acting formulations

Dont use two different stimulants, can use two different dosage forms of the same stimulant

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16
Q

What are some special considerations with stimulants

A

Daytrana is a patch

Vuvanse is a prodrug that is converted to dextroamphetamine

Jornay PM-Take dose in the evening between 6:30 and 9:30

17
Q

stimulant adverse effects

A

Appetite loss
ABdominal pain
Headaches
decrease growth
Sleep disturbances
Hallucinations
Increase BP and HR
Sudden cardiac death
priapism
Raynauds

18
Q

uncommon adverse effects and managemnt

A

Hallucinations- dx stimulant, reassess diagnosis
risk for sudden cardiac death- risk no greater in clinical trials than general population.

19
Q

What alpha 2 agonist drugs are there? Substrates?

A

Intuiv (guanfacine ER)- 3A4 substrate
Clonidine ER
both must be tapered off

20
Q

Norepinephrine reuptake inhibitor drugs? Metabolism?

A

Atomoxetine- 2D6 substrate
weight based dosing
Viloxazine- swallow whole capsule in applesauce
2D6/UGT substrate, strong 1A2 inhibitor

21
Q

Non stimulant drugs adverse effects

A

Atomoxetine (viloxazine )- increased HR and BP
Increase in suicidal thinking (boxed warning)

Clonidine (guanfacine)- decreased HR and BP, orthostasis, somnolence, dizziness, rebound hypertension if abrupt dx

22
Q

Bupropion metabolism? CI?

A

2D6 inhibitor
contraindicated in seizure disorders and eating disorders

23
Q

how effective are tricyclic antidepressants for ADHD? Concerns?

A

Less effective than methylphenidate
cardiac concerns- sudden cardiac death in children, lethal in OD

24
Q

When can we use mood stabilizer/atypical antipsychotics for ADHD

A

may be useful if there is comorbid bipolar disorder, intermittent disorder and conduct disorder

Not monotherapy

Do not treat ADHD