Exam 4 lecture 6 Flashcards
Anorexia Nervosa definition
Restriction of energy intake leading to a significantly low body weight.
Intense fear of gaining weight or becoming fat
depression is common comorbid diagnosis
Specifics of anorexia nervosa
Restricting type-
Binge eating/purging type
severity of anorexia nervosa
Mild<17 BMI
Moderate- 16-17 BMI
severe- 15-16
Extreme Below 15 BMI
18.5 is low end of normal BMI
health consequences of anorexia nervosa
-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
Inpatient vs outpatient treatment of anorexia
inpatient hospitalization- treatment of acute risks
outpatient hospitalization- Treatment of chronic symptoms and relapse prevention
What does anorexia nervosa lead to when refeeding
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
How to treat anorexia nervosa
Increase calories slowly
CBT leads to best outcome
What medication is conraindicated in anorexia
Bupropion
What is binge eating disorder? How often? Is it associated with recurrent use of inappropriate compensatory behavior?
Recurrent episodes of binge eating.
Occurs atleast once a week for 3 months
NOT associated with recurrent use of inappropriate compensatory behavior.
binge eating disorder treatment
Lisdexamphetamine (Vyvanse) is FDA approved
CBT+medication provides best outcomes
what is bulimia nervosa
Recurrent episodes of binge eating. Recurrent inappropriate compensatory behaviors. At least once a week for 3 months.
treatment of bulimia nervosa
Fluoxetine is FDA approved
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?
If diagnosed in a first degree relative
Increased risk of substance use and antisocial disorder if ADHD is left untreated
ADHD types
Inattention
hyperactivity and impulsivity
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?
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
What are some special considerations with stimulants
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
stimulant adverse effects
Appetite loss
ABdominal pain
Headaches
decrease growth
Sleep disturbances
Hallucinations
Increase BP and HR
Sudden cardiac death
priapism
Raynauds
uncommon adverse effects and managemnt
Hallucinations- dx stimulant, reassess diagnosis
risk for sudden cardiac death- risk no greater in clinical trials than general population.
What alpha 2 agonist drugs are there? Substrates?
Intuiv (guanfacine ER)- 3A4 substrate
Clonidine ER
both must be tapered off
Norepinephrine reuptake inhibitor drugs? Metabolism?
Atomoxetine- 2D6 substrate
weight based dosing
Viloxazine- swallow whole capsule in applesauce
2D6/UGT substrate, strong 1A2 inhibitor
Non stimulant drugs adverse effects
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
Bupropion metabolism? CI?
2D6 inhibitor
contraindicated in seizure disorders and eating disorders
how effective are tricyclic antidepressants for ADHD? Concerns?
Less effective than methylphenidate
cardiac concerns- sudden cardiac death in children, lethal in OD
When can we use mood stabilizer/atypical antipsychotics for ADHD
may be useful if there is comorbid bipolar disorder, intermittent disorder and conduct disorder
Not monotherapy
Do not treat ADHD
