Lecture 62 + 63 - Pharmacotherapy of Eating Disorders Flashcards

1
Q

Overview of eating disorders

A

anorexia, bulimia binge and purge, healthy eating, binge eating, obesity

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2
Q

Anorexia Nervosa

A

Restriction of energy intake leading to a significantly low body weight
Intense fear of gaining weight or becoming fat
Depression is a comorbidity

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3
Q

Specifiers of Anorexia Nervosa

A

Restricting type
Binge-eating/purging type

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4
Q

Restricting type

A

 During the last 3 months, the individual has NOT engaged in recurrent episodes of binge eating or purging behavior
 Weight loss is accomplished primarily through dieting, fasting, and/or
excessive exercise

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5
Q

Binge-eating/Purging Type

A

 During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
 **The difference between purging subgroup and bulimia nervosa disorder is the low body weight for AN

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6
Q

Specifiers of Anorexia Nervosa for ICD-10

A

Severity: mild, moderate, severe, extreme
18.5 kg/m^2 to be the low end of normal

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7
Q

Anorexia Nervosa - Health Consequences

A

Abnormally slow heart rate, low blood pressure
Decreased bone density
Weakness
Electrolyte abnormalities, hypoglycemia
Dry skin, hair loss
Severe dehydration
Downy layer of hair (lanugo) all over body
Cold intolerance; Delayed gastric emptying;
constipation

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8
Q

Inpatient vs Outpatient Treatment

A

Inpatient: treatment of acute risks
Outpatient: treatment of chronic symptoms and relapse prevention (psychotherapy, group therapy, nutritional counseling, family systems work)

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9
Q

Anorexia Nervosa – Re-Feeding Syndrome

A

Re-feeding results in shift from fat metabolism to glucose metabolism.
Hypokalemia, water retention, and severe edema
Multiple organ failure

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10
Q

Anorexia Nervosa Treatment

A

increase calories slowly (often eating as low as 300-700 kcal/day)
* Inpatient re-feeding: Increase by 500 kcal/day every 4 days up to 3500 kcal/day
* Outpatient re-feeding: Initial re-feeding 1200 – 1500 kcal/day (increase weekly by 500 kcal)

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11
Q

Anorexia Nervosa Therapy Treatment

A

cognitive behavioral (best outcomes)
pharmacotherapy: bupropion contraindicated; no drug therapy is FDA approved

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12
Q

Binge Eating Disorder

A

recurrent episodes of binge eating characterized by both of the following: Eating, in a discrete period of time an amount of food that is larger than what most people would eat in a similar period of time; A sense of lack of control over eating during the episode
Occurs on average at least once a week for 3 months; NOT associated with the recurrent use of inappropriate compensatory behavior

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13
Q

Severity Specifiers for Binge-Eating Disorder

A

characterized by episodes: mild, moderate, severe, extreme

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14
Q

Binge Eating Disorders - Health Consequences

A

similar to what is observed in obesity
HTN, elevated cholesterol, cardiovascular disease, type 2 diabetes, gallbladder disease

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15
Q

Binge Eating Disorder - Treatment

A
  • Lisdexamfetamine (Vyvanse®) is FDA-approved
    CBT + medication provides best outcomes
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16
Q

Bulimia Nervosa

A

Recurrent episodes of binge eating characterized by both of the following:
 Eating, in a discrete period of time an amount of food that is larger than what most individuals would eat in a similar period of time
 A sense of lack of control over eating during the episode
 Recurrent inappropriate compensatory behaviors in order to prevent weight gain (self-induced vomiting or misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise)
occur on average at least once a week for 3 months

17
Q

Severity Specifiers for Bulimia Nervosa

A

characterized by episodes: mild, moderate, severe, extreme

18
Q

Bulimia Nervosa - Health Consequences

A
  • Electrolyte imbalances due to dehydration and loss of electrolytes through purging (risk for irregular heartbeats and even heart failure and death)
  • Inflammation, gastric rupture, and esophageal rupture from frequent vomiting (Mallory Weiss Tears)
  • Tooth decay, staining, and permanent loss of dental enamel from stomach acids released during frequent vomiting
  • Chronic irregular bowel movements and constipation as a result of laxative abuse
  • Physical sores from exercising too much
  • Diabetic Ketoacidosis from withholding insulin in type 1 DM
19
Q

Bulimia Nervosa - Methods of Purging

A

vomiting, laxatives, diuretics, excessive exercise, diabulimia - pts with type 1 diabetes and bulimia give themselves less insulin than they need or stop taking insulin to promote weight loss

20
Q

Bulimia Nervosa Outward Signs of Purging

A

Russell’s sign
canker sores
Mallory-weiss tear
blood shot eyes
tooth decay

21
Q

Bulimia Nervosa Treatment

A

Fluoxetine is FDA-approved (60 mg/day)