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21 Cards in this Set
- Front
- Back
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What are the criteria for hospitalization?
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20% weight loss of more from normal weight
Reduced Oral intake of food (sudden and persistent) Medical Complications (Edema, Hypoproteinemia, HR <40 or >110, BP < 90/60, K < 3, Inability to maintain core body temperature) |
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Continuation of last answer
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Co-occurring psychiatric symptomsNon-responsive to outpatient treatment/poor motivation
Demoralization or nonfunctional family Denial of severity Continuous ervision required to prevent purging |
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Describe non-pharmacologic treatment.
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Nutritional rehabilitation (target weight and rates of weight gain)
Psychosocial treatments (CBT, Family therapy, nutritional counseling, weight restoration) |
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Describe how to restore weight in an anorexic patient
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30 cal/kg/day
Increase to a maximum of 100 kcal/kg/day Inpatients gain weight at 2-3 pounds per week Outpatients gain weight at 0.5-1 pound per week Oral refeeding is done with liquids unless the patient is severely malnourished in which case TPN is done |
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Phamacologic therapy for AN in the acute stage.
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None - Anti-depressants are ineffective when patients weigh less than 85% of expected weight
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When would you use an anti-depressant in an AN patient?
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Once they have achieved target weight and if they present with depression, anxiety, obsessions/compulsions
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What agent would you use, at what dose and for how long?
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Fluoxetine 20 mg/day x 1 year
Avoid TCA's and MAOI's due to cardiovascular risks and anti-cholinergic side effects |
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What other pharmacologic option do you have?
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Atypical anti-psychotics (weight increase and reduced anxiety/depressive symptoms)
Olanzapine 2.5 mg/day |
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Situations where SSRI's are indicated in eating disorders
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BN
Binge Eating Depression OCD |
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What do you do for severe constipation?
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Hydration
Stool softeners Bulk forming laxatives |
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What do you use for decreased gastric motility?
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Metoclopramide
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What do you use for Amenorrhea? Bone loss?
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Estrogen and Progesterone
Calcium, Vitamin d, Exercise |
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What do you use for electrolyte abnormalities? Pre-meal anxiety? Appetite stimulation?
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Supplementation
Benzodiazepines Cyproheptadine |
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How would you evaluate outcomes in a patient recovering from AN?
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Frequency and severity of abnormal eating habits
Normalized exercise paterns Lab tests Sustained weight Diary Weekly weigh ins in clinicians office Inpatient - Daily weight assessment, caloric intake, vital signs, urine output, bathroom privileges SSRI efficacy - Alleviation of depression, anxiety, obsessions (improvement expected in 4-8 weeks) SSRI toxicity - Agitation, drug-induced anorexia, nausea, weight loss, insomnia |
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What is given pharmacologically in BN?
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SSRI's in the acute and maintenance phase - Help to reduce depression, anxiety, obsessions, impulsive behaviors, and improve eating habits - Do Not NEED A CORBID mood disorder to see effect
Fluoxetine is first line SNRI's may have potential benefit also TCA's avoided due to lethality and toxicity potentional MAOI's cautioned in impulsive patients |
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What drug is important to stay away from in patients with eating disorders?
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Bupropion due to increased risk of seizures
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The doses are the same as for depression, starting at a low dose of 5-20 mg/day and titrating up to a max of 60-80 mg/day
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The time to onset is about 4-8 weeks and the duration of therapy is about 1 year. The decision to continue however is based on initial response and maintenance of benefit. You may need to restart if symptoms return a few months after discontinuation.
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When would you use Lithium or an antivconvulsant?
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If comorbid bipolar disorder exists
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When would you use a benzodiazepine?
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You could use a low dose before meals to reduce pre-meal anxiety
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How would you monitor SSRI therapy for efficacy?
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Response within 4-8 weeks
Binge/purge behavior leading to malabsorption before dose titration If the patient responds, monitor for 6-12 months and then reassess need for continued medication use Restart medication if relapse occurs Monitor for purchases of ipecac and laxatives in large quantities. |
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What are the adverse effects of SSRI therapy?
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ND
HA Insomnia Sexual dysfunction Increased risk for suicidal ideation and behavior |
