12982235
Descripción
Test por Melanie Grynsztejn, actualizado hace más de 1 año
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Creado por Melanie Grynsztejn
hace alrededor de 6 años
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Pregunta 1
Pregunta
Which diagnoses are most often associated with EDOs
Respuesta
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Schizophrenia
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Anxiety disorders
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Obsessive compulsive disorders
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Substance use disorders
Pregunta 2
Pregunta
Anorexia nervosa has a predominantly female disorder with a mean age of onset of 15 years old
Respuesta
- True
- False
Pregunta 3
Pregunta
Patients with Anorexia Nervosa (AN) and a psychiatric comorbidity have [blank_start]higher[blank_end] mortality rates than those without
Respuesta
-
higher
-
lower
Pregunta 4
Pregunta
Comorbid disorders for Anorexia Nervosa include
Respuesta
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MDD
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Anxiety disorders (social phobia & GAD)
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OCD
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Substance use disorders
-
Personality disorders
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Schizophrenia
Pregunta 5
Pregunta
With EDO, a detailed history to clarify timeline is critical because treating the core issue is essential for recovery. ADHD treatment, anxiety and depression may also cause weight loss. MDD may cause loss of appetite.
Respuesta
- True
- False
Pregunta 6
Pregunta
Anorexia nervosa has the highest death rate of any mental health illness
Respuesta
- True
- False
Pregunta 7
Pregunta
[blank_start]Food[blank_end] is your best medicine in aneroxia nervosa
Respuesta
-
Food
Pregunta 8
Pregunta
What is the primary aim in the beginning stages of treatment of aneroxia nervosa?
Respuesta
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Normalize and regulate eating patterns
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Treat with medications to help with mood, andanxiety
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Begin family-based interventions
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Individualized therapy interventions
Pregunta 9
Pregunta
Prior to medication initiation for anorexia nervosa, a prescriber needs to have
Respuesta
-
weight and height
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% IBW
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Orthostatic vitals
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EKG
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24 hour diet diary
Pregunta 10
Pregunta
SSRIs are the gold standard treament for sever depression, anxiety/OCD [blank_start]after[blank_end] weight restoration
Respuesta
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after
-
during initial treatment before
Pregunta 11
Pregunta
Which SSRI should be avoided with anorexia nervosa due to QTc prolongation?
Respuesta
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Fluoxetine
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Citalopram
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Fluvoxamine
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Paroxetine
Pregunta 12
Pregunta
SSRIs are FDA indicated for anorexia nervosa
Respuesta
- True
- False
Pregunta 13
Pregunta
[blank_start]Fluoxetine[blank_end] and [blank_start]citalopram[blank_end] have some evidence for relapse prevention in weight-stored anorexics receiving treatment
Respuesta
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Fluoxetine
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Setraline
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Paroxetine
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Fluvoxamine
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Setraline
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citalopram
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Fluvoxamine
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Paroxetine
Pregunta 14
Pregunta
MOA for SSRI
Respuesta
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Low affinity for D2 receptors/High affinity for serotonin receptors (5HT2A)
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Selectively inhibits serotonin reuptake resulting in enhanced serotonergic transmission in the CNS
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: Interacts with GABA receptors to enhance GABA effects
Pregunta 15
Pregunta
Which atypical antipsychotic has some evidence to help restore weight more quickly as adjunctive treatment to other interventions?
Respuesta
-
Risperidone
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Apiprazole
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Olanzapine
Pregunta 16
Pregunta
MOA for atypical antipsychotic used in anorexia nervosa is
Respuesta
-
Selectively inhibits serotonin reuptake resulting in enhanced serotonergic transmission in the CN
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Low affinity for D2 receptors/High affinity for serotonin receptors (5HT2A)
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Blocks voltage-dependent sodium & calcium channels
Pregunta 17
Pregunta
Cigarettes [blank_start]decrease[blank_end] serum concentration of olanzapine
Respuesta
-
decrease
-
increase
Pregunta 18
Pregunta
Olanzapine will interact with anything causing CNS depression including opioids, barbiturates, benzodiazepines, general anesthetics, and anticonvulsants such as pregabalin
Respuesta
- True
- False
Pregunta 19
Pregunta
There is mixed evidence for the use of BZ to reduce meal anxiety. Typically only ___________ used off-label
Respuesta
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Alprazolam
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Clonazepam
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Lorazepam
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Diazepam
Pregunta 20
Pregunta
BZ should be avoided with opioids
Respuesta
- True
- False
Pregunta 21
Pregunta
MOA for benzodiazepines is
Respuesta
-
Selectively inhibits serotonin reuptake resulting in enhanced serotonergic transmission in the CNS
-
Interaction with GABA receptors to enhance GABA effects
-
Low affinity for D2 receptors/High affinity for serotonin receptors (5HT2A)
Pregunta 22
Pregunta
The epdimiology of Bulimia Nervosa is greater in females than males and onset is later than AN, either late adolescence or early adulthood at 19.4 years as compared to 15 years.
Respuesta
- True
- False
Pregunta 23
Pregunta
Comormid illnesses for bulimia nervosa are similar to AN with
Respuesta
-
Mood disorders
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Anxiety Disorders
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OCD
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Substance abuse
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Schizophrenia
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Personality disorders (Cluster B - dramatic, erratic)
Pregunta 24
Pregunta
Medication of choice for bulimia nervosa is
Respuesta
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Anticonvulsants
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SSRIs
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Atypical antipsychotics
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TCA's
Pregunta 25
Pregunta
Combined pharmacotherapy and psychotherapy appears to be more efficacious than either alone for bingeing and purging. This should be continued for a minimum of
Respuesta
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6 months
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12 months
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18 months
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2 years
Pregunta 26
Pregunta
Which is considered 1st line for bulimia nervosa due to its efficacy and FDA approval for adults
Respuesta
-
Fluoxetine
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Sertraline
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Citalopram
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Paroxetine
Pregunta 27
Pregunta
TCAs and anticonvulsants have been shown in studies to help reduce beingeing and purging, but SSRI Fluxetine is considered first line SSRI therapy
Respuesta
- True
- False
Pregunta 28
Pregunta
Mechanism of action for Fluoxetine used in bulimia nervosa is
Respuesta
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inhibition of 5HT receptor, which leads to an increase in serotonin level
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inhibiting the neuronal reuptake of the neurotransmitters norepinephrine and serotonin. It binds the sodium-dependent serotonin transporter and sodium-dependent norepinephrine transporter reducing the reuptake of norepinephrine and serotonin by neurons
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Combination of antagonism at D2 receptors in the mesolimbic pathway and 5HT2A receptors in the frontal cortex.
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enhances the effects of GABA by increasing GABA affinity for the GABA recepto
Pregunta 29
Pregunta
Fluoxetine is contraindicated in use with the following drugs
Respuesta
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Selegeline
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Pimozide
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Lithium
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Lorazepam
Pregunta 30
Pregunta
When prescribing SSRI Fluoxetine, need to consider other medications that have risk for serotonin syndrome
Respuesta
-
Triptans
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Other antidepressants
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5-HTP
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St. John's Wort
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Anticonvulsants
Pregunta 31
Pregunta
Which anticonvulsants are used off label to treat Bulimia Nervosa
Respuesta
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Topiramate
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Zonisamide
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Valpromide
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Primidone
Pregunta 32
Pregunta
What is the MOA for Topiramate which is used off label for bulimia nervosa
Respuesta
-
Inhibits CNS neuronal uptake of serotonin
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Low affinity for D2 receptors/High affinity for serotonin receptors (5HT2A)
-
Blocks voltage- dependent sodium & calcium channels
-
GABA activity and antagonizes glutamate receptors
Pregunta 33
Pregunta
Binge eating disorder (BED) is the most common ED and almost as common in men as women. Age of onset is 18 years
Respuesta
- True
- False
Pregunta 34
Pregunta
Select the other comorbid disorders of Binge Eating Disorder
Respuesta
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Other ED's
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Schizophrenic disorders
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Mood disorders (MDD, BPD)
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Anxiety disorders
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PTSD
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Elevated risk of suicide
Pregunta 35
Pregunta
What medications are used for Binge Eating Disorders (BED)?
Respuesta
-
SSRI's
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Mood stabilizers
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Stimulants
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Antipsychotics
Pregunta 36
Pregunta
Topiramate, a mood stabilizer, has some evidence to suggest it is effective in which eating disorders
Respuesta
-
Anorexia nervosa
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Binge Eating Disorder
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Bulimia Nervosa
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Avoidant Restrictive Feeding Intake Disorder (ARFID)
Pregunta 37
Pregunta
What are some of the concerns in using Topiramate (Topamax) for BN and BED
Respuesta
-
May trigger restriction and development of AN
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Adverse S/E including sedation and cognitive slowing
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Risk of EPS
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Orthostatic hypotension
Pregunta 38
Pregunta
What is the MOA for Topiramate (Topamax)?
Respuesta
-
GABA activity and antagonizes glutamate receptors. Inhibits carbonic anhydrase
-
Non-selectively antagonizes central and peripheral histamine H1 receptors
-
Low affinity for D2 receptors/High affinity for serotonin receptors (5HT2A)
Pregunta 39
Pregunta
Which drug interactions does a prescriber need to be concerned about with Topiramate (Topamax)?
Respuesta
-
Avoid with other sedating medications
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Anything with CNS depression
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Medications with potential to increase risk of metabolic acidosis
Pregunta 40
Pregunta
What is the first FDA-approved medication to treat moderate to severe binge eating disorder?
Respuesta
-
Atomoxetine
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Lixdexamfetamine
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Methylphenidate
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Dextroamphetamine
Pregunta 41
Pregunta
What are some concerns with using Lisdexamfetamine for BED?
Respuesta
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Risk of misuse or diversion
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Numerous drug interactions that can increase CV events
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Can cause EPS in high doses
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Can cause constipation
Pregunta 42
Pregunta
What is the MOA for Lisdexamfetamine?
Respuesta
-
Stimulates CNS activity (sympathomimetic)
-
Selectively inhibits serotonin reuptake resulting in enhanced serotonergic transmission in the CNS
-
Low affinity for D2 receptors/High affinity for serotonin receptors (5HT2A)
-
Interacts with GABA receptors to enhance GABA effects
Pregunta 43
Pregunta
Avoidant Restrictive Feeding Intake Disorder (ARFID) is more predominant in males than females and has a younger age of onset, 11, than other EDs
Respuesta
- True
- False
Pregunta 44
Pregunta
Which are true about ARFID?
Respuesta
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Most common comorbidities are anxiety disorders, OCD, and neurodevelopmental disorders (autism, ADHD and intellectual disabilities)
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More common in households with high anxiety
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Some medical conditions are associated including GERD, GI problems, vomiting
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Common with Personality Disorders Cluster B (dramatic, erratic)
Pregunta 45
Pregunta
Common comorbid illnesses for ARFID include:
Respuesta
-
Anxiety disorders (GAD)
-
OCD
-
Autism spectrum disorder
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Learning disorders
-
Mood disorders
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Schizophrenia
Pregunta 46
Pregunta
Which appetite stimulants are used to treat ARFID?
Respuesta
-
Cyproheptadine
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Cathine
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Chlorphentermine
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Diethylpropion
Pregunta 47
Pregunta
What is the MOA for Cyrpoheptadine?
Respuesta
-
Non-selectively antagonizes central and peripheral histamine H1 receptors
-
Low affinity for D2 receptors/High affinity for serotonin receptors (5HT2A)
-
Inhibits CNS neuronal uptake of serotonin
Pregunta 48
Pregunta
Which drugs does Cyproheptadine interact with?
Respuesta
-
SSRI
-
MAOIs
-
TCAs
-
Anticonvulsants
Pregunta 49
Pregunta
The following are symptoms of disordered eating
Respuesta
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Picky eating – limited food choices, texture
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Unhealthy dieting – calorie restriction
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Unhealthy eating – skipping meals
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Use of laxatives, diet pills, bingeing, vomiting
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Related to choking fears
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Related to food allergies
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Related to emetaphoibia
Pregunta 50
Pregunta
What are symptoms of disordered eating as related to OCD?
Respuesta
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Contamination (foods, stores, brands of food, contact with certain people, organic or “green” foods, avoidance of fast foods)
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Color of foods (need to eat all tan foods/avoid red foods – devil or blood)
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Symmetry related (need to eat same amount as sibling to maintain identical weight and shape or chewing same number of times on each side of mouth)
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Use of laxatives, diet pills, bingeing, vomiting
Pregunta 51
Pregunta
What are the guidelines for prescribing for disordered eating due to OCD?
Respuesta
-
Typically require higher doses as compared to patients with affective disorders or other anxiety disorders
-
May take 10-12 weeks in OCD to determine efficacy
-
Empirical data supports pharmacologic treatment of OCD
-
Multiple augmentation strategies for treatment-resistant OCD
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Having your mom tell you to "just eat already" while pinching your cheek
Pregunta 52
Pregunta
The following types of drugs are used in the treatment of eating disorders due to OCD
Respuesta
-
SSRIs
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TCA
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Atypical antipsychotics
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Mood stabilizers
Pregunta 53
Pregunta
These are pearls from Mary Carter about the treatment of EDOs
Respuesta
-
Patients with ED’s are more susceptible to adverse side effects, especially if they are purging or if they are at a low weight. START LOW AND GO SLOW!
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Psychotropic medications do not work as well when nutrition status is poor.
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Malnutrition may deplete trytophan which is necessary to make neurotransmitters like serotonin
-
Patients may begin to experience side effects when they are adequately weight restored possibly due to surge in neurotransmitters
-
Goal is to get to a dose that optimizes clinical efficacy while minimizing adverse effects
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