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Psychopharmacology Exam #2: Eating disorders

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Quiz sobre Psychopharmacology Exam #2: Eating disorders, criado por Melanie Grynsztejn em 24-03-2018.
Melanie Grynsztejn
Quiz por Melanie Grynsztejn, atualizado more than 1 year ago
Melanie Grynsztejn
Criado por Melanie Grynsztejn aproximadamente 6 anos atrás
59
2
0

Resumo de Recurso

Questão 1

Questão
Which diagnoses are most often associated with EDOs
Responda
  • Schizophrenia
  • Anxiety disorders
  • Obsessive compulsive disorders
  • Substance use disorders

Questão 2

Questão
Anorexia nervosa has a predominantly female disorder with a mean age of onset of 15 years old
Responda
  • True
  • False

Questão 3

Questão
Patients with Anorexia Nervosa (AN) and a psychiatric comorbidity have [blank_start]higher[blank_end] mortality rates than those without
Responda
  • higher
  • lower

Questão 4

Questão
Comorbid disorders for Anorexia Nervosa include
Responda
  • MDD
  • Anxiety disorders (social phobia & GAD)
  • OCD
  • Substance use disorders
  • Personality disorders
  • Schizophrenia

Questão 5

Questão
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.
Responda
  • True
  • False

Questão 6

Questão
Anorexia nervosa has the highest death rate of any mental health illness
Responda
  • True
  • False

Questão 7

Questão
[blank_start]Food[blank_end] is your best medicine in aneroxia nervosa
Responda
  • Food

Questão 8

Questão
What is the primary aim in the beginning stages of treatment of aneroxia nervosa?
Responda
  • Normalize and regulate eating patterns
  • Treat with medications to help with mood, andanxiety
  • Begin family-based interventions
  • Individualized therapy interventions

Questão 9

Questão
Prior to medication initiation for anorexia nervosa, a prescriber needs to have
Responda
  • weight and height
  • % IBW
  • Orthostatic vitals
  • EKG
  • 24 hour diet diary

Questão 10

Questão
SSRIs are the gold standard treament for sever depression, anxiety/OCD [blank_start]after[blank_end] weight restoration
Responda
  • after
  • during initial treatment before

Questão 11

Questão
Which SSRI should be avoided with anorexia nervosa due to QTc prolongation?
Responda
  • Fluoxetine
  • Citalopram
  • Fluvoxamine
  • Paroxetine

Questão 12

Questão
SSRIs are FDA indicated for anorexia nervosa
Responda
  • True
  • False

Questão 13

Questão
[blank_start]Fluoxetine[blank_end] and [blank_start]citalopram[blank_end] have some evidence for relapse prevention in weight-stored anorexics receiving treatment
Responda
  • Fluoxetine
  • Setraline
  • Paroxetine
  • Fluvoxamine
  • Setraline
  • citalopram
  • Fluvoxamine
  • Paroxetine

Questão 14

Questão
MOA for SSRI
Responda
  • Low affinity for D2 receptors/High affinity for serotonin receptors (5HT2A)
  • Selectively inhibits serotonin reuptake resulting in enhanced serotonergic transmission in the CNS
  • : Interacts with GABA receptors to enhance GABA effects

Questão 15

Questão
Which atypical antipsychotic has some evidence to help restore weight more quickly as adjunctive treatment to other interventions?
Responda
  • Risperidone
  • Apiprazole
  • Olanzapine

Questão 16

Questão
MOA for atypical antipsychotic used in anorexia nervosa is
Responda
  • Selectively inhibits serotonin reuptake resulting in enhanced serotonergic transmission in the CN
  • Low affinity for D2 receptors/High affinity for serotonin receptors (5HT2A)
  • Blocks voltage-dependent sodium & calcium channels

Questão 17

Questão
Cigarettes [blank_start]decrease[blank_end] serum concentration of olanzapine
Responda
  • decrease
  • increase

Questão 18

Questão
Olanzapine will interact with anything causing CNS depression including opioids, barbiturates, benzodiazepines, general anesthetics, and anticonvulsants such as pregabalin
Responda
  • True
  • False

Questão 19

Questão
There is mixed evidence for the use of BZ to reduce meal anxiety. Typically only ___________ used off-label
Responda
  • Alprazolam
  • Clonazepam
  • Lorazepam
  • Diazepam

Questão 20

Questão
BZ should be avoided with opioids
Responda
  • True
  • False

Questão 21

Questão
MOA for benzodiazepines is
Responda
  • 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)

Questão 22

Questão
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.
Responda
  • True
  • False

Questão 23

Questão
Comormid illnesses for bulimia nervosa are similar to AN with
Responda
  • Mood disorders
  • Anxiety Disorders
  • OCD
  • Substance abuse
  • Schizophrenia
  • Personality disorders (Cluster B - dramatic, erratic)

Questão 24

Questão
Medication of choice for bulimia nervosa is
Responda
  • Anticonvulsants
  • SSRIs
  • Atypical antipsychotics
  • TCA's

Questão 25

Questão
Combined pharmacotherapy and psychotherapy appears to be more efficacious than either alone for bingeing and purging. This should be continued for a minimum of
Responda
  • 6 months
  • 12 months
  • 18 months
  • 2 years

Questão 26

Questão
Which is considered 1st line for bulimia nervosa due to its efficacy and FDA approval for adults
Responda
  • Fluoxetine
  • Sertraline
  • Citalopram
  • Paroxetine

Questão 27

Questão
TCAs and anticonvulsants have been shown in studies to help reduce beingeing and purging, but SSRI Fluxetine is considered first line SSRI therapy
Responda
  • True
  • False

Questão 28

Questão
Mechanism of action for Fluoxetine used in bulimia nervosa is
Responda
  • inhibition of 5HT receptor, which leads to an increase in serotonin level
  • 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
  • Combination of antagonism at D2 receptors in the mesolimbic pathway and 5HT2A receptors in the frontal cortex.
  • enhances the effects of GABA by increasing GABA affinity for the GABA recepto

Questão 29

Questão
Fluoxetine is contraindicated in use with the following drugs
Responda
  • Selegeline
  • Pimozide
  • Lithium
  • Lorazepam

Questão 30

Questão
When prescribing SSRI Fluoxetine, need to consider other medications that have risk for serotonin syndrome
Responda
  • Triptans
  • Other antidepressants
  • 5-HTP
  • St. John's Wort
  • Anticonvulsants

Questão 31

Questão
Which anticonvulsants are used off label to treat Bulimia Nervosa
Responda
  • Topiramate
  • Zonisamide
  • Valpromide
  • Primidone

Questão 32

Questão
What is the MOA for Topiramate which is used off label for bulimia nervosa
Responda
  • Inhibits CNS neuronal uptake of serotonin
  • Low affinity for D2 receptors/High affinity for serotonin receptors (5HT2A)
  • Blocks voltage- dependent sodium & calcium channels
  • GABA activity and antagonizes glutamate receptors

Questão 33

Questão
Binge eating disorder (BED) is the most common ED and almost as common in men as women. Age of onset is 18 years
Responda
  • True
  • False

Questão 34

Questão
Select the other comorbid disorders of Binge Eating Disorder
Responda
  • Other ED's
  • Schizophrenic disorders
  • Mood disorders (MDD, BPD)
  • Anxiety disorders
  • PTSD
  • Elevated risk of suicide

Questão 35

Questão
What medications are used for Binge Eating Disorders (BED)?
Responda
  • SSRI's
  • Mood stabilizers
  • Stimulants
  • Antipsychotics

Questão 36

Questão
Topiramate, a mood stabilizer, has some evidence to suggest it is effective in which eating disorders
Responda
  • Anorexia nervosa
  • Binge Eating Disorder
  • Bulimia Nervosa
  • Avoidant Restrictive Feeding Intake Disorder (ARFID)

Questão 37

Questão
What are some of the concerns in using Topiramate (Topamax) for BN and BED
Responda
  • May trigger restriction and development of AN
  • Adverse S/E including sedation and cognitive slowing
  • Risk of EPS
  • Orthostatic hypotension

Questão 38

Questão
What is the MOA for Topiramate (Topamax)?
Responda
  • 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)

Questão 39

Questão
Which drug interactions does a prescriber need to be concerned about with Topiramate (Topamax)?
Responda
  • Avoid with other sedating medications
  • Anything with CNS depression
  • Medications with potential to increase risk of metabolic acidosis

Questão 40

Questão
What is the first FDA-approved medication to treat moderate to severe binge eating disorder?
Responda
  • Atomoxetine
  • Lixdexamfetamine
  • Methylphenidate
  • Dextroamphetamine

Questão 41

Questão
What are some concerns with using Lisdexamfetamine for BED?
Responda
  • Risk of misuse or diversion
  • Numerous drug interactions that can increase CV events
  • Can cause EPS in high doses
  • Can cause constipation

Questão 42

Questão
What is the MOA for Lisdexamfetamine?
Responda
  • 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

Questão 43

Questão
Avoidant Restrictive Feeding Intake Disorder (ARFID) is more predominant in males than females and has a younger age of onset, 11, than other EDs
Responda
  • True
  • False

Questão 44

Questão
Which are true about ARFID?
Responda
  • Most common comorbidities are anxiety disorders, OCD, and neurodevelopmental disorders (autism, ADHD and intellectual disabilities)
  • More common in households with high anxiety
  • Some medical conditions are associated including GERD, GI problems, vomiting
  • Common with Personality Disorders Cluster B (dramatic, erratic)

Questão 45

Questão
Common comorbid illnesses for ARFID include:
Responda
  • Anxiety disorders (GAD)
  • OCD
  • Autism spectrum disorder
  • Learning disorders
  • Mood disorders
  • Schizophrenia

Questão 46

Questão
Which appetite stimulants are used to treat ARFID?
Responda
  • Cyproheptadine
  • Cathine
  • Chlorphentermine
  • Diethylpropion

Questão 47

Questão
What is the MOA for Cyrpoheptadine?
Responda
  • 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

Questão 48

Questão
Which drugs does Cyproheptadine interact with?
Responda
  • SSRI
  • MAOIs
  • TCAs
  • Anticonvulsants

Questão 49

Questão
The following are symptoms of disordered eating
Responda
  • Picky eating – limited food choices, texture
  • Unhealthy dieting – calorie restriction
  • Unhealthy eating – skipping meals
  • Use of laxatives, diet pills, bingeing, vomiting
  • Related to choking fears
  • Related to food allergies
  • Related to emetaphoibia

Questão 50

Questão
What are symptoms of disordered eating as related to OCD?
Responda
  • Contamination (foods, stores, brands of food, contact with certain people, organic or “green” foods, avoidance of fast foods)
  • Color of foods (need to eat all tan foods/avoid red foods – devil or blood)
  • 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)
  • Use of laxatives, diet pills, bingeing, vomiting

Questão 51

Questão
What are the guidelines for prescribing for disordered eating due to OCD?
Responda
  • 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
  • Having your mom tell you to "just eat already" while pinching your cheek

Questão 52

Questão
The following types of drugs are used in the treatment of eating disorders due to OCD
Responda
  • SSRIs
  • TCA
  • Atypical antipsychotics
  • Mood stabilizers

Questão 53

Questão
These are pearls from Mary Carter about the treatment of EDOs
Responda
  • 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!
  • Psychotropic medications do not work as well when nutrition status is poor.
  • 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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