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Psychopharmacology Exam #2: Eating disorders

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Quiz on Psychopharmacology Exam #2: Eating disorders, created by Melanie Grynsztejn on 24/03/2018.
Melanie Grynsztejn
Quiz by Melanie Grynsztejn, updated more than 1 year ago
Melanie Grynsztejn
Created by Melanie Grynsztejn about 6 years ago
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Resource summary

Question 1

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

Question 2

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

Question 3

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

Question 4

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

Question 5

Question
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.
Answer
  • True
  • False

Question 6

Question
Anorexia nervosa has the highest death rate of any mental health illness
Answer
  • True
  • False

Question 7

Question
[blank_start]Food[blank_end] is your best medicine in aneroxia nervosa
Answer
  • Food

Question 8

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

Question 9

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

Question 10

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

Question 11

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

Question 12

Question
SSRIs are FDA indicated for anorexia nervosa
Answer
  • True
  • False

Question 13

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

Question 14

Question
MOA for SSRI
Answer
  • 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

Question 15

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

Question 16

Question
MOA for atypical antipsychotic used in anorexia nervosa is
Answer
  • 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

Question 17

Question
Cigarettes [blank_start]decrease[blank_end] serum concentration of olanzapine
Answer
  • decrease
  • increase

Question 18

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

Question 19

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

Question 20

Question
BZ should be avoided with opioids
Answer
  • True
  • False

Question 21

Question
MOA for benzodiazepines is
Answer
  • 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)

Question 22

Question
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.
Answer
  • True
  • False

Question 23

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

Question 24

Question
Medication of choice for bulimia nervosa is
Answer
  • Anticonvulsants
  • SSRIs
  • Atypical antipsychotics
  • TCA's

Question 25

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

Question 26

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

Question 27

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

Question 28

Question
Mechanism of action for Fluoxetine used in bulimia nervosa is
Answer
  • 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

Question 29

Question
Fluoxetine is contraindicated in use with the following drugs
Answer
  • Selegeline
  • Pimozide
  • Lithium
  • Lorazepam

Question 30

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

Question 31

Question
Which anticonvulsants are used off label to treat Bulimia Nervosa
Answer
  • Topiramate
  • Zonisamide
  • Valpromide
  • Primidone

Question 32

Question
What is the MOA for Topiramate which is used off label for bulimia nervosa
Answer
  • 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

Question 33

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

Question 34

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

Question 35

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

Question 36

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

Question 37

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

Question 38

Question
What is the MOA for Topiramate (Topamax)?
Answer
  • 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)

Question 39

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

Question 40

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

Question 41

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

Question 42

Question
What is the MOA for Lisdexamfetamine?
Answer
  • 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

Question 43

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

Question 44

Question
Which are true about ARFID?
Answer
  • 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)

Question 45

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

Question 46

Question
Which appetite stimulants are used to treat ARFID?
Answer
  • Cyproheptadine
  • Cathine
  • Chlorphentermine
  • Diethylpropion

Question 47

Question
What is the MOA for Cyrpoheptadine?
Answer
  • 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

Question 48

Question
Which drugs does Cyproheptadine interact with?
Answer
  • SSRI
  • MAOIs
  • TCAs
  • Anticonvulsants

Question 49

Question
The following are symptoms of disordered eating
Answer
  • 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

Question 50

Question
What are symptoms of disordered eating as related to OCD?
Answer
  • 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

Question 51

Question
What are the guidelines for prescribing for disordered eating due to OCD?
Answer
  • 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

Question 52

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

Question 53

Question
These are pearls from Mary Carter about the treatment of EDOs
Answer
  • 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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