101706: A Trip to the Drug Store: Non Prescription Medications That Your Eating Disordered Patient May Be Abusing

About the Course:

Webinar from the 2009 International Association of Eating Disorders Professionals Symposium.
Note: For this course there is a small additional fee to obtain the webinar. Please see the “Get Course Materials” link in the right sidebar for details.

Many eating disordered patients abuse non prescription substances in an attempt to lose weight. They typically use these drugs in supra therapeutic doses and in potentially toxic combinations. Our purpose is to alert the clinician to this dangerous and potentially lethal practice. We will describe the major categories of OTC drugs of abuse; diet pills, diuretics, laxatives and emetics. We will explain the clinical complications of abuse. We will present representative cases from our practice. We will review the prevalence data from our large multidisciplinary treatment program. Interspersed throughout the presentation we will include board review-type questions for discussion/debate.

Content Outline:
I. Introduction, OTC drugs A. Diagnostic categories B. Prevalence data 1. Literature review 2. EDI statistics C. Comorbidities 1. Polypharmacy 2. Novelty seeking 3. High risk behaviors 4. ETOH 5. Anxiety disorders 6. Axis II diagnoses D. Review questions/discussion
II. Diet pills A. Historic 1. Ephedra 2. Phenylpropanolamine B. “Top Sellers” 1. Hydroxycut 2. Herbalife 3. Dexatrim C. New products 1. Hoodia gordonii 2. Orlistat D. Case history E. Review questions/discussion
III. Diuretics A. Diurex B. Pamprin C. Midol D. Case History E. Review questions/discussion
IV. Laxatives A. Categories and examples 1. Stimulant, Correctol, Ex-lax, etc – most abused 2. Osmotic, Miralax 3. Bulk, Psillium 4. Emollient, Colace B. Acute sequelae 1. Hypokalemia 2. Volume depletion C. Chronic sequelae 1. Cathartic Colon 2. Melanosis coli 3. Rectal prolapse 4. Colectomy D. Withdrawal 1. Hyperaldosteronism 2. Massive reflex edema 3. Body image disturbance E. Addiction model, recitivism F. Case history G. Review questions/discussion
V. Emetics, ipecac A. History B. Toxicity myopathy and cardiomyopathy C. Literature review, reported deaths D. Case history E. Review questions/discussion
VI. Conclusion A. Constantly changing, need for update B. Role of internet C. Role of FDA D. “Always ask”

Authors

Deborah Mangham, MD (presenter); Ann E. Vosti, MD (presenter)

About the Authors:

Deborah Mangham, MD is board cerftified in internal medicine and practiced primary care internal medicine before joining the Park Nicollet Methodist Eating Disorders Institute in 2000. She has been the Clinical Practice Director of the inpatient unit and the Clinical Practice Director of the residential program at the Anna Westin House. She is currently the Assistant Medical Director of the Institute. She was given many presentations on various eating disorder topics at both the local and national level (please see CV for details). She has been interviewed on television and in the popular press. She is currently completing a manuscript on ipecac myopathy. Research interests include intestinal bacterial overgrowth in patients with anorexia nervosa.

Ann Vosti MD is currently the lead physician at the Park Nicollet Methodist Eating Disorders Institute. She has been with the EDI since 2001. Dr. Vosti is board cerftified in Family Medicine and has practiced primary care. She also has BNS and MPH degrees. She has worked as a nurse in telemetry and in eating disorders. She has taught nursing at the College of St. Catherine in St.Paul, MN. Dr. Vosti has extensive public speaking experience both locally and nationally and is the author of a journal article on eating disorders in older women. In her leisure time she enjoys hiking, riding and yoga. She has 2 young adult sons, 2 cats and a dog.

Recommended For:

This course is recommended for health care professionals, especially psychologists, therapists, and counselors who seek to update their research knowledge and competency in treating patients with eating disorders, increase and acquire new skills, learn new intervention strategies, and obtain continuing education credits. It is appropriate for professionals at all levels of knowledge.

Course Objectives:

1. Following this presentation, participants will be able to recognize red flags for types of prescription abuse.

2. Following this presentation, participants will be able to identify a patient in your office who might be suffering from ipecac toxicity.

3. Following this presentation, participants will be able to recognize what mucomyst has to do with OTC diuretic overdose.