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Clinical 1 (Part B) > 21 - Dysphagia > Flashcards

21 - Dysphagia Flashcards

1
Q

Define dysphagia

A

difficulty chewing or swallowing

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2
Q

What types of patients is dysphagia common in?

A
  • elderly
  • patients with GERD
  • patients with anxiety have shown intermittent dysphagia
  • patients with depression have shown progressive dysphagia
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3
Q

Dysphagia needs to be evaluated by a ____ ______ _______

A

speech language pathologist (SLP)

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4
Q

Dysphagia needs to be diagnosed by a _______

A

physician

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5
Q

How will we (as pharmacists) be involved in dysphagia?

A
  • Evaluate drug-related causes of dysphagia
  • Suggest treatments for xerostomia (dry mouth)
  • Modify time of administration and dosage form and make medication recommendations to minimize, eliminate or adapt to dysphagia where appropriate
  • Communicate with the dysphagia team regarding drug causes of dysphagia and treatments for same.
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6
Q

List the 3 phases of swallowing

A

1) Oral phase
2) Pharyngal phase
3) Esophageal phase

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7
Q

Describe the Oral phase

A
  • Food is chewed and mixed with saliva to form a bolus
  • Voluntary swallowing is initiated and the tongue pushes the bolus posterior towards the pharynx, stimulating several receptors to start the swallowing process
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8
Q

Describe the pharyngeal phase

A
  • The swallowing response stops the breathing and raises the larynx for the bolus to pass
  • The bolus is transported by peristalsis across the closed vocal folds and epiglottis into the esophagus through the cricopharyngeal sphincter
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9
Q

Describe the esophageal phase

A

-Peristalsis drives the bolus through the lower esophageal sphincter into the stomach

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10
Q

What are the 3 main sources that may place a person at risk fro dysphagia?

A
  • Neurological
  • Physical/structural disease of injury
  • Psychogenic conditions
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11
Q

List some acquired (develops after birth) neurological causes of dysphagia

A
  • CVA (stroke)
  • head trauma
  • polio
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12
Q

List some congenital (existing at or before birth) neurological causes of dysphagia

A
  • cerebral palsy
  • ringed esophagus
  • musculoskeletal abnormalities at birth
  • metabolic disturbances at birth
  • interna organ deformities at birth
  • genetic disorders
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13
Q

List some degenerative (defined as a progressive decline in the conditions of one’s organs) neurological causes of dysphagia

A
  • ALS (Lou Gehrig’s Disease)
  • Parkinson’s disease
  • Huntington’s disease
  • MS
  • Dementias
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14
Q

List some physical/structural disease of injury causes of dysphagia

A

Any condition causing injury to the anatomical structures. For example:

  • Trauma
  • Poorly fitting dentures
  • Gum disease, mobile teeth or decayed teeth
  • Disease (cancer, surgical intervention)
  • Generalized weakness
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15
Q

List some psychogenic causes of dysphagia

A

Any physical symptom, disease process, or emotional state that is of psychological rather than physical origin:

  • Emotional disturbances
  • Developmental delay
  • Medication induced
  • Psychiatric diagnosis

ex. anxious patients eating dinner with lots of people

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16
Q

List the oral stage symptoms of dysphagia

A
  • poor lip closure
  • drooling or excessive secretions
  • seepage of food or liquid from the mouth
  • reduced chewing ability
  • pocketing of food on the weak side (likely after a stroke)
  • reduced tongue function (speech may be slurred)
  • dry mouth
  • food and liquid residue remains on the tongue and/or the roof of the mouth after swallowing
  • increased time to complete a meal safely and enjoyably
  • fatigue as the meal progresses (chewing ability may deteriorate)
  • poor dentition or poorly fitting dentures
17
Q

List some pharyngeal stage symptoms of dysphagia

A
  • coughing or throat clearing before, during or after swallowing food or liquid (shows that the food is stuck in the pharynx)
  • choking
  • hoarse, wet force after swallows (gurgly)
  • complaints of food getting stuck in the throat or going down the wrong way
  • nasal regurgitation of food
  • difficulty managing secretions
18
Q

List 2 other symptoms of dysphagia

A
  • Reluctance or refusal to eat

- Unexplained weight loss

19
Q

List some side effects of medications that are related to swallowing dysfunction (only list a few, there is a list of like 20 in the notes tho)

A
  • cough (ex. ACEi causes cough)
  • xerostomia (dry mouth) ex. anticholinergics
  • dysguesia (taste perversion) ex. zopiclone
  • sedation
  • appetite changes
20
Q

What are the adverse effects contributing to dysphagia caused by:
Antibiotics

A
  • nausea
  • vomiting
  • dyspepsia
  • thrush
  • dysguesia
  • glossitis
  • pharyngitis
  • stomatitis
21
Q

What are the adverse effects contributing to dysphagia caused by:
Psychotropics

A
  • xerostomia or hyper salivation
  • movement disorders (ex. dyskinesia, parkinsonism)
  • laryngospasm
  • nausea
  • vomiting
  • hiccups
  • glossitis (inflamed glottis)
22
Q

What are the adverse effects contributing to dysphagia caused by:
Antiepileptics

A
  • tremor
  • hypersecretion in upper respiratory passages
  • increase salivation
  • nausea
  • vomiting
  • xerostomia
  • hiccups
  • glossitis
  • dysguesia
  • gingival hyperplasia
  • enlarged lips
  • motor twitching
  • drowsiness
  • fatigue
23
Q

What are the adverse effects contributing to dysphagia caused by:
NSAIDs/Analgesics

A
  • nausea
  • vomiting
  • esophagitis
  • gastritis
  • dry cough
  • xerostomia
  • throat irritation
  • dysphagia
  • dysguesia
  • laryngeal spasms
  • laryngeal edema
24
Q

What are the adverse effects contributing to dysphagia caused by:
Cardiovascular Meds

A
  • nausea
  • vomiting
  • weakness
  • dyspepsia
  • esophagitis
  • dizziness
  • dry cough
  • pharyngitis
25
Q

What are the adverse effects contributing to dysphagia caused by:
GI Meds

A
  • nausea
  • vomiting
  • xerostomia
  • laryngitis
  • lassitude
  • dyspapsia
26
Q

Treatment of dysphagia may focus on any combination of ??

A
  • swallowing rehabilitation
  • posture
  • food texture
  • feeding tools
  • oral strength
  • physical strength and coordination
  • behaviour modification
  • medication management
27
Q

If the cause is achalasia (disorder of LES), what do we use to treat it?

A
  • anticholinergics

- calcium-channel blockers

28
Q

If the cause is diffuse esophageal spasm, what do we use to treat it?

A
  • nitrates
  • calcium-channel blockers
  • sildenafil
29
Q

If the cause is eosophilic esophagitis, what do we use to treat it?

A
  • proton pump inhibitors

- topical steroids

30
Q

If the cause is infectious esophagitis, what do we use to treat it?

A
  • antivirals

- antifungals

31
Q

If the cause is peptic stricture, what do we use to treat it?

A

-proton pump inhibitor

32
Q

If the cause is scleroderma (systemic tissue sclerosis), what do we use to treat it?

A

Antisecretory drugs, systemic medication management of scleroderma

33
Q

If the cause is xerostomia, what do we use to treat it?

A

moisturizers (i.e. MouthKote, Biotene)

34
Q

If the cause is hyper secretion, what do we use to treat it?

A

Anticholinergics (i.e. scopolamine)

35
Q

If the cause is thrush, what do we use to treat it?

A

Nystatin

36
Q

If the cause is parkinsonism or myasthenia, what do we use to treat it?

A

Treat according to those guidelines (not covered here)

Clinical 1 (Part B) (11 decks)

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