21 - Dysphagia Flashcards
Define dysphagia
difficulty chewing or swallowing
What types of patients is dysphagia common in?
- elderly
- patients with GERD
- patients with anxiety have shown intermittent dysphagia
- patients with depression have shown progressive dysphagia
Dysphagia needs to be evaluated by a ____ ______ _______
speech language pathologist (SLP)
Dysphagia needs to be diagnosed by a _______
physician
How will we (as pharmacists) be involved in dysphagia?
- 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.
List the 3 phases of swallowing
1) Oral phase
2) Pharyngal phase
3) Esophageal phase
Describe the Oral phase
- 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
Describe the pharyngeal phase
- 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
Describe the esophageal phase
-Peristalsis drives the bolus through the lower esophageal sphincter into the stomach
What are the 3 main sources that may place a person at risk fro dysphagia?
- Neurological
- Physical/structural disease of injury
- Psychogenic conditions
List some acquired (develops after birth) neurological causes of dysphagia
- CVA (stroke)
- head trauma
- polio
List some congenital (existing at or before birth) neurological causes of dysphagia
- cerebral palsy
- ringed esophagus
- musculoskeletal abnormalities at birth
- metabolic disturbances at birth
- interna organ deformities at birth
- genetic disorders
List some degenerative (defined as a progressive decline in the conditions of one’s organs) neurological causes of dysphagia
- ALS (Lou Gehrig’s Disease)
- Parkinson’s disease
- Huntington’s disease
- MS
- Dementias
List some physical/structural disease of injury causes of dysphagia
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
List some psychogenic causes of dysphagia
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
List the oral stage symptoms of dysphagia
- 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
List some pharyngeal stage symptoms of dysphagia
- 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
List 2 other symptoms of dysphagia
- Reluctance or refusal to eat
- Unexplained weight loss
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)
- cough (ex. ACEi causes cough)
- xerostomia (dry mouth) ex. anticholinergics
- dysguesia (taste perversion) ex. zopiclone
- sedation
- appetite changes
What are the adverse effects contributing to dysphagia caused by:
Antibiotics
- nausea
- vomiting
- dyspepsia
- thrush
- dysguesia
- glossitis
- pharyngitis
- stomatitis
What are the adverse effects contributing to dysphagia caused by:
Psychotropics
- xerostomia or hyper salivation
- movement disorders (ex. dyskinesia, parkinsonism)
- laryngospasm
- nausea
- vomiting
- hiccups
- glossitis (inflamed glottis)
What are the adverse effects contributing to dysphagia caused by:
Antiepileptics
- tremor
- hypersecretion in upper respiratory passages
- increase salivation
- nausea
- vomiting
- xerostomia
- hiccups
- glossitis
- dysguesia
- gingival hyperplasia
- enlarged lips
- motor twitching
- drowsiness
- fatigue
What are the adverse effects contributing to dysphagia caused by:
NSAIDs/Analgesics
- nausea
- vomiting
- esophagitis
- gastritis
- dry cough
- xerostomia
- throat irritation
- dysphagia
- dysguesia
- laryngeal spasms
- laryngeal edema
What are the adverse effects contributing to dysphagia caused by:
Cardiovascular Meds
- nausea
- vomiting
- weakness
- dyspepsia
- esophagitis
- dizziness
- dry cough
- pharyngitis
What are the adverse effects contributing to dysphagia caused by:
GI Meds
- nausea
- vomiting
- xerostomia
- laryngitis
- lassitude
- dyspapsia
Treatment of dysphagia may focus on any combination of ??
- swallowing rehabilitation
- posture
- food texture
- feeding tools
- oral strength
- physical strength and coordination
- behaviour modification
- medication management
If the cause is achalasia (disorder of LES), what do we use to treat it?
- anticholinergics
- calcium-channel blockers
If the cause is diffuse esophageal spasm, what do we use to treat it?
- nitrates
- calcium-channel blockers
- sildenafil
If the cause is eosophilic esophagitis, what do we use to treat it?
- proton pump inhibitors
- topical steroids
If the cause is infectious esophagitis, what do we use to treat it?
- antivirals
- antifungals
If the cause is peptic stricture, what do we use to treat it?
-proton pump inhibitor
If the cause is scleroderma (systemic tissue sclerosis), what do we use to treat it?
Antisecretory drugs, systemic medication management of scleroderma
If the cause is xerostomia, what do we use to treat it?
moisturizers (i.e. MouthKote, Biotene)
If the cause is hyper secretion, what do we use to treat it?
Anticholinergics (i.e. scopolamine)
If the cause is thrush, what do we use to treat it?
Nystatin
If the cause is parkinsonism or myasthenia, what do we use to treat it?
Treat according to those guidelines (not covered here)
