Prescribing in Dysphagia (ISS) Flashcards
Aggravating factors in GORD?
Smoking Stress Medications, e.g: NSAIDs Alcohol Lying down flat Spicy foods
How can drugs cause dysphagia?
Direct oesophageal injury
Side-effect of the pharmacological action
Complication of the therapeutic action
Examples of drugs that cause direct oesophageal injury?
NSAIDs
Antibiotics, e.g: doxycycline, clindamycin
Theophylline
Vitamin C (ascorbic acid) supplements
How can drugs cause direct oesophageal injury?
Local irritation can be due to, e.g: reclining after taking drugs or inadequate fluids taken or elderly and slower GI movement
Avoiding direct oesophageal injury?
Avoid: Unnecessary night-time drugs Large tablets Shape tablets Polypharmacy
2 mechanisms by which NSAIDs can cause GI irritation?
Direct irritation - acidic molecules directly irritate the gastric mucosa
Indirect irritation - inhibition of COX-1 and COX-2 reduce the levels of protective PGs, causing increased gastric acid synthesis, decreased bicarbonate and mucous secretion and reduced trophic effects on epithelial mucosa
How to overcome complications accompanying NSAID use?
Alternative
Prescribe with a PPI
Different potencies and different coating
Types of side effects that can cause GORD?
Affecting smooth & striated muscles of the oesophagus, e.g: anti-muscarinic effects
Reduced lower oesophageal sphincter tone & reflux, e.g: drugs (theophylline, nitrates, Ca2+ antagonists) and foods (chocolate, alcohol, coffee, garlic and onions)
Dry mouth
Others
Main classes of drugs responsible for dry mouth?
Anti-muscarinics - inhibition of parasympathomimetics
Diuretics
Drugs that cause GORD as a complication of its therapeutic action?
Anti-epileptics, e.g: carbamazipine
Benzodiazepines, e.g: Diazepam
Opiods, e.g: codeina and morphine
Skeletal muscle relaxants, e.g: baclofen
Symptoms of GORD?
RETROSTERNAL pain
Regurgitation (tasting stomach contents at the back of the throat)
Dysphagia, due to strictures (1/3rd)
How to take antacids?
E.g: Mucogel or Gaviscon suspensions after meals and before bed
Take 2 hours before interacting drugs (antacids can reduce absorption of other drugs due to chelation)
How to take H2 receptor antagonists?
E.g: Ranitidine
One tablet twice a day
How to take PPIs?
E.g: Omeprazole
One daily
Mode of action of antacids?
Do not depend on absorption but act physically; protect lining of the oesophageal tract:
Directly (alginates to form raft)
Indirectly (reducing acid levels in the stomach)
