21 - Dysphagia Flashcards
(36 cards)
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
