Medications: Drug-Induced Dysphagia, Complications, and Potential Treatments

Karen Sheffler, MS, CCC-SLP, BCS-S

Medications: Drug-Induced Dysphagia, Complications, and Potential Treatments

CE Information

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Course Brochure

Contains CE information for additional professionals

Course Highlights

  • Immediately improve your knowledge base regarding medications that can potentially help versus harm a person's eating and swallowing safety
  • Resources to use on-the-job and to further your learning
  • Helpful chart to organize classes of drugs and their side effects
  • Practical information to make you a valuable collaborative member of the medical team
  • Add practical safe swallowing strategies to your dysphagia toolbox to help peopleswallow pills easier and absorb their medications better

Additional Info

The therapist can have a tremendous impact in this area of adverse drug reactions, potentially preventing or reducing drug-induced dysphagia and complications from side-effects of medications. Part of our job is to dig through a patient's medical record to uncover what could potentially be the underlying cause(s) of the symptom of dysphagia (Sheffler, 2014). Dysphagia is not a disease in-and-of-itself; therefore, ittakes a collaborative effort with the medical team to revealwhat is causing the dysphagia. One common cause could be iatrogenic (unintended adverse complications or side-effectsfrom a treatment, such as intubations or medications). Medications may be an overlooked reason for iatrogenic complications such as dysphagia, pneumonia, confusion, and falls.

A medical record review should include the potentialimpact of medications, according to the clinical guidelines set forth by both the American Speech-Language HearingAssociation (per ASHA's Practice Portal), as well as the clinical guidelines set by the Royal College of Speech and Language Therapists (per RCSLT.org). Our thorough medical record review has a big impact. The Health and Social Care Information Centre in England found that 15% of hospital admissions of people with dementia with dysphagia could be prevented by contributions from a speech-language pathologist. Part of our prevention is identifying at risk patients who are on medications that could be contributing to aspiration and/or choking risks. Ruschena, et al. (2003) noted that the risk for choking in people with schizophrenia is higher due to the combination of the disease itself and the use of antipsychotics. When SLPs are aware of the risksacross a wide variety of diseases and disorders, steps can be taken to maximize patient safety (including trying to make oral intake potentially safer).

[ASHA:Intermediate level, Professional Area]
  1. Explain how different classes of medications can causecentral nervous system impairment, significant side-effects (e.g., dry mouth, sedation, fall risks, confusion), and direct dysphagia complications that could elevate a person's risk for negative sequela, such as prolonged hospital stay, falls, confusion, poor intake, aspiration, pneumonia, andchoking.
  2. Identify who is at risk for drug-induced dysphagia complications and be prepared to advocate for your patients with the entire medical team, collaborating with pharmacy, nursing, physicians, and more.
  3. Describe medications that could possibly improve swallow function, especially when taken correctly, and to advocate for people who have difficulty swallowingmedications and require safe swallowing strategies and solutions.
  1. Pharmacology and the Role of the Therapist
    • Multidisciplinary approach to dysphagia evaluationand treatment
    • The importance of a therapist being able to discuss medications with the team
    • Medications across the continuum of care: Prevention, evaluations, advocacy, collaboration with team, and contributing to treatment
  2. Why Worry About Medications in Older Adults?
    • Polypharmacy
    • Adverse Drug Reactions (ADRs), includingpneumonia and death
    • Resources for therapists
    • Pharmacokinetics and pharmacodynamics
    • Aging, half-life, higher risk for toxicity, adherence
  3. Dysphagia as a Direct Impact from a Drug
    • ABA's of drug-induced dysphagia
      • Anticholinergics
      • Benzodiazepines
      • Antipsychotics: Typical and atypical
    • Special section on new research on delirium and antipsychotics
    • Direct impact on the esophagus
    • Hard pill to swallow: Warnings on crushing medications and potential solutions
  4. Dysphagia as a Secondary Complication of theMedications' Side-Effects
    • Xerostomia
    • Central nervous system depression
    • Immunosuppression
    • ACE Inhibitors: Angioedema and dry cough
  5. Medications that Can Reduce Dysphagia and RelatedSymptoms
    • Parkinson's and Sinemet with case example
    • Substance P
    • Capsaicin
    • Drooling/hypersalivation
    • Pain management (Gabapentin) and head/neck cancer
  6. The Future is Bright: 3D Printed Pharmaceuticals

Karen Sheffler, MS, CCC-SLP, BCS-S, has over 20 years of experience as a medical speech-language pathologist, specializing in dysphagia since 1995, when she graduated from the University of Wisconsin-Madison. She obtained her Board Certification as a Swallowing Specialist (BCS-S) in 2012. In 2014, she started SwallowStudy.com, which is a dysphagia resource for patients and professionals. Karen has worked in acute care, rehabilitation centers, skilled nursing facilities, and in home health care. She currently works at two different hospitals in the Boston area, owns her own dysphagia consulting business, and provides dysphagia expert services to companies and law firms. Karen also performs peer reviews for DysphagiaGrandRounds.com and the American Board of Swallowing and Swallowing Disorders (ABSSD).Believing in constant continuing education, she has been awarded the ASHA Award for Continuing Education 5 times. She is a member of ASHA's Special Interest Group 13, the National Foundation of Swallowing Disorders (NFOSD), and the Dysphagia Research Society (where she is a member of the Website, Communications and Public Relations Committee).

DISCLOSURES

FINANCIAL: Karen Sheffler is compensated as a consultant and presenter for Hormel Health Labs, and she sits on a Hormel advisory council. She is compensated as an instructor by Summit and SpeechPathology.com/Continued.com. Karen has received or will receive an honorarium for presenting on IDDSI for Hormel, Becky Dorner Associates, and Martin Bros. Distributing Co, Inc. Karen Sheffler's website, SwallowStudy.com, has an affiliate relationships with Medbridge and CWI (which sells dysphagia products). She has performed paid peer reviews for MedBridge.

NONFINANCIAL: Karen Sheffler is the founder and developer of the website SwallowStudy.com. She is a member of the ASHA Special Interest Group 13 and the National Foundation of Swallowing Disorders (NFOSD). She is also a member of the Dysphagia Research Society. She has performed volunteer peer-reviewing for DysphagiaGrandRounds.com and for the American Board of Swallowing and Swallowing Disorders (ABSSD). She is an IDDSI Champion, promoting the International Dysphagia Diet Standardization Initiative since 2014.

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  • Medications: Drug-Induced Dysphagia, Complications, and Potential Treatments |2 Hour Course

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