antidepressants

tranquilizers

B adrenergic agents

narcoleptics

hormones

steroids

DM

CAD

HTN

Ca

HLD

gallstones

arthritis

increased morbidity

orlistat

noloxone

sibutramine

biculine

amphetamines (not recommended)

ephedrine

fenfluramine

food doesn't transport easily from mouth to esophagus

difficulty starting swallow

probs with liquids > oropharyngeal than esophageal

dysarthria

wet/hoarse voice

nasal regurg

cough during swallow

oropharyngeal dysphagia 3 causes

1. 80% central and peripheral NS lesion or muscular diseases

2. Structural lesions

3. upper esophageal sphincter disorders

1. motility

2. mechanical

tetracycline

doxy

potassium

ferrous sulfate

theophylline

alendroante

ASA

quinidine

corticosteroiods

NSAIDS

ascorbic acid

difficulty with food and liquid moving through esophagus

normally 2-3 seconds for liquid

8-10 seconds for solids

blood work to r/o metabolic/endocrine

barium swallow

endoscopy

esophageal manometry (motility)

CXR

refer - speech therapy, GI, dentist, neurology

address cause

r/o malignancy

speech therapy

postural maneuvers

change food consistency

muscle strengthening

nutritional RV

increased protein breakdown

increased metabolic demands

change in protein synthesis

increased cytokinin production

anorexia

wgt loss

metabolic alterations

weakness

ca

pulmonary disease

end stage cardiac

RA

end stage dementia

1. absorption decreases

2. distribution decreases d/t + lean body mass, - albumin, - fat stores

3. metabolism - decreased liver metab

4. excretion - decreased GFR

sedate

memory loss

dizzy

depression

confusion

blurred vision

urine retention

constipation

dry mouth

A - Antipsychotics

B - BB's and benzos

C - cimetidine

 D - diuretics

etc - narcs

steroids

reserpin (anti-htn)

antipsychotics

colinergic angonists (acetylcholine, pilocarpine)

TCA

aspirn

aminoglycosides

BB

neuorleptics

lasix

metronidazole

vasodilators

metoclopramide

dilantin

steroid

heparin

lithium

polypharmacy (usually take 13 meds/year)

self medication

OTC

herbals

take friends meds

multiple comorbidities

multiple prescribers

OTC

herbal

pill for every ill

consult pharmacist

bring all meds in

education

limit to essentials

avoid combo products

lowest effective dosing

comorbidities

extra expense

adverse rxns

depression

nursing home

cimetidine

decongestants

NSAIDS

niacin

antacids

laxatives

calcium

increases toxicity of cardiac glycosides and

thiazide diuretics

increases effects of oral anticoagulants

affects blood sugar control

decreases lasix

estrogenic effects

increases effects of SSRI's

and antidepressants

increases effects of benzos

ETOH and CNS depressants

interacts with cardiac glycosides

and thiazides

decreases by 40% by age 70 y.o.

reduced drug elimination

check CrCl and reduce dosing

increased serum levels of meds

reduce dose

70 years of age or older is significantly reduced

lower therapeutic doses

monitor for safe dosing and adverse reactions with renal insufficiency

medication for chronic ETOH abuse

causes: htn, anxiety, restlessness after ETOH consumed