Patients with swallowing difficulty

In ALS patients, sialorrhea can be a major symptom as bulbar weakness worsens. Wliich of these medications is ideal for a patient with swallowing difficulty ... 

This route can be used in patients with swallowing difficulties. 

Individualised oral liquids from solids (active ingredient in ora-sweet or ora-blend or ora-blend vehicle) [83] Patients with swallowing difficulties or dose determining with children... 

For patients who have difficulty swallowing dilti-azem, tablets can be crushed and mixed with food or liquids. However, the patient should swallow the sus-tained-released tablets whole and not chew or divide them. When nifedipine is ordered sublingually, the capsule is punctured with a sterile needle and the liquid squeezed under the tongue or in the buccal pouch. 

Patients with the following conditions should use laxatives only under the supervision of a health care provider (1) colostomy (2) diabetes mellitus (some laxatives contain large amounts of sugars such as dextrose, galactose, and/or sucrose (3) heart disease (some products contain sodium (4) kidney disease and (5) swallowing difficulty (bulk-formers may produce esophageal obstruction). 

Opioids maybe administered in a variety of routes including oral (tablet and liquid), sublingual, rectal, transdermal, transmucosal, intravenous, subcutaneous, and intraspinal. While the oral and transdermal routes are most common, the method of administration is based on patient needs (severity of pain) and characteristics (swallowing difficulty and preference). Oral opioids have an onset of effect of 45 minutes, so intravenous or subcutaneous administration maybe preferred if more rapid relief is desired. Intramuscular injections are not recommended because of pain at the injection site and wide fluctuations in drug absorption and peak plasma concentrations achieved. More invasive routes of administration such as PCA and intraspinal (epidural and intrathecal) are primarily used postoperatively, but may also be used in refractory chronic pain situations. PCA delivers a self-administered dose via an infusion pump with a preprogrammed dose, minimum dosing interval, and maximum hourly dose. Morphine, fentanyl, and hydromorphone are commonly administered via PCA pumps by the intravenous route, but less frequently by the subcutaneous or epidural route. 

About 75 mg of carbidopa is required to effectively block L-AAD, but some patients may need more. Carbidopa/L-dopa is most widely used in a 25-mg/ 100-mg tablet, but 25-mg/250-mg and 10-mg/100-mg dosage forms are also available. Controlled-release preparations of carbidopa/L-dopa are available in 50-mg/200-mg and 25-mg/100-mg strengths. For patients with difficulty swallowing, an orally disintegrating tablet is available. If peripheral adverse effects are prominent, 25-mg carbidopa (Lodosyn) tablets are available. 

Difficuity swaiiowing - For patients who have difficulty swallowing capsules, add 1 tablespoon of applesauce to an empty bowl, open the omeprazole capsule, and empty the pellets onto the applesauce. Mix the pellets with the applesauce and swallow immediately. Do not heat or chew the applesauce. Do not chew or crush the pellets. Do not store the pellet/applesauce mixture for future use. 

For patients who have difficulty swallowing intact capsules, the capsule can be carefully opened and the contents mixed with 30 ml of yogurt or applesauce. Patients should be cautioned not to chew or crush the beads while swallowing. 

Antecollis is a rare form of tardive dystonia, in which there is forward bending of the neck (331). Patients with this disorder are usually quite disabled and distressed, have severe difficulties with vision, speech, swallowing, and inspiratory obstruction, and are unable to lie supine. In three reported cases (331), the patients developed the symptoms after receiving a number of neuroleptic drugs for 4 months to 14 years. Neither withdrawal of neuroleptic drugs nor the administration of anticholinergic agents affected their symptoms. 

Between January 1983 and March 1994, 302 patients with intractable epilepsy were entered into a nitrazepam compassionate plea protocol (2). Nitrazepam increased the risk of death, especially in young patients with intractable epilepsy. The authors suggested that nitrazepam should be used with caution in young children with intractable epilepsy, especially if they have difficulties in swallowing, aspiration, pneumonia, gastroesophageal reflux, or a combination of these. 

Impaired swallowing with risk of aspiration and pneumonia is common in drowsy patients with severe hemispheric strokes, and those with brainstem strokes. It almost always gets better in days or weeks (Hamdy et al. 1997). Swallowing difficulty is tested by asking the patient to sip some water, observing any tendency to choke in the next minute or so, and for added sensitivity using simple quantification (Mari et al. 1997 Hinds and Wiles 1998). 

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