吞嚥困難相關藥物使用評估

Drug Evaluation Related to Dysphagia

周孫鴻(Sun-Hong Chou)

《長期照護雜誌》 22卷3期 (2018/12) Pp. 245-257

https://doi.org/10.6317/LTC.201812_22(3).0003

摘要

吞嚥困難是老年族群很常面對的問題，加上老年族群也是多重用藥的族群，所以藥物對吞嚥功能的影響特別需要醫療人員加以考量，也需注意如何使得有吞嚥困難的病人能正確選擇和使用藥品。本文探討哪些藥物的副作用及藥理作用可能造成或惡化吞嚥困難、哪些藥物會傷害食道，針對這些副作用的避免列出建議作法，以及該如何衛教正確服藥姿勢及習慣。並非所有口服藥皆適合磨粉以幫助吞服，本文亦整理出不適合磨粉之藥品與可泡水溶解之藥品，並提醒於需要磨粉的藥物，照顧者該如何進行磨藥防護。

關鍵字

吞嚥困難 ； 藥物使用評估 ； 食道傷害 ； 藥品磨粉

並列摘要

Dysphagia is a prevalent problem among the elderly. Since polypharmacy is especially common in senior patients, health care professionals should pay more attention to the effects of drugs on swallowing function. It is also important to choose and use medications correctly in patients with difficulty swallowing. In this article, we review the side effects and pharmacological effects of drugs that can cause or worsen dysphagia and the drugs that can damage the esophagus. We list the recommendations for avoiding these side effects and provide education on the correct posture and habits for drug intake. Not all the oral drugs are suitable for crushing. We discuss the drugs that should not be crushed and the ones that can dissolve in water. Moreover, we remind that some drugs could be harmful to caregivers and how they should protect themselves.

並列關鍵字

dysphagia ； drug evaluation ； esophageal injury ； medicine pulverization

參考文獻

Alt-Epping, B., Nejad, R. K., Jung, K., Gros, U., & Nauck, F. (2012). Symptoms of the oral cavity and their association with local microbiological and clinical findings--a prospective survey in palliative care. Supportive Care in Cancer, 20, 531-537. doi:10.1007/s00520-011-1114-z

Balzer, K. M. (2000). Drug-induced dysphagia. International Journal of MS Care, 2(1), 40- 50. doi:10.7224/1537-2073-2.1.40

Barnett, N., & Parmar, F. (2016). How to tailor medication formulations for patients with dysphagia. The Pharmaceutical Journal, 297. doi:10.1211/PJ.2016.20201498

Boyce, H. W. (1998). Drug-induced esophageal damage: diseases of medical progress. Gastrointestinal Endoscopy. 47(6), 547-550. Doi:10.1016/S0016-5107(98)70264-0

Heckel, M., Stiel, S., & Ostgathe, C. (2015). Smell and taste in palliative care: a systematic analysis of literature. European Archives of Oto-Rhino-Laryngology, 272(2), 279-288. doi:10.1007/s00405-014-3016-4