Interview with Dr. Lynette L. Carl, Pharmacist & Author
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Drugs and Dysphagia: How Medications Can Affect Eating and Swallowing.Lynette R. Carl & Peter R. JohnsonPro-ed, Austin TexasISBN 0-89079-982-2www.proedinc.comBeck: Good Morning Dr. Carl. It's a joy to speak with you.Carl:Hi Dr. Beck. Thanks for the invitation. Beck:My pleasure. I was delighted w
Drugs and Dysphagia: How Medications
Can Affect Eating and Swallowing.
Lynette R. Carl & Peter R. Johnson
Pro-ed, Austin Texas
ISBN 0-89079-982-2
www.proedinc.com
Beck: Good Morning Dr. Carl. It's a joy to speak with you.
Carl:Hi Dr. Beck. Thanks for the invitation.
Beck:My pleasure. I was delighted when your co-author (Dr. Peter Johnson) mentioned your new book had been released.
I cannot recall previously seeing such a comprehensive text which specifically relates to Drugs and Dysphagia. Although I think most Speech Language Pathologists (SLPs) have a general working knowledge of these issues, this is an extraordinary book and will certainly serve nurses, SLPs, OTs, PTs, MDs, and perhaps the dysphagic patient and their families, too.
Carl:Thanks Doug. That's very kind.
Beck:Lynette, before we get to the book itself, would you please spend a moment reviewing a little of your professional education and history for us?
Carl:Sure. I received my B.S. in pharmacy from the University of Florida in Gainesville. After practicing as a pharmacist for ten years, I attended the Medical University of South Carolina in Charleston and earned my doctorate there. I did a post-doctoral Residency in Infectious Disease at Philadelphia College of Pharmacy and Science, the University of Pennsylvania Hospital, and the Children's Hospital in Philadelphia, finishing in 1987. I'm also a Board Certified Pharmacotherapy Specialist and a Consultant Pharmacist.
Beck:Thanks Lynette, I appreciate the background. Please tell me the difference between pharmacology and neuro-pharmacology?
Carl:That's a great question! As you know, Doug, pharmacology is the study of medications; how they're processed within the body, and how they impact different structures and systems within the body. However, neuro-pharmacolgy is a specific subset of pharmacology, addressing the impact of medications on the central and peripheral nervous systems. So neuro-pharmacolgy quite often more specifically addresses issues relating to patients with dysphagia.
Beck:I assume you're referring to the cranial nerves which are involved with swallowing, chewing and eating? For example; cranial nerves V, VII and XII?
Carl:Yes, and also cranial nerves IX and X. The cranial nerves are certainly of paramount importance with regard to dysphagia, as are other body systems, such as the gastrointestinal tract, and of course neurotransmitters throughout the central nervous system and the body.
Beck:I should mention the book does address a plethora of potential dysphagia etiologies beyond medications, such as; neurological disease, depression and other psychiatric issues, structural problems secondary to intubation, xerostomia (dry mouth), chemo-radiation, and various esophageal disorders, too.
Carl:Yes, we tried to cover the entire spectrum of issues related to dysphagia.
Beck:Another issue I'd like to bring up is the cross referencing and indexing you've done, it's excellent, and it makes the book very useful as far as learning about human biologic systems and pharmacy, too. I enjoyed the basic, yet highly detailed overview of dysphagia, swallowing and the normal expectations and intervening physiologic issues. However, one of the main benefits of this book, is that there are whole chapters on each of the following; Bipolar Disorders, Parkinson's and Alzheimer's, and then within each of the chapters, you have the medications typically used to treat those disorders, as well as the potential impact on dysphagia. I think organizational structure will be very helpful for the treating clinician to quickly learn what they need to know.
Carl:Yes, thanks again, Doug. Those chapters are in the section on "Medications Affecting the CNS." We also included individual chapters on medications used to treat psychosis, depression, anxiety and insomnia, seizures and pain.
Beck:Lynette, please tell me about the section titled "Medications Affecting the Gastrointestinal System." That's not what I usually think about when I think about the dysphagia patient.
Carl:We addressed gastroparesis, irritable bowel syndrome, gastroesophageal reflux disease (GERD), constipation, nausea and vomiting, and of course, the meds used to treat these conditions and their relationship to dysphagia. And you're right, these are areas many clinicians overlook, but they do impact dysphagia, and there's still a lot to learn.
Beck:What is the first thing you think of when you see a new patient with dysphagia?
Carl:Obviously the history and physical presentation is very important. I also find myself thinking about "new" meds. In other words, I always wonder "Has a new medication been prescribed?" And if so, is that medication interacting with something else the patient is taking? In fact, when you add a medication to the regimen a person is already on, a drug interaction can occur, and even though the original or the new drug may not have dysphagia as a common side effect, maybe the two combined can indeed cause it! Drug interactions can change specific blood levels and the effects of one or more of the patient's medications, and can worsen side effects such as drowsiness or dry mouth. In addition, particularly in elderly patients, additional or increased side effects can initiate or worsen dysphagia.
Beck:Which meds in particular come to mind?
Carl:Well, there are many, but what comes to mind first are patients on psychotropic drugs, such as anticonvulsants, pain medications, antipsychotics and anti-depressants. When antihistamines are added to these medications, or anti-nausea drugs are added, you can easily develop or increase dysphagia. Anticholinergics are frequently prescribed and their side effects can include confusion, dry-mouth and motility issues within the GI tract...and thus precipitate or worsen dysphagia. So as a pharmacist, I look for psychotropic meds, and medications that affect the central nervous system, and anticholinergic agents. Those are among the first meds I look for.
Beck:Lynette, these are fascinating issues. I highly recommend the book for SLPs and any other healthcare professional dealing with and managing dysphagia patients. The summary tables, the index and the glossary are very well done, as are the "frequently prescribed" charts and tables. I am very appreciative of your time.
Carl:No problem, Doug. Thanks for your time, too.
Can Affect Eating and Swallowing.
Lynette R. Carl & Peter R. Johnson
Pro-ed, Austin Texas
ISBN 0-89079-982-2
www.proedinc.com
Beck: Good Morning Dr. Carl. It's a joy to speak with you.
Carl:Hi Dr. Beck. Thanks for the invitation.
Beck:My pleasure. I was delighted when your co-author (Dr. Peter Johnson) mentioned your new book had been released.
I cannot recall previously seeing such a comprehensive text which specifically relates to Drugs and Dysphagia. Although I think most Speech Language Pathologists (SLPs) have a general working knowledge of these issues, this is an extraordinary book and will certainly serve nurses, SLPs, OTs, PTs, MDs, and perhaps the dysphagic patient and their families, too.
Carl:Thanks Doug. That's very kind.
Beck:Lynette, before we get to the book itself, would you please spend a moment reviewing a little of your professional education and history for us?
Carl:Sure. I received my B.S. in pharmacy from the University of Florida in Gainesville. After practicing as a pharmacist for ten years, I attended the Medical University of South Carolina in Charleston and earned my doctorate there. I did a post-doctoral Residency in Infectious Disease at Philadelphia College of Pharmacy and Science, the University of Pennsylvania Hospital, and the Children's Hospital in Philadelphia, finishing in 1987. I'm also a Board Certified Pharmacotherapy Specialist and a Consultant Pharmacist.
Beck:Thanks Lynette, I appreciate the background. Please tell me the difference between pharmacology and neuro-pharmacology?
Carl:That's a great question! As you know, Doug, pharmacology is the study of medications; how they're processed within the body, and how they impact different structures and systems within the body. However, neuro-pharmacolgy is a specific subset of pharmacology, addressing the impact of medications on the central and peripheral nervous systems. So neuro-pharmacolgy quite often more specifically addresses issues relating to patients with dysphagia.
Beck:I assume you're referring to the cranial nerves which are involved with swallowing, chewing and eating? For example; cranial nerves V, VII and XII?
Carl:Yes, and also cranial nerves IX and X. The cranial nerves are certainly of paramount importance with regard to dysphagia, as are other body systems, such as the gastrointestinal tract, and of course neurotransmitters throughout the central nervous system and the body.
Beck:I should mention the book does address a plethora of potential dysphagia etiologies beyond medications, such as; neurological disease, depression and other psychiatric issues, structural problems secondary to intubation, xerostomia (dry mouth), chemo-radiation, and various esophageal disorders, too.
Carl:Yes, we tried to cover the entire spectrum of issues related to dysphagia.
Beck:Another issue I'd like to bring up is the cross referencing and indexing you've done, it's excellent, and it makes the book very useful as far as learning about human biologic systems and pharmacy, too. I enjoyed the basic, yet highly detailed overview of dysphagia, swallowing and the normal expectations and intervening physiologic issues. However, one of the main benefits of this book, is that there are whole chapters on each of the following; Bipolar Disorders, Parkinson's and Alzheimer's, and then within each of the chapters, you have the medications typically used to treat those disorders, as well as the potential impact on dysphagia. I think organizational structure will be very helpful for the treating clinician to quickly learn what they need to know.
Carl:Yes, thanks again, Doug. Those chapters are in the section on "Medications Affecting the CNS." We also included individual chapters on medications used to treat psychosis, depression, anxiety and insomnia, seizures and pain.
Beck:Lynette, please tell me about the section titled "Medications Affecting the Gastrointestinal System." That's not what I usually think about when I think about the dysphagia patient.
Carl:We addressed gastroparesis, irritable bowel syndrome, gastroesophageal reflux disease (GERD), constipation, nausea and vomiting, and of course, the meds used to treat these conditions and their relationship to dysphagia. And you're right, these are areas many clinicians overlook, but they do impact dysphagia, and there's still a lot to learn.
Beck:What is the first thing you think of when you see a new patient with dysphagia?
Carl:Obviously the history and physical presentation is very important. I also find myself thinking about "new" meds. In other words, I always wonder "Has a new medication been prescribed?" And if so, is that medication interacting with something else the patient is taking? In fact, when you add a medication to the regimen a person is already on, a drug interaction can occur, and even though the original or the new drug may not have dysphagia as a common side effect, maybe the two combined can indeed cause it! Drug interactions can change specific blood levels and the effects of one or more of the patient's medications, and can worsen side effects such as drowsiness or dry mouth. In addition, particularly in elderly patients, additional or increased side effects can initiate or worsen dysphagia.
Beck:Which meds in particular come to mind?
Carl:Well, there are many, but what comes to mind first are patients on psychotropic drugs, such as anticonvulsants, pain medications, antipsychotics and anti-depressants. When antihistamines are added to these medications, or anti-nausea drugs are added, you can easily develop or increase dysphagia. Anticholinergics are frequently prescribed and their side effects can include confusion, dry-mouth and motility issues within the GI tract...and thus precipitate or worsen dysphagia. So as a pharmacist, I look for psychotropic meds, and medications that affect the central nervous system, and anticholinergic agents. Those are among the first meds I look for.
Beck:Lynette, these are fascinating issues. I highly recommend the book for SLPs and any other healthcare professional dealing with and managing dysphagia patients. The summary tables, the index and the glossary are very well done, as are the "frequently prescribed" charts and tables. I am very appreciative of your time.
Carl:No problem, Doug. Thanks for your time, too.