thank u karil mwah SLP1048 PHARMACOLOGY IN VOICE DISORDERS (ashley ni copy)

Agonist

activator

Antagonist

inhibitor

Receptor

specific target molecule

Drug

can be Agonist (activator) or Antagonist (inhibitor) with a specific target molecule (Receptor) that plays a regulatory role in the biologic system

Chemical antagonists

In very small cases, these may interact directly with other drugs, whereas few drugs (osmotic agents) interact almost exclusively with water molecules

Osmotic agents

interact almost exclusively with water molecules

Xenobiotics

chemicals not synthesized by the body

Hormones

drugs that may be synthesized within the body

Pharmacology

the study of substances that interact with living systems through chemical processes

Medical Pharmacology

science of substances used to prevent, diagnose, and prevent diseases

Drug

any substance that brings about a change in biological function through its chemical actions

Polypharmacy

• Use of multiple drugs acting by different mechanisms (multiple drugs for multiple conditions)

• patients with voice problems have been previously seen by a physician and were prescribed with medications for the voice problems or for other medical conditions

• antibiotics, proton-pump inhibitors, antihistamines and oral or inhaled steroids are some of the most common frugs for voice and laryngeal disorders

Induced changes in hydration state

• Laryngeal desiccation

• Xerostomia (hyposalivation)

• Dryness (thickening of mucous)

Direct laryngeal mucosal irritation

localized vocal fold irritation and inflammation (erythema/edema)

Altered laryngeal muscle function

• laryngeal and esophageal tardive dyskinesia (involuntary muscle movements of the throat)

• dysarthria

• tremor

Induction of laryngeal hypersensitivity

chronic cough behaviors or throat clearing (sensitive cough/gag reflex; frequent throat clearing)

Xerostomia

hyposalivation

Laryngeal and esophageal tardive dyskinesia

involuntary muscle movements of the throat

Drugs for induced changes in hydration state

• antihistamine

• decongestants

• alpha-blockers

• diuretics

• antidepressants

Drugs for direct laryngeal mucosal irritation

steroid inhalers and other inhaled medications (potential leukoplakia lesions)

Drugs for altered laryngeal muscle function

• antipsychotics

• sedatives

• anticonvulsants

Drugs for induction of laryngeal hypersensitivity

• hypertension medications

• angiotensin-converting enzymes (ACE)

• angiotensin receptor blocker

Antihistamines and Decongestants

• over-the-counter

• taken intermittently, difficult to motor side effects

• for allergies and possible allergic contributions to voice health

• preparations with pseudoephedrine are particularly responsible for Xerostomia

• first generation antihistamines have sedating properties

Locally Available Antihistamines and Decongestants

• Phenylpropanolamine + Chlorophenamine + Paracetamol

• Phenylephrine + Cetirizine

• Loratadine + Pseudoephidrine

Alpha Blockers

• å1 - adrenegic blockers as a treatment for prostate enlargement

• dry mouth/xerostomia can be severe and is often unable to be treated with hydration or supplemental mouth rinses

• Medication for Benign Prostatic Hypertrophy

• Tamsulosin

Diuretics

• widely used for the treatment of various diseases (hypertension, congestive heart failure, liver cirrhosis, and renal disease)

• acts by enhancing urinary output thereby reducing volume of circulatory fluid and reduce the workload of heart and kidney

• xerostomia is one of the commonly mentioned side-effects due to frequent urination

• Furosemide, Hydrochlorothiazide

Antidepressants

significant dry mouth complaints/xerostomia

Tricyclic Antidepressants

• for laryngeal sensory neuropathy

• Imipramine, Amitriptyline

Selective Serotonin Reuptake Inhibitors (SSRI)

• for chronic pain and sensory neuropathy

• Fluoxetine, Sertraline

Steroids (Oral)

• anti-inflammatory drug

• regular adjunct voice care

• side effects: cumulative/additive over time

• insomnia, irritability, psychosis, mania

• hyperphagia, weight gain, lipodistrophy (redistribution of fat to different parts of the body; round face and fat nape)

• decreased immune system by inhibiting neutrophil function

• osteoporosis, avascular necrosis of the hip

• thinning of skin and easy bruising

• posterior subcapsular cataract and glaucoma

• gastrointestinal ulceration and bleeding

• adrenal supression

• Ex. Prednisone, Methylprednisolone

• max. 2 weeks but some take it for long periods

Steroids (Oral) example

Prednisone, Methylprednisolone

Steroid Inhalers

• treatment of active airway diseases and other inflammatory diseases such as Asthma and Chronic obstructive pulmonary disease (COPD)

• induce direct contact effects on tissues of the upper airway causing laryngeal tissue irritation and inflammation

• high rates of dysphonia are reported after use with the dry powder preparations; there are higher rates of laryngeal depositions with larger inhaled particle sizes

Steroid Inhalers example

Budesonide, Fluticasone

Steroid-Inhaler Laryngitis

• bilateral mid-cord hyperkeratotic plaques with surrounding intense erythema and decreased mucosal wave propagation

• may need cessation of inhaled steroid preparations or change to other smaller particle inhaled agents to resolve the localized inflammation

Alpha Blockers example

Tamsulosin

Diuretics example

Furosemide, Hydrochlorothiazide

Antipsychotics

• treat schizophrenia and other mental conditions

• known to cause Tardive Dyskinesia (involuntary undirected body movements; from prolonged use of medications that block dopamine receptors) and other related movement disorders

• can induce marked alterations in vocal folds movement and speech coordination

• use of Risperidone have reports of bilateral vocal folds paralysis with stridor, may also present with symptomatic dysphagia

• reversible upon discontinuation or symptoms may improve with altered therapy regimen

Risperidone

use of __ have reports of bilateral vocal folds paralysis with stridor, may also present with symptomatic dysphagia

Acetylcholinesterase Inhibitors

• Angiotensin-Converting Enzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARB)

• used for control of hypertension

• side effects of cough have been well established since released into the market

• high risk of angiodema and unusual throat irritation symptoms

• trial of cessation of ACE or ARB therapy for several weeks to see if symptoms resolve; otherwise might be secondary to other causes

Acetylcholinesterase Inhibitors example

Captopril (ACE), Losartan Potassium (ARB)

Reflux Medication

• gasoesophageal reflux disease (GERD) and laryngopharygeal reflux (LPR) has long been proposed as a cause for voice disorders

• Proton Pump Inhibitors (PPI) are commonly prescribed by primary care physicians for initial treatment of dysphonia; not always correct but administered under the assumption that acid reflux causes the dysphonia

• short courses are relatively safe

• risks of long-term PPI administration are believed to be directly caused by its mechanism of action

• side effects: Hypomagnesemia (decrease in magnesium), Vitamin B12 deficiency, iron deficiency anemia, and small intestine bacterial overgrowth

Reflux medication example

Pantoprazole, Esomeprazole, Omeprazole

Caffeine

• laryngologists have long been advising patients to avoid caffeine

• due to potential risks of xerostomia (dryness or thickening of mucous), LPR, and subsequent dysphonia; data to support this association is weak

• recent systematic reviews: no effect on voice production

• Placebo-controlled clinical trials: no effect of moderate caffeine use on total body water or physiologic hydration state over several days of administration

• advice to take in moderation and choose non-acidic caffeine sources

Hormones

• Testosterone-Containing Therapeutic Androgens

• treatment of endometriosis and postmenopausal sexual dysfunction

• induces significant vocal pitch lowering - some develop acne and facial hair

• favorable for patients transitioning; can be distressing if unwanted

• Generic: Danazol - menstrual cycling is known to alter laryngeal vasculature and edema throughout the cycle (dysphonia)

• Estrogen-Based-Hormone Replacement Therapies seems to preserve higher vocal range in women after menopause

Homeopathic Medications

• use of homeopathic medications and dietary supplements continues at a high rate in the general population

St. John's Wort

taken for a wide variety of reasons (anxiety, depression, ADHD) - may interact with cytochrome P-450 processing of other medications

Ginko Biloba

• given for tinnitus and dizziness or vertigo

• aspirin-like property which induces anticoagulation activity and should be avoided for singers and performers with concern for vocal hemorrhage

Ephedra or Ma Huang

• contain Ephridrine alkaloids

• for asthma and bronchitis

• causes dehydration and thickened laryngeal secretions

Licorice products

proposed to have antireflux effects but also have hormonal activity and induce hypertension