Prostaglandins and related compounds

 Cyclooxygenase inhibitors inhibit what substance?

prostaglandins

Name three adverse effects resulting from the inhibition of prostaglandins.

1. gastric ulceration

2. bleeding

3. renal impairment

Aspirin belongs to what chemical family? 

Salicylates 

What is a common name for aspirin? 

acetylsalicylic acid 

Name two sites of absorption of aspirin? 

Small Intestine and Colon 

How does the use of the rectal rouste effect the rate and extent of absorption? 

When given rectally it is absorbed slowly and blood levels are lower then w/ oral dosing. 

What is the term used for toxicity aspirin? 

Salicylism 

Name five known and usual therapeutic uses for aspirin. 

1. suppression of inflammation

2. analgesia

3. reduction of fever

4. dysmenorrhea

5. suppression of platelet aggregation 

How does the dose fo aspirin for arthritis compare to the dose used for analgesia or reduction of fever? 

The dose is larger. 

For what types of pain is aspirin most effective? 

severe pain of visceral origin. 

Why is aspirin not recommended in children? 

Because of the risk for Reye's Syndrome. 

What effect will aspirin have on normal body temp.?

will not lower normal body temp. 

Why is aspirin particularly effective in treating dysmenorrhea? 

Inhibits prostaglandin synthesis in uterine smooth muscle. 

What would be considered a "low dose" of aspirin to reduce the risk of stroke and MI?

75-325mg/day 

How likely is aspirin to cause adverse een affects when administered short term in analgesic or antipyretic doses?

Rarely causes serious adverse effects. 

When is asprin toxicity more common? 

When treating inflammatory disorders. 

What are the most common gastrointestinal side effects of aspirin? 

1.Gastric distress

2. heartburn

3. nausea 

What may result with chronic aspirin use? 

Cumulative blood loss can result in anemia. 

What life threatening adverse effect may occur with long term, high dose therapy?

1.Gastric ulceration

2. perforation

3. Bleeding 

Name 5 factors that might place a person at greater risk of ulceration when taking aspirin? 

1. Advanced age

2. Hx of peptic ulcer disease

3. previous intolerance to aspirin

4. cigarette smoking

5. Hx of alcoholism 

When should aspirin be discontinued prior to surgery? 

One week prior because it can double bleeding time. 

When may salicylism begin to develop? 

When levels climb just slightly above therapeutic. 

Name four overt signs of salicylism. 

1. tinnitus

2. sweating

3. headache

4. dizziness 

What action is taken if salicylism develops? 

w/held until symptoms subside. 

When should aspirin be avoided in children and teenagers? 

When they are suspected of having influenza and chickenpox.

Why is aspirin classified as Pregnancy Risk Category D? 

Evidence of human fetal risk, but benefits outweigh the risks. 

What patients are more common to have hypersensitivity reactions to aspirin? What age group is the rarest?

Hx of asthma,rhinitis,and nasal polyps.

Rare in children 

What are the s/s exhibited when a patient has a hypersensitivity reaction to  aspirin? 

Profuse sweating, watery rhinorrhea, and may progress to generalized urticaria, bronchospasm, laryngeal edema, and shock. 

What drug increases the risk of gastric bleeding when taken with aspirin? 

Warfarin 

If a per a person is taking a low dose aspirin for prevention of MI or stroke and then uses ibuprofen anytime he has pain, what could be the effect?

It could negate aspirins benefits 

What age group is at greatest risk for a lethal overdose of aspirin? 

Children

Why were NSAID's first produced? 

to make an aspirin-like drug w/ fewer GI, renal, and hemorrage effects. 

What conditions do aspirin protect against that might actually be increased with some NSAIDs? 

MI and Stroke 

Name two common brand names for ibuprofen. 

1. Advil

2 Motrin

Name 3 actions of Ibuprofen? 

1. treat fever

2. mild to moderate pain

3.arthritis 

How significant are the side effects of GI bleeding and inhibition of platelet aggregation with ibuprofen? 

Produces less gastric bleeding than aspirin and less inhibition of platelet aggregation. 

Identify the 5 doses of standard tablets for ibuprofen. 

1. 100mg

2. 200mg

3. 400mg

4. 600mg

5.  80mg 

Name four brand names for naproxen or naproxen sodium. 

Aleve, Anaprox, Naprelan, Naprosyn 

What are the half-lives of naproxen or naproxen sodium? How often are they administered? 

Prolonged half lives, 12-16, 15-17, which can be given less frequently. 

How well tolerated are naproxen and naproxen sodium? 

better tolerated NSAID 

How often is naproxen or naproxen sodium given? 

500mg initially then 250mg q6-8hr 

How is acetominophen like asprin? 

It has analgesic and antipyretic properties. 

How is acetominophen not like aspirin? 

Does not have anti-inflammatory actions. 

Why is acetaminophen not effective in treating inflammation? 

it is limited to inhibiting prostaglandins in the CNS only. 

T/F acetominophen at therapeutic doses can cause adverse effects. 

FALSE; it is very rare. 

What is the benefit in using acetominophen over aspirin in children?

No evidence linking it to Reye's syndrome. 

When combined with what substance does acetominophen have an increased risk of liver injury? 

Alcohol 

If someone drinks alcohol on a regular basis, what is the recommended dose of acetaminophen? 

no more than 2 g. 

Why is there an increased risk for bleeding when acetaminophen is combined with warfarin? 

Acetaminophen may inhibit warfarin metabolism, which would cause warfarin levels to rise. 

What two populations of people is acetaminophen preferred over aspirin and NSAIDS? 

Children and people w/ GI injury 

What is the antidote for acetaminophen overdose? 

acetylcysteine 

Why is there an increased risk of overdose seen with acetaminophen? 

Because many OTC drugs and Prescription drugs contain acetaminophen. 

Analgesic 

a drug that releives pain w/out causing loss of consciousness. 

opioid 

Any drug, natural or synthetic, that has actions similar to those of morphine. 

Opiate 

Applies only to compounds present in opium.

(morphine, codeine) 

Name three families of endogenous opioid peptides. 

1. enkephalins

2. endorphins

3. dynorphins 

endogenous 

derived from within the body. 

Name 4 responses to activation of Mu opioid receptors. 

1. analgesia

2. respiratory depression

3. euphoria

4. sedation 

Identify the three major groups of drugs that bind to opioid receptors.

1. pure opioid agonists

2. agonist-antagonist opioids

3. pure opioid antagonists 

What 6 effects are caused by the activation of Mu receptors and kappa receptors by pure agonists? 

1. analgesia

2. euphoria

3. sedation

4. respiratory depression

5. physical dependence

6. constipation 

What effect to agonist-antagonist opioids, such as pentazocine and butorphanol have? 

analgesia 

When takeing a pure opioid agonist, what effect would a agonist-antagonist opioid have? 

They can antagonize analgesia. 

What is the principal use of pure opioid antagonists? 

used for the reversal of respiratory and CNS depression caused by overdose w/ opioid agonists. 

Name 6 pharmacologic effects of morphine. 

1. analgesic

2. sedation

3. euphoria

4. respiratory depression

5. cough supression

6. suppression of bowel motility 

What are the 3 medicinal compounds contained in opium. 

morphine, codeine, papaverine 

where is opium from? 

dried juice of the poppy seedpod. 

Name 5 pharmacologic actions of morphine. 

1. relief of pain

2. causes drowsiness

3. mental clouding

4. anxiety reduction

5. sense of well-being 

Name 8 adverse effects morphine can cause. 

1. respiratory depression

2. orthostatic hypertension

3. emesis

4. constipation

5. urinary retention

6. miosis

7. cough suppression

8. biliary colic 

What is the principle indication for morphine? 

relief of moderate to severe pain 

Name 4 effects that morphine causes the contribute to pain relief. 

1. mental clouding

2. sedation

3. euphoria

4. anxiety reduction 

How soon might respiratory effects occur after an opioid is given? 

7 min. IV

30 min. IM

90 min. SubCut 

How long does respiratory depression persist with opioid? 

What should be done if respiratory rate is below 12 breaths per minute when administering an opioid? 

Name 4 ways opioids promote constipation. 

1. suppress propulsive intestinal contractions

2. intensify non propulsive contractions

3. increase the tone of the anal sphincter

4. inhibit secretion of the intestinal lumen

What can you do to prevent constipation with opioids? 

1. physical activity

2. increased fluid intake 

What effect do opioids have on BP when lying down and standing up?

when lying down it is lowered and when standing up it drops dramatically. 

How does morphine cause urinary hesitation and urinary retention?

increases tone in bladder sphincter and supresses awareness of bladder stimuli. 

How often is a patient assessed for urinary retention while on morphine? 

q4-6hr 

What adverse effect may result because opioids suppress the cough reflex? 

Lead to accumulation of secretions in airway. 

euphoria 

exaggerated sense of well-being 

disphoria 

sense of anxiety and ill ease 

How does morphine and other opioids impair vision? 

impair vision in dim light, causes pupils to constrict. 

Name 6 different routes used to administer morphine. 

1. oral

2. IM

3. IV

4. SubCut

5. epidural

6. intrathecal

Because of the first pass effect through the liver, how are oral doses affected? 

They are substantially larger doses. 

Tolerance 

a state in which a larger dose is required to produce the same response that could formerly be elicited by a smaller dose. 

Physical dependence 

a state in which an abstinence syndrome will occur if drug use is abruptly discontinued. 

Describe 4 early symptoms of opioid abstinence syndrome occuring about 10 hours after the last dose. 

1. anorexia

2. irritability

4. gooseflesh 

At the peak of abstinence syndrome, what symptoms may occur? 

violent sneezing, weakness, vomiting, kicking movements, nausea, diarrhea, abdominal cramps, bone/muscle pain, muscle spasm 

How are morphine and other strong opioids classified according to the controlled substance act? 

Schedule II-moderate to high abuse liability 

Name the classic triad of signs produced with opioid overdose.

1. coma

2. respiratory depression

3. pin-point pupils 

What should be determined before an opioid is administered? 

Respiratory Rate, BP, Pulse Rate 

Why are opioids administered on a "fixed schedule"? 

Meds are given before intense pain returns. 

When morphine in injected into IV tubing, long should the nurse take to give it? 

Injected over 4-5 min. 

When IV injections are made what two things should be available? 

Opioid antagonist

respiratory support 

What is the duration of morphine administered by the epidural route? 

up to 24 hours 

What is the usual dosage range for hydromorphone (Dilaudid) given IM or SubCut? 

1-4mg q4-6hr, which is less than morphine (5-10mg q4hr) 

What is the indication for codeine? 

Relief of mild to moderate pain. 

Why is the degree of pain relief that can be acheived with codeine quite low? 

Because side effects are dose limiting. 

What 2 non-opioid analgesics are frequently combined with codeine to produce greater pain relief than either agent alone? 

aspirin and acetaminophen 

What actions are codeine used for? 

pain and cough suppressant 

What is the brand name for a combination of oxycodone and aspirin? 

Percodan 

Why is Oxycontin unique? 

Long acting analgesic designed to relieve moderate to severe pain. 

What can be done if a patient on Oxycontin has breakthrough pain? 

supplemental dosing w/ a short-acting analgesic can be taken 

Extended release tablets of Oxycontin should never be ________, to prevent fatal overdose. 

Crushed or Chewed; they must be swallowed whole. 

What are 2 brand names for propoxyphene? 

1. Darvon

2. Darvocet 

What additional drug is in Darvocet? 

acetaminophen 

T/F Agonist-antagonist have a low potential for abuse, produce less respiratory depression, and generally have a less powerful analgesic effect than pure opioid agonists. 

TRUE 

What are agonist-antagonist opioids such as pentazocine (Talwin) indicated for? 

Mild to moderate pain-much less effective than morphine against severe pain. 

If pentazocine (Talwin) is given to a patient who is physically dependent on a pure opioid what can happen? 

can precipitate withdrawal. 

T/F pentazocine (Talwin) and butorphanol (Stadol), which are agonist-antagonists, decrease cardiac work. 

FALSE: the INCREASE cardiac work. 

When should pain be assessed when being treated with opioids? 

Before administration and one hour after. 

Name four characteristics of pain that should be part of pain assessment. 

1. location

2. type

3. how it changes w/time

4. what makes it better/worse 

What 3 reasons might a patient under-report pain? 

1. fear of addiction

2. fear of needles

3. need to be stoic

4. bear the pain 

What is Patient Controlled Analgesia? 

Method of drug delivery that permits the patient to self-administer parenteral opioids on an "as-needed" basis. 

What patients have PCA been used for? 

1.post-op patients

2. cancer patients 

3.trauma patients

4. myocardial iinfarction

5. vasoocclusive sickle cell crisis

6. Labor 

What is an essential component of all PCA devices? 

Timing Control, which limits the total dose that can be administered each hour, minimizing risk of overdose. 

What opioid is used most extensively for PCA? 

Morphine 

What are the principle uses for opioid antagonists? 

Block the effects of opioid agonists

Treatment of opioid overdose, reversal of post-op opioid effects and management of opioid addiction. 

What effect occurs when Naloxone is administered in the absence of opioids? 

Has no significant effect

What effect does naloxone have if administered prior to an opioid? 

It will block opioid actions. 

What effects will naloxone have if given to a patient already receiving an opioid? 

they will have reverse analgesia, sedation, euphoria, and resp. depression. 

what effect will naloxone have if administered to a patient physically dependent on opioids? 

it will precipitate an immediate w/drawal reaction. 

How soon will effects begin when naloxone is administered IV, IM, or SubCut? 

IV- immediatly and persist for about an hour

IM and SubCut- w/in 2 to 5 min. and persist severl hours. 

Name two terms that may be used for drugs given to treat anxiety. 

Antianxiety agents or anxiolytics

old term: tranquilizers 

What are the two most frequently prescribed benzodiazepines? 

lorazepam (Ativan)

alprazolam (Xanax,Niravam) 

Name the 3 therapeutic effects of benzodiazepines due to action on the CNS. 

1. reduce anxiety

2. promote sleep

3. induce muscle relaxation 

T/F, benzodiazepines are  weak respiratory depressants.

TRUE 

Name 3 principle indications for benzodiazepines. 

1.Anxiety

2.Insomnia

3.Seizure disorders 

When taken in sleep inducing doses, benzodiazepines cause 4 CNS affects, what are they? 

1. drowsiness

2. lightheadedness

3.incoordination

4. difficulty concentrating 

Anterograde amnesia 

Impaired recall of events that take place after dosing. (forgetfulness) 

Name 5 possible symptoms of withdrawal after short term use with benzodiazepines. 

anxiety, insomnia, sweating, tremors, dizziness 

After long term use with benzodiazepines, what more serious reactions to withdrawal may occur? 

panic, paranoia, delirium, hypertension, muscle twitches, outright convulsions. 

How can the intensity of withdrawal symptoms with benzodiazepines be minimized? 

discontinuing treatment gradually 

What is the indication for benzodiazepine-like drugs? 

Insomnia 

What is the brand name for zolpidem? 

Ambien 

What are the two most common side effects of zolpidem? 

Daytime drowsiness and dizziness 

What is the recommended dose adjustment when zolpidem is given to elderly and debilitated patients? 

5mg, half of regular dose 

Melatonin 

a hormone produced by the pineal gland. 

T/F Melatonin levels in insomniacs is high. 

FALSE; low levels 

What is the mechanism of action of ramelteon? 

activation of receptors for melatonin 

In what way does ramelteon promote sleep? 

has a rapid onset and short duration, which enhances sleep induction 

Name 3 advantages for the use of ramelteon. 

1. no significant residual effects

2. no rebound insomnia

3. rapid onset, no limit on use 

Name 4 side effects of ramelteon related to sexuality and reproduction which may result from increased levels of prolactin and decreased levels of testosterone. 

1. amenorrhea

2. galactorrhea

3. reduced libido

4. fertility problems 

List 4 undesirable properties of barbiturates that have lead to the decreased use  of these agents. 

Tolerance, dependence, have high abuse potential, subject to multiple drug interactions, powerful respiratory depressant.

Name the short to intermediate acting barbiturate used to treat insomnia. 

secobarbital 

Identify 3 disadvantages to the use of chloral hydrate for insomnia. 

1. nightmares

2. subject to abuse

3.abstinence syndrome can be fatal 

insomnia 

inability to sleep well 

Identify 4 characteristics of poor sleep. 

1. difficulty falling asleep

2.difficulty maintaining sleep

3. early morning awakening

4. non-refreshing sleep 

List 3 non-drug ways to treat insomnia. 

1. avoid naps

2. decrease consumption of caffeine-containing beverages.

3. restful activity as bedtime nears 

What is the brand name for flurazepam? 

Dalmane 

Flurazepam has a delayed onset and more prolonged duration which is good for what kind of insomnia? 

T/F, flurazepam has a long half life which prevents daytime drowsiness. 

FALSE; causes daytime drowsiness

Brand name for zolpidem? 

Ambien 

Brand name for eszopiclone 

Lunesta 

What is the active ingredient in Nytol and Sominex? 

diphenhydramine, which is an antihistamine 

What is a common brand name for diphenhydramine? 

Benadryl 

Name 4 factors why the elderly experience more adverse reactions and drug-drug reactions. 

1) altered pharmokinetics

2) multiple and severe illnesses

3) multiple drug therapy

4) poor adherence 

How does aging affect the absorption of drugs? 

Rate of absorption is slower, which causes a delayed drug response.

Gastric acidity is reduced. 

Name 4 factors that can alter drug distribution in the elderly. 

1) increased % body fat

2) decreased % lean body mass

3) decreased total body water

4) reduced concentration of serum albumin 

Diminished liver function can _______ half-lives of certain drugs. 

increase 

Drugs that ordinarly undergo extensive first-pass metabolism ______? 

May be enhanced. 

What is the most important cause of adverse drug reactions in the elderly? 

Drug accumulation secondary to reduced renal excretion. 

what is a more reliable test for kidney function in the elderly? 

Creatinine Clearance 

How much more common is an adverse reaction  in the elderly than young adults? 

7 times more common. 

What percent of hospital admissions among older patients result from adverse drug reactions? 

16% 

Name two symptoms that are non-specific and make identification of adverse reactions difficult iin older adults. 

dizziness, and cognitive impairment 

Name 4 possible factors that may lead to UNintentional nonadherence to prescribed drugs in the elderly. 

-Forgetfulness

-failure to comprhend instructions, intellectual, visual, auditory

-inability to pay for meds.

-use of complex regimens 

What is the principle reason for INtentional nonadherence to prescribed drugs in the elderly? 

Patients conviction that the drug was simply not needed in the dosage prescribed. 

What measure is necessary when nonadherence is intentional? 

Intensive education. 

What technique should be used by the nurse when discontinuing an IV to prevent a hematoma? 

Apply Pressure. 

Name three signs that an IV line has Infiltrated? 

1. slowed or stopped flow

2. swelling, tenderness, pallor, hardness, and coolness at the site.

3. burning sensation 

What is the difference between infiltration and extravasation? 

Infiltration includes nonvesicant solutions or meds. into surrounding tissues.

Extravasation includes vesicant substance into the tissues, which can cause necrosis. 

If there is extravasation at an IV site, in addition to elevation of the extremity, what should be applied to the site? 

Apply cold compresses. 

Phlebitis 

inflammation of the vein-due to mechanical irritation, irritating solutions, sepsis. 

What does an IV site with phlebitis look like? 

Redness, pain, warmth at the site, local swelling, palpable cord along the vein, sluggish infusion rate and elevated temp. 

What 2 actions should a nurse take at the first site of phlebitis? 

1. discontinue the IV infusion

2. apply cold compresses to the site. 

How frequently should an IV site be rotated to prevent phlebitis? 

 q96hr 

What are 2 causes of fluid overload due to IV therapy? 

Infusing excessive amounts of IV fluids or administering fluid too rapidly. 

what are signs of fluid overload? 

weight gain, edema, hypertension, shortness of breath, crackles heard in the lungs, distended neck veins. 

What do diurectics do? 

Increase the output of urine. 

Name two major applications for diuretics. 

-treatment of hypertension

- mobilization of edematous fluid 

Name 4 functionally distinct regions of the nephron. 

1. the glomerulus

2. proximal convoluted tubule

3. loop of henle

4. distal convoluted tubule 

What is the basic mechanism of action that most diurectics share? 

Blockage of sodium and chloride reabsorption. 

What does the blocking of the reabsorption of sodium and chloride create and cause? 

-create osmotic pressure w/in the nephron that prevents the passive reabsorption of water. Which causes water and solutes to be retained w/in the nephron and thereby promotes the excretion of both. 

What is the increase in urine flow that a diuretic produces directly related to? 

The amount of sodium and chloride reabsorption that it blocks. 

What drugs have the opportunity to block the greatest amount of solute reabsorption? 

Drugs whose site of action is early in the nephron. 

Name the 3 adverse effects that result because diuretics must compromise the normal operation of the kidney in order to promote excretion of water. 

1.hypovolemia

2. acid-base imbalance

3. disturbance of electrolyte levels. 

Name the 4 major categories of diuretic drugs. 

1. high-ceiling (loop) diuretics

2. thiazide diuretics

3. osmotic diuretics

4. potassium-sparing diuretics 

What are the most effective diuretics available? 

High-ceiling (loop) diuretics 

What is the brand name for furosemide? 

LASIX 

What is furosemides mechanism of action? 

works in the thick segment of the ascending limb of Henle's loop to block reabsorption of sodium and chloride by blocking solute reabsorption it prevents passive reabsorption of water can produce profound diuresis. 

When given orally how soon does furosemide cause diuresis? 

60 min. 

When given IV, how soon does furosemide cause diuresis? 

5 min. 

When is IV diuretic therapy used? 

in critical situations that demand immediate mobilization of fluid.

 ex: pulmonary edema 

Name the 4 most notable side effects of high ceiling (loop) diuretics. 

1. hyponatremia, hypochloremia, dehydration

2.hypotension

3.hypokalemia

4.ototoxicity 

Name 4 s/s of dehydration that a patient will show when on diuretics. 

1. dry mouth

2. unusual thirst

3. oliguria

4. loss of weight 

What 2 reasons can cause a substantial drop in bp when taking furosemide. 

1. loss of volume

2. relaxation of venous smooth muscle, which reduces venous return to the heart. 

Describe 3 signs that a patient with hypotension might exhibit. 

1. dizziness

2.fainting

3. lightheadedness 

what level of serum potassium may fatal dysrhythmias result? 

if it falls below 3.5 mEq/L 

Due to drug interaction,when is a loss of potassium of special concern? 

when a patient is also taking digoxin. 

Name some potassium rich foods. 

dried fruits, nuts, spinach, citrus fruits, potatoes, bananas. 

Name a class of drugs that can decrease the effects of furosemids. 

 NSAIDS 

What time of day should be avoided when scheduling administration of a loop diuretic? 

Administration late in the day because it produces nocturia. 

What is the brand name of bumetanide? 

BUMEX 

When given orally when does bumetanide start to cause diuresis? 

30-60 min. 

When given IV when does bumetanide start to cause diuresis? 

w/in a few minutes 

Although very similar in many properties with furosemide, is bumetanide used for hypertension? 

NO 

What is hydrochlorothiazide commonly used for, making it one of the most widely used drugs? 

Hypertension 

How does hydrochlorothiazide promote urine production? 

By blocking the reabsorption of sodium and chloride in the early segment of the distal convoluted tubule. 

When does diuresis begin following a thiazide diuretic? 

about 2 hours after oral administration 

What is the pimary indication for hydrochlorothiazide? 

Hypertension 

Are thiazides used to treat edema? 

They are preferred drugs for mobilizing edema associated w/ mild to moderate heart failure. 

Do thiazides cause hypokalemia? 

Yes, from excessive potassium excretion. 

What is the brand name of spironolactone? 

Adlactone 

What is the mechanism of action of spironolactone? 

-blocks the actions of aldosterone in the distal nephron

-retention of potassium and increased excretion of sodium

How long does it take for the onset of spironolactone? 

up to 48 hours to develop. 

what is the most notable adverse effect of spironolactone? 

hyperkalemia 

at what level of serum potassium is the increase a serious concern? 

5 mEq/L 

What physical assessment finding might indicate hyperkalemia? 

abnormal cardiac rhythm 

Because of the risk of hyperkalemia, what should spironolactone never be combined with? 

w/ potassium supplements, salt substitutes, ceiling diuretics or w/ another potassium-sparing diuretic. 

Why does triamterene (Dyrenium) act so much more quickly than spironolactone? 

It is a direct inhibitor of te exchange mechanism itself. 

Name four ways that laxatives may ease or stimulate defecation. 

1. soften the stool

2. increase the stool volume

3. hasten fecal passage through the intestine

4. facilitate evacuation from the rectum 

What is misuse of laxatives largely the result of? 

of misconceptions about what constitutes normal bowel function. 

laxative effect 

refers to production of a soft, formed stool over a period of 1 or more days 

catharsis 

refers to a prompt, fluid evacuation of the bowel 

How does fiber facilitate colonic function? 

1. it can absorb water, thereby, softening the feces and increasing their mass

2. can be digested by colonic bateria which increases fecal mass 

list six symptoms that a patient may use to define constipation. 

1. hard stools

2. infrequent stools

3.excessive straining

4. prolonged effort

5. sense of incomplete evacuation

6. unsuccessful defecation 

what factor is more significant in determining constipation?

Frequency OR Stool Consistency 

Stool Consistency 

What is a common cause of constipation? 

Poor diet 

List the 4 major categories of laxatives traditionally used. 

1. Bulk-forming laxatives

2. surfacant laxatives

3. stimulant laxatives

4. osmotic laxatives 

Which group of laxatives are most frequently abused?

A. group 1, Rapid acting (2-6hrs)

B. group 2, Intermediate acting (6-12hrs)

C. group 3, slow acting (1-3 days) 

B.