Pharmacology exam 2

Emesis

Vomiting

Hematemesis

Vomiting blood

Prandial

taken with meal

Ascites 

Muscle contraction 

Tympanites

Swelling of the abdomen with air or gas

esophagus:

protecting the airway

stomach

facilitate the digestion of food

duodenum 

break down food 

cenum

absorb fluids after digestion

large intestine

turns food waste into stool

small intestine

absorb nutrients from digested food

appendix

no role

descending colon

stores stool

sigmoid colon

stores stool

rectum

expel food waste

Liver - gallblader- spleen- kidneys

abdominal organs of the GI tract

• liver

• gallbladder

• duodenum

• head of pancreas

• right adrenal glan

• portion of right kidney

• portions of ascending and transverse colon

upper right quadrant of the abdomin

left lobe of liver

spleen 

stomach 

body of pancreas 

left adrenal gland 

portion of left kidney

portions of ascending and transverse colon 

upper left quadrant of the abdomin

• lower pole of right kidney

• cecum and appendix

• portion of acending colon

• bladder

• ovary, uterus

• right spermatic cord

• right ureter

lower right quadrant of the abdomin

lower pole of kidney 

sigmoid colon 

bladder 

portion of descending colon 

ovary, uterus 

left spermatic cord 

left ureter 

Lower left quadrant of the right 

somatic pain 

visceral pain 

Referred pain

types of pain patterns

somatic pain

physical pain ( Muscles, joints, bones)

viceral pain

pain from internal organs

epigastric (stomach, duodenum, pancreas), RUQ (biliary), LUQ (gastric/splenic).

paint patterns of upper GI

 periumbilical → RLQ (appendicitis), LLQ (diverticulitis), suprapubic (bladder/uterus).

pain patterns of lower GI

Hematemesis, melena/hematochezia, severe dehydration, persistent vomiting, high fever, peritoneal signs (rebound/guarding), severe constant pain, jaundice, unintentional weight loss, age >55 with new pain, immunosuppression, pregnancy with abdominal pain, sudden severe pain (think rupture/ischemia).

“Red flags” needing urgent referral/ER - gastrointestinal system

location, onset, any meds, what did they eat? alcohol? any prior surgeries

Key abdominal History questions

Distention, scars, hernias, visible peristalsis/pulsations, contour (flat/rounded/scaphoid), discoloration (Cullen’s/Grey-Turner), rash, striae, caput medusae, guarding/restlessness, stoma/Drains

Inspection phase—what to look for ( gastrointestinal system)

When: before percussion/palpation.
a) Why: palpation can alter bowel sounds.
b) Listen for: frequency/character of bowel sounds (normo/hyper/hypo), bruits (aorta, renal, iliac—vascular disease), friction rubs (liver/spleen inflammation).

Auscultation- gastrointestial system (when, why, listen)

antidiarrheals, antiemetics, antacids, proton pump Inhibitors, H2 antagonists 

Common GI Meds - gastrointestinal system 

Antidiarrheals

loperamide (slows motility), bismuth subsalicylate (antisecretory).

Antiemetics

ondansetron (5-HT3), promethazine/prochlorperazine (dopamine), meclizine (vestibular), metoclopramide (prokinetic).

Antacids:

calcium carbonate, Mg/Al hydroxide—neutralize acid (fast, short).

Proton Pump Inhibitors (PPIs):

 omeprazole, pantoprazole—block H+/K+ ATPase (GERD, ulcers).

H2 antagonists

 famotidine—block histamine H2 on parietal cells (milder GERD/dyspepsia).

assess dehydration; oral rehydration first line; antiemetic PRN; antidiarrheal if no dysentery/fever/bloody stool. Identify triggers (food, meds).

Treating nausea, vomiting, diarrhea;

BRAT diet:

Bananas, Rice, Applesauce, Toast—gentle, low-fiber transition after acute gastroenteritis.

Rule of thumb (afebrile, mild illness):

hydrate, rest, simple diet; avoid antidiarrheals if blood/high fever; seek care if symptoms >48–72 h or red flags.

Viral gastroenteritis:

 fecal-oral viruses (norovirus/rotavirus); watery D, N/V, cramps, low fever → refer if dehydration, blood, prolonged → ORS, diet, antiemetic.

Food poisoning/bacterial diarrhea:

 toxins/invasive bacteria; sudden N/V (toxin) or fever/bloody D (invasive) → refer if high fever, blood, severe pain, travel → fluids; abx only for select invasive cases.

Constipation:

low fiber, meds (opioids), dehydration → hard stools, straining → refer if alarm features (blood, weight loss, anemia) → fiber, fluids, osmotic laxatives; address meds.

Dyspepsia/GERD:

acid reflux/LES incompetence → heartburn, regurgitation, worse supine → refer if alarm sxs, age >55 new sxs → lifestyle (weight loss, elevate head, avoid late meals), H2/PPI; test/treat H. pylori as indicated.

Crohn’s disease (IBD)

•  transmural, any GI (skip lesions) → cramps, diarrhea, weight loss, perianal disease → GI referral → steroids, immunomodulators/biologics; nutrition; surgery for complications.

IBS:

functional; recurrent pain + change in stool, relief with defecation; no alarm signs → education, low-FODMAP, fiber (IBS-C), loperamide (IBS-D), antispasmodics.

Appendicitis

obstruction → periumbilical pain → RLQ (McBurney), anorexia, fever, rebound → urgent surgical referral → appendectomy; pre-op abx.

Hemorrhoids:

 venous dilation → rectal pain/bleed/itch → refer if severe bleed or prolapse → fiber, topical steroids, sitz baths; procedures if refractory.

Hepatitis (A–E, alcoholic, drug-induced)

 jaundice, fatigue, dark urine, RUQ pain → refer if jaundice, coagulopathy → supportive; antivirals for chronic B/C; abstain alcohol; vaccinate A/B.

Cholelithiasis (± cholecystitis)

gallstones; biliary colic post-fatty meals; cholecystitis adds fever, Murphy sign → refer if fever/jaundice → analgesia; lap chole if symptomatic.

Appendicitis.

 Most common cause for urgent abdominal surgery (US)

• Location: one-third from ASIS to umbilicus on right.

• Pain there suggests: appendicitis (parietal peritoneal irritation).

McBurney’s point & meaning

Kidney functions

Filtration/excretion (urea, creatinine, drugs), fluid/electrolyte balance, acid–base regulation, BP control (renin–angiotensin), EPO (RBC production), vitamin D activation, gluconeogenesis.

Kidney stones (nephrolithiasis)

crystals (Ca oxalate > uric acid) → sudden colicky flank pain radiating to groin, hematuria, N/V → refer for fever (infected stone) or uncontrolled pain → NSAIDs, fluids, tamsulosin; lithotripsy/ureteroscopy if large/obstructing.

UTI

 cystitis → dysuria, frequency, urgency; pyelo → fever, flank pain, CVA tenderness → refer if male, pregnant, febrile, recurrent, or systemic → abx (nitrofurantoin, TMP-SMX per local resistance), analgesia; pyelo needs systemic abx ± IV.

STI

infection present (may be asymptomatic)

STD

disease with symptoms/complications.

HIV, syphilis, gonorrhea, chlamydia, chancroid, hepatitis B (acute), and others per state

Reportable (providers must report)

Herpes Simplex I/II:

painful grouped vesicles → ulcers; primary often systemic sxs → test (PCR) → antivirals (acyclovir/valacyclovir), counseling (transmission even when asymptomatic).

Testicular torsion:

twisting of spermatic cord → sudden severe unilateral testicular pain, high-riding testis, absent cremasteric reflex → surgical emergency (detorse/fixate).

Varicocele:

dilated pampiniform plexus (“bag of worms”), worse standing → discomfort, infertility risk → scrotal support; surgery if symptomatic/infertility.

Pelvic Inflammatory Disease (PID)

ascending STI (gonorrhea/chlamydia) → pelvic pain, CMT/adnexal tenderness, fever, discharge → red flags: severe pain, pregnancy, tubo-ovarian abscess signs → treat promptly (ceftriaxone + doxycycline ± metronidazole); hospitalize if severe/pregnant.

CNS and PNS

Two main functional components

Central Nervous System (CNS):

brain/spinal cord—integrates, processes, initiates responses.

Peripheral Nervous System (PNS)

 nerves/ganglia—somatic (voluntary, sensation) + autonomic (sympathetic/parasympathetic: involuntary).

cerebrum, cerebellum, diencephalon, brainstem ( midbrain, pons, medulla)

Base functions of brain regions

Cerebrum:

higher cognition, motor/sensory cortex, language, memory, emotion.

Cerebellum:

coordination, balance, motor learning.

Diencephalon:

thalamus (relay/sensory gate), hypothalamus (homeostasis, endocrine/autonomic), epithalamus.

Brainstem (midbrain, pons, medulla):

• vital centers (cardio-resp), consciousness (RAS), CN nuclei

Medical exam—inspection signs (neurological)

Postering: decorticate, decerebrate, battle signs, and raccoon eyes

Decorticate

flexed arms, extended legs—lesion above red nucleus (cerebral hemispheres).

Decerebrate:

extended arms/legs—brainstem dysfunction (worse prognosis)

Stroke

• ischemic or hemorrhagic → sudden focal deficit (FAST: face droop, arm weakness, speech trouble, time) → activate EMS, stroke code; CT to rule bleed; thrombolysis/thrombectomy when eligible; prevent: BP, DM, AF anticoagulation, statins, lifestyle.

Migraine:

 unilateral, throbbing, ± aura, N/V, photophobia; treat triptans/NSAIDs, antiemetics; prevent with beta-blockers, topiramate, CGRP mAbs.

Cluster:

severe unilateral periorbital, autonomic signs (tearing, ptosis), circadian clusters; treat high-flow O₂ and triptan; prevent verapamil.

Concussion & PCS

transient functional brain injury after trauma: headache, dizziness, cognitive fog; remove from play, graded return; red flags (worsening neuro, repeated vomiting) → imaging; PCS = symptoms >2–4 weeks → multidisciplinary care

Meningitis:

 fever, nuchal rigidity, headache, photophobia ± rash; emergency: blood cultures + empiric IV abx promptly; vaccinate (meningococcal).

Seizures:

abnormal cortical discharges → transient neuro events; evaluate electrolytes, glucose, provoking factors; start antiseizure meds for unprovoked recurrent or high-risk first; safety counseling (driving, swimming).

Eyeglobe

anatomical container of ocular structures

Sclera:

 tough outer coat; protection, shape

Optic nerve (CN II)

visual signal to brain.

Cornea:

clear anterior refractive surface; major focusing power.

Conjunctiva:

•  mucous membrane lining lids/eye; lubrication, barrier.

iris

controls pupil size (light entry).

lens

aperture for light.

lens

fine-tunes focus (accommodation).

Ciliary body

aqueous humor production; lens accommodation.

Retina:

photoreceptors; transduction of light.

Vitreous humor

gel filling posterior segment; maintains shape.

Macula (fovea)

central high-acuity vision.

Visual acuity

clarity of vision at a standardized distance.

snellen chart at 20 ft

how to check for visual acuity?

Snellen (e.g., 20/40)

at 20 ft you see what a “normal” eye sees at 40 ft (worse than normal). 20/20 = standard normal.

myopia, hyperopia, antistigatism, presbyopia

refractive errors

Myopia:

nearsighted (distant blurry); eye too long/strong; fix with minus lenses.

Hyperopia

farsighted (near blurry); eye too short/weak; plus lenses.

Astigmatism

 irregular curvature; distorted at all distances; cylindrical correction

Presbyopia:

•  age-related loss of accommodation; need reading add.

Immediate urgent referral to ophthalmology/ER—possible globe injury, CN III palsy, or increased ICP.

 Abnormal pupil (larger, non-reactive, not round) after injury—action

Optometrist (OD)

• vision care, refraction, many manage common ocular disease; no surgery.

Ophthalmologist (MD/DO):

 full medical/surgical eye care.