PATHOPHYSIOLOGY
|PHARMACOLOGY II (NURS 432)
STUDY SHEET FOR EXAM 1 (a
comprehensive and thorough
review of all the material that will
be tested on Exam 1 in this course)
PACE UNIVERSITY.
,NURS 432 – Pathophysiology/Pharmacology II Exam 1 Study
Sheet
Modules
1-2
Genitourinary System
Renal A&P and Altered Elimination:
Urinary Incontinence:
➢ Types of Urinary Incontinence
• Enuresis: involuntary urination; common in children >4-5yo; causes can be
psychological (anxiety) or structural (bladder size); typically self-resolving with
our without Tx
o Nocturnal enuresis: bed-wetting
• Transient incontinence: incontinence
secondary to temporary Dx (i.e., Delirium,
infection, atrophic vaginitis)
o Drug-induced: diuretics, sedatives
o Psychological: depression, anxiety
o Consumption: EtOH, caffeine
• Urge incontinence: sudden, intense urge to urinate caused by
involuntary contractions of detrusor muscle
o Overactive bladder: (OAB) no known cause
▪ Frequency: ≥ 8x/24h
▪ Nocturia: ≥ 2x
• Stress incontinence:
o Pressure exerted on bladder: (coughing,
sneezing, laughing, heavy lifting, etc.)
▪ Lung Dx: chronic coughing
o Weakened sphincter/pelvic floor muscles:
▪ Females: pregnancy, childbirth, menopause, cystocele
▪ Males: prostatectomy
▪ Obesity: increased weight (stress) on muscles
• Overflow incontinence: inability to empty the bladder (retention)
o GU Damage: Bladder damage, urethral blockage, prostate DX
o Nerve damage: due to DM
o Drug induced: opiates, Ca antagonists, anticholinergics
o Chronic overdistension: perceived inability to interrupt activity to void
▪ Areflexia: (hyporeflexia) of detrusor muscle
• Reflex incontinence: involuntary voiding w/o any urge or warning
o Nerve damage: S2-S4 injury, MS, DM
o Detrusor hyperreflexia: ↑ contractility when 𝖰 void sensation
• Mixed incontinence: symptoms of more than 1 type of incontinence
• Functional incontinence: physical or mental impairment leading to inability to
physically reach toilet in time; common in elderly pts in LTC
• Gross total incontinence: continuous leakage ATC, with periodic uncontrolled
leakage of large volumes; no storage capacity in the bladder
➢ Risk Factors for Urinary Incontinence:
• Females: (>males) pregnancy, childbirth, menopause, normal female anatomy;
, • Males: w/ prostate DX urge and overflow incontinence
• Age: inevitable w/ aging but NOT considered normal (except in infancy)
• Overweight: ↑ pressure on bladder & muscles stress incontinence
• Smoking: chronic coughing stress incontinence & overactive bladder
• Renal DX & DM: cause changes in renal function & nerve innervation
➢ Complications of Urinary Incontinence:
• Skin: moisture, rashes, infections, ulcers
• Recurrent UTIs: caused by incomplete emptying
• Psychological consequences: self-image, embarrassment, sexual dysfunction,
anxiety, depression
• Interrupted of QOL: work, exercise
, ➢ Treatment Approach for Urinary Incontinence: option vary based on type, cause, and
severity
• 1st line options:
o Behavioral: bladder training, scheduled toileting, coping strategies, support
o Absorption: absorbent pads, protective garments
o Fluid & diet: no EtOH, caffeine, acidic foods; ↓ liquid consumption & timing
intake; Wt loss & ↑ physical
activity
o Pelvic floor strengthening: Kegel exercises, electric stimulation PV/PR
o Mechanical: urethral inserts, pessary (stiff vaginal ring supporting bladder),
artificial urinary sphincter
• 2nd line – Medications: muscarinic antagonists (anticholinergics), estrogen
replacement, botulinum toxin A
(bladder), bulking material - collagen (urethral tissue)
• Last Line - Surgery & Procedures: radiofrequency therapy (firming of lower UT
via heat), sacral nerve stimulator, bladder neck suspension, urinary catheter
• Non-traditional: acupuncture, hypnotherapy, herbal (crataeva nurvala, equisetum
(horsetail), aloe vera extract)
➢ Prophylaxis of Urinary Incontinence: increased perineal hygiene, skin barrier creams, fall
precautions & safety measures
Neurogenic Bladder: interruption of normal bladder nerve innervation
➢ Causes:
• Nervous system Dx: brain/spinal cord injury or infections, MS, Heavy metal poisoning,
Herpes zoster
• Other Dx: SLE, Nervous system tumors, Dementia, Parkinson’s, Spina bifida, DM,
Stroke, Childbirth
• Drug-induced: Antidepressants, Antihistamines, Analgesics, Antihypertensives,
Antiemetics
➢ Clinical Manifestations:
• Presentation: Overactive bladder (frequency, urgency); Underactive bladder
(hesitancy retention)
• Diagnosis: refer to incontinence; underlying cause determined via CT, MRI
➢ Treatment: dependent on etiology; refer to incontinence
Parasympathetic Nervous System: (Chapters 13 & 14)
➢ PNS Patho:
• Cholinergic Receptors: mediate response to Ach; Nicotinic or Muscarinic subtypes
o Muscarinic: M1, M2, M3; many locations
▪ M3: bladder
o Receptor Activation: promotes voiding
▪ Coordinating events:
• Detrusor contraction: ↑ bladder pressure
• Relaxation of trigone & sphincter: allows urine to exit
o Receptor Blockade: promotes retention
• Adrenergic Receptors: mediate response to EPI/NE; α1 & β3 subtypes
o Alpha-1: many location; male sex organs, prostate, bladder
▪ Activation of alpha-1: promotes retention
• Contraction/constriction: bladder and prostate
• Other: Eye (mydriasis), Sex organs (ejaculation)
▪ Blockade of alpha-1: promotes voiding; relaxation
➢ PNS Pharmacology: overactive bladder give muscarinic antagonists; underactive bladder
|PHARMACOLOGY II (NURS 432)
STUDY SHEET FOR EXAM 1 (a
comprehensive and thorough
review of all the material that will
be tested on Exam 1 in this course)
PACE UNIVERSITY.
,NURS 432 – Pathophysiology/Pharmacology II Exam 1 Study
Sheet
Modules
1-2
Genitourinary System
Renal A&P and Altered Elimination:
Urinary Incontinence:
➢ Types of Urinary Incontinence
• Enuresis: involuntary urination; common in children >4-5yo; causes can be
psychological (anxiety) or structural (bladder size); typically self-resolving with
our without Tx
o Nocturnal enuresis: bed-wetting
• Transient incontinence: incontinence
secondary to temporary Dx (i.e., Delirium,
infection, atrophic vaginitis)
o Drug-induced: diuretics, sedatives
o Psychological: depression, anxiety
o Consumption: EtOH, caffeine
• Urge incontinence: sudden, intense urge to urinate caused by
involuntary contractions of detrusor muscle
o Overactive bladder: (OAB) no known cause
▪ Frequency: ≥ 8x/24h
▪ Nocturia: ≥ 2x
• Stress incontinence:
o Pressure exerted on bladder: (coughing,
sneezing, laughing, heavy lifting, etc.)
▪ Lung Dx: chronic coughing
o Weakened sphincter/pelvic floor muscles:
▪ Females: pregnancy, childbirth, menopause, cystocele
▪ Males: prostatectomy
▪ Obesity: increased weight (stress) on muscles
• Overflow incontinence: inability to empty the bladder (retention)
o GU Damage: Bladder damage, urethral blockage, prostate DX
o Nerve damage: due to DM
o Drug induced: opiates, Ca antagonists, anticholinergics
o Chronic overdistension: perceived inability to interrupt activity to void
▪ Areflexia: (hyporeflexia) of detrusor muscle
• Reflex incontinence: involuntary voiding w/o any urge or warning
o Nerve damage: S2-S4 injury, MS, DM
o Detrusor hyperreflexia: ↑ contractility when 𝖰 void sensation
• Mixed incontinence: symptoms of more than 1 type of incontinence
• Functional incontinence: physical or mental impairment leading to inability to
physically reach toilet in time; common in elderly pts in LTC
• Gross total incontinence: continuous leakage ATC, with periodic uncontrolled
leakage of large volumes; no storage capacity in the bladder
➢ Risk Factors for Urinary Incontinence:
• Females: (>males) pregnancy, childbirth, menopause, normal female anatomy;
, • Males: w/ prostate DX urge and overflow incontinence
• Age: inevitable w/ aging but NOT considered normal (except in infancy)
• Overweight: ↑ pressure on bladder & muscles stress incontinence
• Smoking: chronic coughing stress incontinence & overactive bladder
• Renal DX & DM: cause changes in renal function & nerve innervation
➢ Complications of Urinary Incontinence:
• Skin: moisture, rashes, infections, ulcers
• Recurrent UTIs: caused by incomplete emptying
• Psychological consequences: self-image, embarrassment, sexual dysfunction,
anxiety, depression
• Interrupted of QOL: work, exercise
, ➢ Treatment Approach for Urinary Incontinence: option vary based on type, cause, and
severity
• 1st line options:
o Behavioral: bladder training, scheduled toileting, coping strategies, support
o Absorption: absorbent pads, protective garments
o Fluid & diet: no EtOH, caffeine, acidic foods; ↓ liquid consumption & timing
intake; Wt loss & ↑ physical
activity
o Pelvic floor strengthening: Kegel exercises, electric stimulation PV/PR
o Mechanical: urethral inserts, pessary (stiff vaginal ring supporting bladder),
artificial urinary sphincter
• 2nd line – Medications: muscarinic antagonists (anticholinergics), estrogen
replacement, botulinum toxin A
(bladder), bulking material - collagen (urethral tissue)
• Last Line - Surgery & Procedures: radiofrequency therapy (firming of lower UT
via heat), sacral nerve stimulator, bladder neck suspension, urinary catheter
• Non-traditional: acupuncture, hypnotherapy, herbal (crataeva nurvala, equisetum
(horsetail), aloe vera extract)
➢ Prophylaxis of Urinary Incontinence: increased perineal hygiene, skin barrier creams, fall
precautions & safety measures
Neurogenic Bladder: interruption of normal bladder nerve innervation
➢ Causes:
• Nervous system Dx: brain/spinal cord injury or infections, MS, Heavy metal poisoning,
Herpes zoster
• Other Dx: SLE, Nervous system tumors, Dementia, Parkinson’s, Spina bifida, DM,
Stroke, Childbirth
• Drug-induced: Antidepressants, Antihistamines, Analgesics, Antihypertensives,
Antiemetics
➢ Clinical Manifestations:
• Presentation: Overactive bladder (frequency, urgency); Underactive bladder
(hesitancy retention)
• Diagnosis: refer to incontinence; underlying cause determined via CT, MRI
➢ Treatment: dependent on etiology; refer to incontinence
Parasympathetic Nervous System: (Chapters 13 & 14)
➢ PNS Patho:
• Cholinergic Receptors: mediate response to Ach; Nicotinic or Muscarinic subtypes
o Muscarinic: M1, M2, M3; many locations
▪ M3: bladder
o Receptor Activation: promotes voiding
▪ Coordinating events:
• Detrusor contraction: ↑ bladder pressure
• Relaxation of trigone & sphincter: allows urine to exit
o Receptor Blockade: promotes retention
• Adrenergic Receptors: mediate response to EPI/NE; α1 & β3 subtypes
o Alpha-1: many location; male sex organs, prostate, bladder
▪ Activation of alpha-1: promotes retention
• Contraction/constriction: bladder and prostate
• Other: Eye (mydriasis), Sex organs (ejaculation)
▪ Blockade of alpha-1: promotes voiding; relaxation
➢ PNS Pharmacology: overactive bladder give muscarinic antagonists; underactive bladder
