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There are two parts of the autonomic nervous system. The first is called the sympathetic nervous system (SNS), also known as the adrenergic system. The second division is called the parasympathetic nervous system (PNS), also known as the cholinergic system.

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Also known as the adrenergic system

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Also known as the cholinergic system.

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The neurotransmitters are epinephrine and norepinephrine.

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The neurotransmitter is acetylcholine.

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-Epinephrine is released at the adrenal medulla.
-Norepinephrine is released at the postganglionic nerve endings.
-Dopamine is located at the midbrain.

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The acetylcholine neurotransmitter is released at ganglia, as well as the postganglionic nerve endings.

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The SNS consists of alpha 1, alpha 2, beta 1, and beta 2 receptors.
-The alpha 1 receptor is found on glands, smooth muscles, eyes, and most arteries and veins.
-The alpha 2 receptor is found on the vascular smooth muscle cells.
-The beta 1 receptor is found at the heart.
-The beta 2 receptor is located on smooth muscles, lungs, uterus, skeletal muscle arteries, and the coronary arteries.

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The PNS consists of the muscarinic, nicotinic 1, and nicotinic 2 receptors.
-The muscarinic receptor is located at the cardiac, smooth muscles, glands, and postganglionic nerve endings.
-The nicotinic 1 (Nn) receptor is located at the ganglia of parasympathetic and sympathetic nerves.
-The nicotinic 2 (Nm) receptor is located at the somatic neuromuscular junction of skeletal muscle.

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1. Adrenal medulla: It is where EPI is released.
2. Heart: The heart rate increases, as well as contractility. Also, AV conduction occurs.
3. Arteries: Vasoconstriction occurs except at the arteries to the skeletal muscle and coronary arteries, as they are dilated.
4. GI tract/Intestines/secretions: These are all decreased.
5. Postganglionic neurotransmitter: Norepinephrine is released here.
6. Pupil: Dilation occurs.
7. Respiratory passages, lower: Bronchodilation occurs.
8. Urinary bladder: Relaxation occurs.
9. Urinary sphincter: Contraction occurs.

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1. Arteries: Most arteries are not supplied by parasympathetic nerves
2. Heart: decreases heart rate and AV conduction, slightly decrease in contractility.
3. Intestines, GI motility, and secretions: Increased
4. Postganglionic neurotransmitter: Acetylcholine released.
5. Pupil of the eye: Constriction (miosis)
6. Respiratory passages, lower: Bronchoconstriction
7. Urinary bladder: Contraction
8. Urinary sphincter: Relaxation

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 Receptor/action: Stimulates all alpha and beta receptors. Vasopressor-constriction occurs, increases BP, cardiac stimulant, bronchodilator.
 Drug: epinephrine (Adrenaline®)

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Drug classification: Alpha-1 Adrenergic Agonists

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Drug classification: Alpha-1 Adrenergic Agonists

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 Receptor/action: Alpha 1 receptor stimulated. Contraction of smooth muscle occurs as well as blood vessels constrict which leads to an increase in BP. Nasal passages are vasoconstricted and give a decongestant effect.
 Drug:  ephedrine and phenylephrine (Neo-Synephrine®).

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Drug classification: Alpha-1 Adrenergic Blocking Drug

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Drug classification: Alpha-1 Adrenergic Blocking Drug

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 Receptor/action: In the mechanism of action, alpha-1 receptors are bound and blocked. Relaxation of smooth muscle occurs, as well as vasodilation of blood vessels which decreases BP. It also relaxes smooth muscle of ureters and increases urine flow.
 Drugs: prazosin (Minipress®)-HTN, terazosin (Hytrin®)-HTN, BPH, doxazosin (Cardura®)-HTN, BPH.

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Drug classification: Beta-1 Adrenergic Agonists

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Drug classification: Beta-1 Adrenergic Agonists

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 Receptor/action: At a low dose, dopaminergic is stimulated in the kidneys, causing vasodilation and increased renal blood flow.
At moderate dose, beta-1 receptors are stimulated, increasing force of contraction and cardiac input
At a high dose, alpha-1 receptors are stimulated, causing vasoconstriction which leads to an increase in blood pressure.
 Drugs: dobutamine

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Drug classification: Beta 2 Adrenergic Agonists

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Drug classification: Beta 2 Adrenergic Agonists

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 Receptor/action: Beta 2 receptors are stimulated causing relaxation in the smooth muscles of the lungs which lead to bronchodilation. They also cause relaxation of the smooth muscles of the uterus.
 Drugs: formoterol (Foradil®), albuterol (Proventil®, Ventolin®), salmeterol (Serevent®), terbutaline (Brethine®).

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Drug classification: Selective Beta-1 Blockers

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Drug classification: Selective Beta-1 Blockers

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 Receptor/action: Beta-1 receptors are blocked which causes a decrease in force of contraction as well as a decrease in cardiac output. It also decreases HR, conduction, cardiac output which in turn decreases BP.
 Drugs: atenolol (Tenormin®) and metoprolol (Lopressor®)

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Drug classification: Non-selective Beta Blocker

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Drug classification: Non-selective Beta Blocker

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 Receptor/action: Beta 1 and beta 2 receptors are blocked, a decrease in force of contraction, cardiac output, and HR occurs. As well as a decrease in cardiac output which also decreases BP. It can also cause bronchoconstriction.
 Drugs: nadolol timolol (Blocadren®), (Corgard®), and propranolol (Inderal®).

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Drug classification: Direct Acting Cholinergic Agonist

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Drug classification: Direct Acting Cholinergic Agonist

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 Receptor/action: It is able to stimulate and bind to the muscarinic receptors in the parasympathetic division. It also has the ability to mimic ACH.
 Drugs: acetylcholine, pilocarpine (Pilocar®), bethanechol (Urecholine®)

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Drug classification: Indirect Acting Cholinergic Agonists

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Drug classification: Indirect Acting Cholinergic Agonists

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 Receptor/action: It inhibits acetylcholinesterase, which is an enzyme that breaks down ACH in the synapse, it also increases ACH.
 Drug: neostigmine (Prostigmin®)

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 Receptor/action: It is used to bind to a cholinergic receptor and also acts as a blocking drug (competitive antagonism).
 Drugs: atropine, dicyclomine (Bentyl®), and ipratropium bromide (Atrovent®)

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Noback, Charles R, and Thomas L Lentz. “The Autonomic Nervous System.” Encyclopædia Britannica, Encyclopædia Britannica, Inc., 9 Apr. 2020, www.britannica.com/science/human-nervous-system/The-autonomic-nervous-system.
Moore, Donna. ANS Part 1, ANS Part 2 Powerpoint.