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You have parasympathomimetic drugs that mimic the parasympathetic system (agonists, cholinergics) and parasympatholytic drugs that work against parasympathetic system(antagonists, anticholingerics)

Direct - Acting Cholinergic Agonists: this mimics ACH and directly stimulates/binds to the muscarinic receptors in the parasympathetic division

Example: pilocarpine (Pilocar®), bethanechol (Urecholine®)

Indirect - Acting Cholinergic Agonist: this increases ACH, inhibits acetylcholinesterase which are the enzymes that destroy ACH in the synapse

Example: neostigmine (Prostigmin®)

Anticholinergics: these bind to a cholinergic receptor acting as a block drug; competitive antagonism

Example: atropine (Atropen®), dicyclomine (Bentyl®), ipratropium bromide (Atrovent®)

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There are 3 types cholinergic (parasympathetic NT) receptors:

Muscarinic: these are located on cardiac, smooth muscle, and glands, they are at the parasympathetic postganglionic nerve endings. They decrease heart rate, cause bronchoconstriction, causes pupillary constriction, and increases digestion, GI secretions, and urination

Nicotinic 1 (Nn): found at the ganglia of the both parasympathetic and sympathetic nerves (synapse area)

Nicotinic 2 (Nm): somatic, neuromuscular junction of the skeletal muscle and when stimulated it causes muscle contraction (Somatic Nervous system - voluntary control; division of Peripheral Nervous System)

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At each receptor, the NT have different responses as listed below:

Adrenal Medulla: none

Arteries: Most arteries are not supplied by the parasympathetic nerves

Heart: Decrease of heart rate and AV conduction, slight decrease in contractility

Intestines, GI motility, and secretions: Increased

Postganglionic neurotransmitter: acetylcholine released

Pupil of the eye: constriction (miosis)

Respiratory passages, lower: bronchoconstriction

Urinary bladder: Contraction

Urinary sphincter: Relaxation

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The parasympathetic nervous system has one neurotransmitters:

Acetylcholine (ACH): releases at ganglia and postganglionic nerve endings (cholinergic)

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There are two divisions of the ANS:

Parasympathetic- also known as the craniosacral division. The nerves for this division are the cranial nerves from C3, C7, C9 and C10, as well as the sacral nerves S2 through S4. The cranial nerves supply the internal organs and glands of the head, thoracic cavity, and upper portion of the abdominal cavity. Where as the sacral nerves supply the lower portion of the abdomen and the pelvic cavity.

Sympathetic - also known as the thoracolumbar division. The nerves for this division are the thoracic and lumbar nerves T1 through L3. The thoracic nerves supply the internal organs & glands of the head, thoracic cavity, and upper abdominal cavity. The lumbar nerves supply the lower portion of the abdominal cavity and pelvic cavity.

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BETA  Agonists

Beta - 1: different doses have different MOA

Low doses: Renal blood flow is increased with the stimulation of dopaminergic receptors in the kidneys causing vasodilation

Moderate doses: Cardiac output and contraction increased by stimulating beta - 1 receptors on the heart

High doses: Increases the blood pressure by stimulation alpha - 1 receptors causing vasoconstriction

Example: dobutamine (Dobutrex®)

Beta -2: this stimulates the beta - 2 receptors causing bronchodilation by relaxing the smooth muscle of the lungs and also relaxes the smooth muscle of the uterus

Example: albuterol (Proventil®, Ventolin®), terbutaline (Brethine®), formoterol (Foradil®), and salmeterol (Serevent®)

Beta Blockers (a way to tell is the name ends in "olol")

Selective Beta - 1: receptors are blocked causing decrease in cardiac output, which decreases the blood pressure, by decreasing the force of contraction, also decreases the heart rate, and conduction

Example: atenolol (Tenormin®), metoprolol (Lopressor®)

Non-selection: these effect both beta - 1 and beta - 2 causing decrease in cardiac output, which decreases the blood pressure, by decreasing the force of contraction, also decreases the heart rate, and conduction, also can cause bronchoconstriction

Example: nadolol (Corgard®), propanolol (Inderal®), timolol (Blocadren®)

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You have sympathomimetic drugs that mimic the sympathetic system (adrenergics, and agonists) and sympatholytic drugs that work against the sympathetic system ( adrenergic blocking, blockers, inhibitors, antagonists). They are as follows:

Adrenergic Agonists: stimulates all alpha and beta receptors causing increase in blood pressure, cardiac stimulation, and bronchodilator.

Example: Epinephrine (Adrenalin®)

ALPHA - 1

Alpha - 1 Adrenergic Agonists: stimulates the alpha - 1 receptors which causes increase in blood pressure with contraction of smooth muscle and constriction of blood vessels. Also causes decongestion with the vasoconstriction of the nasal passages.

Example: phenylephrine (Neo-Synephrine®)

Alpha - 1 Adrenergic Blocking Drugs (these drug names tend to end in "azosin"): these bind to the alpha - 1 receptors and blocks them causing a decrease in blood pressure by vasodilation of blood vessels, relaxes the smooth muscle, and also relaxes the smooth muscle of ureters and increases urine flow

Example: prazosin (Minipress®), terazosin (Hytrin®), and doxazosin (Cardura®)

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At each receptor, the NT have different responses as listed below:

Adrenal Medulla: releases epinephrine

Arteries: vasoconstriction (exceptions are the coronary arteries and arteries to skeletal muscle, which are dilated)

Heart: Increase of heart rate and AV conduction

Intestines, GI motility, and secretions: Decreased

Postganglionic neurotransmitter: norepinephrine released

Pupil of the eye: Dilation (mydriasis)

Respiratory passages, lower: bronchodilation

Urinary bladder: Relaxation

Urinary sphincter: Contraction

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The neurotransmitter receptors in the sympathetic nervous system are adrenergic receptors. They are divided into four different types, are stimulated by EPI and NE causing the "flight or fight" reaction in various target organs.

Alpha 1: this receptor is found on glands, smooth muscles, eyes, and most arteries and veins.

Alpha 2: are found is the same areas as the Alpha 1 but are responsible for relaxation/inhibition; PARASYMPATHETIC RESPONSE

Beta 1: located on the heart

Beta 2: located on smooth muscle, lungs, uterus, skeletal muscle arteries, coronary arteries

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The sympathetic nervous system has four neurotransmitters:

Acetylcholine (ACH) - cholinergic

released at ganglia from presynaptic nerve endings (both systems)

Norepinephrine (NE) - adrenergic

released at postganglionic nerve endings, synthesized from dopamine, and released by adrenal medulla and neurons

Epinephrine (EPI) - adrenergic

acts on adrenergic receptors and produced by adrenal medulla as well

Dopamine (DA)

precursor to NE, this stimulates many receptors with different action based on dose given, and also a CNS neurotransmitter

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Adrenergic System: "Fight, Flight, Fright"
Regulates activity of internal organs and glands during stressful situations both mentally and physically, the whole body is stimulated

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Cholinergic - "Rest and Digest"
Restoration of energy stores, balance, and stimulates one specific body part/system

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my sources were from the textbook as well as the PowerPoint presentations in our course content:

Pharmacology for Healthcare professionals 5th edition by Hitner