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1.  Two divisions of the ANS and their alternate names

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1.  Two divisions of the ANS and their alternate names

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Sympathetic Division or the thoracolumbar division (fight-or-flight response)

Parasympathetic Division or craniosacral division (rest-and-digest response)

Source: (ACC Textbook page 61, LO 5.3) Pharmacology: An Introduction 7th Edition, Henry Hitner Ph.D.

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2.  The neurotransmitters for each division

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2.  The neurotransmitters for each division

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SNS:
Preganglionic neurons - Acetylcholine (ACH)
Postganglionic neurons - Norepinephrine (NE)

PNS:
Preganglionic neurons - Acetylcholine (ACH)
Postganglionic neurons - Acetylcholine (ACH)

Source: (ACC Textbook page 64) Pharmacology: An Introduction 7th Edition, Henry Hitner Ph.D.

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3.  Locations where each NT is released in each division of the ANS

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3.  Locations where each NT is released in each division of the ANS

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SNS:

Presynaptic sympathetic neurons release acetylcholine (ACH) at synapses within the sympathetic ganglia.

Postsynaptic neurons release norepinephrine (NE) in response to this stimulus

PNS:

When stimulated, the presynaptic nerve releases acetylcholine (Ach) at the ganglion

Ach in turn acts on nicotinic receptors of postsynaptic neurons. Postsynaptic nerves then releases acetylcholine to stimulate the muscarinic receptors of the target organ

Source: http://www.dantest.com/dtr_ans_overview.htm

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4.  Receptors of each division and their main location

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4.  Receptors of each division and their main location

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Sympathetic receptors - Alpha 1, Alpha 2, Beta 1 and Beta 2
Alpha 1 - on smooth muscle membranes of arteries, veins, and sphincters of the urinary and gastrointestinal tract
Alpha 2 - located on adrenergic nerve endings
Beta 1 - in the heart
Beta 2 - in the bronchioles of the lungs and blood vessels of the skeletal muscles

Source: (ACC Textbook page 71) Pharmacology: An Introduction 7th Edition, Henry Hitner Ph.D.

Paraympathetic receptors - Muscarinic and Nicotinic
Muscarinic - cell membranes of the visceral organs and glands
Nicotinic-nerve (Nn) - located at both the parasympathetic and sympathetic ganglia
Nicotinic-muscle (Nm) - located on cell membranes of skeletal muscle

Source: (ACC Textbook page 66) Pharmacology: An Introduction 7th Edition, Henry Hitner Ph.D.

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5.  End organ responses to each ANS division

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5.  End organ responses to each ANS division

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Adrenal Medulla: SNS - release EPI, PNS - no response
Arteries: SNS - vasoconstriction (except coronary arteries and arteries to skeletal muscles which are dilated), PNS - no response
Heart: SNS - increased heart rate, AV conduction and contractility, PNS - decreased heart rate, AV conduction and contractility
Intestines: SNS - decreased digestion, PNS - increased digestion
Pupil of the eye: SNS - dilation, PNS - constriction
Respiratiory passages (lower): SNS - bronchodilation, PNS - bronchoconstriction
Urinary bladder: SNS - relaxation, PNS - contraction
Urinary sphincter: SNS - contraction, PNS - relaxation

Source: (ACC Textbook page 65, Table 5.1) Pharmacology: An Introduction 7th Edition, Henry Hitner Ph.D.

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6.  Drug classifications for each division of the ANS, their receptors and responses

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6.  Drug classifications for each division of the ANS, their receptors and responses

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SNS - sympathomimetics (agonists) and sympatholytics (antagonists) drug class.
*Sympathomimetics (receptor site and drug effect):
Alpha 1 - vasoconstriction and increased blood pressure
Alpha 2 - negative feedback effect to decrease release of NE
Nonselective Beta 1 - cardiac stimulation, increased heart rate and force of contraction
Nonselective Beta 2 - relaxation of beta 2 mediated smooth muscle, bronchodilation and increased blood flow to heart and skeletal muscle
Selective Beta 2 - relaxation of beta 2 mediated smooth muscle, bronchodilation and increased blood flow to heart and skeletal muscle
*Sympatholytics (receptor site and drug effect):
Selective Alpha 1 - vasodilation of alpha 1 mediated smooth muscle
Nonselective Beta 1 - decreased cardiac function, heart rate and force of contraction
Nonselective Beta 2 - beta 2 mediated smooth muscle contraction
Selective Beta 1 - decreases cardiac function, heart rate and force of contraction
Neuronal blockers on adrenergic nerve ending - interferes with synthesis and/or release of NE from nerve ending, decreases all sympathetic activity, lowers blood pressure and cardiac function

Source: (ACC Textbook page 73, Table 6.2) Pharmacology: An Introduction 7th Edition, Henry Hitner Ph.D.

PNS - Cholinergic drugs or parasympathomimetic, divided into direct-acting and the indirect-acting drugs.
Direct-Acting drugs bind to muscarinic receptors. The direct-acting cholinergic drugs primarily increase GI secretions and motility, increase urinary tract function (urination), and cause pupillary constriction (miosis). The effects of these drugs on the heart (decrease heart rate) and respiratory smooth muscle (bronchoconstriction) are usually clinically insignificant.
Indirect-Acting drugs also known as anticholinesterases bind to all cholinergic receptors. These drugs inhibit the enzyme acetylcholinesterase and allow the accumulation of ACH at all cholinergic receptor sites. Subdivided into the reversible inhibitors and the irreversible inhibitors.

Source: (ACC Textbook page 89-90) Pharmacology: An Introduction 7th Edition, Henry Hitner Ph.D.

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7.  Specific drug examples - Generic and Brand names

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7.  Specific drug examples - Generic and Brand names

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Alpha-1 Adrenergic Agonists - ephedrine, phenylephrine (Neo-Synephrine®)

Adrenergic Agonists - epinephrine (Adrenalin®)

Alpha-1 Adrenergic Blocker - prazosin (Minipress®), terazosin (Hytrin®), doxazosin (Cardura®)

Beta-1 Adrenergic Agonist - dobutamine

Beta-2 Adrenergic Agonist - formoterol (Foradil®), albuterol (Proventil®/Ventolin®), terbutaline (Brethine®)

Beta Blocker:

Nonselective - nadolol (Corgard®), propranolol (Inderol®), timolol (Blocadren®)

Selective - atenolol (Tenormin®), metoprolol (Lopressor®)

Direct Acting Cholinergic Agonist - acetylcholine, pilocarpine (Pilocar®), bethanechol (Urecholine®)

Indirect Acting Cholinergic Agents - neostigmine (Prostigmin®)

Anticholinergic - atropine, dicyclomine (Bentyl®)

Skeletal Muscle Relaxants:

a.Peripherally Acting

Depolarizing Agent - succinylcholine

Non-depolarizing Agent - rocuronium bromide (Zemuron®)

Direct Acting - dantrolene (Dantrium®)

b.Centrally Acting - cyclobenzaprine (Flexeril®), carisoprodol (Soma®), methocarbamol (Robaxin®), orphenadrine citrate (Norflex®), chlorzoxazone (Parafon Forte DSC®), metaxalone (Skelaxin®)

Respiratory Drugs

Mast Cell Stabilizers - cromolyn Sodium (Intal® / Nasalcrom®)

Bronchodilators:

Sympathomimetics “B-2 agonist” (Short and long acting)

albuterol (Proventil®/Ventolin®), formoterol (Foradil®), terbutaline (Brethine®), salmeterol (Serevent )

Xanthine Derivatives - theophylline (Theo-Dur), aminophylline (Paladron®)

Cysteinyl Leukotriene Receptor Antagonist - montelukast (Singulair®)

Anticholinergic - ipratropium bromide(Atrovent®)

Combination Bronchodilator - ipratropium bromide and albuterol sulfate (Combivent®)

Antihistamines:

Generation I (sedating) - brompheniramine (Dimetapp®), chlorpheniramine (Chlor-Trimeton®), clemastine (Tavist®), diphenhydramine (Benadryl®), hydroxyzine (Atarax®), promethazine (Phenergan®), azelastine (Astelin® or Astepro®)

Generation II (non-sedating) - loratidine (Claritin®), fexofenadine (Allegra®), cetirizine (Zyrtec®)

Corticosteroid (asthma or allergic rhinitis) - budesonide (Rhinocort® or Pulmicort®), mometasone (Nasonex® or Asmanex®), fluticasone (Flonase® or Flovent®), flunisolide (Nasalide®), triamcinolone (Nasacort®/Azmacort®)

Antitussives:

a.Narcotic - hydrocodone (Hycodan®), codeine/guaifenesin (Robitussin AC®)

b.Nonnarcotic - dextromethorphan/guaifenesin (Robitussin DM®), benzonatate (Tessalon Perles®)

Decongestants - oxymetazoline (Afrin®), pheniramine (Dristan®), phenylephrine (Neo-Synephrine®), pseudoephedrine (Sudafed®)

Expectorants - guaifenesin (Robitussin®, Mucinex®, Organidin®)

Source: ACC Unit 2 Drug List