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Controls body's automatic processes. Regulates the rate at which organs work by increasing or decreasing their activity- homeostasis.

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Direct Acting Cholinergic Agonist

increased urinary frequency and diarrhea

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Indirect Acting Cholinergic Agonist

chest pain or swelling

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Anticholinergic

dry mouth or blurred vision

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Acetylcholine (ACH)-cholinergic

NT released at ganglia from presynaptic nerve endings (both systems)

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Sympathetic- fight or flight response, adrenergic.

- stimulates whole body response during physical and mental stressful situations.

-Adrenal medulla release epinephrine and some norepinephrine that travel to receptor sites and produce sympathetic responses (endocrine function).

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Parasympathetic- rest and digest, cholinergic.

-stimulates only one body part or system.

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muscarinic:

located on cardiac, smooth muscle, and glands

at parasympathetic postganglionic nerve endings

decrease HR, bronchoconstriction, increase digestion, increase GI secretions, and increase urination, pupillary constriction

nicotinic 1 (Nn):

at ganglia of parasympathetic nerves and sympathetic nerves (synapse area)

nicotinic 2 (Nm):

somatic, neuromuscular junction of skeletal muscle

If stimulated, muscle contracts. (Somatic Nervous system-voluntary control; division of Peripheral Nervous System)

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Parasympathetic
MOA: Direct-Acting Cholinergic Agonists

directly stimulate/bind to the muscarinic receptors in the parasympathetic division

mimics ACH

Drugs
1. acetylcholine-used for miosis, cataract and other eye surgeries. MOA: pupil constriction
2. pilocarpine (Pilocar®)-used for glaucoma. MOA: pupil constriction; decreases amount of fluid in eye; decreases intraocular pressure
3. bethanechol (Urecholine®)- used for urinary retention and ileus/intestinal stasis. MOA: stimulates muscarinic receptors of bladder and GI tract to prevent constipation and urinary retention post-op and in the elderly.

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Unit 2 ANS part 1 Lecture Notes
Unit 2 ANS part 2 Lecture Notes
Unit 2 Somatic System Lecture Notes
Unit 2 Respiratory System Lecture Notes
Unit 2 Drug List

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Alpha-1 Adrenergic Agonists

increased blood pressure or itching

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MOA: Anticholinergics/Parasympatholytics

bind to cholinergic receptor

acts as a blocking drug; competitive antagonism

Drugs

1. atropine- antidote for cholinergic poisoning; increase HR, decreases vagus nerve activity (parasympathetic), pre-op med-slows digestion and urination, mydriasis

2. dicyclomine(Bentyl®)-used for GI disorders (ulcers, colitis, IBS); decreases GI secretions and motility

3. ipratropium bromide (Atrovent®)-bronchodilation

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MOA: Indirect-Acting Cholinergic Agonists

inhibit acetylcholinesterase, the enzyme that destroys ACH in the synapse and increases ACH

Drugs
1. neostigmine (Prostigmin®)

Used for urinary retention and intestinal stasis/ ileus, reversal of anticholinergic-rocuronium bromid (Zemuron®) with respiratory paralysis from anesthesia by increasing ACH at the nicotinic 2 (Nm) receptors on skeletal muscle, treatment for myasthenia gravis

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Sympathetic

MOA: alpha 1 receptors are stimulated (adrenergic agonists)

ephedrine increases BP, phenylephrine increased BP but is also a decongestant

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Sympathetic

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

smooth muscle contraction and vasoconstriction which leads to increased BP

Dilation of pupils (mydriasis)

Stimulated by NE and EPI (catecholamines)

2. Alpha 2

Relaxation/inhibition; parasympathetic response

Decreases contraction of smooth muscle and vasodilation which leads to lowered BP.

Negative feedback system.

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Acetylcholine (ACH)- cholinergic

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Alpha-1 Adrenergic Blocker

low blood pressure or dizziness

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Norepinephrine (NE)- adrenergic

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Epinephrine (EPI)- adrenergic

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3. Beta 1

Located on the heart

Stimulated by NE and EPI (stronger effect by EPI)

Increase in force of contraction (inotropic)

Increase in force of conduction (dromotropic)

Increase in force of heart rate (chronotropic)

4. Beta 2

Located on smooth muscle, lungs, uterus, skeletal muscle arteries, and coronary arteries

- Smooth muscle

-Bronchodilation

-Uterine relaxation

-Relaxation of coronary arteries and skeletal muscle blood vessels (vasodilation)

-stimulated by EPI only

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Norepinephrine (NE)-adrenergic

NT released at postganglionic nerve endings

synthesized from dopamine

released by adrenal medulla and neurons

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MOA: adrenergic agonists stimulates all alpha and beta receptors. (Cardiac stimulant, bronchodilator (beta), vasopressor-vasoconstriction)

epinephrine (Adrenalin®)

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MOA: Adrenergic blocking drugs binds to alpha 1 receptors and block them, relaxation of smooth muscle, vasodilation.

prazosin (Minipress®)- HTN

terazosin (Hytrin®)- HTN, BPH

doxazosin (Cardura®)- HTN, BPH

terazosin (Hytrin®)

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MOA: beta 1 adrenergic agonists

Low dose stimulates d-1 receptors in kidneys causing vasodilation and increased renal blood flow.

Moderate dose stimulates beta 1 receptors-heart, increases force of contraction and cardia output

High dose stimulates alpha 1 receptors causing vasoconstriction that increase in blood pressure

Dobutamine is used treatment of shock, increases blood pressure, and increases heart function.

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MOA: beta 2 adrenergic agonists

Stimulates beta 2 receptors

Relaxation of the smooth muscle of the lungs (bronchodilation)

Relaxation of the smooth muscle of the uterus

Drugs

1. albuterol (Proventil®, Ventolin®)- bronchodilator

2. terbutaline (Brethine®)- bronchodilator, uterine relaxant

3. formoterol (Foradil®)- bronchodilator

Used for asthma, respiratory illness, disease, preterm labor

4. salmeterol (Serevent®)- bronchodilator

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MOA: Selective Beta-1 Blockers

beta-1 receptor is blocked (antagonizes beta-1 effects of NE and EPI)

decreases force of contraction (negative inotropic), decreases cardiac output

decreases HR (negative chronotropic)

decreases conduction (negative dromotropic)

decrease in cardiac output also decreases BP

Drugs

1. atenolol (Tenormin®)

2. metoprolol (Lopressor®)

Used for hypertension (HTN), angina, arrhythmias, tachycardia, migraines, glaucoma (lowers IOP), heart failure (decreases sympathetic activity)

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MOA: Non-selective beta blockers

block beta-1 and beta-2 receptors

decreases force of contraction (negative inotropic), decreases cardiac output

decreases HR (negative chronotropic)

decreases conduction (negative dromotropic)

decrease in cardiac output also decreases BP

can cause bronchoconstriction

Drugs

1. nadolol (Corgard®)

2. propanolol (Inderal®)

3. timolol (Blocadren®)

Used for HTN, arrhythmias, angina, tachycardia, migraines, glaucoma (lower IOP), heart failure (decreases sympathetic activity)

Contraindication: asthma and respirator disease patient, can trigger respiratory distress

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Adrenergic Agonists

changes in heart rate or blood pressure

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Beta-1 Adrenergic Agonists

nausea or headaches

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Beta-2 Adrenergic Agonists

Dizziness or chest pain

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Selective Beta-1 Blocker

diarrhea or stomach pain

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Non-Selective Beta Blockers

constipation or body aches