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The Autonomic Nervous System has two branches of nerves.
1) Sympathetic nervous system: also known as Fight, Flight, or Freeze or Visceral.
2) Parasympathetic nervous system: also known as Rest and digest, or vegetative.

https://www.britannica.com/science/autonomic-nervous-system

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Sympathetic Neurotransmitters:
* Acetylcholine (ACH): cholinergic

* Norepinephrine (NE): adrenergic - released at postganglionic nerve endings

* Epinephrine (EPI): adrenergic

* Dopamine (DA)

Parasympathetic Neurotransmitters:
* Acetylcholine (ACH): cholinergic

https://www.openanesthesia.org/autonomic_neurotransmitters/

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SNS:
-Acetylcholine (ACH) cholinergentic - released at ganglia from presynaptic nerve endings.
- Norepinephrine (NE) released at postganglionic nerve endings. Adrenal medulla and neurons releases NE.

PNS:
- Acetylcholine (ACH) cholinergentic - released at ganglia from presynaptic nerve endings. ACH is ALSO released at postganglionic nerve endings.

https://www.ncbi.nlm.nih.gov/books/NBK538516/

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SYMPATHETIC NS:
alpha-1 (contraction of smooth muscle): Found on glands, smooth muscles, eyes (iris muscle), most arteries and veins.
alpha-2: Found on adrenergic nerve ending.
beta-1 (stimulation of cardiac muscle): Located on the heart.
beta-2 (relaxation of smooth muscle): Located on smooth muscle, lungs, uterus, skeletal muscle arteries, coronary arteries.

PARASYMPATHETIC NS:
muscarinic: located on cardiac smooth muscle, and glands.
nicotinic 1: Located at ganglia (synapse area)
nicotinic 2: Somatic, neuromuscular junction of skeletal muscle.

https://www.britannica.com/science/human-nervous-system/The-autonomic-nervous-system

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Effects from SYMPATHETIC stimulation:
-Adrenal Medulla : release of epinephrine
-Arteries: vasoconstrictions (exceptions: coronary arteries and skeletal muscles, which are dilated)
-Heart: increases heart rate and AV conduction. Increased contractility.
-I ntenstines, GI motility, and secretions: decreased
Pupil of the eye: dilation (mydriases)
- Respiratory passages (lower): bronchodilation
- Urinary bladder: relaxation
- Urinary sphincte r: contraction

PARASYMPATHETIC effects:
-Arteries: most arteries are not supplied by the PNS.
-Heart: decreases heart rate and AV conduction. Slight increase in contractility.
-I ntenstines, GI motility, and secretions: increased
Pupil of the eye: dilation (mydriases)
- Postganglionic neurotransmitter: ACH released
- Respiratory passages (lower): bronchoconstriction
- Urinary bladder: contraction
- Urinary sphincte r: relaxation

https://www.physio-pedia.com/Sympathetic_Nervous_System

https://wtcs.pressbooks.pub/pharmacology/chapter/4-2-ans-basics/

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SNS:

•Sympathomimetics: drugs that mimic the sympathetic system (adrenergics, agonists)
•Sympatholytics: drugs that work against the sympathetic system (adrenergic blocking, blockers, inhibitors, antagonists)

Alpha-1 Adrenergic Agonists
MOA:

-alpha-1 receptor is stimulated

-contraction of smooth muscle, blood vessels constrict, increases BP

-vasoconstriction of nasal passages à decongestant effect

Adrenergic Agonists
MOA:

-Stimulates all alpha and beta receptors, an exception

-Vasopressor-vasoconstriction, increases BP

-Cardiac stimulant

-Bronchodilator
Uses: severe allergic reactions/anaphylaxis, shock, cardiac arrhythmias

Alpha-1 Adrenergic Blocking Drugs
MOA:

-binds to alpha-1 receptors and blocks them

-relaxation of smooth muscle

-vasodilation of blood vessels, decreases BP

-relaxes smooth muscle of ureters and increases urine flow
Uses: Hypertension, Benign Prostatic Hyperplasia

Beta Adrenergic Agonists

Beta-1
MOA:

-Low dose: stimulates dopaminergic (d-1) receptors in kidneys causing vasodilation and increased renal blood flow

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

-High dose: stimulates alpha-1 receptors causing vasoconstriction à increase in blood pressure
Uses: treatment of shock, increases blood pressure, and increases heart function

Beta-2
MOA:

-stimulates beta 2 receptors

-relaxation of the smooth muscle of the lungs > bronchodilation

-relaxation of the smooth muscle of the uterus
Uses: asthma, respiratory illness/disease, preterm labor

Beta-Adrenergic Blocking Drugs

Selective Beta-1 Blockers
MOA:

-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
Uses: hypertension (HTN), angina, arrhythmias, tachycardia, migraines, glaucoma (lowers IOP), heart failure (decreases sympathetic activity)

Non-selective Beta Blockers
MOA:

-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
Uses: HTN, arrhythmias, angina, tachycardia, migraines, glaucoma (lowers IOP), heart failure (decreases sympathetic activity)

PNS:

* Parasympathomimetics: drugs that mimic the parasympathetic system (agonists, cholinergics)

*Parasympatholytics: drugs that work against parasympathetic system (antagonists, anticholingerics)

Direct –Acting Cholinergic Agonists

MOA:

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

-mimics ACH

Indirect –Acting Cholinergic Agonists

MOA:

-inhibit acetylcholinesterase, the enzyme that destroys ACH in the synapse

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

Anticholinergics/Parasympatholytics
MOA:

-bind to a cholinergic receptor

-acts as a blocking drug; competitive antagonism

https://wtcs.pressbooks.pub/pharmacology/chapter/4-2-ans-basics/

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Autonomic Nervous System

1.              Alpha-1 Adrenergic Agonists

ephedrine

phenylephrine (Neo-Synephrineâ)

2.             Adrenergic Agonists

epinephrine (Adrenalinâ)

3.             Alpha-1 Adrenergic Blocker

prazosin (Minipressâ)

terazosin (Hytrinâ)

doxazosin (Carduraâ)

4.             Beta-1 Adrenergic Agonist

dobutamine

5.           Beta-2 Adrenergic Agonist

formoterol (Foradilâ)

albuterol (Proventilâ/Ventolinâ)

terbutaline (Brethineâ)

6.          Beta Blocker

Nonselective

nadolol (Corgardâ)

propranolol (Inderolâ)

timolol (Blocadrenâ)

Selective

atenolol (Tenorminâ)

metoprolol (Lopressorâ)

7.          Direct Acting Cholinergic Agonist

acetylcholine

pilocarpine (Pilocarâ)

bethanechol (Urecholineâ)

8.        Indirect Acting Cholinergic Agents

neostigmine (Prostigminâ)

9.          Anticholinergic

atropine

dicyclomine (Bentylâ)

10.          Skeletal Muscle Relaxants

a. Peripherally Acting

Depolarizing Agent:

succinylcholine

Non-depolarizing Agent:

rocuronium bromide (Zemuronâ)

Direct Acting:

dantrolene (Dantriumâ)

b. Centrally Acting

cyclobenzaprine (Flexerilâ)

carisoprodol (Somaâ)

methocarbamol (Robaxinâ)

orphenadrine citrate (Norflexâ)

chlorzoxazone  (Parafon Forte DSCâ)

metaxalone (Skelaxinâ)

* FROM: Master Drug List - Unit 2