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The two divisions of the Autonomic Nervous System includes the Sympathetic and Parasympathetic nervous systems. Other names for the Sympathetic Nervous System is called, "Fight or Flight" and "Adrenergic". Other names for the Parasympathetic Nervous System is called, "Rest and Digest" and "Cholinergic".

- information source: Hitner, Henry, and Barbara T. Nagle. Pharmacology: An Introduction. , 2004. Online Book. (p.60,63)

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Parasympathetic System ("Cholinergic Receptors")
-1. Acetylcholine (ACH)
Sympathetic System ("Fight, Firght, Flight")
- 1. Acetylcholine (ACH)
- 2. Norepinephrine (NE)
- 3. Epinephrine (EPI)
- 4. Dopamine (DA)

-Information source: Hitner , Henry, and Barbara T. Nagle. Pharmacology: An Introduction. , 2004. Online Book. (p.63)
- Information source: Unit 2 ANS Part 1 & 2 Powerpoint

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Parasympathetic Nervous System
- Acetylcholine (ACH): located at the ends of the ganglia and postganglionic nerve endings
Sympathetic Nervous System
- Acetylcholine (ACH): located at the ganglia
- Norepinephrine (NE): located at the postganglionic nerve endings
- Epinephrine (EPI): located in the medulla
- Dopamine (DA): located in the adrenergic nerve

Information source: Hitner, Henery, and Barbara T. Nagle. Pharmacology: An Introduction. , 2004. Online Book (p.63-65)

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Sympathetic:
- Alpha-1 adrenergic receptors: located on glands, smooth muscle, eyes (iris), arteries, and veins
- Alpha-2 adrenergic receptors: Adrenergic never ending
- Beta-1 receptors: located on the heart
- Beta-2 receptors: located in the smooth muscle of coronary and skeletal muscle blood vessels and bronchiolar smooth muscle
Parasympathetic-
- 1. Muscarinic: located on cardiac, smooth muscle, and glands
-2. Nicotinic-1 (Nn): located at the ganglia of parasympathetic nerves and sympathetic nerves
-3. Nicotinic-2 (Nm): located on cell membranes of skeletal muscle

Information source: Hitner, Henry, and Barbara T. Nagl., Pharmacology: An Introductio., 2004. Ebook (p.71)

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ACH (sympathetic):
- Adrenal medulla: Releases epinephrine (EPI)
- Arteries: Vasoconstriction
- Heart: Increases in heart rate, contractility, and AV conduction
- Intestines/GI tract/Secretions: Decreased
- Pupil (eye): Dilates (mydriasis)
- Lower respiratory passage: Bronchodilation
- Urinary bladder: Relaxation
- Urinary sphincter: Contracts
ACH (parasympathetic):
- Eye muscle: miosis
- Heart: decreases heart rate
- Lungs: Bronchoconstriction
- GI Tract/secretions: increased
- Urinary Tract: contracts
EPI:
- Uterus: relaxes smooth muscle
- Bronchiolar smooth muscle: promotes bronchodilation
- Veins/Arteries: vasconstriction
- Eye muscle: pupil dilation
-Blood Vessels: vasodilation
Heart: increases heart rate, contraction, and Av conduction
NE:
- Ateries/Veins: vasoconostriction
- Eye muscle: pupil dilation
- Heart: increases heart rate, contraction, and AV conduction
-GI tract/secretions: decreased
-Urinary bladder: no contraction
*** Doesn't stimulate beta-2 receptors
DA (Dopamine):
** Converts into NE

- information: ANS Powerpoint P 1 and 2

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1) Alpha-1 Adrenergic Agonists
• Receptor: stimulates alpha-1
• MOA: contracts smooth muscle, blood vessels constrict = increase in blood pressure. Vasconstriction of nasal passage = decongestant effect

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2) Adrenergic Agonists
•Receptor: Stimulates all alpha and beta receptors
• MOA: Vasopressor (vasoconstriction = increases blood pressure), cardiac stimulant, and bronchodilator

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3) Alpha-1 Adrenergic Blocking Drugs
•Receptor: binds to alpha-1 and blocks them
•MOA: relaxes smooth muscle, smooth muscle located in the uterus, increases urine flow, vasodilation of blood vessels = decreases blood pressure

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4) Beta-1 Adrenergic Agonists
•Receptor: Varies on dose amount (DA, Beta-1, or Alpha-2)
• Low Dose MOA: stimulates dopamine receptors in kidneys = vasodilation and increased renal blood flow
• Moderate Dose MOA: stimulates beta-1 receptors in the heart = increases contraction and cardiac output
• High Dose MOA: stimulates alpha-1 receptors (BV) = Vasoconstriction which increases blood pressure

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5) Beta-2 Adrenergic Agonists
•Receptor: stimulates beta-2
•MOA: relaxes lung smooth muscle = bronchodilation, and smooth muscle of uterus

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6) Selective Beta-1 Blockers
• Receptor: blocks Beta-1
• MOA: decreases contraction, cardiac output, heart rate, conduction, and blood pressure

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7) Non-Selective Beta Blockers
• Receptor: blocks beta 1 and beta 2
• MOA: decreases contraction, cardiac output, heart rate, conduction, blood pressure, and can cause bronchoconstriction

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1) Direct- Acting Cholinergic Agents (Parasympathomimetics)
• Receptor: binds and stimulates to muscarinic
• MOA: mimics ACH

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2) Indirect-Acting Cholinergic Agonists (Parasympathomimetics)
• Receptor: All cholinergic receptor sites
• MOA: Inhibits aceytlcholinesterase enzyme; Accumulation of ACH occurs

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3) Anticholinergics (Parasympatholytics)
• Receptor: binds to cholinergic receptor
• MOA: Acts as a blocking drug; competitive antagonism

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Skeletal Muscle Relaxants Drug Classification

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Skeletal Muscle Relaxants Drug Classification

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1) Peripherally Acting (Depolarizing)
• Receptor: combines with Nicotinic-Muscle Receptors (Nm)
• MOA: Causes ACH not to combine with receptors and prevents depolarization from happening

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2) Peripherally Acting (Non-depolarizing Agents)
• Receptors: Binds to Nicotinic-muscle receptors (Nm)
• MOA: inhibits muscle contractions by: 1) Succinlycholine binds to Nm receptors and induces depolarization and 2) Succinlycholine alters Nm receptors to respond to ACH stimulation

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3) Peripherally Acting (Direct-Acting)
• Receptor: binds to ACH
• MOA: inhibits skeletal muscle fiber contractions by messing with calcium ion release. Prevents actin and myosin from interacting with each other = no muscle contraction.

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4) Centrally Acting
• Receptors: GABA receptors interacts with GABA(a) and GABA(b)
• MOA: Spastic contraction of skeletal muscle in response to overexertion, trauma, and nervous tension.

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1) ephedrine
2) phenylephrie (Neo-Synephrine®)

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1) epinephrine (Adrenalin®)

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1)  prazosin (Minipress®)
2) terazosin (Hytrin®)
3) dxazosin (Cardura®)

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1) dobutamine

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1) formoterol (Foradil®)
2) albuterol (Proventil®/Ventolin®)
3) terbutaline (Brethine®)

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Nonselective
- nadolol (Corgard®)
- propranolol (Inderol®)
- timolol (Blocadren®)
Selective
- atenolol (Tenormin®)
- metoprolol (Lopressor®)

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1) acetylcholine
2) pilocarpine (Pilocar®)
3) bethanechol (Urecholine®)

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1) neostigmine (Prostigmin®)

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1) atropine
2) dicyclomine (Bently®)

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Peripherally Acting
-Depolarizing: succiylcholine
-Non-depolarizing: rocuronium bromide (Zemuron®)
-Direct: dantrolene (Dantrium®)
Centrally Acting
-cyclobenzaprine (Flexeril®)
-carisprodol (Soma®)
-methocarbamol (Robaxin®)
-orphenadrine citrate (Norflex®)
-chlorzxazone (Parafoon Forte DSC®)
-metaxalone (Skelaxin®)

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1) cromolyn Sodium (Intal®/Nasalcrom®)

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Sympathomimetics
-albuterol (Proventil®/Ventolin®)
-formoterol (Foradil®)
-terbutaline (Brethine®)
-salmeterol (Serevent®)
Xanthine Derivatives
-theophylline (Theo-Dur®)
-aminophylline (Paladron®)

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1) montelukast (Singulair®)

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1) ipratropium bromide (Atrovent®)

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1) ipratropium bromide and albuterol sulfate (Combivent®)

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Generation I (sedating)
-brompheniramine (Dimetapp®)
-chlorpheniramine (Chlor-Trimeton®)
-diphenhydramine (Benadryl®)
-hydroxyzine (Atarax®)
-promethazine (Phenergan®)
-azelastine (Astelin® or Astepro®)
Generation I (non-sedating)
-loratidine (Claritin®)
-fexofenadine (Allergra®)
-cetirizine (Zyrtec®)

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Corticosteroid (asthma or allergic rhinitis)

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Corticosteroid (asthma or allergic rhinitis)

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1) budesonide (Rhinocort® or Pulmicort®)
2) mometasone (Nasonex® or Asmanex®)
3) fluticasone (Flonase® or Flovent®)
4) flunisolide (Nasalide®)
5) triamcinolone (Nasacort®/Azmacort®)

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Narcotic
-hydrocodone (Hycodan®)
-codine/guaifensin (Robitussin AC ®)
Non-Narcotic
-dextromethroophan/guaifenesin (Robitussin DM ®)
-benzonatate (Tessalon Perles®)

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1) oxymetazoline (Afrin®)
2) pheniramine (Dristan®)
3) phenylephrine (Neo-Synephrine®)
4) psuedoephedrine (Sudafed®)

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1) guaifenesin (Robitussin®, Mucinex®, Organidin®)

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information: ANS Powerpoint Pt 1 and 2

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information: Drug List document on Blackboard