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1. Two divisions of the Autonomic Nervous System (ANS)

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1. Two divisions of the Autonomic Nervous System (ANS)

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Sympathetic Nervous System

"Fight or Flight"

Adrenergic System

Increases energy expenditure and inhibits digestion

Parasympathetic Nervous System

"Rest and Digest"

Cholinergic System

Functions in opposition to the sympathetic nervous system

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LeBouef T, Yaker Z, Whited L.  Physiology, Autonomic Nervous System. [Updated 2021 May 9]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, 2022. ncbi.nlm.nih.gov/books/NBK538516/

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Physiology, Autonomic Nervous System - StatPearls - NCBI Bookshelf

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The autonomic nervous system (ANS) is made up of pathways of neurons that control various organ systems inside the body, using many diverse chemicals and signals to maintain homeostasis. It divides into the sympathetic and parasympathetic systems. The sympathetic component is better known as “fight…

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Sympathetic Nervous System

ACH - Acetylcholine - cholinergic

EPI - Epinephrine - adrenergic

NE - Norepinephrine - adrenergic

DA - Dopamine - precursor to NE

Parasympathetic Nervous System

ACH - Acetylcholine - cholinergic

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Peirson, Erica. "Acetylcholine: How and Why to Optimize the Synthesis of this Vital Neurotransmitter," Peirson Center for Children. 2018 Oct. 28. https://www.peirsoncenter.com/articles/acetylcholine-how-and-why-to-optimize-the-synthesis-of-this-vital-neurotransmitter. Accessed 2022 Mar. 04.

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Sympathetic Nervous System

ACH: Preganglionic neurons

NE: Postganglionic neurons, adrenal medulla

EPI: Adrenal medulla

DA: Hypothalamus

Parasympathetic Nervous System

ACH: Ganglia and postganglionic nerve endings

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Zydus Medical College & Hospital, "The Autonomic Nervous System." https://www.zmchdahod.org/pdf/college/Physiology25102018.pdf. Accessed 2022 Mar 04.

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4. Locations of receptors in each division

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4. Locations of receptors in each division

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Sympathetic Nervous System

Alpha 1: Glands, smooth muscle, eyes, arteries, veins, abdominal viscera

Alpha 2: Pancreas, membrane of adrenergic axon terminals

Beta 1: Heart, kidneys, adipose tissue

Beta 2: Smooth muscle, lungs, uterus, blood vessels serving heart, liver, and skeletal muscles

Parasympathetic Nervous System

Muscarinic: Heart, smooth muscle, glands

Nicotinic: ganglia, pastganglionic neurons

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Marieb, Elaine N. and Katja Hoehn. Human Anatomy & Physiology, eleventh edition. Pearson Education Inc. 2019. pp 543-546

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5. End organ responses when each transmitter is stimulated

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5. End organ responses when each transmitter is stimulated

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Sympathetic Nervous System

ACH

Sweat glands: increase sweating

NE

Heart: increased HR & force of heartbeat

Eyes: dilates pupils

Glands: inhibited secretory activity

Kidney: decreased urine output, promotes renin release

GI Tract: sphincter constriction

EPI

Heart: large increase in HR & force of heartbeat

Lungs: bronchodilation

Coronary blood vessels: vasodilation

Liver: release of glucose to blood

DA

Different actions based on dose given

Receptors widely found in the brain

Parasympathetic Nervous System

ACH

Heart: decreased HR

GI Tract: increase digestion and secretions

Eyes: constriction of pupils

Lungs: constricts bronchioles

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Marieb, Elaine N. and Katja Hoehn. Human Anatomy & Physiology, eleventh edition. Pearson Education Inc. 2019. pp 543-546

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6a. Drug classifications - Sympathetic Nervous System

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6a. Drug classifications - Sympathetic Nervous System

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Sympathomimetics (adrenergics, agonists)

Alpha-1 Adrenergic Agonists

Alpha-1 receptor

Increase BP

Vasoconstriction of nasal passage - decongestant

Increase circulation of vital organs

Adrenergic Agonists

Stimulates all alpha and beta receptors

Vasopressor - Vasoconstriction, increased BP

Cardiac stimulant

Bronchodilation

Beta-1 Adrenergic Agonists

Low dose: Stimulates dopaminergic receptors in kidneys = vasodilation and increased renal blood flow

Moderate dose: Stimulates beta-1 receptors = increased force of heartbeat, cardiac output

High dose: Stimulates alpha-1 receptors = vasoconstriction = increase BP

Beta-2 Adrenergic Agonists

Beta-2 receptors

Bronchodilation, relax smooth muscle of lungs

relax smooth muscle of uterus

Sympatholytics (adrenergic blocking, blockers, inhibitors, antagonists)

Alpha-1 Adrenergic Blocker

Binds and blocks alpha-1 receptors

Relax smooth muscle = vasodilation = decrease BP

Increase urine flow

Selective Beta-1 Adrenergic Blockers

Binds and blocks beta-1 receptors

Decrease force of contraction = decrease cardiac output

Decreased HR

Decreased conduction

Decreased BP

Non-Selective Beta Blockers

Blocks beta-1 and beta-2 receptors

Decrease force of contraction = decreased cardiac output

Decreased HR

Decreased conduction

Decreased BP

Can cause bronchoconstriction

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7b. Drug List - Parasympathetic Nervous System

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7b. Drug List - Parasympathetic Nervous System

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Direct-Acting Cholinergic Agonist

acetylcholine

pilocarpine (Pilocar®)

bethanechol (Urecholine®)

Indrect-Acting Cholinergic Agonist

neostigmine (Prostigmin®)

Anticholinergics/Parasympatholytics

atropine

dicyclomine (Bentyl®)

ipratropium bromide (Atrovent®)

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7a. Drug List - Sympathetic Nervous System

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7a. Drug List - Sympathetic Nervous System

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Alpha-1 Adrenergic Agonist

ephedrine

phenylephrine (Neo-Synephrine®)

Adrenergic Agonists

epinephrine (Adrenalin®)

Beta-1 Adrenergic Agonists

dobutamine

Beta-2 Adrenergic Agonists

albuterol (Proventil®)

terbutaline (Brethine®)

formoterol (Foradil®)

salmeterol (Serevent®)

Alpha-1 Adrenergic Blocker

prazosin (Minipress®)

terazosin (Hytrin®)

doxazosin (Cardura®)

Selective Beta-1 Blocker

atenolol (Tenormin®)

metoprolol (Lopressor®)

Non-selective Beta Blocker

nadolol (Corgard®)

propanolol (Inderal®)

timolol (Blocadren®)

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6b. Drug classifications - Parasympathetic Nervous System

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6b. Drug classifications - Parasympathetic Nervous System

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Parasympathomimetics (agonists, cholinergics)

Direct-Acting Cholinergic Agonists

Bind/stimulates muscarinic receptors

Mimics ACH

Pupil constriction

Stimulate bladder/GI tract to prevent post-op constipation and urinary retention

Indirect-Acting Cholinergic Agonists

Inhibits acetylcholinerase = increase ACH

Allows ACH to accumulate and stimulate for a longer period of time than normally expected

Parasympatholytics (antagonists, anticholinergics)

Bind to/blocks cholinergic receptors

Increase HR

Bronchodilation