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The 2 Divisions of ANS/Alternate Names: 

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The 2 Divisions of ANS/Alternate Names: 

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- Sympathetic: Adrenergic: "Fight, Fright, Flight"
-Parasympathetic: Cholinergic "Rest and Digest"

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- Acetylcholine (ACH): NT is released at ganglia from presynaptic nerve endings.
- Norepinephrine (NE): NT is released at postganglionic nerve endings. Synthesized from dopamine, released by adrenal medulla & neurons.
- Epinephrine (EPI): Acts on adrenergic receptors, released/produced by adrenal medulla.
-Dopamine (DA): Precursor to NE. Stimulates alpha, beta, dopaminergic receptors.

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Acetylcholine (ACH): NT is at ganglia and postganglionic nerve endings.

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- Adrenal Medulla: release of epinephrine
- Arteries: vasoconstriction (exceptions: coronary arteries, arteries to skeletal muscles, which are dilated)
- Heart: Increases heart rate and AV conduction. Increases contractility.
- Intestines, GI motility, and Secretions: decreased
- Postganglionic NT: norepinephrine released
- Respiratory passages, lower: brochodialation
- Urinary bladder: relaxation
- Urinary sphincter: contraction

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- Alpha 1: Found on glands, smooth muscles, eyes, most arteries and veins. Stimulated by NE & EPI.
- Beta 1: Located on the heart. Stimulated by NE & EPI.
- Beta 2: Located on smooth muscle, lungs, uterus, skeletal muscles blood vessels-vasodialation. Stimulated by EPI only.

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- Heart: Decreases heart rate and AV* conduction. Slight decrease in contractility.
- Intestines, GI motility and secretions: increased
-Pupil of eye: constriction (mitosis)
-Respiratory passages lower: Bronchoconstriction
-Urinary bladder: Contraction
-Urinary sphincter: Relaxation

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- Muscarinic: located on cardiac, smooth muscle, glands.
- Nicotinic 1 (Nn): located at synapse area
-Nicotinic 2 (Nm): If stimulated muscle contracts
*all stimulated by ACH*

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Drug Classifications of ANS- Parasympathetic:

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Drug Classifications of ANS- Parasympathetic:

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- Direct-Acting Cholinergic Agonist (Parasympathomimetics):
Directly stimulate/Bind to muscarinic receptors. Mimic ACH.
Uses: miosis, glaucoma, urinary retention, and ileus/intestinal stasis.

- Indirect-Acting Cholinergic Agonist (Parasympathomimetics):
Increases ACH at the Nm receptors on skeletal muscle.
Uses:  urinary retention, intestinal stasis/ileus, reversal of anticholinergic-rocuronium bromide, respiratory paralysis, treatment for myasthenia gravis.

- Anticholinercis( parasympatholytics): bind to a cholinergic receptor.
Uses: Increase HR, decreases vagus nerve activity, ulcers/colitis/IBS, bronchodialation.

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ephedrine

phenylephrine (Neo-Synephrine®)

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Drug Classifications of ANS- Sympathetic: 

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Drug Classifications of ANS- Sympathetic: 

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- Alpha 1 Adrenergic Agonist: alpha-1 receptor stimulated.
Use: increase BP, increase circulation of vital organs, promote decongestion.

-Adrenergic Agonist: stimulates all alpha and beta receptors.
Use: severe allergic reactions/anaphylaxis, shock, cardiac arrhythmias

-Alpha 1 Adrenergic Blockers: binds to alpha-1 receptors & blocks them.
Uses: Hypertension, Benign prostatic hyperplasia

-Beta-1 Adrenergic Agonists: low dose= stimulates d-1 receptors,
moderate dose=stimulates beta-1 receptors, high dose= stimulates alpha-1 receptors.
Uses: treatment of shock, increases b.p. and increases heart function.

- Beta-2 Adrenergic Agonist: stimulates beta-2 receptors.
Uses: asthma, respiratory illness/disease, preterm labor.

-Selective Beta-1 Blockers: beta-1 receptor is blocked
Uses: HTN, angina, arrhythmias, tachycardia, migraines, glaucoma, heart failure.

-Non-Selective Beta-1 Blockers: blocks beta-1 and beta-2 receptors
Uses: HTN, angiina, tachycardia, migraines, glaucoma, heart failure.

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prazosin (Minipress®)

terazosin (Hytrin®)

doxazosin (Cardura®)

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epinephrine (Adrenalin®)

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Beta-1 Adrenergic Agonist                          

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Beta-1 Adrenergic Agonist                          

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dobutamine

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formoterol (Foradil®)

albuterol (Proventil®/Ventolin®)

terbutaline (Brethine®)

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Nonselective:

nadolol (Corgard®)

propranolol (Inderol®)

timolol (Blocadren®)

Selective:

atenolol (Tenormin®)

metoprolol (Lopressor®)

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acetylcholine

pilocarpine (Pilocar®)

bethanechol (Urecholine®)

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neostigmine (Prostigmin®)

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atropine

dicyclomine (Bentyl®)

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Peripherally Acting
Depolarizing Agent: succinylcholine

Non-depolarizing Agent:

rocuronium bromide (Zemuron®)

b) Direct Acting:

dantrolene (Dantrium®)

Centrally Acting:

cyclobenzaprine (Flexeril®)

carisoprodol (Soma®)

methocarbamol (Robaxin®)

orphenadrine citrate (Norflex®)

chlorzoxazone  (Parafon Forte DSC®)

metaxalone (Skelaxin®)

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Mast Cell Stabilizers:

cromolyn sodium (Intal®/Nasalcrom®)

Brochodilators:
-- Sympathomimetics "B-2 agonist" (short and long acting):

albuterol (Proventil®/Ventolin®)

formoterol (Fordil®)

terbutaline (Brethine®)

-- Xanthine Derivatives:

theophylline (Theo-dur®)

aminophylline (Paladron®)

Cysteinyl Leukotriene Receptor Antagonist:

montelukast (Singular®)

Anticholinergic:

ipratropium bromide (Atrovent®)

Combination Brochodilator:

ipratropium bromide and albuterol sulfate (Combivent®)

-Antihistamines:
--Generation 1 (sedating):

brompheniramine (Dimetapp®)

chlorpheniramine (Chlor-Trimeton®)

clementine (Tavist®)

diphenhydramine (Benadryl®)

hydroxyzine (Atarax®)

promethazine (Phenergan®)

azelastine (Astelin® or Astepro®)

--Generation 2 non-sedating:

loratadine (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.) Non-Narcotic:

dextromethorphan/guaifenesin (Robitussin DM®)

benzonatate (Tessalon Perles®)

- Decongestants:

oxymetazoline (Afrin®)

pheniramine (Dristan®)

phenylephrine (Neo-Synephrine®)

pseudoephedrine (Sudafed®)

-Expectorants:

guaifenesin (Robitussin®, Mucinex®, Organidin®)