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1. The two divisions of the ANS are the somatic division and the visceral division. Their alternate names are the sympathetic and parasympathetic nervous systems.

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2. epinephrine and some norepinephrine are neurotransmitters that travel to all sympathetic receptor sites. The neurotransmitters bind to and stimulate several. autonomic receptor sites. In the parasympathetic division these are known as cholinergic receptors and in the sympathetic division they are known as adrenergic receptors. There are 2 types of nicotinic receptors- nicotinic-nerve and nicotinic-muscle. Nicotinic nerve receptors are located on both parasympathetic and sympathetic ganglia

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3. Neurotransmitters are released at synapses

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4. In the parasympathetic division there are two types of cholinergic receptors: muscarinic and nicotinic. Muscarinic receptors are located on the cell membranes of the visceral organs and glands. Nicotinic receptors are located on cell membranes of skeletal muscle. In the sympathetic  the postganglionic neurons release NE and that stimulates the adrenergic receptors. The adrenergic receptors are subdivided by two types and those are alpha and beta receptors. Alpha and beta receptors are subdivided into alpha-1, alpha-2, beta-1, and beta-2.

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Alpha-1 Adrenergic Agonists: Stimulates alpha-1 adrenergic receptors.
Action: Constriction of blood vessels (vasoconstriction) leading to increased blood pressure.
Adrenergic Agonists: Stimulates adrenergic receptors.
Action: Can include increased heart rate, vasoconstriction, and increased contractility.
Alpha-1 Adrenergic Blockers: Block alpha-1 adrenergic receptors.
Action: Vasodilation leading to decreased blood pressure.
Beta-1 Adrenergic Agonists: Stimulate beta-1 adrenergic receptors.
Action: Increased heart rate and contractility.
Beta-2 Adrenergic Agonists: Stimulate beta-2 adrenergic receptors.
Action: Bronchodilation (relaxation of smooth muscles in the airways), relaxation of uterine smooth muscles.
Beta Blockers: Block beta adrenergic receptors.
Action: Decreased heart rate, decreased contractility, and vasodilation, leading to decreased blood pressure.
Direct Acting Cholinergic Agonist: Stimulate cholinergic receptors (muscarinic or nicotinic receptors).
Action: Varies depending on the specific receptor subtype stimulated. Can include increased glandular secretions, constriction of smooth muscles, increased gastrointestinal motility
Indirect Acting Cholinergic Agents: Increase the concentration of acetylcholine by inhibiting cholinesterase
Action: Prolonged activation of cholinergic receptors, leading to increased glandular secretions
Anticholinergics: Block cholinergic receptors (muscarinic or nicotinic receptors).
Action: Varies depending on the specific receptor subtype blocked. Can include decreased glandular secretions
Skeletal Muscle Relaxants: Varies depending on the drug.
Action: Act on the central nervous system or peripheral nerves to reduce muscle tone and induce muscle relaxation.
Centrally Acting: The receptor interactions vary greatly depending on the specific drug.

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5. The effects depend on the individual organ. For the GI tract actions are increased and for the heart actions are decreased.

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Alpha-1 Adrenergic Agonists

ephedrine

phenylephrine (Neo-Synephrine®)

Adrenergic Agonists

epinephrine (Adrenalin®)

Alpha-1 Adrenergic Blockers

prazosin (Minipress®)

terazosin (Hytrin®)

doxazosin (Cardura®)

Beta-1 Adrenergic Agonists

dobutamine

Beta-2 Adrenergic Agonists

formoterol (Foradil®)

albuterol (Proventil®, Ventolin®)

terbutaline (Brethine®)

Beta Blockers

1. Nonselective

nadolol (Corgard®)

propranolol (Inderal®)

timolol (Blocadren®)

1. Selective

atenolol (Tenormin®)

metoprolol (Lopressor®)

Direct Acting Cholinergic Agonist

acetylcholine

pilocarpine (Pilocar®)
bethanechol (Urecholine®)

Indirect Acting Cholinergic Agents

neostigmine (Prostigmin®)

Anticholinergics

atropine

dicyclomine (Bentyl®)

Skeletal Muscle Relaxants
Peripherally Acting
-Depolarizing Agent

succinylcholine

-Non-depolarizing Agent

rocuronium bromide (Zemuron®)
Direct Acting

dantrolene (Dantrium®)

Centrally Acting

cyclobenzaprine (Flexeril®)

carisoprodol (Soma®)

methocarbamol (Robaxin®)

orphenadrine citrate (Norflex®)

chlorzoxazone  (Parafon Forte DSC®)

metaxalone (Skelaxin®)

Mast Cell Stabilizers

cromolyn Sodium (Intal®, Nasalcrom®)

Bronchodilators
Sympathomimetics/beta-2 agonists  (Short and long acting)

albuterol (Proventil®, Ventolin®)

formoterol (Foradil®)

terbutaline (Brethine®)

salmeterol (Serevent®)

Xanthine Derivatives

theophylline (Theo-Dur®)
aminophylline (Paladron®)

Cysteinyl Leukotriene Receptor Antagonists/Inhibitors

montelukast (Singulair®)

Anticholinergics

ipratropium bromide (Atrovent®)

Combination Bronchodilators

ipratropium bromide + albuterol sulfate (Combivent®)

Antihistamines

1. Generation I (sedating)

brompheniramine (Dimetapp®)

chlorpheniramine (Chlor-Trimeton®)

clemastine (Tavist®)

diphenhydramine (Benadryl®)

hydroxyzine (Atarax®)

promethazine (Phenergan®)

azelastine (Astelin®, Astepro®)
-Generation II (non-sedating)

loratadine (Claritin®)

fexofenadine (Allegra®)

cetirizine (Zyrtec®)

Corticosteroids (asthma or allergic rhinitis, inhaled or nasal)

budesonide (Rhinocort®, Pulmicort®)

mometasone (Nasonex®, Asmanex®)

fluticasone (Flonase®, 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®)

Expectorants

guaifenesin (Robitussin®, Mucinex®, Organidin®)

Decongestants

oxymetazoline (Afrin®)

pheniramine (Dristan®)

phenylephrine (Neo-Synephrine®)

pseudoephedrine (Sudafed®)