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2 Divisions Of The Autonomic Nervous System:

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2 Divisions Of The Autonomic Nervous System:

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This system is also referred to as:
- Adrenergic System
- Fight, Fright, Flight

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PARASYMPATHOMIMETICS-AGONIST/CHOLINERGIC
(Mimic parasympathetic system)

Direct-Acting Cholinergic Agonist- stimulate/bind to muscarinic receptors

Drugs:
- Acetylcholine (ACH)- causes pupil constriction
-pilocarpine (Pilocar®)- used for pupil constriction to decrease the fluid and pressure in the eye.
-bethanechol (Urecholine®)- stimulates the muscarinic receptors of the bladder & GI tract to help with urinary retention and ileus/intestinal stasis.

Indirect-Acting Cholinergic Agonist-
(Inhibits acetylcholinesterase enzyme that destroys ACH causing more production of ACH).

Drugs:
- neostigmine (Prostigmin®)- used to help with urinary retention & intestinal stasis/ileus, reversal of anticholinergic (Zemuron®), respiratory paralysis from anesthesia, increases ACH at nicotinic 2 (Nm) receptors on skeletal muscle.
respiratory paralysis, treatment for myasthenia gravis.

PARASYMPATHOLYTICS-ANTAGONIST/ANTICHOLINERGIC
(Work against the parasympathetic nervous system)

Anticholinergics- bind to cholinergic receptors blocking drugs, competitive antagonism

Drugs:
-atropine- antidote for cholinergic posioning  (increases HR, decreases vagus nerve activity, pre-op meds slow digestion and urination, mydriasis.
-dicyclomine (Bentyl®)- decrease GI motility and secretions.
-ipratropium bromide (Atrovent®)- bronchodilation

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- Decreased heart rate, conduction and contractility
-Miosis (pupil constriction)
-Bronchoconstriction
-Increased digestion, urination and defecation
-Urinary bladder contraction
-Urinary sphincter relaxation

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This system is also referred to as:
- Cholinergic System
- Rest and Digest

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The effects on organs when stimulated by the Sympathetic Nervous System:

Pupil of the Eye-Dilates (mydriasis)

Heart-Increases in rate, contractility and conduction

Respiratory-Bronchodilation

Gastrointestinal-Decrease in digestion, motility and secretions

Urinary Bladder-Relaxation of the muscles in the bladder

Urinary Sphincter-Contraction of the sphincter muscles for decreased urination

Blood Vessel-Vasoconstriction of blood vessel causing an increase in heart rate and blood pressure for the fight or flight response.

Renal Medulla-Release of Epinephrine (EPI) and some Norepinephrine (NE)

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Acetylcholine (ACH) is the neurotransmitter for the parasympathetic system and is released at the ganglia and post ganglionic nerve endings.

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Neurotransmitter and Location of Release

Acetylcholine (ACH)- released at ganglia of presynaptic nerve ending

Norepinephrine (NE)- released at post ganglionic nerve ending

Epinephrine (EPI)- acts on adrenergic receptors

Dopamine (DA)- acts on many receptors (alpha, beta, dopaminergic)

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ALPHA-1 ADRENERGIC AGONIST- Alpha-1 receptor stimulated
MOA: contraction of smooth muscle, blood vessels constrict, increased bp, vasoconstriction of nasal passage
Drugs: ephedrine-increases bp
phenylephrine (Neo-Synephrine®)-increases bp,
nasal decongestant

ADRENERGIC ANTAGONIST- stimulates ALL alpha & beta receptors
MOA: vasopressor-vasoconstriction, increases bp
cardiac stimulant, bronchodilator
Drugs: epinephrine (Adrenalin®)

ALPHA-1 ADRENERGIC ANTAGONIST(BLOCKING)- binds to alpha-1 receptors and blocks them
MOA: relaxation of smooth muscles, vasodilation of blood vessels, decreases bp and relaxes smooth muscles of the uterus to increase urine flow.
Drugs: prazosin (Minipress®) HTN
terazosin (Hytrin®) HTN, BPH
doxazosin (Cardura®) HTN, BPH

BETA-1 ADRENERGIC AGONIST- stimulates the beta-1 receptors.
MOA:  Low doses-stimulates dopaminergic receptors to cause vasodilation in the kidneys for increased renal blood flow.
Moderate doses- stimulates beta-1 receptors in the heart for force of contraction and cardiac output
High dose- stimulates alpha-1 receptors causing vasoconstriction for increased bp.
Drugs: dobutamine

BETA-2 ADRENERGIC AGONIST- stimulates beta-2 receptors.
MOA: relaxation of smooth muscles of the lungs for bronchodilation, relaxation of the uterus.
Drugs:  albuterol (Proventil®)-Bronchodilator
terbutaline (Brethine®)-Brochodilator, Uterine Relax
formoterol (Foradil®)-Bronchodilator
salmeterol (Serevent®)-Bronchodilator

BETA-1 ADRENERGIC ATAGONIST(SELECTIVE)-blocks beta-1 receptors
MOA: decrease force of contractions & conduction, heart rate, cardiac output and blood pressure
Drugs: atenolol (Tenormin®)
metoprolol (Lopressor®)

BETA ADRENERGIC ATAGONIST(NON-SELECTIVE) - blocks beta-1 and beta-2 receptors
MOA: decreases force of contraction, heart rate, conduction cardiac output which decreases BP and can cause bronchoconstriction.
Drugs:  nadolol (Corgard®)
propanolol (Inderal®)
timolol (Blocadren®)

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Alpha 1 receptors are found on- glands, smooth muscles, eyes and most arteries & veins.

Beta 1 receptors are found on the heart.

Beta 2 receptors are found smooth muscles, lungs, uterus skeletal muscles arteries and coronary arteries.

*** Alpha 2 receptors have an PARASYMPATHETIC RESPONSE and acts as a Negative Feedback Sytem that regulates the release of Norepinnephrine (NE) to keep the body in homeostasis.***

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3 Types of Cholinergic Receptors

Muscarinic - Located on cardiac muscle, smooth muscle and glands.

Nicotinic (Nn)- Located at the ganglia of parasympathetic nerves and sympathetic nerves.

Nicotinic 2 (Nm)- Somatic, located on neuromuscular junction of skeletal muscle.

ALL ARE STIMULATED BY
ACETYLCHOLINE (ACH)