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Subdivisions of ANS:
1 - Sympathetic Nervous System: "Fight, Flight, Fright"

Neurotransmitters: Adrenergic

Norepinephrine (NE) - Released at postganglionic nerve endings

Epinephrine (EPI) - produced by adrenal medulla

Dopamine (PA) - Sympathetic and CNS neurotransmitter and precursor to NE

2 - Parasympathetic Nervous System: "Rest, Digest"
Neurotransmitters: Cholinergic (ACH) - Released at ganglia from presynaptic and postganglionic nerve endings (both systems)

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Alpha 1 found on glands, smooth muscles, eyes, most arteries and veins
-- Organ Response --

Eyes: Dilation of pupil

Blood vessels to digestive, urinary organs, and skin: vasoconstriction

Sphincters: Contraction

Beta 1 located on the heart
-- Organ Response --

Heart: Increase in heart rate and force of contraction

Salivary glands: increase in secretion in certain cells

Beta 2 located on smooth muscles, lungs, uterus, skeletal muscle arteries, coronary arteries
-- Organ Response --

Salivary glands: increase in secretion in certain cells

Lung, Bronchus: bronchodilation

Smooth muscle cells of blood vessels to skeletal muscle: vasodilation

Cells of digestive glands: Decrease in secretion

Cells of pancreas and liver: Increase in release of glucose

Urinary: Relaxation of digestive and urinary tracts

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Receptor of Parasympathetic Nervous System

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Receptor of Parasympathetic Nervous System

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Muscarinic located at cells of sweat glands
-- Organ Response --

Cells of swear glands: Increase in secretion

Nicotinic 1 (Nn) located at cells of adrenal medulla
-- Organ Response --

Cells of adrenal medulla: Release of epinephrine and norepinephrine

Nicotinic 2 (Nm) located skeletal muscle

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Drug Classification For Sympathetic Nervous System

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Drug Classification For Sympathetic Nervous System

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Alpha 1 - Adrengergic Agonists

MOA:

Alpha-1 receptor is stimulated

Contraction of smooth muscle, blood vessels constrict, increases BP

Vasoconstriction of nasal passages -> decongestant effect

Drugs:

1. Ephedrine
2. phenylephrine (Neo-Synephrine ®)

Alpha-1 Adrenergic Blocking Drugs
MOA:

binds to alpha-1 receptors and blocks them

relaxation of smooth muscle

vasodilation of blood vessels, decreases BP

relaxes smooth muscle of ureters and increases urine flow

Drugs:
1. prazosin (Minipress®)

2. terazosin (Hytrin®)

3. doxazosin (Cardura®)

Beta Adrenergic Agonists
Beta -1 Adrenergic Agonists
MOA :

Low dose-stimulates dopaminergic (d-1) receptors in kidneys causing vasodilation and increased renal blood flow

Moderate dose-stimulates  beta 1 receptors-heart, increases force of contraction and cardiac output

High dose- stimulates alpha-1 receptors causing vasoconstriction à increase in blood pressure

Drugs:
1. dobutamine

Beta-2 Adrenergic Agonists
MOA:

stimulates beta 2 receptors

relaxation of the smooth muscle of the lungs à bronchodilation

relaxation of the smooth muscle of the uterus

Drugs:
1. albuterol (Proventil®, Ventolin®)
2. terbutaline (Brethine®)
3. formoterol (Foradil®)
4. salmeterol (Serevent®)

Beta-Adrenergic Blocking Drugs

Selective Beta-1 Blockers
MOA:

beta-1 receptor is blocked (antagonizes beta-1 effects of NE and EPI)

decreases force of contraction  (negative inotropic), decreases cardiac output

decreases HR  (negative chronotropic)

decreases conduction (negative dromotropic)

decrease in cardiac output also decreases BP

Drugs:
1. atenolol (Tenormin®)

2. metoprolol (Lopressor®)

Non-selective Beta Blockers
MOA:

block beta-1 and beta-2 receptors

decreases force of contraction  (negative inotropic), decreases cardiac output

decreases HR  (negative chronotropic)

decreases conduction (negative dromotropic)

decrease in cardiac output also decreases BP

can cause bronchoconstriction

Drugs:
1. nadolol (Corgard®)

2. propanolol(Inderal®)

3. timolol (Blocadren®)

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Drug Classifications For Parasympathetic Nervous System

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Drug Classifications For Parasympathetic Nervous System

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Direct - Acting Cholonergic Agnosist
- Receptor: muscarinic
MOA:

directly stimulate/bind to the muscarinic receptors in the parasympathetic division and mimics ACH

Drugs:
1. Acetylcholine
2. Pilocarpine (Pilocar  ®)
3. Bethanechol (Urecholine  ®)

Indirect - Acting Cholonergic Agnosist
- Receptor: Nicotinic 2
MOA:

inhibit acetylcholinesterase, the enzyme that destroys ACH in the synapse and increase ACH

Drugs:
1. Neostigmine (Prostigmin  ®)

Anticholonergics
- Receptor: cholinergic
MOA:

Bind to a cholinergic receptor and acts as a blocking drug; competitive antagonism

Drugs:
1. Atropine
2. Dicyclomine (Bentyl ®)
3. Ipratropium bromide (Atrovent ®)