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-Involuntary control
-Branches of cranial and spinal motor innervate ( Cardiac and smooth muscle of internal organs and glands)
-Regulated by hypothalamus and medulla oblongata
-Autorhythmicity
-Homeostasis regulation

ANS Subdivision:
1. Sympathetic Nervous System (Adrenergic)
2. Parasympathetic Nervous System (Cholinergic)

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1. Sympathetic Nervous System = Adrenergic

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1. Sympathetic Nervous System = Adrenergic

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Fight, Fright, Flight

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Acetylcholine (ACH) ---> at ganglion
Norepinephrine (NE) ---> at postganglionic nerve endings
Epinephrine (EPI)
Dopamine (DA)

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Alpha-1: Most arteries and veins, glands, eyes, smooth muscle
Alpha-2: Adrenergic nerve ending (Parasympathetic response)
Beta-1: Heart
Beta-2: Lungs, coronary and skeletal muscle blood vessels

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Adrenal medulla ---> Release epinephrine
Arteries ------------> Vasoconstriction (except the coronary arteries and arteries to skeletal muscle, which are dilated)
Heart-------------->Increase conduction and contractility
Postganglionic NT --> Norepinephrine released
Pupil of eye -------> Mydriasis (dilation)
Respiratory passages, lower--> Bronchodilation

GI motility, and secretions--> Decreased
Urinary bladder-------------> Relaxation
Urinary sphincter------------> Contraction

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1.4 Sympathomimetics: mimic the sympathetic system  (Adrenergics, Agonists)

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1.4 Sympathomimetics: mimic the sympathetic system  (Adrenergics, Agonists)

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1. Alpha-1 Adrenergic Agonists
Alpha-1 receptor is stimulated
Action: contraction of smooth muscle, blood vessels constrict, increases BP
vasoconstriction of nasal passages - decongestant effect

*ephedrine-increases BP
*phenylephrine (Neo-Synephrine®)

2. Adrenergic Agonists
Stimulates all alpha and beta receptors
Action: Vasopressor-vasoconstriction, increases BP
Cardiac stimulant
Bronchodilator

*epinephrine (Adrenalin®)

3. Beta-Adrenergic Agonists
Beta -1 Adrenergic Agonists
Low dose: dopaminergic (d-1) receptors in kidneys vasodilation/ increased renal blood flow
Moderate dose: beta 1 receptors-heart, increases the force of contraction and cardiac output
High dose: alpha-1 receptors causing vasoconstriction increase blood pressure

*dobutamine

4. Beta-2 Adrenergic Agonists
Stimulates beta 2 receptors
Action: Relaxation of the smooth muscle of the uterus and the lungs (bronchodilation)

*formoterol (Foradil®)
*albuterol (Proventil®, Ventolin®)
*terbutaline (Brethine®)
*salmeterol (Serevent®)

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1.5 Sympatholytics: works against the sympathetic system (Adrenergic blocking, blockers, Inhibitors, Antagonists)

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1.5 Sympatholytics: works against the sympathetic system (Adrenergic blocking, blockers, Inhibitors, Antagonists)

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1. Alpha-1 Adrenergic Blocking Drugs
Binds to alpha-1 receptors and blocks them
Action: Relaxation of smooth muscle and ureters,
vasodilation of blood vessels, decreases BP

*prazosin (Minipress®)
*terazosin (Hytrin®)
*doxazosin (Cardura®)

2. Beta-Adrenergic Blocking Drugs

2.1 Selective Beta-1 Blockers
Beta-1 receptor is blocked
Action: Decreases force of contraction(- inotropic), decreases HR(- chronotropic), decreases conduction(- dromotropic), decrease in cardiac output, decreases BP

*atenolol (Tenormin®)
*metoprolol (Lopressor®)

2.2 Non-selective Beta Blockers
block beta-1 and beta-2 receptors
Action: Decreases force of contraction(- inotropic), decreases HR(- chronotropic), decreases conduction(- dromotropic), decrease in cardiac output, decreases BP, and can cause bronchoconstriction

*nadolol (Corgard®)
*propanolol (Inderal®)
*timolol (Blocadren®)

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2. Parasympathetic Nervous System = Cholinergic

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2. Parasympathetic Nervous System = Cholinergic

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Rest and Digest

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Acetylcholine(ACH) --- > at ganglion, at postganglionic nerve endings

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Muscarinic: Cardiac, smooth muscle, and glands at the parasympathetic postganglionic nerve ending.
Nicotinic 1 (Nn): At ganglia of parasympathetic nerves and Sympathetic nerves ( synapse area)
Nicotinic 2 (Nm): Somatic neuromuscular junctions (NMJ) skeletal muscle

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2.3 Effect from Parasympathetic Stimulation

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2.3 Effect from Parasympathetic Stimulation

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Adrenal medulla ---> None
Arteries ------------> Most arteries are not supplied by parasympathetic nerves
Heart-------------->Decreases conduction and a slight decrease in contractility

GI motility, and secretions--> Increased
Postganglionic NT --> Acetylcholine released
Pupil of eye -------> Miosis ( constriction)-smaller
Respiratory passages, lower--> Bronchoconstriction
Urinary bladder-------------> Contraction
Urinary sphincter------------> Relaxation

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1. Direct–Acting Cholinergic Agonists
Directly stimulate/bind to the muscarinic receptors in the parasympathetic division, mimics ACH
Action: Pupil constriction, decreases intraocular pressure, prevent constipation and urinary retention post-op

*acetylcholine
*pilocarpine (Pilocar® )
*bethanechol (Urecholine®)

2. Indirect –Acting Cholinergic Agonists
inhibit acetylcholinesterase, the enzyme that destroys ACH in the synapse
Action: increases ACH

*neostigmine (Prostigmin®)

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1. Anticholinergics
Bind to a cholinergic receptor
Action: Acts as a blocking drug; Competitive antagonism

*atropine
*dicyclomine (Bentyl®)
*ipratropium bromide (Atrovent®)