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1.  The two divisions of the ANS and alternate names associated with each:

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1.  The two divisions of the ANS and alternate names associated with each:

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- Parasympathetic Nervous System 'PNS' (alt name: Craniosacral Division; craniosacral & cholinergic)
-Sympathetic Nervous System 'SNS' (alt name: Thoracolumbar Division; thoracolumbar & adrenergic)

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2.  The neurotransmitters for each division:

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2.  The neurotransmitters for each division:

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- Parasympathetic Nervous System: Acetylcholine
- Sympathetic Nervous System: Epinephrine & Norepinephrine

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3.  The locations where each NT is released in each division of the ANS:

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3.  The locations where each NT is released in each division of the ANS:

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- PNS: Acetylcholine is release in the postganglionic nerve endings

- SNS:
*Norepinephrine is released in adrenal medulla & neurons

*Epinephrine is released in postganglionic nerve endings

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4.  The receptors of each division with main locations of each receptor:

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4.  The receptors of each division with main locations of each receptor:

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- PNS: Muscarinic & Nicotinic
*Muscarinic - located on the cells membranes of visceral organs & glands.
*Nicotinic - two types of nicotinic receptors (Nicotinic-1 [Nm = Nicotinic muscle] & Nicotinic-2 [Nn = Nicotinic muscle]

- SNS: Divided into two types of receptors (alpha & beta)
*alpha-1: glands, eyes, smooth muscle..

*alpha-2: adrenergic nerve endings

*beta-1: located on the heart

*beta-2: smooth muscles, lungs, uterus..

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5.  The end organ responses that occur when each transmitter is stimulated. List the specific organ and state what response is generated in that organ when stimulated by each ANS division:

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5.  The end organ responses that occur when each transmitter is stimulated. List the specific organ and state what response is generated in that organ when stimulated by each ANS division:

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- PNS:
*Arteries: not supplied by parasympathetic nerves
*Heart: decreases heart rate & atrioventricular conduction
*GI Tract: Increases
*Post ganglionic transmitter: releases ACH
*Pupil: experiences miosis
*Respiratory passages: bronchoconstriction
*Urinary Bladder: contracts
*Urinary Sphincter: experiences relaxation

- SNS:
*Adrenal medulla: releases EPI
*Arteries: vasoconstriction (exceptions are coronary arteries & skeletal muscle arteries)
*Heart: increases heart rate & atrioventricular conduction
*GI Tract: Decreases
*Post ganglionic transmitter: releases NE
*Pupil: Mydriasis
*Respiratory passages: Bronchonstriction
*Urinary bladder: experiences relaxation
*Urinary Sphincter: contracts

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6.  The drug classifications for each division of the ANS. Under each classification, identify which receptors are interacted with, then include the action that occurs:

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6.  The drug classifications for each division of the ANS. Under each classification, identify which receptors are interacted with, then include the action that occurs:

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- PNS:
*Parasympathomimetic: drugs that mimic the parasympathetic system ---> cholinergic & antagonists
*Parasympatholytics: drugs that work against the parasympathetic system ---> anticholinergic & antagonist

-Receptors:
*Muscarinic: decreases heart rate, bronchoconstriction, digestion increases along w/ GI, urinary secretions & pupillary constriction.
*Nicotinic (Nm): depolarization in ganglia which results in post ganglionic impulse
*Nicotinic (Nn): neuromuscular junction of muscle & if stimulated the muscle contracts.

- SNS:
*Sympathomimetics: drugs that mimic the sympathetic system (adrenergic & agonists)
*Sympatholytics: drugs that work against the sympathetic system (adrenergic blocking, blockers & inhibitor antagonists)

-Receptors:
*Alpha-1: smooth muscle contraction
*Alpha-2: decreases contraction of smooth muscle
*Beta-1: increase force of contraction
*Beta-2: smooth muscle relaxation

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7.  The specific drug examples found on your drug list under each drug classification including generic (lowercase) and brand (capitalized in parentheses with the trademark symbol at the end- ®):

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7.  The specific drug examples found on your drug list under each drug classification including generic (lowercase) and brand (capitalized in parentheses with the trademark symbol at the end- ®):

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Alpha-1 Adrenergic Agonists:
increase circulation of vital organs, increase BP, and promote digestion
*ephedrine
increases BP
*phenylephrine (Neo-Synephrine®)
increases BP, nasal        congesting

Adrenergic Agonists: severe allergic reactions/anaphylaxis, shock, and cardiac arrhythmias
*epinephrine (Adrenalin®)
increases heart rate and BP, cardiac stimulant, bronchodilator

Alpha-1 Adrenergic Blocker: hypertension, benign prostatic hyperplasia
*prazosin (Minipress®)
HTN
*terazosin (Hytrin®)
HTN & BPH
*doxazosin  (Cardura®)
HTN & BPH
Orthostatic hypertension - causation with position changes, reflex tachycardia, GI upset, and increased urination

Beta-1 Adrenergic Agonist: treatment of shock, increases blood pressure, and increases heart function
*dobutamine
Overstimulation of the heart, CNS irritation

Beta-2 Adrenergic Agonist: Asthma, respiratory illness/disease, preterm labor
Bronchodilators
*formoterol (Foradil®)
*albuterol (Proventil® Ventolin®)
*terbutaline (Brethine®)
Tachycardia, jittery, tremors, headache

Beta Blocker (Non-Selective):
Hypertension (HTN) arrhythmias, angina, tachycardia, migraines, glaucoma (lowers IOP), heart failure (decreases sympathetic activity)
*nadolol (Corgard®)
*propranolol (Inderol®)
*timolol (Blocadren®)
drowsiness, GI upset, CNS depression, bradycardia, need to monitor serum lipid levels, mental depression, monitor glucose in diabetic

Beta Blocker (Selective):
Hypertension (HTN), angina, arrhythmias, tachycardia, migraines, glaucoma (lowers IOP), heart failure (decreases sympathetic activity)
*atenolol (Tenormin®)
*metoprolol (Lopressor®)
drowsiness, GI upset, CNS depression, bradycardia, need to monitor serum lipid levels, mental depression, monitor glucose levels

Direct Acting Cholinergic Agonist
*acetylcholine (ACH)
Used for miosis, cataract, and other eye surgeries
*MOA: pupil constriction
*pilocarpine (Pilocar®)
*Used for glaucoma
*MOA: pupil constriction; decreases the amount of fluid in eyes; decreases intraocular pressure

*bethanechol (Urecholine®)
Used for urinary retention and ileus/intestinal stasis

MOA: stimulates muscarinic receptors of bladder and GI tract to prevent constipation and urinary retention post-op and in the elderly

Indirect Acting Cholinergic Agents: Urinary retention and intestinal stasis/ileus, reversal of anticholinergicrocuronium bromide (Zemuron®) with respiratory paralysis from anesthesia by increasing ACH at the nicotinic 2 (NM) receptors on skeleton muscle, treatment for myasthenia gravis
*neostigmine (Prostigmin®)
Lacrimation, urinary incontinence, emesis (sLUdgE)

Anticholinergic
*atropine
Used as an antidote for cholinergic poisoning

Increases heart rate (HR), decreases vague nerve activity (parasympathetic), pre-op medicine slows digestion and urination, mydriasis
*dicyclomine (Bentyl®)
Used for GI disorders (ulcers, colitis, IBS)

Decreases GI secretions and motility

ipratropium bromide (Atrovent®)
*bronchodilation

Skeletal Muscle Relaxants (A)
* Peripherally Acting      *succinylcholine

Depolarizing Agent
Uses: intubation, adjunct therapy for general anasthesia

(Fasiculatations) Pain, jaw riggidity, hypotension, arrhythmias, potential for toxicity if cholinesterase is abnormal, malignment hypothermia - obtain family history, should only be used in emergent situations in pediatric patients

recuronium bromide (Zemuron®)

Non-depolarizing Agent

Used for intubation, adjunct therapy for general anasthesia, and mechanical ventilation

(Fasiculations) pain, jaw riggidity, hypotension, arrhythmias, respiratory depression

dantrolene (Dantrium®)

Direct Acting

Used for spastic conditions, ie. cerebral palsy, multiple sclerosis, sprinal cord injuries, malignment hyperthermia

Hepatotoxicity - box warning, vomiting, dizziness, fatigue, weakness

Skeletal Muscle Relaxants (B): spasms, injury, tension, overexertion
Centrally Acting
*cyclobenzaprine (Flexeril®)
*carisoprodol (Soma®)
*methocarbamol (Robaxin®)
*orphenadrine citrate (Norflex®)
*chlorzoxazone (Parafon Forte DSC®)
*metaxalone (Skelaxin®)

Blurred vision, fatigue, decreased mental alertness, lethargy, dizziness, decreased muscle tone, hypotension, avoid alcohol, patients may need to avoid operating a vehicle if effects are intense