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

Sympathetic - fight or flight response, adrenergic.
- stimulates whole body response during physical and mental stressful situations.
- Adrenal medulla releases EPI/NE that travel to receptor sites to produce a sympathetic response.

Parasympathetic - rest and digest, cholinergic.
- stimulates only one body part or system.

both work together to create balance.

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2. The neurotransmitters for each division

Sympathetic
- ACH (acetylcholine) - cholinergic (both systems)
- NE (norepinephrine)
- EPI (epinephrine)
- DA (dopamine)
Parasympathetic
- ACH (acetylcholine)

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

neurotransmitters stimulates internal organ or gland to produce change or action by binding to receptors.

Sympathetic
- ACH (acetylcholine) released at the synapse/ganglia from presynaptic nerve endings. also at the postganglionic nerve endings to be released onto the effector organ. - cholinergic
- NE (norepinephrine) - released at the postganglionic nerve endings by adrenal medulla. - synthesized from dopamine.
- EPI (epinephrine) - produced by adrenal medulla
- DA (dopamine) - sympathetic and CNS neurotransmitter, precursor to NE.
Parasympathetic:
- ONE main Neurotransmitter = acetylcholine (ACH)
- Found at the ganglia or postganglionic nerve endings.

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

Sympathetic
- alpha 1: found on glands, smooth muscle and arteries.
when stimulated leads to vasoconstriction, increase in BP, contraction in smooth muscle, and pupil dilation. EPI/NE is released.
- Beta 1: located on the heart. stimulated by EPI/NE (stronger response by EPI)
a) force of contraction - inotropic
b) force of conduction - dromotropic
c) force of HR (increase) - chronotropic
- Beta 2: located on smooth muscle, lungs, uterus, coronary arteries and skeletal muscle arteries. Stimulated by EPI ONLY.
a) smooth muscle relaxation
b) bronchodilation c) uterine relaxation d) relaxation of coronary arteries and skeletal muscle (vasodilation)

Parasympathetic
- muscarinic
located:  on cardiac, smooth muscle, glands, and parasympathetic postganglionic nerve endings.
- nicotinic 1 (Nn)
located: at ganglia of parasympathetic nerves/sympathetic nerves (the synapse area)
- nicotinic 2 (Nm) when stimulated muscle contracts
located: somatic, neuromuscular junction of skeletal muscle.
ALL PARASYMPATHETIC are stimulated by ACH ^^

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5. The end organ responses that occur when each transmitter is stimulated. specific organ/response generated by each ANS division.

Sympathetic
1) adrenal medulla-  release of EPI/NE (postganglionic) increase activity of sympathetic nervous system.
2) arteries- vasoconstriction, increasing BP, gives myocardium greater blood flow and flow to skeletal muscles.
3) heart- increases HR and AV conduction. also contributes to contractility. (more efficient, stronger, and faster)
4) intestines/GI motility- have a decreasing effect
5) pupil- dilation (mydriasis), more light can enter.
6) Respiratory- bronchodilation
7) UA bladder- relaxation
8) UA sphincter- contraction.
9) glycogen to glucose energy is used.

Parasympathetic
1) adrenal medulla - no parasympathetic effect.
2) arteries - most arteries are NOT supplied by the parasympathetic nerves.
3) heart- decreases HR and AV conduction
4) intestines/GI motility- increased parasympathetic effect
5) pupil- constriction (Miosis)
6) respiratory- bronchoconstriction
7) UA bladder - contraction
8) UA sphincter- relaxation

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7. The specific drug examples/classification including generic and brand name.

Autonomic Nervous System :

1. Alpha-1 Adrenergic Agonists
eg:  ephedrine, phenylephrine (Neo-Synephrine)
2. Adrenergic Agonists
eg: epinephrine (Adrenalin)
3. Alpha-1 Adrenergic Blocker
eg: prazosin (Minipress), terazosin (Hytrin), doxazosin (Cardura)
4. Beta-1 Adrenergic Agonists
eg: dobutamine
5. Beta-2 Adrenergic Agonists
eg: formoterol (Foradil), albuterol(Proventil/Ventolin), terbutaline (Brethine)
6. Beta Blockers
eg: Non-Selective - nadolol (Corgard), propranolol (Inderol), timolol (Blocadren)
eg: Selective - atenolol (Tenormin) metoprolol(Lopressor)
7. Direct Acting Cholinergic Agonist
eg: acetylcholine, pilocarpine (Pilocar), bethanechol (Urecholine)
8. Indirect Acting Cholinergic Agents
eg: neostigmine (Prostigmin)
9. Anticholinergic
eg: atropine, dicyclomine (Bentyl)
10. Skeletal Muscle Relaxants
eg: Peripherally Acting -
Depolarizing Agent: succinylcholine
Non-Depolarizing Agent: rocuronium bromide (Zemuron)
Direct Acting: dantrolene (Dantrium)
eg: Centrally Acting -
cyclobenzaprine (Flexeril), Carisoprodol (Soma), methocarbamol (Robaxin), orphenadrine citrate(Norflex), chlorzoxazone(Parafon Forte DSC), metaxalone (Skelaxin)

Respiratory Drugs:
1. Mast Cell Stabilizer
eg: cromolyn sodium (Intal)
2. Bronchodilators
Sympathomimetics (short/long acting beta 2 agonists)
eg: albuterol (Proventil/Ventolin), formoterol (Foradil), terbutaline (Brethine), salmeterol (Serevent)
Xanthine Derviatives
eg: theophylline (Theo-dur) , aminophylline (Paladron)
3. Leukotriene Receptor Antagonist
eg: montelukast (Singulair)
4. Anticholinergic
eg: ipratropium bromide (Atrovent)
5. Combination Broncholiator
eg: ipratropium bromide and albuterol sulfate (Combivent)
6. Antihistamines
Generation I (sedating)

eg: brompheniramine (Dimetapp®), chlorpheniramine (Chlor-Trimeton®), clemastine (Tavist®), diphenhydramine (Benadryl®), hydroxyzine (Atarax®), promethazine (Phenergan®), azelastine (Astelin® or Astepro®)
Generation II (Non-sedating)
eg: loratidine (Claritin®) , fexofenadine (Allegra®)

cetirizine (Zyrtec®)
7. Corticosteroid

eg: budesonide (Rhinocort® or Pulmicort®), mometasone (Nasonex® or Asmanex®), fluticasone (Flonase® or Flovent®)

flunisolide (Nasalide®), triamcinolone(Nasacort®/Azmacort®)
8. Antitussives

Narcotic

eg: hydrocodone (Hycodan®), codeine/guaifenesin (Robitussin AC®)

Nonnarcotic

eg: dextromethorphan/guaifenesin (Robitussin DM®)

benzonatate  (Tessalon Perles®)
9. Decongestants

eg: oxymetazoline (Afrin®), pheniramine (Dristan®), phenylephrine (Neo-Synephrine®), pseudoephedrine (Sudafed®)

10. Expectorants

guaifenesin (Robitussin®, Mucinex®, Organidin®)

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6. The drug classifications for each division of the ANS.  Identify which receptors and include the action that occurs.

1. Sympathetic
MOA : alpha 1 receptors are stimulated (adrenergic agonists)
eg: ephedrine increases BP, phenylephrine increases BP but is also a decongestant.
MOA: adrenergic agonists stimulates all alpha and beta receptors. (cardiac stimulant, bronchodilator (beta), vasopressor-vasoconstriction)
eg: epinephrine (Adrenalin)
MOA: adrenergic blocking drugs binds to alpha 1 receptors and block them, relaxation of smooth muscle, vasodilation.
eg: prazosin (Minipress) HTN, terazosin (Hytrin) HTN, BPH,  doxazosin (Cardura) HTN, BPH.
MOA: beta 1 adrenergic agonists
a) low dose stimulates d-1 receptors in kidneys causing vasodilation and increased renal blood flow.
b) moderate dose stimulates beta 1 receptors of the heart increasing force of contraction and cardiac output.
c) high dose stimulates alpha 1 receptors causing vasoconstriction and increase in BP.
eg: dobutamine (Dobutamine)
MOA: Beta 2 adrenergic agonists stimulates beta receptors and relaxation of smooth muscle of lungs, bronchodilator
eg: albuterol(Ventolin), terbutaline(Brethine), formoterol(Foradil), salmeterol(Serevent)
MOA: SELECTIVE Beta adrenergic blocking drugs BLOCK beta 1 effects of EPI/NE. (Negative feedback, decreasing force of contraction(inotropic), HR(chronotropic), conduction(dromotropic), cardiac output and BP.
eg: atenolol(Tenormin), metoprolol(Lopressor)
MOA: NON-SELECTIVE Beta Blockers block both beta 1 and beta 2 receptors.
eg: nadolol(Corgard), propranolol(Inderal), timolol(Blocadren).

2. Parasympathetic
Direct Acting Cholinergic Agonists: directly stimulate and bind to muscarinic receptors. mimics ACH.
eg: 1. acetylcholine (MOA pupil constriction)
2. pilocarpine(Pilocar) - used for glaucoma (MOA pupil constriction, decreases amount of fluid in the eye)
3. bethanechol (Urecholine) - used for UA retention, intestinal stasis, ileus (lack of muscle contractions in the intestines) MOA stimulates muscarinic receptors of bladder and GI tract to prevent constipation.
In-direct Acting Cholinergic Agonists: inhibits acetylcholinesterase at the synapse, increases ACH.
eg: neostigmine(Prostigmine)
Anticholinergics: binds to cholinergic receptors, competitive antagonism.
eg: 1. atropine - antidote for cholinergic poisoning. Increases HR and decreases vagus nerve activity(parasympathetic). 2. dicyclomine(Bentyl) 3. ipratroprium bromide(Atrovent)-bronchodiliation.