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The Autonomic nervous system, also called the visceral efferent nervous system has two subdivisions. The sympathetic nervous system and parasympathetic nervous system.

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The sympathetic nervous system is also called the Adrenergic system. This system regulates the activity of the internal organs and glands during physical and mentally stressful situations.
-For example, the whole body will be stimulated as one neuron acts on many.
- The adrenal medulla releases epinephrine and some norepinephrine that travels to receptor sites and produces sympathetic responses.

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Neurotransmitters keep impulse going, and stimulate internal organ or gland to produce a change/ action by binding receptors.

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Neurotransmitters of Sympathetic Nervous System

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Neurotransmitters of Sympathetic Nervous System

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The neurotransmitters of the sympathetic nervous system:
- Acetylcholine (ACH)
>released at ganglia from the presynaptic nerve ending
- Norepinephrine (NE)
> released at postganglionic nerve endings
> released by the adrenal medulla
- Epinephrine (EPI)
>Acts on adrenergic receptors
>produced by the adrenal medulla
- Dopamine (DA)
>sympathetic and CNS neurotransmitter
>precursor to NE
>stimulates many receptors ( alpha, beta, dopaminergic)

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> Alpha-1 (contraction of smooth muscle): It's usually located in most arteries and veins. It can also be found in the iris muscle of the eye.
> Alpha-2: Located in Adrenergic nerve ending.
> Beta-1 (stimulation of cardiac muscle): Located in the heart.
> Beta-2 (relaxation of smooth muscle): Located in bronchiolar smooth muscle, uterus, coronary and skeletal muscle blood vessels.

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-Adrenal Medulla: releases epinephrine
-Arteries: Vasoconstrict (Except for the coronary arteries to skeletal muscle, which are dilated.)
-Heart: Increases heart rate and AV conduction. Increases contractility.
-Intestines/ GI motility/ and secretions: Decreased
-Postganglionic neurotransmitter: Norepinephrine released
-pupil of the eye: dilation (mydriasis)
-Respiratory passages (lower): bronchodilation
-Urinary bladder: relaxation
-Urinary Sphincter: contaction

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The parasympathetic nervous system also know as Cholinergic, works on:
- Balance
- Stimulation of ONE specific body part/system
- Increases digestion
- Increases Urination and defecation

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Neurotransmitters of the Parasympathetic Nervous System

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Neurotransmitters of the Parasympathetic Nervous System

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The PNS uses Acetylcholine (ACH) as it's main neurotransmitter at ganglia and postganglionic

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-Adrenal Medulla: No effects.
-Arteries: Most arteries are not supplied by parasympathetic nerves.
-Heart: Decreases heart rate and AV conduction.
-Intestines, GI motility, and secretion's: Increased
-Postganglionic neurotransmitter: Acetylcholine released.
-Pupil of the eye: constriction (miosis)
-Respiratory passages (lower): Bronchoconstriction
-Urinary bladder: contraction
-Urinary sphincter: relaxation

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>Sympathomimetics: drugs that mimic the sympathetic system (adrenergic, agonists)
>sympatholytic: drugs that work against the sympathetic system (adrenergic blocking, blockers, inhibitors, antagonists)

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MOA:
-Alpha-1 receptor is stimulated
-contraction of smooth muscle, blood vessels constrict, increases BP.
-vasoconstriction of nasal passages which leads to decongestant effect.
DRUGS:
-ephedrine: increases BP
-phenylephrine (Neo-synephrine®)- increases BP, nasal decongestant

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MOA:
-Stimulates all alpha and beta receptors, an exception
-Vasopressor- vasoconstriction, increases BP
-Cardiac stimulant
-Bronchodilator
DRUGS:
-epinephrine (Adrenalin®)

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MOA:
-Binds to alpha-1 receptors and blocks them
-relaxation of smooth muscle
-vasodilation of blood vessels, decreases BP
-relaxes smooth muscle and increases urine flow.
DRUGS:
1. prazosin (Minipress prazosin®): Hypertension
2. terazosin (Hytrin®): Hypertension, benign prostatic hyperplasia.
3. doxazosin (cardura®): Hypertension, benign prostatic hyperplasia.

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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 which increases blood pressure.

DRUGS:
1. dobutamine
uses: treatment of shock, increases blood pressure, and increases heart function.

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Beta-2 Adrenergic Agonists
MOA:
-stimulates beta-2 receptors
-relaxation of the smooth muscle of the lungs, leading to bronchodilation.
-relaxation of the smooth muscle of the uterus

DRUGS:
1. albuterol (Proventil®, ventolin®)- bronchodilation
2. terbutaline (Brethine®)- bronchodilator, uterine relaxant
3. formoterol (Foradil®)- bronchodilator
4.salmeterol (Serevent®)- bronchodilator
>Uses: asthma, respiratory illness/ disease, preterm labor

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MOA:
- beta-1 receptor is blocked (antagonizes btea-1 effects of NE and EPI)
- decreases force of contraction (negative inotropic), decreases cardiac output
- decreases HR (negative dromotropic)
- decrease in cardiac output also decreases BP.

DRUGS:
1. atenolol (Tenormin®)
2. metoprolol (Lopressor®)
>Uses: hypertension, angina, arrhythmias, tachycardia, migraines, glaucoma, heart failure (decreases sympathetic activity)

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MOA:
>block beta-1 and beta-2 receptors
> decreases force of contraction (negative inotropic), decreases cardiac output.
> decreases heart rate (negative chronotropic)
> decreases conduction (negative dromotropic)
> decrease in cardiac output, also decreases blood pressure.
> can cause bronchoconstriction

DRUGS:
1. nadolol (Corgard®)
2. propanolol (Inderal®)
3. timolol (Blocadren®)
>Uses: Hypertension, arrhythmias, angina, tachycardia, migraines, glaucoma, hear failure.

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> Parasympathomimetics: drugs that mimic the parasympathetic system (agonists, cholinergic.)
> Parasympatholytics: drugs that work against the parasympathetic system (antagonists, anticholingerics)

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MOA:
- directly stimulate/bind to the muscarinic receptors in the parasympathetic division
- mimics ACH
DRUGS:
1. acetylcholine-used for miosis, cataract, and other eye surgeries

-MOA: pupil constriction
2. pilocarpine (Pilocar® )-used for glaucoma

-MOA: pupil constriction; decreases the amount of fluid in the eye; decreases  intraocular pressure
3. bethanechol (Urecholine®)-used for urinary retention and ileus/intestinal stasis

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

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MOA:
> inhibit acetylcholinesterase, the enzyme that destroys ACH in the synapse
> increases ACH

DRUGS:
1. neostigmine (Prostigmin®)

Uses: urinary retention and intestinal stasis/ileus, reversal of anticholinergic- rocuronium bromide (Zemuron®) with respiratory paralysis from anesthesia by increasing ACH at the nicotinic 2 (Nm) receptors on skeletal muscle, treatment for myasthenia gravis

myasthenia gravis-autoimmune disease causing skeletal muscle weakness and paralysis, antibodies attack the Nm/N2 receptor

Antidote to overdose of anticholinergics: physostigmine (Eserine®)

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MOA:

bind to a cholinergic receptor

acts as a blocking drug; competitive antagonism

DRUGS:
1. atropine -the antidote for cholinergic poisoning

Increase HR, decreases vagus nerve activity (parasympathetic), pre-op med-slows digestion and urination, mydriasis

2. dicyclomine (Bentyl®)- used for GI disorders (ulcers, colitis, IBS)

decreases GI secretions and motility

3. ipratropium bromide (Atrovent®)-bronchodilation

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Powerpoints:
> U2 ANS part 1
>U2 ANS part 2