-Parasympathetic Nervous System - rest and digest (cholinergic)

-Parasympathetic Nervous System Neurotransmitters: Acetylcholine (ACH) - cholinergic, released at ganglia from postsynaptic nerve endings

-Parasympathetic Nervous System Receptors: Muscarinic - cardiac, smooth muscle, and glands, Nicotinic 1 (Nn) - ganglia of parasympathetic nerves and sympathetic nerves (synapse area), Nicotinic 2 (Nm) - somatic, neuromuscular junction of skeletal muscle

-Parasympathetic Nervous System: Arteries - most arteries are not supplied by parasympathetic nerves, Heart - decreases heart rate and AV conduction, slight decrease in contractility, Intestines, GI motility, and secretions - increased, Postganglionic neurotransmitter - Acetylcholine released, Pupil of the eye - constriction (miosis), Respiratory passages, lower - bronchoconstriction, Urinary bladder - contraction, Urinary sphincter - relaxation

-Sympathomimetics (adrenergic, agonists) that mimic the sympathetic system 

—> Alpha-1 Adrenergic Agonists: Alpha-1 receptors interacted with, contraction of smooth muscle, constriction of blood vessels, increases BP, vasoconstriction of nasal passages - decongestant effect

—> Adrenergic Agonists: All alpha and beta receptors interacted with, vasopressor - vasoconstriction, increases BP, cardiac stimulant, bronchodilation 

—> Beta Adrenergic Agonists: 

— Beta-1 Adrenergic Agonists: Beta-1 receptors interacted with, low dose: stimulates dopaminergic receptors in kidneys - vasodilation and increased renal blood flow, moderate dose: stimulates beta-1 receptors of the heart - increases force of contraction and cardiac output, high dose: stimulates alpha-1 receptors causing vasoconstriction - increase in blood pressure

— Beta-2 Adrenergic Agonists: Beta 2 receptors interacted with, relaxation of the smooth muscle of the lungs - bronchodilation, relaxation of the smooth muscle of the uterus

-Sympatholytics (adrenergic blocking, blockers, inhibitors, antagonists) that work against the sympathetic nervous system

—> Alpha-1 Adrenergic Blocking Drugs: Alpha-1 receptors interacted with, relaxation of smooth muscle, vasodilation of blood vessels, decreases BP, relaxation of smooth muscle of ureters - increases urine flow

—> Beta-Adrenergic Blocking Drugs:

— Selective Beta-1 Blockers: Beta-1 receptors interacted with, decreases force of contraction (negative inotropic) and cardiac output - decrease in BP, decreases HR (negative chronotropic), decreases conduction (negative dromotropic) —> Non-selective Beta Blockers: Beta-1 and Beta-2 receptors interacted with, decreases force of contraction (negative inotropic) and cardiac output - decrease in BP, decreases HR (negative chronotropic), decreases conduction (negative dromotopic), can cause bronchoconstriction

Parasympathetic Nervous System has 2 main drug classifications:

-Parasympathomimetics (cholinergic, agonists) that mimic the parasympathetic system 

—> Direct-Acting Cholinergic Agonists: muscarinic receptors interacted with, directly stimulate/bind to the muscarinic receptors, mimics ACH, pupil constriction, decreases amount of fluid in eye and intraocular pressure, stimulates muscarinic receptors of bladder and GI tract to prevent constipation and urinary retention post-op and in the elderly

—> Indirect-Acting Cholinergic Agonists: muscarinic, Nicotinic 2 (Nm), and Nicotinic 3 (Nn) receptors interacted with, inhibit acetylcholinesterase - increases ACH, urinary retention and intestinal stasis/ileus, reversal of anticholinergicrocuronium bromide with respiratory paralysis from anesthesia by increasing ACH at the nicotinic 2 (Nm) receptors on skeletal muscle

-Parasympatholytics (anticholinergic, antagonists) that work against the parasympathetic system: cholinergic receptors interacted with, blocking drug, competitive antagonism, increases HR, decreases vagus nerve activity (parasympathetic), slows digestion and urination, mydriasis, decreases GI secretions and motility, bronchodilation

-Alpha-1 Adrenergic Agonists

--> ephedrine

--> phenylephrine (Neo-Synephrine®)

-Adrenergic Agonists

--> epinephrine (Adrenalin®)

-Alpha-1 Adrenergic Blockers

--> prazosin (Minipress®)

--> terazosin (Hytrin®)

--> doxazosin (Cardura®)

-Beta-1 Adrenergic Agonists

--> dobutamine

-Beta-2 Adrenergic Agonists

--> formoterol (Foradil®)

--> albuterol (Proventil®, Ventolin®)

--> terbutaline (Brethine®)

-Beta Blockers
A) Nonselective

--> nadolol (Corgard®)

--> propranolol (Inderal®)

--> timolol (Blocadren®)
B) Selective

--> atenolol (Tenormin®)

--> metoprolol (Lopressor®)

-Direct Acting Cholinergic Agonist

--> acetylcholine

--> pilocarpine (Pilocar®)

--> bethanechol (Urecholine®)

-Indirect Acting Cholinergic Agents

--> neostigmine (Prostigmin®)

-Anticholinergics

--> atropine

--> dicyclomine (Bentyl®)

 

-Skeletal Muscle Relaxants
A) Peripherally Acting
--> Depolarizing Agent - succinylcholine
--> Non-depolarizing Agent - rocuronium bromide (Zemuron®)
--> Direct Acting - dantrolene (Dantrium®)
B) Centrally Acting

--> cyclobenzaprine (Flexeril®)

--> carisoprodol (Soma®)

--> methocarbamol (Robaxin®)

--> orphenadrine citrate (Norflex®)

--> chlorzoxazone  (Parafon Forte DSC®)

--> metaxalone (Skelaxin®)

                                                         

-Mast Cell Stabilizers

--> cromolyn Sodium (Intal®, Nasalcrom®)

-Bronchodilators
A) Sympathomimetics/beta-2 agonists  (Short and long acting)

--> albuterol (Proventil®, Ventolin®)

--> formoterol (Foradil®)                                                                 

--> terbutaline (Brethine®)                                                       

--> salmeterol (Serevent®)
B) Xanthine Derivatives

--> theophylline (Theo-Dur®)

--> aminophylline (Paladron®)

-Cysteinyl Leukotriene Receptor Antagonists/Inhibitors

-->montelukast (Singulair®)

-Anticholinergics

-->ipratropium bromide (Atrovent®)

-Combination Bronchodilators

--> ipratropium bromide + albuterol sulfate (Combivent®)

-Antihistamines
A) Generation I (sedating)

--> brompheniramine (Dimetapp®)

--> chlorpheniramine (Chlor-Trimeton®)

--> clemastine (Tavist®)

--> diphenhydramine (Benadryl®)

--> hydroxyzine (Atarax®)

--> promethazine (Phenergan®)

--> azelastine (Astelin®, Astepro®)

B) Generation II (non-sedating)

--> loratadine (Claritin®)

--> fexofenadine (Allegra®)

--> cetirizine (Zyrtec®)

-Corticosteroids (asthma or allergic rhinitis, inhaled or nasal)

--> budesonide (Rhinocort®, Pulmicort®)

--> mometasone (Nasonex®, Asmanex®)

--> fluticasone (Flonase®, Flovent®)

--> flunisolide (Nasalide®)

--> triamcinolone (Nasacort®, Azmacort®)

-Antitussives

A) Narcotic

--> hydrocodone (Hycodan®)

--> codeine/guaifenesin (Robitussin AC®)

B) Non-narcotic

--> dextromethorphan/guaifenesin (Robitussin DM®)

--> benzonatate  (Tessalon Perles®)

-Decongestants

--> oxymetazoline (Afrin®, Dristan®)

--> phenylephrine (Neo-Synephrine®)

--> pseudoephedrine (Sudafed®)

-Expectorants

-->guaifenesin (Robitussin®, Mucinex®, Organidin®)