1. The Autonomic Nervous System
Def: The ANS consists of all visceral motor neurons innervating smooth muscle, cardiac muscle and glands.

2. Divide Autonomic Pharmacology into Four Categories: 1
Divide Autonomic Pharmacology into Four Categories: Drugs that increase the sympathetic nervous system response 2. Drugs that increase the parasympathetic response 3. Drugs that block the sympathetic nervous system response 4. Drugs that block the parasympathetic response

3. Sympathetic Nervous System
Adrenaline Rush
Autonomic nervous system response to fear, anger, stress

4. Parasympathetic Nervous System
Rest and Digest
Relax, Repair, Renew

5. Sympathetic Parasympathetic
Agonist
Antagonist

6. Sympathetic Parasympathetic
Agonist
Antagonist

7. Sympathetic Parasympathetic
Agonist
Antagonist

8. Autonomic Nervous System
Autonomic means automatic
You do not control your ANS, it works automatically
Controls the functions of MANY organs automatically
That’s why many drugs that affect the ANS affect many organs

9. Drugs that increase the sympathetic nervous system response.
Sympathomimetic – mimic, imitate the sympathetic nervous system response

10. Drugs that increase the parasympathetic nervous system response.
Parasympathomimetic – mimic, imitate the parasympathetic nervous system response

11. Drugs that decrease the sympathetic nervous system response.
Sympatholytic – decrease or block the sympathetic nervous system response

12. Drugs that decrease the parasympathetic nervous system response.
Parasympatholytic – decrease or block parasympathetic nervous system response

13. Drugs that affect the ANS will affect many organs:
Heart Lung airways
Blood vessels
Bowels
Pancreas
Ureters
Bladder
Eyes
Pupils
Lacrimal gland
Salivary glands

14. Do not confuse the autonomic nervous system with:
Peripheral Nervous System
Outside of skull and spinal cord
Neurons end on organs and muscle
Central Nervous System
Brain and spinal cord
Neurons end on other neurons

15. Do not confuse the ANS with Voluntary Nervous System
Voluntary means willing, like to volunteer
You do control your voluntary nervous system
You control your skeletal muscles to move your body

16. The autonomic nervous system is divided into two systems:
Sympathetic
Adrenaline rush
Fear, flight, fight

17. B. Parasympathetic
rest, repair, digest

18. Can you guess what is happening to this girl’s organ function?

19. Running is voluntary in this case (she has no choice) 
But everything else is automatic
Effects of epinephrine or adrenalin
(heart is pounding)

20. Adrenergic Receptors
Heart is innervated by sympathetic neurons
Norepinephrine – comes from the sympathetic neuron
The heart senses Adrenaline from Adrenal gland on top of the kidneys
Epinephrine is adrenalin
Adrenergic Beta 1 receptors

21. Effects of Epinephrine – Adrenaline
Lung Airways WIDE OPEN
BP is high – systemic vessels constrict

22. Adrenergic Receptors
Blood vessel smooth muscle is innervated by sympathetic neuron
Norepinephrine
Receptors also sense adrenaline from adrenal
Epinephrine
Adrenergic Alpha 1 receptors

23. Adrenergic Receptors
Lung bronchiole smooth muscle is innervated by sympathetic neuron
Norepinephrine
Blood vessels sense adrenaline from adrenal
Epinephrine
Adrenergic Beta 2 Receptors

24. Effects of Epinephrine – Adrenalin
Blood to muscles increased
Blood to GI decreased
Pupils dilated
Norepinephrine – neurotransmitter that dilates lungs, constricts blood vessels, lung airways open, shutting down GI tract

25. Why are all these changes occuring?
Sympathetic nervous system (Norepinephrine)
Adrenal gland – on top of kidneys (that extra boost)
Adrenalin (Epinephrine)
Adrenergic Neurons or Adrenergic Agonist
Adrenergic System

27. Adrenergic Agonists
Adrenergic Agonist substances are also called sympathomimetics

28. Epinephrine or Adrenaline
Adrenaline is an adrenergic agonist
- increased heart rate
- constricts blood vessels
- dilates lung airways
- dilates pupils

29. Albuterol
Is an adrenergic beta agonist used in asthma, what are some of its other effects besides bronchodilation?
Increased heart rate
Increased blood pressure

30. Adrenergic Antagonists
Beta blockers are common drugs used to treat high blood pressure
Beta blockers are common drugs used to treat high eye pressures (glaucoma)

31. Asthma
Do you understand why beta blockers can make asthma worse?
That’s why one of the reasons we try to use cardioselective beta blockers in patients with asthma

32. Autonomic Nervous System
Although we have discussed many organ functions
We have only discussed HALF of the Autonomic Nervous System
The other half does the opposite

33. Can you guess what is happening to his heart rate? His blood pressure?

34. Effects of parasympathethic tone
This is the rest and digest system
- Acetylcholine – neurotransmitter
- Muscurinic receptors

35. Parasympathetic Nervous System
Cholinergic
Agonism
Cholinomimetic
Rx: Bethanecol
- cholinergic muscurinic agonist
- used to stimulate bowel and bladder function

36. Indirect Cholinergic Agonism
Acetylcholinesterase inhibitors
Blocking the breakdown of acetylcholine increases acetylcholine levels
Acetylcholineterase inhibitors are cholinomimetic
Rx: Neostygmine
Toxin: Organophosphate – acetylcholinesterase inhibitors

37. Cholinergic Antagonism
Rx: Atropine – classic cholinergic antagonist
Cholinergic muscuranic antagonist
Anticholinergic
Antimuscuranic

38. Rx: Atropine
Speeds up heart rate
Emergency treatment for bradycardia (slow heart rate)
Atropine also causes mydriasis
Atropine used for diarrhea
Atropine used as antidote for organophosphate poisoning

39. Asthma
Beta agonists are used in asthma
But so are cholinergic muscuranic blockers

40. DuoNeb for Asthma contain two drugs
Rx: Albuterol – beta2 agonist
- sympathomimetic
Rx: Ipratropium – anticholinergic
- antimuscarinic
- parasympatholytic

41. Heart rate up or down
Blood pressure up or down
Eye pressure up or down
Lung airways open or closed
Bladder relax or less relaxed
GI stimulate or slow

42. Dilating the pupils is – Mydriasis

43. Dilating the pupils is – Mydriasis
Both
Sympathomimetic adrenergic drugs
and
Anticholinergic parasympatholytic drugs
cause mydriasis

44. Constricting the pupils is Miosis

45. Both sympatholytic adrenergic antagonist drugs
and
- Cholinergic parasympathomimetic drugs cause miosis

46. Dry lacrimal glands
Both sympathomimetic adrenergic drugs
And
Anticholinergic parasympatholytic drugs
Cause dry eyes

47. Stimulate lacrimal glands to make tears
Both sympatholytic adrenergic antagonist drugs
and
Cholinergic parasympathomimetic drugs
Stimulate tear production

48. Dries salivary glands
Both sympathomimetic adrenergic drugs
And
Anticholinergic parasympatholytic drugs
Cause dry mouth

49. Stimulates salivary glands to make saliva
Both sympatholytic adrenergic antagonist drugs
and
Cholinergic parasympathomimetic drugs
Stimulate saliva production

50. Both sympathomimetic adrenergic drugs
And
Anticholinergic parasympatholytic drugs
Dry respiratory airways

51. Both sympatholytic adrenergic antagonist drugs
And cholinergic parasympathomimetic drugs
Can stimulate airway secretion

52. Bronchodilation: relaxing bronchiole smooth muscle to open airways
Both sympathomimetic adrenergic drugs and
Anticholinergic parasympatholytic drugs
Cause bronchodilation and are used in asthma

53. Bronchoconstriction/Bronchospasm: contracting bronchiole smooth muscle to close or constrict airways

54. Both sympatholytic adrenergic antagonist drugs
And
Cholinergic parasympathomimetic drugs
Can cause bronchospasm

55. Drugs that cause tachycardia (fast heart rate) are called positive chronotropes
Both sympathomimetic adrenergic drugs
And
Anticholinergic parasympatholytic drugs
Cause tachycardia

56. Drugs that increase the force of contraction are positive inotropes

57. Sympathomimetic adrenergic drugs are positive inotropes

58. Drugs that cause bradycardia (slow heart rate) are called negative chronotropes

59. Both sympatholytic adrenergic antagonist drugs
And
Cholinergic parasympathomimetic drugs can cause bradycardia

60. Drugs that decrease the force of contraction are negative inotropes

61. Sympatholytic adrenergic antagonist drugs are negative inotropes

62. Vasoconstriction: contracting arteriole smooth muscle to raise blood pressure

63. Sympathomimetic adrenergic drugs raise blood pressure by vasoconstriction

64. Vasodilation: relaxing arteriole smooth muscle to drop blood pressure

65. Sympatholytic adrenergic antagonist drugs can drop blood pressure

66. Some drugs relax the GI tract and slow peristalsis

67. Both sympathomimetic adrenergic drugs
And
Anticholinergic parasympatholytic drugs
Slow peristalsis, relax GI

68. Some drugs stimulate peristalsis in the GI tract

69. Cholinergic parasympathomimetic drugs are used to stimulate GI

70. Drugs that affect autonomic nervous system may affect the pancreas

71. Some drugs relax the bladder and urinary tract smooth muscle and slow peristalsis

72. Both sympathomimetic adrenergic drugs and anticholinergic parasympatholytic drugs slow ureter peristalsis and relax bladder

73. Some drugs stimulate the smooth muscle of the bladder and urinary tract, increasing peristalsis

74. Cholinergic parasympathomimetic drugs are used to stimulate the bladder

76. Sympathetic and Parasympathetic Divisions of the ANS
How they are similar:
Both divisions are part of the ANS
Both have effects on smooth muscle, cardiac muscle and glands
How they differ:
Stimulation of effectors by each system vary from one body system to another. Effects may be stimulatory or inhibitory.
Location
Length of pre and postganglionic fiber
Neurotransmitters used

77. Comparison of ANS and Somatic Motor Pathways
Somatics
Single neuron from spinal cord to effector
One neuron innervates the effector cell
NTS is acetylcholine (ACh)
Autonomics
Two neurons relay (ganglion) to effector
Dual innervation of effectors
NTS at ganglia (ACh); NTS at effector can be ACh or norepinephrine

78. Location and neurotransmitters used by Sympathetic/Parasymp
adrenergic receptors
sympathetic
preganglionic neuron
postganglionic neuron
parasympathetic
nicotinic receptors
muscarinic receptors

79. Characteristics of Sympathetic and Parasympathetic Function
Post-ganglionic sympathetic nerves release norepinephrine at their nerve endings
these nerves are called adrenergic nerves
Pre and post-ganglionic parasympathetic nerves release acetylcholine at their nerve endings (Nitric oxide- corpora cavernosa)‏
these nerves are called cholinergic nerves
EXCEPTION FOR SYMPATHETIC:
Cholinergic: mACH; used in body wall.
Vasodilation of vessels in brain and skeletal muscle
Piloerector muscles
Sweat glands
Nitric oxide: vasodilation of vessels in brain, skeletal muscle

80. Sympathetic Nervous System “Thoracolumbar” When active?
Length of pre and postganglionic nerve?
Location of cell bodies of preganglionic nerve?
Location of cell bodies of postganglionic nerve?
Neurotransmitters released?
Adrenal medulla
Figure 60-1; Guyton & Hall

81.  3  2  1  2c  2b  2a  1B  1a Actions Where found? Receptor
Lipolysis and thermogenesis
Adipose tissue
 3
Inhibitory, relaxation of resp. tract to get dilation
Respiratory tract, GI, glands, hepatocytes
 2
Increased heart rate and inotropy
HEART, kidney, adipocytes
 1
Presynaptic control/ release of NT
Vascular endothelium
 2c
Increase vasoconstriction (increased MI mortality w/polymorphism)‏
 2b
Lipid metabolism
Vascular endothelium and adipocytes
 2a
Increased BP, vasoconstriction
Arteries, heart
 1B
Increased inotropy, closure of GI sphincters, vasoconstriction, pupil dilation
Iris, intestine, heart and arteries
 1a
Actions
Where found?
Receptor

82. Parasympathetic Nervous System “cranio-sacral”
Parasympathetic nerves originate from cranial nerves III, VII, IX, and X and the sacral spinal cord.
occulomotor nerve - fibers to the pupillary sphincters and ciliary muscle
facial nerve - fibers to lacrimal and submandibular gland
glossopharyngeal nerve - fibers to parotid gland
vagus nerve - motor inputs to visceral organs
sacral segments - fibers to descending colon, rectum, bladder and genitalia
Vagus nerve doesn't innervate involuntary muscle
preganglionic fiber
Figure 60-3;
Guyton & Hall

83. Effects of the ANS on the Organs
eye
sympathetic --pupillary dilation (alpha 1 receptor)‏
parasympathetic--pupillary constriction and accommodation (focusing) of the lens (mACh receptor)‏
glands of the body
parasympathetic stimulate the nasal, lacrimal, salivary, and G.I. glands (mACh receptor)‏
sympathetic stimulates the sweat glands (mACh receptor)‏
Sphincter muscle: muscle will constrict pupil (parasympathetic)‏
radial muscle: muscle will dilate pupil (sympathetic)‏

84. Effect of the Autonomic Nervous System on the Organs
G.I. tract
parasympathetic stimulates overall activity including G.I. smooth muscle
sympathetic has very little effect
heart
sympathetic increases the rate and contractility
parasympathetic decreases heart rate
blood vessels
sympathetic causes vasoconstriction. Reduced sympathetic response accounts for most vasodilation.
parasympathetic causes some vasodilation (e.g., penis)‏

85. Sympathetic and Parasympathetic “Tone”
the basal rate of activity of each system
this background activity allows for an increase or decrease in activity by a single system
sympathetic tone normally causes about a 50 % vasoconstriction
increasing or decreasing “tone” can change vessel diameter
parasympathetic tone provides background G.I. activity

86. adrenergic or sympathomimetic drugs act like norepinephrine
these drugs have an effect which is much more prolonged than that of either norepinephrine
phenylephrine stimulates alpha receptors
isoproterenol stimulates both beta1 and beta2 receptors
albuterol stimulates only beta2 receptors
some drugs act indirectly by increasing the release of norepi from its storage terminals
ephedrine, amphetamine, pseudoephedrine,

87. Pharmacology of the Sympathetic Nervous System
drugs that block the effect of norepinephrine
alpha blockers
phentolamine
Cheap Viagra!
beta blockers
beta1 and 2 - propranolol

88. Pharmacology of the Parasympathetic Nervous System
parasympathomimetic drugs
muscarine
pilocarpine
activates muscarinic receptors, cause profuse sweating (why if sweat glands are controlled by sympathetic system?)‏
cholinesterase inhibitors
neostigmine, potentiates the effect of acetylcholine
antimuscarinic drugs
atropine blocks the effect of acetylcholine on effector cells