Autonomic nervous system

Anatomy and General Functions of the Autonomic Nervous System:

-It is called the visceral, or involuntary.

-It regulates the involuntary functions.

Divisions of the Autonomic Nervous System:

1- Sympathetic Division (thoracolumbar outflow):

a) Origin: in the lateral horn cells of all thoracic and upper three
lumber segments of the spinal cord.

b) The preganglionic nerve fiber is short, while the postganglionic nerve

fibers are long.

c) The synapse between the pre- and postganglionic nerve fiber is located
in the sympathetic chain.
2- Parasympathetic Division (Craniosacral outflow):

a) Origin:
i. -Cranial outflow and ii- Sacral outflow.

b) The preganglionic nerve fiber is long while the postganglionic nerve

fiber is short.

a) The ganglia being close or even embedded in the effector organ.

C, cervical; GI,
Chemical transmitters in autonomic nervous system:
The autonomic nervous system can be divided into:

a) Cholinergic division:
Where acetylcholine is the main chemical transmitter and the
cholinergic
neurons are:

1- All preganglionic neurons.

2- The parasympathetic postganglionic neurons.
3- The sympathetic postganglionic neurons that innervate sweat glands.
4- The parasympathetic neurons that end on blood vessels in skeletal
muscles and produce vasodilatation when stimulated.
5- The sympathetic neurons innervating the adrenal medulla.
b) Noradrenergic division:
-The remaining postganglionic sympathetic neurons are noradrenergic
and secret norepinephrine.
-The adrenal medulla is essentially a sympathetic ganglion that secrets
Nor-epinephrine (20%), epinephrine (80%) and some dopamine directly
into the bloodstream.
Adrenergic Receptors:

A) Alpha (α) adrenergic receptors:

i- Alpha 1 α1 ii- Alpha 2 α2

B) Beta ( β ) adrenergic receptors:

i- Beta 1 β1
ii- Beta 2 β2
iii-Beta 3 β3
A) α1 - receptors:
These receptors are present on the postsynaptic membrane of the effector
organs.
- Actions:

1- Active mydriasis through contraction radial muscle.

2- Generalized vasoconstriction, leading to increased peripheral resistance and
hypertension.
3- Decrease of G.I.T.motility & Spasm of urinary bladder sphincters.

- Selective agonists: Phenylephrine & Methoxamine.

- Selective antagonists: Prazosin .
B) α2 - receptors:
- These receptors are located mainly in the presynaptic membrane of the
adrenergic nerve terminals and in CNS. They are also found in the β cells of
the pancreas to control insulin release. They are inhibitory in function .

- Actions:

1- Inhibit sympathetic outflow from C.N.S.

2- Inhibition of insulin release.
3- Decreased lipolysis in fat cells.
- Selective Agonists: α-methyl noradrenaline, &clonidine.
- Selective Antagonists: yohimbine.
C) β – receptors:
- They can be subdivided into β1 and β2 .
- β-receptors are more sensitive to isoproterenol , epinephrine & norepinephrine.

- β1- receptors are found predominantly in the heart.

-β2-receptors are found at other sites, but most importantly, on bronchial and vascular
smooth muscle.

- Actions of β1- receptors:

- Cardiac stimulation: tachycardia an increased myocardial contractility.

- Selective Agonists: dobutamine .
- Selective Antagonists: atenolol, metoprolol & acebutolol.
- Actions of β 2- receptors:

1- Generalised vasodilation especially in skeletal muscles

2- Bronchodilation.
3-Increased muscle and liver glycogenolysis.
4- Increasesd release of insulin.

- Selective Agonists: salbutamol & terbutaline.

- Selective Antagonist: butoxamine.
I- Sympathomimetics (Adrenergic Agonists):

These agents can be classified according to their mechanism of action into:

a) Direct-acting agonists:
These drugs act directly on α or β receptors and produce effects similar to those
occur following following stimulation of sympathetic nerves.
Examples:
i- Epinephrine
ii- Norepinephrine
iii- Isoproterenol.
iv. Phenylephrine.

b) Indirectly acting sympathomimetics:

They are taken up into the presynaptic neuron and cause the release of the
sympathetic neurotransmitters from the nerve terminals:
Examples:
i- Amphetamine
ii- Methamphetamine
c- Mixed-action agonists:

These agents act by both mechanisms:

i- Ephedrine

A) Direct-Acting Agonists:

1. Epinephrine (Adrenaline):
- Not administered orally due to:
i- Poor absorption from the GIT.
ii- Rapid destruction by intestinal juices
Pharmacological Actions:

a) Cardiovascular System:

1- It increases the heart rate (+ve chronotropic action).

2- It increases the force of contraction (+ve Inotropic action). Cardiac output is
therefore Increases (β1- receptors.).
3- Increases the arterial blood pressure (mainly the systolic with slight decrease in
diastolic).
b) Respiratory system:

- Bronchodilatation and increase in tidal volume (β2 effect).

c) GIT:
1- It inhibits the tone and motility (relaxation).
2- It decreases the secretions.
3- It causes constriction of the sphincters.

d) Urinary bladder:
It causes urine retention due constriction of trigone muscle and internal sphincters of the
bladder.

e) Eye:
1- Topically on normal eye it produces vasoconstriction of conjunctival blood vessels,
so it is used to relief decongestion.
2- In cases of open angel glaucoma it reduces the production of aqueous humor by
vasoconstriction of the ciliary body blood vessels.
3- Systemic epinephrine produces decongestion and active mydriasis.
f) Metabolic effects:
- Epinephrine exerts inhibition on insulin secretion via
activation of α2 - receptors and the stimulation of glucagon
secretion via β2-receptors.

- The major metabolic effects of epinephrine are increased

circulating concentrations of:
a- Glucose.
b- Lactic acid.
c- Hyperglycemia
d- Free fatty acids (lypolysis). β3 receptors
g) Anti-allergic:
- Epinephrine decreases the release of histamine from mast
cells.