Autonomic Nervous System

For Med II Students

June 2021
Gondar, Ethiopia

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 At the end of this session you will be able to:

 Describe the organization of nervous system

 Describe the over all division of the ANS
 Explain functions of ANS
 Enumerate autonomic NTs & their receptors
 Describe some examples of different autonomic reflex's
 Pharmacology of ANS
 List clinical correlates
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Organization of nervous system

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 Organization of the Nervous System
Two big divisions:
1. Central Nervous System(CNS)
 Center of integration & control
– Brain + SC
2. Peripheral Nervous System(PNS)
• Carry information to &from SC
– Spinal nerves- 31 pairs
– Cranial nerves-12 pairs
• Divided in to somatic &
autonomic NS

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1. Somatic nervous system
 Somatic nerve fibers that conduct impulses from the
CNS to skeletal muscles
 Voluntary (generally)
2. Autonomic nervous system
 Conducts impulses from the CNS to
 Smooth muscle
 Cardiac muscle
 Glands
 Involuntary (generally)
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 Comparison of Somatic NS and ANS
1. Function

2. Origin
3. Number of neurons

4. NT type
5. Receptor type

6. Effect of NT on effector
7. Ganglia

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 Comparison of Somatic NS and ANS
Somatic NS Autonomic NS
1. Controls voluntary 1. Controls involuntary activities
activities e.g. Skeletal CVS, GIT, sweat glands
muscle contraction
2. Nerve fibres are 2. Nerve fibres are originated
originated from the from the lateral horn of the
anterior horn of the GM GM of SC.
of the spinal cord. 3. Autonomic fibres contain two
3. The motor nerve contains neurons-disynaptic
single, long, thick and
myelinated axon. 4. NTs are both Ach & NE &
4. The NT is always Ach receptors are cholinergic &
and the receptor is always adrenergic.
NR
5. Excitatory or inhibitory
5. The NT is always
excitatory . 6. Their is ganglia
6. No ganglia
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Somatic NS vs ANS

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 Sensory & motor division of Somatic & ANS
1. Sensory (afferent) division
 Transmits impulse from
receptors to CNS
I. Somatic afferent fibers
II. Visceral afferent fibers
2. Motor (efferent) division
 Transmits impulses from
CNS to effectors
I. Somatic efferent
II. Visceral efferent

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 ANS
 Derived from Gk words “autos & nomos
Auto - self
Nomos -control
ANS= self governing
 ANS carries out its actions involuntarily, without our
conscious intent or awareness,
 It controls glands, cardiac muscle, and smooth muscle

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 ANS …
In most situations,

 We are unaware of the workings of the ANS

b/c it functions in an involuntary, reflexive manner

For example, we do not notice when our

– blood vessels change size or

– heart beats faster

Prepare the body for normal & life threatening stress

Regulate removal of waste products from the body

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 Primary target organs of the ANS

1. Viscera of the thoracic & abdominal cavities

2. Some structures of the body wall, including

Cutaneous blood vessels,

Sweat glands &

Piloerector muscles

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 ANS …
It controls most visceral (involuntary) functions of body

Example- ANS controls

Arterial pressure

Gastrointestinal motility & secretion

Urinary bladder emptying

Sweating

Body temperature etc.

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 Striking characteristics of ANS is its rapidity & intensity.

For instance,

1.It can double PR within 3-5 seconds

2.ABP can be doubled/decreased within 10 -15’’

3.Sweating can begin within seconds, and

4.Urinary bladder may empty within seconds.

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 Two neuron chain are found in ANS

1. Preganglionic neuron 2. Postganglionic neuron

Originates in the brain or Originate in the ganglion

SC(the soma found in CNS) Unmyelinated

Myelinated Innervates effecter organ
Its axon synapse with soma of They release NT that may
second neuron
be stimulatory or inhibitory
Excitatory

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 Divisions of ANS
 ANS have 2 major divisions

1. Sympathetic NS

2. Parasympathetic NS

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 Autonomic Nervous System
Sympathetic Parasympathetic
 “Fight or Flight” • Rest & Digest”(strives to
 Activated during(E”division)
reduce energy
 Exercise
 Excitement consumption)
 Emergency & • Promotes
 Embarrassment
Digestion of food
 Rise up body to respond Defecation &
to situations that upset Diuresis
homeostasis. Storage of energy
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 Autonomic ganglia
 Ganglion (ganglia) -collection of cell bodies outside CNS
 Nucleus (nuclei) - collection of cell bodies within the CNS

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 Types of Autonomic ganglia
1. Lateral (Paravertebral) ganglia
– Sympathetic ganglia
– form sympathetic chains on both sides of the
vertebral column.
2. Collateral (Prevertebral) ganglia
– Sympathetic ganglia
– located in midway b/n SC & viscera. Of 3 types:
• Celiac , superior & inferior mesenteric ganglia.
3. Terminal ganglia
– Parasympathetic ganglia
– Located near/within the innervated organ

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 Sympathetic Division (Thoracolumbar out flow)
 Originates in lateral horns of T1-T12 and L1-L2 region
of SC           
Components of sympathetic neurons:
1. Cell bodies of preganglionic neurons are located in
thoracic & lumbar part of SC
2. Preganglionic axons synapse in lateral/collateral
ganglia, which are located near SC.
3. Contains short mylinated preganglionic cholinergic
neurons
4. Sympathetic postganglionic axons travel from
lateral/collateral ganglia to target organ
5. Contains long unmylinated postganglionic neurons
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Pathway of pre-ganglionic sympathetic fibers:

1. May synapse in first sympathetic chain ganglion,

it enters.
2. Synapsing in other sympathetic chain ganglia up
or down.
3. Synapse in collateral ganglia
4. Synapse in adrenal medulla itself
Function of Sympathetic NS(SyNS)
1. Largely fight or flight response

2. Simultaneous activation of various organs

3. Works with adrenal medulla (epinephrine)

4. Increases metabolic rates & cardiac out

5. Generally excitatory to almost all body parts except for

the GIT (inhibitory).

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 Changes in sympathetic activation…
Respiratory system:
During sympathetic NS stimulation

There is increased O2 demand & utilization

More CO2 will be produced

– So bronchodilation (relaxation of bronchial SM)

-To permit maximal airflow

•Skin: blood vessels to skin constricted

– More blood goes to muscle 25

 Changes in sympathetic activation
Pupil:
Dilates to allow more light to enter
– Due to contraction of radial muscle of iris
Far vision will occur

– See entire threatening scene

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Changes in sympathetic activation…

• Cardiovascular system

– Cutaneous blood flow decreases

– GIT blood flow decreases

– Blood flow to kidney is reduced

– Blood flow to skeletal & heart muscle increases

– BP elevated due to constriction of blood vessels

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Changes in sympathetic activation…

• Heart

– Positive chronotropic action-

• Chronotropic (Heart rate) :SA

– Inotropic (Contractility)

• Ventricular muscle stimulation

Heart beats more rapidly & forcefully to pump more

blood
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Changes in sympathetic activation…
• GIT
– Reduced absorption and secretion
– Sphincters in GIT will be constricted
– Peristalsis inhibited
• Metabolism
– Increases metabolic rate
– Glycogenolysis to increase blood glucose
– Lipolysis due to activation of adipocytes
• To release extra fuel into blood
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Changes in sympathetic activation…
• Sweating

– is promoted in anticipation of excess heat production

– To flush waste and to cool down the body

• Sense organs
– Your senses: e.g- sight, hearing, smell- become more
acute, ready to identify any threats
• Renal system

• Detrusor muscle relaxed

• Sphincter constricted (contracted) 30

 Sympathoadrenal system
 Preganglionic sympathetic neurons project from SC to the

adrenal medulla cells (Chromaffin cells)

 Causes release of E & NE to the blood

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Chromaffin cells are
Modified sympathetic ganglion

Stimulated with preganglionic cholinergic neuron

Contain nicotinic receptors.

Release mixed catecholamine-80 % E & 20% NE

Create prolonged response (removed from blood slowly)

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Sympathoadrenal system

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 Sympathoadrenal system
Values of adrenal medulla to Sympathetic NS functions
1.Organs can be stimulated indirectly form the gland
2.Has substitution function
 If direct sympathetic stimulation blocked, organ
still stimulated sufficiently
 Sympathetic destruction may not stop organ
stimulation

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Fig. 45.34(TE Art)
Hypothalamus activates
sympathetic division of
nervous system
HR, BP,& and RR increase
Adrenal medulla
secretes
E & NE

Blood flow to Stomach

skeletal muscles contractions
increases are inhibited
 Parasympathetic Division: (Craniosacral)
 Originates from cranial &
sacral regions.
 Cranial components are
part of cranial nerves
 CN III (Oculomotor)
 CN VII(Facial)
CNIX (Glossopharyngeal )
 CN X (Vagus)

 Sacral components from

S2 - S4 segments of SC
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 Parasympathetic NS (Craniosacral outflow)
Cranial outflow

Comes from the brain

Innervates organs of

Head, neck,

Thorax and abdomen

Sacral outflow

Supplies remaining abdominal & pelvic organs

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Components of parasympathetic neurons

1. Cell bodies of preganglionic neurons located in certain

nuclei of CN & sacral part of SC

2. Contains long mylinated preganglionic cholinergic neurons

3. Preganglionic axons synapse in terminal ganglia w/c are

located close to or on organ being innervated.
4. Their postganglionic axons travel from terminal ganglia to
target organ
5. Contains short unmylinated postganglionic cholinergic
neurons

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39
Cranial nerves with ANS branch
Autonomic
 CN  Name  Sensory  Motor
Parasympathetic
4 extrinsic
Oculomotor Pupillary
III Proprioception  eye
Nerve constriction
muscles

Stimulate secretion
of glands

Muscles of Nasal gland

 Facial  Taste
 VII facial Lacrimal gland
nerve Proprioception
expression
Salivary gland
Parotid glands
Submandibular40
 Cranial nerves with ANS branch
 Autonomic
 CN  Name  Sensory  Motor
Parasympathetic

Stimulate secretion

 Taste Swallowing of
 IX Glossopharyngeal
Blood gases Gagging Parotid glands
Salivary glands

ABP Swallowing Visceral organs

 X  Vagus Blood gases Gagging
(heart, gut, lungs)
Taste
Speech

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 Vagus nerve (X)
Major nerve of the PsNS(75%)
Innervates most visceral organs
 Heart
 Lungs
 Esophagus, stomach, small intestine
 Proximal half of the colon
 liver, gallbladder, pancreas
 Kidneys & upper portions of the ureters
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 Sacral parasympathetic fibers, distribute to

– Descending colon, rectum

– Lower portions of ureter,

– Urinary bladder &

– External genitalia

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Function of Parasympathetic NS

1. Regulation of digestion, defecation & micturition

2. Conservation of energy (anabolic)

3. Maintains a homeostatic environment  

"resting & digesting" system

5. Parasympathetic neurons in general have inhibitory effect

on almost all body tissues except GIT.

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6. Five parasympathetic increasing responses(SLUDD)
Salivation (S)

Lacrimation (L)

Urination (U)

Digestion (D) and

Defecation (D)

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 Three decreases responses

– Decreased heart rate

– Decreased diameter of airways ( bronchoconstriction )&

– Decreased diameter of the pupils (miosis)

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 NOTE :

1. All preganglionic neurons of ANS are cholinergic

2. All preganglionic neurons of ANS are excitatory
3. Parasympathetic post ganglionic neurons are
cholinergic
4. Sympathetic post ganglionic neurons are
adrenergic with few exceptions

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5. Parasympathetic post ganglionic neurons are either
Excitatory (e.g on GIT) OR
Inhibitory ( e.g. on heart)
6. Sympathetic post ganglionic neurons are either
Excitatory (e.g. on the heart) OR
Inhibitory ( e.g on GIT )

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 Summary -Anatomic difference b/n SyNS & PaSNS
Parasympathetic Sympathetic
1. Origin of preganglionic neuron

2. Type of neurotransmitter

3. Location of autonomic ganglia

4. Length of pre & postganglionic

neurons

5. Branching of axons-Sympathetic
division has more branching

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 Dual innervation
 It is innervation of a single organ by both branches of ANS

 Most body structures receive dual innervations

 It can be
Antagonistic

Complementary or

Cooperative

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 1. Antagonistic effects
 Sympathetic & parasympathetic fibers innervate same
cells but their actions are opposite. e.g. on heart rate
 Most internal organs are under antagonistic control

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2. Complementary
Stimulation of both divisions ANS act on different effectors
to produce a unified overall effect(similar effects).

e.g. Salivary gland secretion

Sympathetic stimulation:
 Stimulates mucous cells of salivary glands to secrete small
volume of thick saliva rich in mucus

Parasympathetic stimulation:
 Stimulates serous cells of salivary gland to secrete large volume
of watery saliva rich in enzymes
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3. Cooperative (synergistic)
 Both ANS divisions produce different effects on different
tissues that work together to achieve common goal

For example: ANS cooperation is best seen in control of external

genitalia

– Parasympathetic fibers cause vasodilation and are responsible

for erection of penis and clitoris
– Sympathetic fibers cause ejaculation of semen in males and
reflex peristalsis in females

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 The following structures do not receive dual innervation;

• Most sweat glands

• Adrenal medulla

• Most peripheral blood vessels

• Skin piloerectors

receive only sympathetic innervations

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 Sympathetic and parasympathetic “tone”
Usually both divisions of ANS are partially active

– This basal rates of activity are called

sympathetic tone & parasympathetic tone
respectively
 This tone allows a single nervous system to both increase
& decrease the activity of a stimulated organ

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Example
The sympathetic fibers to a blood vessel have a baseline sympathetic tone

– which keeps the vessels in a state of partial constriction called vasomotor

tone.
An increase in firing rate causes vasoconstriction

 By increasing smooth muscle contraction.

A drop in firing rate causes vasodilation

 By allowing the smooth muscle to relax

Thus, sympathetic division alone exerts opposite effects on the vessels.

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Sympathetic “tone”
Causes partial contractions of vascular system

Removal of the tone reduces ABP from 100 to 50 mmHg

To adrenal medulla, increases E, NE

• A safety mechanism of sympathetic innervations

To the heart, helps maintain the normal heart rate

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Parasympathetic “tone”
To the gut maintains normal tone & secretion

To the heart maintains normal heart rate

Removal of the tone causes

• GIT atony

• Heart rate acceleration

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 Effect of Loss autonomic tone

Immediately after a sympathetic/parasympathetic

nerve is cut,
– Innervated organ loses its sympathetic/parasympathetic
tone
 Effect of Loss autonomic tone…
In many blood vessels, for instance,
– cutting sympathetic nerves results in vasodilation
within 5” -30”

– However, over time, intrinsic tone in the smooth

muscle of the vessels increases
• This tone restores almost normal vasoconstriction

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• Essentially the same effects occur in most
other effector organs whenever sympathetic or
parasympathetic tone is lost. .

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 Denervation supersensitivity
 During the 1st week or so after a sympathetic/
parasympathetic nerve is destroyed,
No release of NE or Ach at the synapses

Innervated organ becomes more sensitive to injected

NE or Ach, respectively
 Denervation supersensitivity
Mechanism

Up-regulation of the receptors

Therefore, when a dose of the hormone is now injected
into the circulating blood, the effector reaction is vastly
enhanced

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 The Enteric Nervous System(ENS)
 Nervous system of digestive tract

 Can be considered as the third division of the ANS

 It doesn’t arise from CNS

 It innervates smooth muscle & glands of GIT

 Consists ~100 million neurons embedded in the wall of

the digestive tract
a "mini -brain”

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 ENS…
 ENS contains

1. Sensory neurons

2. Interneurons

3. Motor neurons
Control motility, secretion, & absorption

Receptors- in the mucosa that respond to mechanical &

chemical stimuli

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 ENS…
• It is comprised of 2 neural plexuses

– Myenteric plexus -control of GI motility

– Submucosal plexus – Secretion

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 ENS…
ENS regulates the

Motility of the

Esophagus

Stomach

Intestines

Secretion of digestive enzymes and acid

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 ENS…
 So what is the role of ANS to GIT function??

For regulation

Connect the CNS to ENS or directly to the GIT

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ANS Neurotransmitters & Their Receptors

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 Neurotransmitters of ANS
 Neurotransmitters are chemical substances released by
neurons at synapses
 Autonomic neurons release NTs at synapses:

Between neurons

Preganglionic to postganglionic

With autonomic effectors

Smooth muscle, cardiac muscle, and glands

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 After release NTs bind to specific receptors in
postsynaptic cell membrane.
Binding has either an excitatory or inhibitory
effect on the effectors, depending on the
specific receptor

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 Neurotransmitters in the ANS

Acetylcholine (ACh)

Norepinephrine (NE)

Others

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Neurons that release NE are called adrenergic neurons

NE is released by
Most of postganglionic neurons of sympathetic division

Adrenal medulla cells

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Neurons that release ACh are called cholinergic neurons
ACh is released by
Preganglionic axon & few postganglionic neurons in
sympathetic division
Both pre & postganglionic neurons of parasympathetic division

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 Other Autonomic Neurotransmitters
 Certain postganglionic autonomic axons produce their
effects through mechanisms that do not involve either
NE or Ach.
These axons, are called Nonadrenergic, noncholinergic
(NANC) fibers
 Parasympathetic axons that innervate the blood vessels
of the penis uses NO as their NT
NO relax smooth muscles of penile vessel- erection

 Nitric oxide can produce relaxation of smooth muscles in

– Stomach

– small intestine,,

– large intestine
Neurotransmitter synthesis and removal

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 NE synthesis, release& removal
 NE is synthesized in nerve terminals

From tyrosine (from food)

tyrosine DOPA Dopamine Beta

hydroxylase decarboxylase hydroxylase

Tyrosin DOPA DA NE
eRelease of NE -Ca++ dependent exocytosis
 DOPA -Dehyderoxy phenil alanine
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 Removal of NE from
Synaptic cleft
1. Reuptake by presynaptic
neuron-80%
2. Degradation by COMT in
postsynaptic membrane
3. Diffuse to general
circulation
Key
MAO- monoamine oxidase
COMT-catechol-O-methyl transferase

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 ACh synthesis & removal
-synthesis of Ach occurs in nerve terminal
Choline from food will be absorbed 1 st. Then entry
of choline in to cholinergic nerve ending.

choline
acetyltransferase
Choline + Acetyl CoA ACh + CoA

Release of Ach-Ca++ dependent exocytosis

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 ACh synthesis & removal
 Once ACh is secreted into a synapse by a cholinergic nerve ending,

it persists in the synapse for a few seconds. Then it is

Acetylcholinesterase
Ach acetate ion + choline
Then the choline formed in this way is transported back
into the terminal nerve ending & used again and again
for synthesis of new ACh

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 ANS Receptors
 Receptor
A protein molecule on cell membrane of target organ

When NT substance binds with receptor

Conformational change in the structure of receptor

Both the SyNS & PaSN divisions have

Excitatory effects on some target cells &

Inhibitory effects on others

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 ANS Receptors…
Example

1.PaSN
Contracts wall of urinary bladder But it uses ACh

Relaxes IUS for both purposes

2.SyNS
Constricts most blood vessels But it uses NE
Dilates coronary arteries for both purposes

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It is clear that

The difference is not due to the NT

Rather, it is due to the fact that different

effector cells have different kinds of
receptors for it.

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There are 2 types of ANS receptors
1.Cholinergic receptors (Acetylcholine Receptors)
 Receptors for ACh are called cholinergic receptors

 Two principal cholinergic receptors

a. Nicotinic receptors

b. Muscarinic receptors

2. Adrenergic receptors
a. Alpha receptors

b. Beta receptors

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1. Cholinergic receptors
a. Nicotinic receptors
Nicotinic receptors are found at

• Autonomic ganglia (NN)

• Neuromuscular junction (NM)

• In the adrenal medulla(NN)

1.Activated by ACh and nicotine (found in tobacco)

2.Almost always excitatory

3.They are ligand-gated ion channels

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Nicotinic receptors…

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Cholinergic receptors…
b. Muscarinic receptors
Are found on all effector cells stimulated by postganglionic
cholinergic neurons of both SyNS & PaSNS
Activated by Ach & muscarine

5 sub types-M1 , M2, M3,M4,M5

Are G protein coupled receptors

When Ach bind to them, they will excite or decrease

activity depending specific receptor on target organ
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cholinergic receptors

90
 Autonomic Receptor
Receptor Name Typical Locations Result of Ligand Binding
Cholinoceptors 
Muscarinic M1 CNS neurons, sympathetic Formation of IP3 and
  postganglionic neurons DAG, increased
intracellular Ca++
Muscarinic M2 Myocardium, smooth muscle, CNS Opening of K channels,
  neurons inhibition of adenylyl
cyclase
Muscarinic M3 Exocrine glands, vessels (smooth muscle Like M1 receptor-ligand
  and endothelium); CNS neurons binding
Muscarinic M4 CNS neurons; possibly vagal nerve Like M2 receptor-ligand
endings binding
Muscarinic M5 Vascular endothelium, especially cerebral Like M1 receptor-ligand
vessels; CNS neurons binding
Nicotinic NN Postganglionic neurons, some presynaptic Opening of Na+, K+
  cholinergic terminals channels, depolarization
Nicotinic NM Skeletal muscle neuromuscular endplates Opening of Na+, K+
channels, depolarization
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Mechanism of muscarinic receptors(M1,M3 & M5)

92
Mechanism of muscarinic receptors(M2 & M4)

93
 Muscarinic Receptor Effects

 When ACh binds to muscarinic receptors on

Cardiac Muscle
 Slows heart rate &

 Decrease strength of contraction(for atria)

Eye
 Causes contraction of circular smooth muscles of iris

 thus reducing the size of the pupil & allowing less

light into the eye
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 Muscarinic Receptor Effects
Digestive System –Increases digestive activity

Glands -increase the secretion of glands

smooth muscle- increases contractions of smooth

muscle cells in the walls of the digestive organs to
promote peristalsis.
Increases flow of blood to liver, pancreas & other
digestive organs through dilation of arterioles

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2. Adrenergic receptors
Adrenergic
receptors

Alpha Beta

Alpha 1 Alpha 2 Beta 1 Beta 2

Beta 3
 ANS Receptors…
 Adrenergic receptors
Are receptors for NE
Are G protein coupled receptors

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RECEPTOR Typical Locations Result of Ligand Binding
TYPE
Adrenoreceptors 
  Alpha1 Postsynaptic effector cells, Formation of IP3 and DAG,
  especially smooth muscle increased intracellular
calcium
  Alpha2 Presynaptic adrenergic nerve Inhibition of adenylyl
  terminals, platelets, cyclase, decreased cAMP
lipocytes, smooth muscle
  Beta1 Postsynaptic effector cells, Stimulation of adenylyl
  especially heart, lipocytes, cyclase, increased cAMP
brain
  Beta2 Postsynaptic effector cells, Stimulation of adenylyl
  especially smooth muscle cyclase and increased
and cardiac muscle cAMP.  
  Beta3 Postsynaptic effector cells, Stimulation of adenylyl
especially lipocytes; heart cyclase and increased
cAMP 98
99
 Adrenergic Receptor Types & Effects
Alpha 1:
 Produce excitation(e.g. contraction or constriction)

 Blood vessel walls-vasoconstriction

 GIT-Constricts sphincters & decrease secretion

 Eye-Contracts iris radial muscle

 Penis-Ejaculation

 Bladder sphincters

 Uterus -contraction
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Alpha 2:
 Often produce inhibition(e.g relaxation or dilation)

 Found on

Membranes of platelets
Promotes blood clotting

Presynaptic nerve terminals

101
 Beta 2:
Beta 1:
 Produce relaxation, dilation
 has excitatatory effect
 Blood vessel of skeletal muscle
 Found in heart - both
 Coronary artery
1. Nodal tissues
 Bronchial smooth muscles
Increases HR
– Bronchodilation
2. Muscles
 Walls of GIT- GIT activity
Increase strength
 Walls of urinary bladder-
of contraction
urination 102
Major effects mediated by alpha and beta adrenoreceptors

103
Effects of ANS on different organs

104
Effect of SyNS stimulation Effect of PaSNS stimulation

105
Effects of ANS on different organs…

106
 Autonomic Reflexes
 A reflex is a fast & involuntary action in response to a stimulus
 A reflex action consists of an action signalled to CNS &
a reaction ordered by CNS
 Any reflex is transmitted through a reflex arc
A reflex arc of any reflex has 5-components
1. A receptor that detects changes
2. Afferent (sensory) pathway
3. Integrating centre-SC,brain stem, HT, cerebral cortex
4. Efferent (motor) pathway
5. Effectors organs-cardiac & smooth muscles, glands

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Autonomic reflex

108
Representative autonomic reflexes

1. Baroreceptor reflex:
 Maintaining BP

2. Chemoreceptor reflex:
 Monitor blood O2, CO2 & pH

3. Defecation reflex

4. Micturition reflex

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1. Baroreceptor reflex

110
Baroreceptor reflex…

111
2. Chemoreceptor reflex

112
3. Micturition reflex

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Neuronal control of urination
1. Stimulation of stretch receptors by
large volume of urine (200-400 ml)
2. Sensory impulse transmitted to the
SC through Parasympathetic
nerves
stretch
3. Motor impulse stimulates smooth receptors
muscle lining bladder and
4. Relax IUS
5. Stretch receptors also send impulse
to higher centers (Pons, HT and
cerebral cortex)
6. Motor impulse from higher centers
promote readiness to urinate
7. Identify places for urination
8. relax external urethral sphincter

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 4. Defecation reflex
1. Pressure in rectum from mass
peristalsis sends afferent stimuli to
SC

2. Parasympathetic stimuli cause

 Contraction of rectal muscle &
 Relaxation of internal anal sphincter.

3. Voluntary stimuli relax external

anal sphincter and cause
abdominal contraction -defecation

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 Higher Autonomic Center
ANS is not an independent nervous system.
It is activated mainly by higher brain regions
All of ANS output originates in the CNS, and it
receives input from the
Cerebral cortex
Hypothalamus
 medulla oblongata and
 spinal cord 116
Higher Autonomic Center…
1. The Cerebral Cortex
 Even if we usually cannot consciously control the
ANS, it is clear that the mind does influence it.
Example
Anger raises BP

Thoughts of good food make stomach rumble

Sexual thoughts /images increase BF to genitals

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2. Hypothalamus
Functions, including hunger, thirst, thermoregulation,
emotions, and sexuality
Main regulator of autonomic preganglionic fibers in
response to body status

118
3. Midbrain, Pons & Medulla Oblongata
Houses nuclei of cranial nerves that mediate several
autonomic responses

4. Spinal Cord
Integration of defecation & micturition reflexes

119
 Pharmacology of ANS
 AUTONOMIC DRUGS are classified in two groups

1. Drugs acting on sympathetic nervous system

Sympathomimetics/adrenergic drugs

Sympatholytics

2. Drugs acting on parasympathetic nervous system

Parasympathomimetics or cholinergic drugs

Parasympatholytics

120
1. Sympathomimetic/adrenergic drugs
Drugs producing similar effects/ agonists to the
stimulation of SyNS

E.g. NE, Epinephrine, methoxamine etc

Their effect is to cause release of NE from its storage

vesicles in the sympathetic nerve endings.
The released NE in turn causes the sympathetic effects.

E.g. they increase HR and decrease GIT motility

121
2. Sympatholytics (Sympathetic blockers)
 Prevent the actions of sympathetic NTs

 Adrenergic activity can be blocked at several points like

– Synthesis, storage & release of NE

– Autonomic ganglia

– Receptors (alpha & beta receptors )

 Bring PaSNS stimulation like effects

122
 Blocking of Adrenergic Activity
1. Synthesis CNS Alpha methyl dopa

2. Storage Reserpine

X
3. Release Guanethidine

4. Autonomic ganglia Hexamethonium

X
5. Alpha receptors Dibenamine
Phenoxybenzamine

6. Beta receptors Propranolol

Oxprenolol

123
 Pharmacology of the ANS…
3. Parasympathomimetic /Cholinergic Drugs
 Produce effects similar to the stimulation of
parasympathetic fibers
Examples
1. Drugs which act on muscarinic type of cholinergic
receptors:
– pylocarpine and metacholine
2. Drugs which prolong the action of Ach: inhibit the
action of acetylcholinesterase enzyme
– neostigimine, pylocarpine, & ambenonium

124
 Pharmacology of the ANS…
4. Parasympatholytics (parasympathetic blockers)

Drugs blocking cholinergic activity at effector organs

Are antimuscarinic drugs

E.g. –atropine

-homatropine

-scopolamine

126
Autonomic dysfunction

127
 Autonomic dysfunction
• Raynaud’s disease
– Hyperactivation of sympathetic
nervous system
– Extreme vasoconstriction of
peripheral blood vessels
• Lead to tissue hypoxia

– Provoked by exposure to cold or by

emotional stress
128
 Autonomic dysfunction…
• Horner's syndrome

– Damage to sympathetic trunk

– Signs occur on same side of lesion

– Characterized by

• Miosis (constricted pupil)

• Partial ptosis

• Apparent anhidrosis

129
 Autonomic dysfunction…
• Achalasia of cardia
– Defect in autonomic innervation of
esophagus
– Failure of smooth muscle fibers to
relax
– Sphincter remains closed and fail
to open when needed
• Erectile & ejaculation failure
– Impotence
130
Excess activation of ANS resulting in stress related
disorders such as
• Ulcer

• Hypertension

• Heart attack

• Stress induced diabetes

 Reading assignment

• Autonomic nervous system and adrenal

medulla
– Guyton from page 773-785-13th edition

• Mechanism of action for Autonomic receptors

132