Dr.

Niranjan Murthy H L
Asst. Prof. of Physiology
SSMC, Tumkur
• Part of CNS but not a distinct entity
• Involuntary
• Organizes visceral support of somatic
behaviour
• Winslow, Langley, Loewi, Cannon, Bacq,
Dale
 Anatomic Organization
Sympathetic nervous system

Parasympathetic nervous system

Enteric nervous system

Center: IML horn cells, CNS centers and 3rd,
7th, 9th & 10th cranial nuclei.
Efferents: pre- and post-ganglionic neurons
Pre-ganglionic neurons are B type & leave
spinal cord with motor nerves.
Receptors in viscera: sparse pain receptors,
few thermal and touch receptors & no
proprioceptors.
 Sympathetic Division
• Preganglionic neurons-Thoracolumbar
outflow- T1 to L3
• Pass to paravertebral or collateral ganglia
• Postganglionic neurons- comparatively
longer
• Short noradrenergic neurons- uterus &
male genital tract
• Intrinsic cardiac adrenergic (ICA) cells
 Parasympathetic Division
• Craniosacral outflow
• 3rd, 7th, 9th & 10th nerves
• Ganglia embedded in organs
 Chemical Divisions
1. Cholinergic neurons-
a) all preganglionic
b) parasympathetic postganglionic
c) sympathetic vasodilator nerves
d) sympathetic fibers to sweat glands
2. Noradrenergic neurons- rest of
postganglionic sympathetic fibers
 Autonomic neurotransmitters
• Norepinephrine, Acetylcholine
• Dopamine- in interneurons of sympathetic
ganglia (SIF cells)
• GnRH- preganglionic neurons
• VIP- released with acetylcholine
• ATP, Neuropeptide Y- released with
norepinephrine
 Transmission in sympathetic
ganglia
Potential Duration Mediator receptor

Fast EPSP 30ms Acetylcholine nicotinic

Slow IPSP 2s Dopamine D2

Slow EPSP 30s Acetylcholine M2

Late slow 4min GnRH GnRH

EPSP
 Autonomic functions
• Most of the viscera have dual supply
• Actions of two divisions are opposing
• Cholinergic actions are discrete, localized
& of short duration- Anabolic
• Noradrenergic actions are prolonged &
diffuse- flight of fight
Parasympathetic outflow
Sympathetic outflow
 Flight or fight reaction
• Acceleration of heart and lung action
• Inhibition of stomach and intestinal action
• Constriction of blood vessels in many parts of
the body
• Liberation of nutrients for muscular action
• Dilation of blood vessels for muscles
• Inhibition of tear glands and salivation
• Dilation of pupil
• Relaxation of bladder
• Inhibition of erection
 Sympathetic receptors

Adrenergic
receptors

Alpha Beta

Alpha 1 Alpha 2 Beta 1 Beta 2

Beta 3
Alpha1 receptors:
Location- arterioles, eyes, bladder, male sex
organ
Mechanism- IP3 DAG second messenger
system
Alpha 2 receptors:
Location- presynaptic nerve terminals,
pancreatic beta cells, CNS, platelets
Mechanism- adenylyl cyclase cAMP
inhibition
Beta 1 receptors:
Location- heart, JGA

Beta 2 receptors:
Location- Blood vessels, Smooth muscles
(of uterus, Bladder, Bowel, Eye, Bronchi)
Metabolic
 Parasympathetic receptors
Nicotinic receptors- Nn & Nm
Ligand gated cation channels
Location- NMJ, Ganglia & Adrenal medulla
Muscarinic receptors- M1 to M5
G protein coupled
Location-
M1- CNS & gastric glands
M2- Heart
M3- Smooth muscles & Glands
 Sympathetic neurotransmitters-
synthesis and fate
• Noradrenaline, adrenaline, dopamine
• Synthesis begins in axoplasm and
complete in vesicles
• Fate:
(iv) Reuptake- 50 to 80%
(v) Diffusion into blood
(vi) Destruction by tissue enzymes- COMT &
MAO
 Acetylcholine- synthesis & fate
• Synthesis in axoplasm
• Duration of action is very short because of
acetylcholinesterase
• Reuptake of choline
 Autonomic reflexes
• Baroreceptor reflex
• Cardiac reflexes
• Reflexes involving chemoreceptor and
visceral receptors
• Micturition reflex
• Defecation reflex
• Sexual reflexes
Central control of autonomic functions
1. Spinal cord
spinal shock
2. Medulla- cardiovascular and respiratory
centers
4. Midbrain
midbrain injuries cause inhibition of micturition
reflex, changes in skin resistance, modification
of BP & HR
• Hypothalamus-temperature regulation, co-
ordination of visceromotor reflexes, etc
• Limbic system- closely connected with
hypothalamus
• Cerebellum
• Cerebral cortex
 Pharmacology of ANS
1. Sympathomimetic Drugs
a) drugs stimulating adrenergic receptors
eg: Epinephrine, phenylephrine,
Isoproterenol, albuterol
b) drugs releasing noradrenaline
eg: Ephedrine, Amphetamine
Therapeutic uses:
ii. Vasopressors- Dopamine
iii. Cardiac stimulants- Adrenaline,
Dopamine, Dobutamine
iv. Bronchodilators- Adrenaline, Salbutamol
v. Uterine relaxants- Salbutamol,
Isoxsuprine
vi. Nasal decongestant- Pseudoephedrine,
Xylometazoline
vii. Anorexiants- Fenfluramine
2. Sympatholytic Drugs
i) Inhibitors of synthesis & storage of
norepinephrine- Reserpine
ii) Blockers of norepinephrine release-
Guanethidine
iii) Alpha blockers- Phentolamine,
Phenoxybenzamine
iv) Beta blockers- Atenolol
v) Ganglion blockers- Hexamethonium
Therapeutic uses- Antihypertensives
3. Parasympathomimetic drugs
a) Direct stimulants of muscarinic
receptors- Pilocarpine & Methacholine
b) Anticholinesterase drugs- Neostigmine,
Physostigmine, Ambemonium
Used in myasthenia gravis
4. Parasympatholytic drugs- Atropine,
Scopalamine, Homatropine
Used as mydriatics
5. Drugs stimulating autonomic
postganglionic neurons- Nicotine,
Acetylcholine, Methacholine
6. Ganglion blocking drugs-
Hexamethonium, Pentolinium
Used as antihypertensives