I.    Introduction to Sympathetic and Parasympathetic

II.    Differences in Distribution
 
III.   Difference in Length of Fibers and Location of Ganglia

        A.    Sympathetic

                1. Para-vertebral
                2. Collateral (Pre-vertebral)

        B.    Parasympathetic (Terminal)

IV.   Differences in neurotransmitters and receptors (Cholinergic)

        A. Synthesis of Neurotransmitter

        B.     Mechanism of Release

                1. Movement of vesicles
                2. Rupture of vesicles

        C.    Binding of neurotransmitter to post-synaptic structure

                1. Description & density of receptors
                2. Responses in post-synaptic structure
                3. Receptor types
                    a. Nicotinic
                            - N₁
                            - N₂
                    b. Muscarinic
                            - M₁
                            - M₂

        D.     Destruction of ACH

                1. Eucholinesterase
                        a. Description


              b. Mechanism
 

V.     Adrenergic (Nor-epinephrine) secreting

         A.    Anatomical location

                1. Postganglionic sympathetic
                2. Adrenal medulla
 
          B.    Synthesis

          C.    Storage

          D.    Release

          E.    Binding to receptors

                1. Types
                    a. Alpha
                    b. Beta
                 2. Generalizations
                 3. Mechanism of excitation

          F.    Turning off adrenergic neurons

                  1. Uptake by adrenergic terminal
                  2. Diffusion and uptake-2
                  3. Enzymes
                        a. C.O.M.T.
                        b. M.A.O.
                  4. Alpha-2 receptors

VI.    Differences in function

         A. General Afferent and Efferent

         B. Tonic activity and double inervaton

        C. Predictions
 
        D. Specific examples

VII.  Differences in Pharmacology

        A. Cholinergic

                1. Block N.T. Synsthesis
                        - hemicholinium (HC-3)

                2. False Displacement
                        - black widow venom

                3. Block release
                        - botulin

                4. Receptor mimics (cholinomimetics)

                    a. Clinical Uses
                            - Glaucoma
                            - Urinary retention
                            - tobacco substitute

                    b. Examples
                            - pilocarpine (Isoptocarpine)
                            - carbachol (Isopto-carbachol)
                            - bethanechol (Urecholine)
                            - nicotine (Nicorette, Habitrol, Nicoderm)

                 5. Receptor Blockade - Nicotinic 1

                     a. Clinical Uses
                             - hypertensive crisis
                     b. Example
                             - trimethaphan (Alfound) (N-l)

                6. Receptor Blockade - Nicotinic - 2

                      a. Clinical Uses
                             - intubations
                             - muscle relaxation

                      b. Examples
                            - DTC (Tubadil)
                            - gallamine (Flaxidil)
                            - succinylcholine (Anectine)

                7. Receptor Blockade - Muscarinic

                      a. Clinical Uses
                            - Pre-op. Medication
                            - Eye Exam
                            - Bladder instability
                            - Ulcer
                            - Asthma
                            - Motion Sickness

                        b. Examples
                            - Atropine (Bella Donna)
                            - Tropicamide (Mydriacyl)
                            - Oxybutynin chloride (Ditropin)
                            - Propantheline (Pro-Banthine)
                            - Scopolamine (Transderm Scop)
                            - Ipratroprium (Atrovert)
                            - Donnatol

                8. Anticholinesterases

                        a. Clinical Uses
                              - Myasthenia
                              - Post operative Urinary Retention
                              - Glaucoma

                        b. Examples
                                - Physostigmine (Eserine)
                                - Pyridostigmin (Mestinon)
                                - Neostigmin (Prostigmin)
 
 

    B.     Adrenergic

             1. Block transmitter synthesis
                        - metyrosine (Demser)
             2. False transmitter
                        - methyldopa
             3. Block uptake
                        - cocaine
             4. Block transport into storage granules
                        - reserpine (Serpasil)
             5. False displacement
                        - amphetamines - e.g. ephedrine
             6. Block release
                        - guanethidine (Ismelin)
             7. Adrenominetics - Alpha
                   a. Clinical Uses - Alpha 1
                         - hemostasis
                         - nasal decongestant
                         - local anesthesia adjunct
                         - mydriasis
                         - anaphylaxis treatment
                         - Alpha 2 - hypertension

                    b. Examples
                          - Epinephrine (Adrenaline) Alpha 1&2; Beta 1&2
                          - Norepinephrine (Levophed) Alpha 1 & 2
                          - Phenlyephrine (Neosynephrine)
                          - Clonodine (Catapress) Alpha-2
                          - Guanfacine (Tenex) Alpha-2

            8. Adenominetics - Beta

                1. Clinical Uses
                    a. Beta-i
                        - cardiac arrest
                        - heart failure
                        - shock
                    b. Beta-2
                        - asthma
                        - delay labor
                2. Examples
                    a. Isoproterenol (Isoprel) Beta 1 & 2
                    b. Dobutamine (Dobutrex) Beta-1
                    c. Terbutaline (Brethine) Beta-2
                    d. Albuterol (Ventolin) (Proventil) Beta-2
                    e. Ritodrine (Yutopar) Beta-2

    9. Alpha Antagonists

        A. Alpha

               1. Clinical Uses
                     a. Hypertension
                     b. Pheochromocytoma
                     c. Raynaud's Syndrome
 
               2. Examples
                    a. Phentolamine (Regitine) - Alpha 1 & 2
                    b. Prazosin (Minipress) - Alpha 1
                    c. Terazosin (Hytrin) - Alpha 1
                    d. Beta Antegonists
        B. Beta
 
                1. Clinical Uses
                     a. Hypertension
                     b. Angina
                     c. Dysrhythmias
                     d. Migraine
                     e. Glaucoma

                 2. Examples
                      a. Propranolol (Inderal) Beta 1 & 2
                      b. Nadolol (Corgard) Beta 1 & 2
                      c. Timolol maleate (Timoptic) Beta 1 & 2
                      d. Metoprolol (Lopressor) B-l
                      e. Atenolol (Tenormin) B-l