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Introduction to Pharmacology > Behavior Modification, Pt. 2 > Flashcards

Behavior Modification, Pt. 2 Flashcards

1
Q

What are 8 indications for short-term psychotropics?

A
  1. veterinary visits
  2. car travel
  3. separation anxiety (+ long-term meds)
  4. visitors
  5. noise aversion
  6. new baby/family members
  7. bridge medication (switch from one medication to another)
  8. adjunct to daily medication
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2
Q

What are 5 common classes of short-term psychotropics?

A
  1. serotonin antagonist and reuptake inhibitors (SARIs) - Trazodone
  2. α2 agonists - Dexmedetomidine gel (Sileo)*, Clonidine
  3. GABA analogues - Gabapentin, Imepitoin (not in US)
  4. benzodiazepines - Diazepam (Valium), Alprazolam (Xanax), Clonazepam (Klonipin), Lorazepam (Ativan)
  5. phenothiazine neuroleptics - acepromazine (PromAce)
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3
Q

What is the mechanism of action of SARIs?

A

(Trazodone)

blocks serotonin 2A and 2C receptors and blocks serotonin reuptake

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4
Q

What receptor does Trazodone have an affinity for? What is it a partial agonist for?

A

5-HT2A receptor

  • histamine H1 receptors
  • α1 adrenergic receptors
  • 5-HT1A**
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5
Q

What are the 4 most common situations that Trazodone is used for? 2 additional?

A
  1. situational fear and anxiety
  2. event stress (vet visit, thunderstorm, fireworks)
  3. noise aversion
  4. bridge - immediate relief while waiting on SSRI/TCA
  • post-op confinement (keep pets from hurting themselves after surgery)
  • stress in shelters
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6
Q

How many/what percent of dog owners seek treatment for their dog for noise aversion (storm phobia, fireworks, etc.), per recent studies?

a. nearly all or most (>75%)
b. many (51-75%)
c. half (~50%)
d. some (25-40%)
e. few (<20%)
f. none (0%)

A

E

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7
Q

Trazodone can be used as an adjunct with SSRIs and TCAs (careful: serotonin syndrome!). How is this possible?

A

antagonizes 5-HT2 receptors, which augments efficacies of SSRIs

(can be long-term, but not typically first choice)

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8
Q

How is Trazodone classified? What other effect does it have?

A

atypical antidepressant (via SERT inhibitor, which increases serotonin)

sedation due to antihistaminic, α1 adrenergic antagonist

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9
Q

Why is Trazodone recommended to be given with food?

A

slows down absorption —> sticks around

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10
Q

Why isn’t Trazodone commonly used in cats?

A

large, bitter pills

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11
Q

What is Trazodone’s efficacy onset?

A

quick —> 30-45 mins
duration —> 4+ hours

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12
Q

Why is Trazodone so commonly used in dogs?

A

well-tolerated with high margin of safety
- 5-HT2A/C antagonism = less side effects
- fewer anticholinergic effects
- lower seizure risk
- less cardiac issues

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13
Q

What are 3 less common adverse effects of Trazodone?

A
  1. GI - vomiting, hyporexic, diarrhea
  2. tachycardia, increased anxiety
  3. behavior disinhibition, aggression
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14
Q

In what 3 cases should Trazodone use be avoided? What is a common drug interaction?

A
  1. severe cardiac disease
  2. hepatic and renal impairment, glaucoma
  3. those taking MAOIs

Fluoxetine

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15
Q

What is the most common use of Dexmedetomidine orotransmucosal (Sileo)? What else can it be used for?

A

(α2 agonist)
noise aversion in dogs

reduce fear/anxiety during vet visits

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16
Q

How is Dexmedetomidine dosed? What happens if it is swallowed?

A

applied to gums - orotransmucosal gel
- no treats within 15 mins
- administer 30-60 mins before adverse stimulus

loss of absorption/efficacy

17
Q

What are 3 side effects of Sileo? What are 3 important aspects owners should know about?

A
  1. sedation
  2. emesis
  3. depression of CNS (peripheral and cardiac vasoconstriction, bradycardia, respiratory depression)
  • adjust dose stopper BEFORE dispensing
  • wear gloves
  • tube only lasts 4 weeks once opened
18
Q

What is the reversal of Sileo (Dexmedetomidine)?

A

Atipamezole

19
Q

What is the mechanism of action of Clonidine? What are 2 common uses?

A

α-2A and imidazoline receptor agonist

  1. fear-based behavior problems and anxiety in dogs
  2. quick calming in overly hyperkinetic dogs
20
Q

What are 5 possible adverse effects of Clonidine?

A
  1. high sedation
  2. α2: transient hyperglycemia, dry mouth, constipation
  3. aggressive behavior
  4. hypotension, collapse, bradycardia
  5. gradual reduction over 2-4 days due to withdrawal symptoms (agitation, nervousness, hypertension)
21
Q

What is Gabapentin? What are 4 uses/indications?

A

GABA analogue —> anti-convulsant, treats chronic and neuropathic pain (spinal chord injuries, limb amputation)

  1. high doses: sedative, anxiolytic
  2. reduce fear responses associated with handling and vet clinic visits in cats**
  3. storm phobia in dogs, but must be dosed earlier than storm
  4. long-term/chronic pain
22
Q

When does Gabapentin reach peak plasma concentrations?

A

1-2 hours after administration
- half-life of 2-4 hours

23
Q

Why should Gabapentin not be used in patients with kidney disease? What are 2 possible adverse effects?

A

eliminated exclusively via kidneys —> adjust dose

(generally low side effect profile)
1. sedation and ataxia in higher doses
2. cats: hypersalivation and vomiting

24
Q

Gabapentin, controlled drug:

A
25
Q

What are the main 2 indications/uses of Imepitoin? What are 4 issues with use?

A

(GABA analogue)
1. noise aversion in dogs (Pexion) not available in US
2. reduce fear/anxiety

  • administration must start 2 days before noise event
  • administration should continue 2x daily as long as noise stimuli is expected
  • caution with hepatic, renal, and cardiovascular disease
  • ADVERSE: ataxia, lethargy, emesis, aggression, hypersalivation
26
Q

Are Benzodiazepines controlled drugs? What are the 4 most common ones used? What is their reversal?

A

yes

  1. Diazepam (Valium)
  2. Alprazolam (Xanax)
  3. Clonazepam (Klonipin)
  4. Lorazepam (Ativan)

Flumazenil

27
Q

How is the type of Benzodiazepine to use chosen?

A

based on duration of action

Clonazepam (10-12hr) > Lorazepam (6-8hrs) > Diazepam (4-6hr) > Alprazolam (2-3hr)

28
Q

What are 6 uses of Benzodiazepines? How can it affect learning?

A
  1. panic, profound fear
  2. sedative/hypnotic
  3. anxiolytic
  4. muscle relaxant
  5. appetite stimulant
  6. anticonvulsant

potential amnesic —> wont remember anxiety-inducing event —> no learning

29
Q

What are 4 adverse effects of Benzodiazepines? What is a common contraindication?

A
  1. paradoxical excitation in 1/3 dogs
  2. ataxia
  3. dependence/tolerance if used daily
  4. withdrawal: anxiety, seizures

AGGRESSIVE animals —> disinhibition of aggression

30
Q

When is it best to use Alprazolam compared to other Benzodiazepines?

A

events of BRIEF duration —> storm phobia, anxiety-related stress
(shortest acting)

31
Q

How does Diazepam compare to Alprazolam? In what animals should it not be used?

A

(Alprazolam = shortest duration)
longer duration, better for storm phobia in cases where storm is delayed

CATS = idiosyncratic hepatic failure

32
Q

What is the best Benzodiazepine for cats? Why?

A

Lorazepam

no active liver metabolites —> noo hepatic necrosis

33
Q

Why is Lorazepam good for behavioral modification?

A
  • less sedating than other BZDs
  • increases appetite
34
Q

What is the longest acting Benzodiazapine? What 2 characteristics make it a good option?

A

Clonazepam (10-12hr)

  1. readily available and affordable
  2. best for daily treatment of global fear and a daily panicked dog
35
Q

What makes Acepromazine unique compared to other psychotropics? What is it FDA-approved for use in?

A

NOT and anxiolytic —> does not decrease anxiety, it is a sedative/tranquilizer (best used in addition to anxiolytic)

dogs, cats, horses as an aid in controlling intractable animals (anti-pruritic, antiemetic, preanesthetic)

36
Q

How do clinical doses of Acepromazine compare to the label? In what 2 dogs should it be used carefully?

A

clinical doses are significantly lower

  1. aggressive dogs —> startle response and worsening of aggression and CNS stimulation
  2. dogs with MDR1 mutation —> need drug reduction or avoidance
37
Q

What medications are most commonly used for separation anxiety? Repetitive, obsesive-compulsive behaviors? Aggression? Inter-cat conflict? Noise aversion? Canine cognifive dysfunction?

A

Fluoxetine or Clomipramine

Fluoxetine

(only with behavior modification and thorough behavioral work-up) - Fluoxetine

Fluoxetine

Sileo transmucosal. or trazadone

Selegiline

38
Q

Which psychoactive drugs can be used for daily (long-term) AND/OR event (short-term) use?

a. Fluoxetine
b. Trazodone
c. Clomipramine
d. Gabapentin
e. Buspirone
f. Acepromazine
g. Lorazepam

A

B, D

39
Q

What are 4 important considerations veterinarians should take into account when evaluating the efficacy of psychotropics?

A
  1. What is success? Change in duration, intensity and frequency of behavior? DON’T abruptly stop medication —> need to solidify desirable behavior (taper)
  2. dosing strategy: start low to minimize side effects and possibly increase for longer efficacy
  3. client compliance: ability, schedule, causing more stress and anxiety (Fear Free), enough time on therpeutic dose
  4. monitor health and responses: follow up with PE, CBC, chem panels, T4, urinalysis prior to and repeated at least yearly

Introduction to Pharmacology (39 decks)

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