Behavior Modification, Pt. 2 Flashcards
What are 8 indications for short-term psychotropics?
- veterinary visits
- car travel
- separation anxiety (+ long-term meds)
- visitors
- noise aversion
- new baby/family members
- bridge medication (switch from one medication to another)
- adjunct to daily medication
What are 5 common classes of short-term psychotropics?
- serotonin antagonist and reuptake inhibitors (SARIs) - Trazodone
- α2 agonists - Dexmedetomidine gel (Sileo)*, Clonidine
- GABA analogues - Gabapentin, Imepitoin (not in US)
- benzodiazepines - Diazepam (Valium), Alprazolam (Xanax), Clonazepam (Klonipin), Lorazepam (Ativan)
- phenothiazine neuroleptics - acepromazine (PromAce)
What is the mechanism of action of SARIs?
(Trazodone)
blocks serotonin 2A and 2C receptors and blocks serotonin reuptake
What receptor does Trazodone have an affinity for? What is it a partial agonist for?
5-HT2A receptor
- histamine H1 receptors
- α1 adrenergic receptors
- 5-HT1A**
What are the 4 most common situations that Trazodone is used for? 2 additional?
- situational fear and anxiety
- event stress (vet visit, thunderstorm, fireworks)
- noise aversion
- bridge - immediate relief while waiting on SSRI/TCA
- post-op confinement (keep pets from hurting themselves after surgery)
- stress in shelters
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%)
E
Trazodone can be used as an adjunct with SSRIs and TCAs (careful: serotonin syndrome!). How is this possible?
antagonizes 5-HT2 receptors, which augments efficacies of SSRIs
(can be long-term, but not typically first choice)
How is Trazodone classified? What other effect does it have?
atypical antidepressant (via SERT inhibitor, which increases serotonin)
sedation due to antihistaminic, α1 adrenergic antagonist
Why is Trazodone recommended to be given with food?
slows down absorption —> sticks around
Why isn’t Trazodone commonly used in cats?
large, bitter pills
What is Trazodone’s efficacy onset?
quick —> 30-45 mins
duration —> 4+ hours
Why is Trazodone so commonly used in dogs?
well-tolerated with high margin of safety
- 5-HT2A/C antagonism = less side effects
- fewer anticholinergic effects
- lower seizure risk
- less cardiac issues
What are 3 less common adverse effects of Trazodone?
- GI - vomiting, hyporexic, diarrhea
- tachycardia, increased anxiety
- behavior disinhibition, aggression
In what 3 cases should Trazodone use be avoided? What is a common drug interaction?
- severe cardiac disease
- hepatic and renal impairment, glaucoma
- those taking MAOIs
Fluoxetine
What is the most common use of Dexmedetomidine orotransmucosal (Sileo)? What else can it be used for?
(α2 agonist)
noise aversion in dogs
reduce fear/anxiety during vet visits
How is Dexmedetomidine dosed? What happens if it is swallowed?
applied to gums - orotransmucosal gel
- no treats within 15 mins
- administer 30-60 mins before adverse stimulus
loss of absorption/efficacy
What are 3 side effects of Sileo? What are 3 important aspects owners should know about?
- sedation
- emesis
- depression of CNS (peripheral and cardiac vasoconstriction, bradycardia, respiratory depression)
- adjust dose stopper BEFORE dispensing
- wear gloves
- tube only lasts 4 weeks once opened
What is the reversal of Sileo (Dexmedetomidine)?
Atipamezole
What is the mechanism of action of Clonidine? What are 2 common uses?
α-2A and imidazoline receptor agonist
- fear-based behavior problems and anxiety in dogs
- quick calming in overly hyperkinetic dogs
What are 5 possible adverse effects of Clonidine?
- high sedation
- α2: transient hyperglycemia, dry mouth, constipation
- aggressive behavior
- hypotension, collapse, bradycardia
- gradual reduction over 2-4 days due to withdrawal symptoms (agitation, nervousness, hypertension)
What is Gabapentin? What are 4 uses/indications?
GABA analogue —> anti-convulsant, treats chronic and neuropathic pain (spinal chord injuries, limb amputation)
- high doses: sedative, anxiolytic
- reduce fear responses associated with handling and vet clinic visits in cats**
- storm phobia in dogs, but must be dosed earlier than storm
- long-term/chronic pain
When does Gabapentin reach peak plasma concentrations?
1-2 hours after administration
- half-life of 2-4 hours
Why should Gabapentin not be used in patients with kidney disease? What are 2 possible adverse effects?
eliminated exclusively via kidneys —> adjust dose
(generally low side effect profile)
1. sedation and ataxia in higher doses
2. cats: hypersalivation and vomiting
Gabapentin, controlled drug:
What are the main 2 indications/uses of Imepitoin? What are 4 issues with use?
(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
Are Benzodiazepines controlled drugs? What are the 4 most common ones used? What is their reversal?
yes
- Diazepam (Valium)
- Alprazolam (Xanax)
- Clonazepam (Klonipin)
- Lorazepam (Ativan)
Flumazenil
How is the type of Benzodiazepine to use chosen?
based on duration of action
Clonazepam (10-12hr) > Lorazepam (6-8hrs) > Diazepam (4-6hr) > Alprazolam (2-3hr)
What are 6 uses of Benzodiazepines? How can it affect learning?
- panic, profound fear
- sedative/hypnotic
- anxiolytic
- muscle relaxant
- appetite stimulant
- anticonvulsant
potential amnesic —> wont remember anxiety-inducing event —> no learning
What are 4 adverse effects of Benzodiazepines? What is a common contraindication?
- paradoxical excitation in 1/3 dogs
- ataxia
- dependence/tolerance if used daily
- withdrawal: anxiety, seizures
AGGRESSIVE animals —> disinhibition of aggression
When is it best to use Alprazolam compared to other Benzodiazepines?
events of BRIEF duration —> storm phobia, anxiety-related stress
(shortest acting)
How does Diazepam compare to Alprazolam? In what animals should it not be used?
(Alprazolam = shortest duration)
longer duration, better for storm phobia in cases where storm is delayed
CATS = idiosyncratic hepatic failure
What is the best Benzodiazepine for cats? Why?
Lorazepam
no active liver metabolites —> noo hepatic necrosis
Why is Lorazepam good for behavioral modification?
- less sedating than other BZDs
- increases appetite
What is the longest acting Benzodiazapine? What 2 characteristics make it a good option?
Clonazepam (10-12hr)
- readily available and affordable
- best for daily treatment of global fear and a daily panicked dog
What makes Acepromazine unique compared to other psychotropics? What is it FDA-approved for use in?
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)
How do clinical doses of Acepromazine compare to the label? In what 2 dogs should it be used carefully?
clinical doses are significantly lower
- aggressive dogs —> startle response and worsening of aggression and CNS stimulation
- dogs with MDR1 mutation —> need drug reduction or avoidance
What medications are most commonly used for separation anxiety? Repetitive, obsesive-compulsive behaviors? Aggression? Inter-cat conflict? Noise aversion? Canine cognifive dysfunction?
Fluoxetine or Clomipramine
Fluoxetine
(only with behavior modification and thorough behavioral work-up) - Fluoxetine
Fluoxetine
Sileo transmucosal. or trazadone
Selegiline
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
B, D
What are 4 important considerations veterinarians should take into account when evaluating the efficacy of psychotropics?
- What is success? Change in duration, intensity and frequency of behavior? DON’T abruptly stop medication —> need to solidify desirable behavior (taper)
- dosing strategy: start low to minimize side effects and possibly increase for longer efficacy
- client compliance: ability, schedule, causing more stress and anxiety (Fear Free), enough time on therpeutic dose
- monitor health and responses: follow up with PE, CBC, chem panels, T4, urinalysis prior to and repeated at least yearly
