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Clinical Pharmacology > Behavior Modifying Drugs > Flashcards

Behavior Modifying Drugs Flashcards

1
Q

What are CNS neutrotransmitters affected by behavior modifying drugs

A

SEROTONIN
Dopamine
NE
Gaba etc

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2
Q

What are the 3 FDA approved behavior modyifying drugs

A

Clomipramine (Clomicalm)
Fluoxetine (Renoconcile)
L-deprenyl; Selegilene (Anipryl)

“CFL”

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3
Q

What are 3 classes of BMD

A

Anxiolytics
Antidepressants
Monoamine Oxidase Inhibitors

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4
Q

Anxiolytic example

A

Buspirone

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5
Q

Antidepressant name 2 examples

A

Tricyclic Antidepressants

SSRI

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6
Q

Monoamine Oxidase Inhibitors example

A

Selegiline

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7
Q

Buspirone MOA

A

An anxiolytic.

It inhibits serotonin (5HT) synthesis by binding at pre-synaptic 5HT1A receptors

Possibly enhances dopamine activity

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8
Q

Buspirone adverse drug reactions

A

No sedative effects

Cats- increased aggression to other cats

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9
Q

Buspirone clinical use

A

Canine aggression, feline spraying
Thunderstorm phobias
Self mutilation
others

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10
Q

Name 2 other anxiolytics besides buspirone

A

Benzodiazepines

Butyrophenones

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11
Q

Antidepressants - which one is FDA approved in dogs

A

Clomipramine

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12
Q

Antidepressant use in dogs

A

We use antidepressants like clomipramine to treat behaviors we (humans) find unacceptable, i.e. chewing up the mattress

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13
Q

Antidepressants- MOA

A

enhances activity of NT (5HT, NE)

blocks physiologic inactivation (blocks reuptake pumps at synapse–> less reuptake)

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14
Q

Tricyclic antidepressants MOA

A

MAO degrades NE and 5HT into inactive metabolites
Clomipramine blocks BOTH pumps !!!!!! (both NE and serotonin receptor)

More NE and Serotonin

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15
Q

Antidepressants- adverse drug reactions (toxicity)

Describe therapeutic index? Less serious vs Serious toxicity ?

A

Narrow therapeutic index
Ranges from Mild to fatal
Less serious: behavior changes, lethargy, GI
Serious: cardiac arrhythmias, hypotension, CNS depression (coma, DEATH)

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16
Q

Antidepressants – what to remember when dispensing

A

use childproof containers!!!

adverse effects!! arrythmias, hyptension, coma/death

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17
Q

Antidepressants- metabolism

A

Metabolized by CYP450 enzymes!!

careful when concurrently using P450 inhibitors

18
Q

Cyt P450 inhibitors

A

Ketoconazole
Fluoroquinolones
Cimetidine
Rifampin

“KFCR”

19
Q

Cyt P450 inducers

A

Phenobarbital
Griseofulvin
Concurrent use of these drugs -> subtherapeutic [TCA]

20
Q

What are other drugs that potentiate NE or 5HT

A

MAO inhibitors
Others (later)
May lead to Serotonin syndrome

21
Q

Antidepressants are labeled for separation anxiety in dogs. What are some EL uses? How long does it take for effect?

A

Dog, cat, horse behaviors associated with: fear, aggression, obsessive-compulsive disorders, self mutilation

These are CNS changes –> takes several weeks

22
Q

Selective Serotonin reuptake inhibitors: relative sedative effects?

A

These are newer class of antidepressants, less likely to cause sedation

23
Q

SSRI examples (3)

A

Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)

24
Q

SSRI MOA

A

Similar to TCA, but specific to Serotonin Reuptake pump (5HT pump gets inhibited –> less breaking down of serotonin to inactive metabolites)

25
Q

Do SSRIs have more or fewer adverse drug reactions compared to TCAs

A

Fewer!

26
Q

SSRI drug interactions

A

Can inhibit CYP 450, and cause serotonin syndrome

27
Q

What is the FDA approved use for SSRI? Off label use?

A

FDA approved for Separation anxiety (like TCA)

Also clinically used for: Lick granulomas, Tail mutilation, Aggression, Psycogenic alopecia, other behavior disorders

28
Q

Canine cognitive dysfunction- what is an FDA approved drug for treatment

A

Selegiline or I-deprenyl (Anipryl)

29
Q

Selegiline MOA

A

It is a MAO inhibitor so less NE ,Dopamine, and 5HT are broken down into inactive metabolites

30
Q

Selegiline is also metabolized to what two things

A

Amphetamine

Methamphetamine

31
Q

Selegiline clinical uses

A

Canine cognitive dysfunction

Potential benefits in people with Alzheimer’s

32
Q

Selegiline and horses

A

High abuse potential in performance horses

Can detect amphetamine and metamphetamine in urine of horses

33
Q

Selegiline adverse drug reactions

A

Notes say “well tolerated”. May see anorexia, restlessness, repetitive movements. Potential for human abuse.

34
Q

Selegiline drug interactions

A

Associated with serotonin syndrome in humans (interactions of selegiline with TCAs and SSRIs)

35
Q

Serotonin syndrome occurs how

A

Excessive concentrations of serotonin in CNS (such as selegiline use with TCAs, SSRIs, Tramadol; also OTC things like ginseng, tryptophan, dextromethorphan, St John’s wort should not be used concurrently)

36
Q

Serotonin syndrome signs

A 
V/D, abd pain
Hypertension, hyperthermia, hypersalivation
Seizures, tremors, hyperesthesia
Ataxia, blindness
Death!!! *medical emergency
37
Q

What are some examples of MAO inhibitors and why is this important regarding serotonin syndrome

A

Anipryl
Amitraz (used for mange)
St John’s wort

These inhibit MAO which increases CNS Serotonin (and catecholamine) concentration!

38
Q

What are some examples of TCAs and why is this important regarding serotonin syndrome

A

Clomipramine
Amitriptyline
Imipramine

These block both reuptake pumps (NE and 5HT) –> less serotonin (and NE) being uptaken! More Serotonin (and NE) in CNS

39
Q

What are some examples of SSRIs and why is this important regarding serotonin syndrome

A

Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)

SSRIs block specifically the 5HT receptor –> Increased CNS Serotonin

40
Q

Of MAO, TCAs, and SSRIs, which lead to increased CNS catecholamines and serotonin? Which lead to just increased serotonin?

A

MAO and TCAs- both

SSRIS- just increased Serotonin

41
Q

Summary- describe drug combinations to avoid serotonin syndrome

A

SSRIs, TCAs, MAOs (Selegiline, Amitraz)
OTC (St johns wort, ginseng, dextromorphan)
Other compounds increasing CNS NE or Serotonin

42
Q

What about Fluoxetine for treatment of compulsive disorders in dogs

A

clinical trials- showed improvement (70%)

Key= IMPROVEMENT (we don’t get complete ELIMINATION)

Clinical Pharmacology (7 decks)

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