Behavioral Modification Drugs Pt 1 (Long Term) Flashcards
What are the FDA approved psychoactive drugs for dogs? Are their any for cats?
What must you have if you are going to prescribe drugs extra label?
1.) A reason
2.) Client Patient Doctor relationship.
3.) Informed Consent - owner must be aware why its being used over other options and agree to it.
Why do we use psychotropics in veterinary medicine?
What must always occur with prescriptions of psychoactives in animals?
Must be used in adjunct with behavioral modification. Must do the work.
What are other terms for behavior modifying drugs?
What are the 3 welfare states/models?
- Affective State
- Functioning
- Natural living
What are the 5 welfare domains?
When do you use psychotropics?
- When you have a veterinary client patient relationship
- After ruling out medical cause.
- Must have behavioral medical diagnosis.
- Plan for behavior modification
What are potential kinds of appropriate behavioral modification techniques?
Counter-conditioning, systematic
desensitization, positive reinforcement, etc.
What are the 6 key biogenic amine transmitters/ neurotransmitters
What is the main target of human psychotropics?
Serotonin is one of the main targets in human psychotropics as well.
What is serotonin responsible for in the CNS?
In CNS – regulates mood, appetite, sleep, and some cognitive functions
What percent of the brain contains serotonin? Where is the rest of it?
▪only 1-2% in brain; most in enteric nervous system
How do we get serotonin ? How is it used by the pre and post synaptic cells?
Tryptophan (from food) is converted to serotonin. Its stored in vesicles of presynaptic neurons. Stimulation releases serotonin -> binds to postsynaptic receptor and is activation.
Serotonin ends due to high affinity reuptake of serotonin in presynaptic terminal by SERT proteins
What causes the serotonin action to end?
Serotonin ends due to high affinity reuptake of serotonin in presynaptic terminal by SERT proteins
What are the 2 major categories of psychotropics?
Long term daily medication
Short term event medications
How long does it take for long term/ daily medications to take effect?
Weeks to effect
How long does it take for short term meds to take effect? When are they used?
- Short-term or “Event” medication for acute use
▪ Stressful events
▪ Quick onset, last for set # of hours
▪ Sometimes daily as multimodal/poly-therapy
A few of the short-term meds can also be used long-term
What are the indications for using long term/ daily medication?
▪ Generalized anxiety
▪ Fearful behavior leading to aggression
▪ Inter-pet conflict
▪ Separation anxiety
▪ Cognitive Dysfunction Syndrome
▪ Urine marking (vertical) in cats
▪ Stress related house soiling
▪ Repetitive behaviors (Compulsive disorders, e.g., spinning, licking, fly-biting,
etc)
What are the 5 common classes of Long term psychoactives?
- Selective serotonin reuptake inhibitors (SSRIs)
▪ Fluoxetine, Paroxetine, Sertraline - Tricyclic antidepressants (TCAs)
▪ Clomipramine, amitriptyline - Azapirones (Serotonergic)
▪ Buspirone - Monoamine oxidase inhibitors (MAOIs)
▪ Selegiline - Selective serotonin/norepinephrine reuptake inhibitors (SNRIs)
▪ Venlafaxine (not commonly used; not discussed)
How are the long term psychoactives administered?
Orally administered
What class of long term medications are the most commonly used? Why?
SSRI
They are preferable due to efficacy and few side effects (transitory)
What is the mechanism of action of SSRIs?
-> Inhibits serotonin reuptake by blocking the SERT transporter for serotonin. This allows serotonin to remain near the postsynaptic terminal and increase serotonergic neuro transmission.
What causes side effects of SSRIs?
-> initiall there is a flood of serotonin because reuptake receptors are blocked. Subtype receptors get saturated which lead to side effects?
Why does it take too long for SSRIs to work?
What are SSRIs properties? What is it considered? Why is it preferred for use?
Selective inhibiition
What is the efficacy of onset for SSRIs? What happens if it is given as needed?
What are the uses and indications for SSRIs?
How is SSRIs metabolized? Where is it excreted? Is there a relationship between plasma levels of SSRIs and response?
What is the importance of dosing for SSRIs? What happens if it is abruptly stopped?
What are adverse side effects of SSRIs?
When is administration of SSRIs contraindicated?
What is Serotonin Syndrome? What is important to note about using SSRIs, MAOIs, TCAs, ect?
What are the clinical signs of serotonin syndrome? How quickly would serotonin syndrome onset ?
What are the common SSRIs used in dogs and cats? Which is FDA approved?4
What is the most commonly used SSRI? What is it FDA approved for?
Fluoxetine (Prozac)
FDA approved for separation anxiety
What can fluoxetine be used extra label for? What has it been found to be very effective for?
What is the best route of administration for Fluoxetine? What is the worst and not recommended? Why is it a drug that is popular for use?
What is paroxetine? Why is it not used as much? What is important to note about use of paroxetine?
How is sertraline excreted? What is the benefit of this route of excretion, as well as use of the drug in general?
What is the MOA of TCAs? What is the other properties of these drugs?
Similar to SSRI but inhibits both serotonin AND norepinephrine → increased availability of NT
in synapses
- antihistaminic and anticholinergic
- anxiolytic, anti-compulsive, some anti-aggression
▪ Antihistamine effects can lead to more calming
What can occur with chronic administration of TCAs?
What is the second line behavioral modification medication? What is the 1st?
TCA are 2nd line choice
SSRI are first line
What is TCAs classified as? What are its uses and indications? Efficacy? What should you remember with dosing?
What are the TCAs used in veterinary medicine? Which are not used often?
What is Clomipramine? What is it FDA approved for? What else can it help treat?
What is noted on the bottle about administration requirements?
Must be paired with behavioral training/ modification
What are the side effects of clomipramine?
What are the contraindications of Clomipramine?
What is amitriptyline? What is it used for? What is important to remember about choice in administration method? What are additional side effects?
Indications / Uses:
▪ NOT typically 1st choice for anxiety disorders
▪ Maybe neuropathic pain and acral lick in dogs
▪ Some use it for cats with feline interstitial cystitis and house-soiling in cats, but “old school”
Pharmacologic
▪ Systemic absorption of transdermal is POOR. Do NOT use transdermal
Additional Side effects (plus all from Clomipramine)
▪ Moderate to severe sedation (cat “zombies”)
▪ Arrhythmogenic (decreased Q-T interval)
Side effects from Clomipramine is the image attached
What is amitriptyline? What is it used for? What is important to remember about choice in administration method? What are additional side effects?
Indications / Uses:
▪ NOT typically 1st choice for anxiety disorders
▪ Maybe neuropathic pain and acral lick in dogs
▪ Some use it for cats with feline interstitial cystitis and house-soiling in cats, but “old school”
Pharmacologic
▪ Systemic absorption of transdermal is POOR. Do NOT use transdermal
Additional Side effects (plus all from Clomipramine)
▪ Moderate to severe sedation (cat “zombies”)
▪ Arrhythmogenic (decreased Q-T interval)
Side effects from Clomipramine is the image attached
What is the MOA of azapirone ( Buspirone)?
▪ Serotonin 1A partial agonist
Full agonist at pre, partial agonist at post synaptic.
Where do azapirone (buspirone) bind?
Binds at pre synaptic autoreceptor -> blocks -> which increases serotonin production
Binds at post synaptic serotonin autoreceptor-> mimics effects of serotonin
What is the effects of azapirone?
▪ Decreases anxiety
▪ Increases BOLDNESS
Where is azapirone available? What is it considered? What is it used for?
Would you give azapirone to aggressor cats who intimidate their housemates?
No this is more for anxious cats who are the recipients of aggression from housemates.
What is the efficacy onset of buspirone?
What is the difference of buspirone and the other long term behavioral modification drugs? Should you give transdermal form?
- Given 2/3 times a day orally not once daily like the others
- No do not give transdermal
What are the side effects of buspirone? What is the rare/ uncommon side effects that can occur?
What is the contraindications for giving buspirone to patients?
What are MAOI’s, how do they work?
- Not very selective
- MAO enzymes break down dopamine, serotonin and norepi.
◦ MAOIs prevent the break down of these NT and accumulate them.
◦ Also enhances the activity of catecholamines.
What happens to dogs brains as they age?
- As dog ages, dopamine production in brain decreases and more free radicles are produced, (which can cause damage to the brain. )
What is the mechanism of selegeline? How does it help older dog?
What is selegiline FDA approved to treat? What is it used off label for? What is its efficacy/ onset?
What are potential side effects of selegeline? Is it common? What are some listed things to be cautious of when you are prescribing selegiline?
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