Behaviour modifying drugs Flashcards
What are serotonergic drugs?
SSRIs
increase serotonin by blocking the reabsorption of serotonin and noradrenaline into neurons.
What is amitriptyline?
serotonergic drug
SRI:NRI 1:4
used for anxiety and pain
has a poor side effect profile
What is clomipramine?
serotonergic drug
SRI:NRI 5:1
used for anxiety and compulsion (impulse control, repetitive behaviours)
risk of discontinuation syndrome
What is fluoxetine?
serotonergic drug
SRI:NRI 15:1
used for anxiety, compulsion, impulsivity, aggression
risk of anorexia
anti-compulsive drug of choice
What is Selegiline?
dopaminergic drug
enzyme breaks down dopamine
used for cognitive impairment, specific fear, compulsion, avoidance, fear-related aggression
risk of aggressiveness and confrontation
What is Mirtazapine?
noradrenergic and specific serotonergic antidepressant
axiolytic
increases motivation, appetite, makes reinforcement easier
used in ppl for GAD, social anxiety, OCD, panic disorder, insomnia, inappetance
risk of discontinuation syndrom and increasing chase behaviour
What is important to consider when prescribing a dopaminergic drug?
there must be 2 weeks between it and the last serotonergic drug
needs behavioural support as well
When is mirtazapine mostly prescribed?
failed response to SSRI
SSRI caused anorexia
generalised anxiety
panic
specific fear
What is Imepitoin?
partial benzodiazepine receptor antagonist
an anti-epileptic that is also used as an axiolytic (mixed evidence)
What is the onset of action of amitriptyline?
3-4 weeks
What is the onset of action of Clomipramine?
3.5 to 5 weeks
What is the onset of action of fluoxetine?
4-8 weeks
What is the onset of action of selegiline?
8-10 weeks
What is the onset of action of mirtazapine?
1.5-4 weeks
What is the onset of action of Imepitoin?
1-6 weeks
What are the main interactions with Selegiline?
SRI/SSRI/TCA
amitraz
What are the main interactions with Clomipramine?
selegiline
amitraz
What are the main interactions with fluoxetine?
selegiline
amitraz
NSAIDs (clotting)
What are the common adverse effects of SRI/SSRI/TCA?
usually seen in first 7-10 days
increased anxiety
sedation
anorexia
irritability
How can we help manage the adverse effects of SRI/SSRI/TCA?
add appetite stimulant
use anti-nausea
OR
change administration:
- morning vs night
- with a meal
- reduce dose
- switch drug
What are the signs of serotonin syndrome?
clonus
agitation
tremor
hyperreflexia
hypertonicity
hyperpyrexia
coma, death
What is the use of augmentation drugs and the common vet med ones?
when mainline drug isn’t doing what we want it to do
trazodone
alpha2adrenoreceptor agonist
gabapentin
B-adrenoreceptor antagonist (propranolol)
memantine
What is Trazodone?
serotonin receptor agonist and reuptake inhibitor
adjunct therapy for many problems but NOT aggression
short term anxiolytic
What is Clonidine?
alpha2 adrenoreceptor agonist
potential augmentation therapy with SSRIs especially for short planned events
no effect on appetite
What is Demedetomidine?
alpha2 adrenoreceptor agonist
minimal sedation, no effect on cognition
What is Propranolol?
beta adrenoreceptor blocker
useful for situational anxiety and social phobia
commonly used adjunct therapy
no effect on appetite
What is Memantine?
antagonist of glutamatergic NMDA receptors
used for tx of pain and alzheimers
improves attention and cognition
used as an augmentation for OCD
most effective with fluoxetine for compulsive behaviour
What is Gabapentin?
GABA analogue
used for pain, anxiety, acute anxiety
When would you decide to use a combination of drugs?
when onset of action of main drug is too slow or to deal with high intensity events
main drug isnt working well enough
add effect that main drug doesn’t produce
How can diet help when the main drug isn’t working well enough?
can affect efficacy
fibre level (high fiber reduces absorption)
protein:carbohydrate balance
fish oil content (DHA)
How do we evaluate if main drug isn’t working well enough?
misdiagnosis? new problem? health problem? stressors? diet change?
review response every 60 days
no effect: switch drugs
partial effect: increase dose or add drug
good effect: continue drug
How can we properly explain behavioural improvement expectations to clients?
increase monitoring and recording events
set realistic expectations for the drug
ask to evaluate key masures: % of events dog reacts to, severity of response
