Behaviour Modifying Drugs Flashcards
What are six licensed, first line, behaviour modifying drugs?
FIMSCA- Fluoxetine, Imepitoin, Mirtazapine, Selegiline, Clomipramine, Amitriptyline
Which first line, behaviour modifying drug is unlicensed in animals?
Sertraline
What do these drugs have in common- Amitriptyline, Clomipramine and Fluoxetine?
they’re all serotonergic drugs- they inhibit serotonin reuptake and act as agonists for histamine, acetylcholine and alpha adreno receptors
How does Amitriptyline work?
acts mainly as a noradrenaline reuptake inhibitor rather than serotonin- commonly used for anxiety in cats and pain in UTI’s
Is Amitriptyline commonly used by vets? If not why?
No- has a poor side effect profile
What is the seratonin- noradrenaline inhibition ratio of Clomipramine?
4:1
When is Clomipramine indicated?
In patients with anxiety and compulsion (helps with impulse control)
When is Clomipramine contraindicated?
In animals prone to discontinuation syndrome- when stopped abruptly can increase/ worsen anxiety
What is the serotonin- noradrenaline inhibition ratio of Fluoxetine?
SRI: NRI = 15:1
[basically a selective serotonin reuptake inhibitor]
Which of the serotonergic drugs is the most favoured?
Fluoxetine more favoured than Clomipramine
Clomipramine more favoured than Amitriptyline
What is Fluoxetine commonly used to treat?
anxiety, compulsion, impulsiveness and aggression
What are common side effects of Fluoxetine?
Anorexia & Motion Sickness
What do Selegline, Mirtrazapine and Imepitoin have in common?
They’re all dopaminergic drugs (block the enzyme that breaks down dopamine)
When is Selegiline contraindicated?
CANNOT be given at the same time as a serotonergic drug as it also has effects on the serotonin neurotransmitters- can cause serotonin syndrome
What is Selegiline used for?
Cognitive impairment, specific fears e.g. Fireworks
What is a negative behavioural side effect of Selegiline and how do we combat this?
Can cause assertiveness and confrontation with fear- needs to be combined with training
How does Selegiline work?
Monoamine oxidase B inhibitor
Mirtazapine increases an individuals …
motivation- making reinforcement easier
What disorders is Mirtazapine usually used for?
anxiety disorder, social anxiety, OCD, panic disorder, insomnia and inappetence
What is a possible behavioural side effect from the use of Mirtazapine?
Can increase chase behaviour in dogs
When is Mirtazapine indicated?
In a failed response to SSRI’s or in cases of SSRI induced anorexia
What does Imepitoin agonise?
its a partial benzodiazepine receptor agonist
What is Imepitoin commonly used for?
commonly used as an anti-epileptic drug but recent trials testing it for anxiety
What are the clinical signs of serotonin syndrome?
Clonus ((Involuntary, rhythmic muscular contractions and relaxations)
Tremors
Hyperreflexia (overreactive responses)
Hyperpyrexia
What are augmentation drugs?
drugs that we wouldn’t use by themselves but may add in if our mainline drug is not producing the effects we want
What are the 5 augmentation drugs used?
MAT GB
Memantine, Alpha2adrenoreceptor agonists, Trazadone, Gabapentin, Beta adrenoreceptor antagonists
What receptors does Trazadone work on?
serotonin receptor agonist & reuptake inhibitor
What is Trazadone used for?
Used for dogs with noise phobia but NOT aggression
Can also be used as a short term anxiolytic e.g. Before vet visits, car rides- but more sedation effects rather than anti anxiety
What are the two types of alpha 2 adrenoreceptor agonists available for augmentation?
Clonidine
Dexmedetomidine
Give an example of a beta adrenoreceptor blocker?
Propanolol
What are beta adrenoreceptor agonists good for?
Useful for situational anxiety and social phobia
Commonly used in adjunct therapy with SSRI’s in people
What is Memantine used for?
Treatment of pain & Alzheimer’s but overall improves attention and cognition
Also used in people with OCD with SSRI’s
What’s a common side effect of Memantine and how do we combat this?
Commonly causes nausea- low doses are recommended and then titrate to effect
What is Gabapentin used for?
pain relief, anxiety and acute anxiety in cats
Why is Gabapentin not commonly used?
Dosage is every 8 hours which can be inconvenient for owners away from their pets
What are the three reasons as to why we would use augmentation/ combinations of drugs?
i. When the onset of action of the main drug is too slow, or to deal with high intensity events
ii. The main drug isn’t working well enough
iii. To add an effect that the main drug doesn’t produce
