Behaviour Modifying Drugs

Question 1

What are six licensed, first line, behaviour modifying drugs?

Answer 1

FIMSCA- Fluoxetine, Imepitoin, Mirtazapine, Selegiline, Clomipramine, Amitriptyline

Question 2

Which first line, behaviour modifying drug is unlicensed in animals?

Answer 2

Sertraline

Question 3

What do these drugs have in common- Amitriptyline, Clomipramine and Fluoxetine?

Answer 3

they’re all serotonergic drugs- they inhibit serotonin reuptake and act as agonists for histamine, acetylcholine and alpha adreno receptors

Question 4

How does Amitriptyline work?

Answer 4

acts mainly as a noradrenaline reuptake inhibitor rather than serotonin- commonly used for anxiety in cats and pain in UTI’s

Question 5

Is Amitriptyline commonly used by vets? If not why?

Answer 5

No- has a poor side effect profile

Question 6

What is the seratonin- noradrenaline inhibition ratio of Clomipramine?

Answer 6

4:1

Question 7

When is Clomipramine indicated?

Answer 7

In patients with anxiety and compulsion (helps with impulse control)

Question 8

When is Clomipramine contraindicated?

Answer 8

In animals prone to discontinuation syndrome- when stopped abruptly can increase/ worsen anxiety

Question 9

What is the serotonin- noradrenaline inhibition ratio of Fluoxetine?

Answer 9

SRI: NRI = 15:1
[basically a selective serotonin reuptake inhibitor]

Question 10

Which of the serotonergic drugs is the most favoured?

Answer 10

Fluoxetine more favoured than Clomipramine
Clomipramine more favoured than Amitriptyline

Question 11

What is Fluoxetine commonly used to treat?

Answer 11

anxiety, compulsion, impulsiveness and aggression

Question 12

What are common side effects of Fluoxetine?

Answer 12

Anorexia & Motion Sickness

Question 13

What do Selegline, Mirtrazapine and Imepitoin have in common?

Answer 13

They’re all dopaminergic drugs (block the enzyme that breaks down dopamine)

Question 14

When is Selegiline contraindicated?

Answer 14

CANNOT be given at the same time as a serotonergic drug as it also has effects on the serotonin neurotransmitters- can cause serotonin syndrome

Question 15

What is Selegiline used for?

Answer 15

Cognitive impairment, specific fears e.g. Fireworks

Question 16

What is a negative behavioural side effect of Selegiline and how do we combat this?

Answer 16

Can cause assertiveness and confrontation with fear- needs to be combined with training

Question 17

How does Selegiline work?

Answer 17

Monoamine oxidase B inhibitor

Question 18

Mirtazapine increases an individuals …

Answer 18

motivation- making reinforcement easier

Question 19

What disorders is Mirtazapine usually used for?

Answer 19

anxiety disorder, social anxiety, OCD, panic disorder, insomnia and inappetence

Question 20

What is a possible behavioural side effect from the use of Mirtazapine?

Answer 20

Can increase chase behaviour in dogs

Question 21

When is Mirtazapine indicated?

Answer 21

In a failed response to SSRI’s or in cases of SSRI induced anorexia

Question 22

What does Imepitoin agonise?

Answer 22

its a partial benzodiazepine receptor agonist

Question 23

What is Imepitoin commonly used for?

Answer 23

commonly used as an anti-epileptic drug but recent trials testing it for anxiety

Question 24

What are the clinical signs of serotonin syndrome?

Answer 24

Clonus ((Involuntary, rhythmic muscular contractions and relaxations)
Tremors
Hyperreflexia (overreactive responses)
Hyperpyrexia

Question 25

What are augmentation drugs?

Answer 25

drugs that we wouldn’t use by themselves but may add in if our mainline drug is not producing the effects we want

Question 26

What are the 5 augmentation drugs used?

Answer 26

MAT GB
Memantine, Alpha2adrenoreceptor agonists, Trazadone, Gabapentin, Beta adrenoreceptor antagonists

Question 27

What receptors does Trazadone work on?

Answer 27

serotonin receptor agonist & reuptake inhibitor

Question 28

What is Trazadone used for?

Answer 28

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

Question 29

What are the two types of alpha 2 adrenoreceptor agonists available for augmentation?

Answer 29

Clonidine
Dexmedetomidine

Question 30

Give an example of a beta adrenoreceptor blocker?

Answer 30

Propanolol

Question 31

What are beta adrenoreceptor agonists good for?

Answer 31

Useful for situational anxiety and social phobia
Commonly used in adjunct therapy with SSRI’s in people

Question 32

What is Memantine used for?

Answer 32

Treatment of pain & Alzheimer’s but overall improves attention and cognition
Also used in people with OCD with SSRI’s

Question 33

What’s a common side effect of Memantine and how do we combat this?

Answer 33

Commonly causes nausea- low doses are recommended and then titrate to effect

Question 34

What is Gabapentin used for?

Answer 34

pain relief, anxiety and acute anxiety in cats

Question 35

Why is Gabapentin not commonly used?

Answer 35

Dosage is every 8 hours which can be inconvenient for owners away from their pets

Question 36

What are the three reasons as to why we would use augmentation/ combinations of drugs?

Answer 36

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