Drugs Flashcards
When do we use drugs in behavior?
- Adjunct to behavioral therapy.
- To speed resolution.
- If welfare is poor (anxiety/fear/phobia).
- Drug desensitization.
- Medicate during desensitization/counterconditioning.
- Gradually reduce medication during sessions.
- It is the Vet’s responibility to decide when drugs are appropriate.
- A resolution is unlikely with behavioral modification alone.
- Urine marking.
- Compulsive disorder.
- There is an underlying pathology.
- Medical - endocrine disorders.
- Behavioral - compulsive disorders.
How does the Vet begin to select the drug?
The first choice is a drug licensed for species and condition.
- Separation anxiety in dogs (should be using brand name with this disorder):
- Clomicalm - Clomipramine
- Reconcile - Fluoxetine
- Cognitive dysfunction in dogs:
- Anipryl-Selegiline or L-deprenyl
What are the classes of drugs that are commonly used in behavioral medicine?
- Benzodiazepine
- Tricyclic antidepressents (TCA)
- Selective serotonin reuptake inhibitor (SSRI)
- Monoamine oxidase inhibitor (MAOI)
- Azapirone
- Antihistamines
Benzodiazepines: Basics
-
Action: GABA agonist
- works like GABA (normal product).
- GABA is an inhibitor of the nervous system.
- Use: Short term relief of anxiety, appetitie stimulant, induction of sleep.
-
Examples:
- diazepam (Valium)
- alprazolam (Xanax)
- clonazepam (Klonopin)
Benzodiazepines: Contraindications
- Impaired liver or kidney function.
- Hepatic necrosis in cats with diazepam.
- Food aggression!
Benzodiazepines: Side Effects
- Drug dependence and tollerance.
- Paradoxical Excitation
- NOT the expected result, if you see it switch drugs!!
- Sedation
- Lethargy
- Ataxia
- Increased appetite and affection.
NOTE: give one hour prior to desired effect. Always do a trail dose!!
Benzodiazepines: Effect of Various Doses
-
At Low Doses:
- act as a sedative.
- have a calming or soothing effect.
-
At Moderate Doses:
- act as an anxiolytic.
- relieve anxiety and reduce tension and irritability.
-
At High Doses:
- produces sleep.
Tricyclic Antidepressants (TCA): Basics
-
Action: Blocks serotonin/norepi reuptake pumps, antagonist at histamine / alpha adrenergic / muscarinic receptors.
- block = nerotrans stays in synapse.
- antagonist = blocks the function.
- Tricyclic = 3 rings and therefore more side effects than SSRI’s.
- Use: anxiety, urine marking, compulsive behavior, aggression, fears/phobias.
-
Examples:
- clomipramine (Clomicalm)
- only labeled for sep anx in dogs.
- amitriptyline (Elavil)
- not licensed for use in dogs, much older medicine.
- clomipramine (Clomicalm)
Tricyclic Antidepressants (TCA): Contraindications
- With concurrent use of
- TCA / SSRI / MAOI
- acepromazine / ketaconazole
Tricyclic Antidepressants (TCA): Side Effects
- Sedation
- Arrhythmia
- Urinary retention
- Constipation
- D/V
- Excitement
- Seizure
NOTE: may take 4-6 weeks for effect. If animal has seizure history DO NOT USE! Do not use this drug with other drug categories.
SSRI’s: Basics
- Action: Blocks reuptake of serotonin. Blocks serotonin pump, that is all it does!
- Use: anxiety, urine marking, compulstive disorders, separation anxiety, aggression, fears/phobias.
-
Examples:
- fluoxetine (Prozac, Reconcile)
- paroxetine (Paxil)
- sertraline (Zoloft)
Note: Use instead of clomipramine because no seizures.
SSRI’s: Contraindications
- Contraindicated with concurrent use of:
- TCA
- SSRI
- MAOI
SSRI’s: Side Effects
- Sedation
- Nausea
- Diarrhea
- Anxiety
- Decreased Appetite
- Tremors
- Rare Seizures
- GI Upset
NOTE: May take 4-6 weeks for effect. Less for urine marking.
What is Serotonin Syndrome?
Over-activation of central serotonin receptors.
What are the signs of Serotonin Syndrome?
- Abdominal Pain
- Diarrhea
- Sweating
- Fever
- Tachycardia
- Increased BP
- Altered mental state.
- Myoclonus
- Irritability
- Hyperpyrexia
- Cardiovascular Shock
- Death
How is Serotonin Syndrome treated?
- Discontinue all serotonergic drugs.
- Emesis if recent ingestion.
- Supportive care.
- Diazepam or lorazepam for myoclonus and hyperthermia.
- Serotonin antagonists:
- cyproheptadine
- propranolol
MAO Inhibitors: Basics
-
Action: Inhibits monoamine oxidase.
- enzyme that breaks down dopamine, norepinephrine, serotonin so increases NT
- enzymes that break down the neurotransmitter.
- Use: cognitive dysfunction, pituitary dependent hyperadrenocoticism, anxiety.
-
Examples:
- selegiline or L deprenyl (Anipryl)
- Active metabolite of selegiline
- amphetamine
- Amitraz
- found in Preventic collars.
- found in mitaban dips.
- if using tca/ssri/maoi remember to advise against use.
Note: Give to dog during the day.
MAO Inhibitors: Contraindications
- Contraindicated with concurrent use of:
- TCA
- SSRI
- MAOI
- Possible interactions with metronidazole, pred, trimeth sulfa.
Mao Inhibitors: Side Effects
- Restlessness
- Vomitting / Diarrhea
- Disorientation
- Decreased Hearing
NOTE: takes 4 weeks to see effect. Effective in 60% of dogs. LONG TERM DRUG!
Azapirones: Basics
- Action: serotonin agonist, dopamine antagonist. Blocks dopamine.
- Use: urine marking in cats, anxieties / phobias, aggression. May make cat a bully so use on subordinate not confident cat.
-
Example:
- buspirone (BuSpar)
Azapirones: Side Effects
- Uncommon
- Sedation
- Anxiety
- Increased Affection
- Increased Aggression in Cats
Anithistamines: Basics
- Action: Blocks histamine release.
- Use: car sickness, allergies, mild sedation
-
Examples:
- diphenhydramine (Benedryl)
- hydroxyzine (Atarax)
- chlorpheniramine (Chlortrimeton)
Antihistamines: Contraindications
- Concurrent use of:
- TCA
- MAOI
Antihistamines: Side Effects
- Sedation
- Urinary Retention
- Constipation
Melatonin: Basics
- Action: Binds melatonin receptors, dopamine inhibitor.
- Use: jet lag in humans, sleep disorders and fears / phobias in pets.
Melatonin: Contraindications in People
- Seizures
- Concurrent use of tranquilizers or benzodiazepines.
Melatonin: Side Effects Common in Pets
- GI Discomfort
- Hallucinations
- Panting
Neuroleptics: Basics
- Action: Dopamine antagonist, causes decreased motor movements, and decreased muscle activity.
- Uses: restraint, sedation.
-
Example:
- Acepromazine
Neuroleptics: Contraindications
- Not used alone in behavioral medicine for anxiety.
- Use benzodiazapine if need short acting medication.
- Fireworks
- Vet Visit
Neuroleptics: Side Effects
- Hypotension
- Decreased Respiratory Rate
- Bradycardia
- Penile Prolapse in Horses
What are some complimentary / alternative pharmaceuticals?
- Tryptophan
- Herbals
- Neutraceuticals
- Dietary
- Homeopathy
- Pheromones
Tryptophan: Basics
- A precursor of:
- serotonin
- Commonly used OTC in horses.
- Uncommonly used in dogs and cats.
- Only one study in pets in conjunction with diet.
- Some potential for very bad side effects!
What are some examples of Herbals that are used in pets?
- St John’s Wort
- Valerian
- Lavendar Aromatherapy
- Catnip
St John’s Wort: Basics
- Reuptake inhibitor of:
- Norepinephrine
- Serotonin
- GABA
- Dopamine
- MAO I
- As effective as fluoxetine (SSRI) in human study.
Valerian: Basics
- GABA receptor agonist.
- Inhibits reuptake and degradation of GABA.
- Increases glutamine conversion to GABA.
- Works just like GABA!
- Valerian sounds like Valium so it reacts like a benzodiazapine.
Lavender: Basics
- Action: Increases alpha brain waves for relaxation.
- Studies in:
- Swine: added to straw for transport.
- Dogs: Aromatherapy for transport. Decreased movement and barking by 20%-30%.
Catnip: Basics
- Action: Opiate agonist.
- Effect seen after: 8 weeks of age.
- Effect lasts: 15 minutes.
- Percentage of cats affected: 50% - 75%.
- Uses: reward, environmental enrichment, diversion.
Neutraceuticals: Basics
- A food or naturally occuring food supplement thought to have a beneficial effect on health.
- Milk decapeptide (alpha-casozepine, Zylkene) for anxiety in dogs and cats.
- Commonly used in cognitive dystunction.
- Ginkgo
- Phosphatidylserine
- Choline
- Phosphatidylcholine
-
Examples:
- senilife, proneurozone, geriactive.
Dietary: Basics
- Hill’s b/d
- vitamins E & C, other antioxidants including beta carotene, selenium, dlalpha-lipoic acid and a number of flavonoids and carotenoids, l-carnitine, and dl-alpha-lipoic, omega 3 fatty acids.
Homeopathy: Basics
- Like treats like.
- method of tx dz by drugs, given in minute doses, that would produce in healthy patient symptoms similar to those of the dz.
- The more dilute, the more effective they are believed to be.
- Likely to be safe.
- Placebo effect?
Pheromone Products: Basics
- Any chemical substance released by an animal that influcences physiology or behavior of other members of the same species.
-
Examples:
- EAP
- DAP
- Feliway
What are the ethical uses of pharmaceuticals?
- Imperative that there is a valid diagnosis.
- Needs to be part of comprehensive treatment plan.
- NO QUICK FIX
- Breeding animals.
Conclusions
- Pharmaceuticals can be helpful but are NEVER the only treatment for problem behaviors.
- Make sure owner understand all ramifications of drug use - good communication imperative.
- Chose cases and drugs carefully.
