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BVetMed - Animal Behaviour > Psychopharmacological agents used in practice > Flashcards

Psychopharmacological agents used in practice Flashcards

1
Q

When would drug therapy be advocated?

A
  • Behavioural response extreme and well established
  • Difficult to start any form of behavioural therapy due to response at a low threshold
  • Strong ‘organic’ component (eg. neuro pathologies)
  • Rapid changes are needed for client compliance/motivation
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2
Q

What 3 things should be considered when thinking about drug use?

A

Possible side effects/costs/risk of misuse v pros.
Owner aware that drugs are an adjunct not alternative?
Non-specific action of drugs -> Disinhibitoin risk?

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3
Q

Why is off-label drug usage common with behavioural drugs?

A

Few licensed in the species we need them for.

  • ensure sufficient quality scientific evidence to support use
  • ensure owner has given informed written consent
  • use in accordance with published guidelines
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4
Q

What are the six main NTs behavioural drugs will work on?

A 
Ach (Achetylcholine)
DA (Dopamine)
NA (Noradrenaline)
GABA (Gama-aminobutyric acid)
5-HT (Serotonin) 
Melatonin
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5
Q

List the 8 classes of anxiolytic drug

A 
Benzodiazepenes 
B Blockers
Azapirones
Barbituates 
Antihistamines
Tri-Cyclic Antidepressants (TCAs)
Selective serotonin reuptake inhibitors 
Monoamine oxidase inhibitors
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6
Q

List the anxiolytic medications useful for SHORT TERM use.

A
  • Benzodiazepenes (Diazepam, Alprazolam)

- B Blockers (Propanolol)

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7
Q

List the anxiolytic medications useful for LONG TERM use.

A
  • Azapirones (Buspirone)
  • TCAs (Amytriptaline, clomipramine (Clomicalm), Imipramine, Doxepin, Desiprsamine, Nortriptyline
  • SSRIs (Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), Citalopram, Fluvoxamine)
  • MAO inhibitors (Selegiline, MAO-B inhibitor)
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8
Q

What is another name for Diazepam? What is it commonly used for?

A

Valium

Seizure medication in dogs and cats

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9
Q

What is the main effect of the benzodiazepines?

A

Facilitate the INHIBITORY effect of GABA in the CNS -> dampen excitation in the brain

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10
Q

Why are benzodiazepines well formulated to affect the CNS? What repercussions does this have?

A

They are highly lipophilic.
Pharmacokinetics/dynamics affected depending on obesity level of dog
- fat dog -> absorption and slow release
- skinny dog -> rapid ^conc and then vconc

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11
Q

What side effects are associated with benzodiazepines and how soon is their onset?

A

Very quick onset

  • sedation
  • ataxia
  • mm relaxation
  • ^apetite esp in cats
  • paradoxical excitement in 10-20% cases
  • memory deficits
  • hepatic necrosis in cats (rare)
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12
Q

Why are benzodiazepines not good to give in conduction with behaviour therapy?

A

Block consolidation of memory so will not learn new things

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13
Q

How might these effects change with time?

A

Tolerance to sedation and ataxia after a few days

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14
Q

How can these side effects be predicted?

A

Give test doses to evaluate reaction

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15
Q

What are benzodiazepines useful for in behavioural medicine?

A

Anxiolytic

Amnesic if given ~1 hour before event

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16
Q

What are the potential problems associated with benzo use?

A 
Disinhibition of aggression 
Interference with learning 
Risk of fatal liver failure in cats 
Human abuse potential 
Addictive properties/dependence 
Teratogenic properties 
Drug interactions
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17
Q

How should benzos be stopped?

A

Gradually

- suddenly stopping -> recurrence, extreme nervousness, seizures

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18
Q

What is the half life of diazepam in dogs?

A

Hours (v short)

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19
Q

What is the greatest risk associated with the use of diazepam in cats? Other risks?

A

Hepatic necrosis
Reduced depth perception (do not let outside!)
Apetite stimulant

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20
Q

What is the efficacy of diazepam like?

A

Varied - dose adjusted to effect

Sometimes dose required causes unacceptable level of ataxia

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21
Q

How does alprazolam compare to diazepam?

A

Higher potency
Better retrograde amnesia (NB: no anxiolytic effect until given obviously)
Longer half life - 12 hrs, peak levels in 1-2hrs
Increased friendliness in cats (but still loss of depth perception and ataxia)

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22
Q

How do B-blockers work?

A

Selective blocking of b1 and/or b2 adrenergic receptors in myocardium, bronchi and vascular smooth muscle
Reduced sympathetic response in a fearful situation -> v feeling of anxiety feedback loop
Possibly also central activity

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23
Q

When would B-Blockers be useful in a behavioural therapy programme?

A

When animal is too hyper-reactive to even begin training.

Only mild anxiolytics but no cognitive impairment

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24
Q

What are the potential side effects of B-blockers?

A 
Bradicardia
Hypotension
Lethargy
Depression
Hypoglycaemia 
Bronchoconstriction 
Syncope 
Diarrhoea
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25
Q

What is syncope?

A

Fainting

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26
Q

Where are B-blockers contra-indicated?

A

Hypotension
Heart failure
Bronchospastic disease
Bradycardia

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27
Q

What type of drug is Propanolol?

A

Non-selective B-blocker (b1+b2)

Metabolised in liver

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28
Q

What is the half life of propanolol in dogs?

A

0.77-2hours

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29
Q

What four mechanisms of actions do azapirones have?

A

Serotonergic, noradrenergic, dopaminergic and cholinergic

“Dirty”

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30
Q

What is the only azapirone used in behavioural therapy?

A

Buspirone

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31
Q

What is buspirone’s main mechanism of action?

A

Partial 5-HT1a agonist at PRE and POST synaptic receptors.

Mixed ag/ant properties on DA receptors

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32
Q

How is buspirone excreted?

A

Inactive metabolite in the urine

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33
Q

Why will buspirone have varying effects in individual animals?

A

As it acts on PRE and POST synaptic receptors, effects will depend on number of receptors in individual animal.

  • if more PRE synaptic receptors to be affected, will DEcrease activity
  • if more POST synaptic receptors to be affected, will INcrease activity
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34
Q

How and why do effects of buspirone differ in the short and long term?

A

Short term: ^ likelihood of 5-HT impulses

Long term: Downregulation of post synaptic receptors -> v likelihood of 5-HT impulses

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35
Q

How commonly is buspirone used?

A

RARELY

  • some success reported in feline spraying but high relapse rate, no placebo controlled trials
  • poor efficacy in specific fears
36
Q

How quickly does Buspirone act?

A

Slow onset of action (1-3 weeks)

Short half life - BID/TID

37
Q

What are the side effects of buspirone?

A

GI disturbance, irritability, ^aggression, paradoxical excitability, humans - headaches, dizziness, insomnia, bradycardia, cramps, stereotypic behaviours

38
Q

What makes buspirone a good choice of drug? (despite not commonly used)

A

Wide safety margin
No sedative/hypotic effect
No withdrawal phenomenon
No abuse potential

39
Q

Give examples of TCAs

A 
Amitryptaline 
Clomipramine (licensed for dogs)
Imipramine 
Doxepin 
Desipresamine 
Noritryptaline
40
Q

How do TCAs work?

A

Block reuptake of 5HT and NA (different compounds block each to a different degree)
- Most have active metabolites

41
Q

Which behaviour problems are TCAs advocated for?

A

Wide variety - compulsive disorders, separation anxiety, urine marking

42
Q

How long does it take for TCAs to reach therapeutic levels?

A

Long time - 2-4 weeks

43
Q

What are the side effects of TCAs and when do they begin?

A

RAPID ONSET (despite therapeutic action slow onset)

  • mild transient sedation
  • Anticholinergic effects (urinary retention, constipation, dry mouth)
  • Antihistiminic effects - Hypotension, motor incoordination, cardiac conduction disturbance (in healthy animals this is not pathological), agranulocytosis (rare)
44
Q

When may the antihistaminic effects of TCAs be useful? Which TCA is particularly antihistaminic?

A

Itching/scratching based problems
Cystitus
- amytriptaline good

45
Q

Which two drugs should NEVER be given together?

A

Clomipramine and Selegeline

  • inexact with MAObs -> SEROTONIN SYNDROME
  • hyperthermia, rigidity, myoclonus, confusion, delerium, coma - fatal
46
Q

What conditions are TCAs contraindicated for?

A 
Heart disease
Hypertension
Hypothyroidism 
Epilepsy (lowers seizure threshold) 
Concurrent use with MAOBs 
Other potential problems
- bitter taste
- potential for human misuse 
- OD fatal with no antidote
47
Q

When is amitryptaline usually used?

A

Greater NA and H1/2 effects required

  • FLUTD (although beware urine retention due to Anticholinergic side effects)
  • Pyschogenic alopenia
  • ALD in dogs
48
Q

What is the most common use of Clomipramine?

A

Clomicalm - licensed for separation anxiety in dogs
- multi centre, palcebo controlled, blinded trial
- Main effect 5HT
> used in cats off label but tolerated less well than dogs, side effects worse and more variable

49
Q

Give examples of` SSRIs

A 
Fluoxetine (Prozac)
Paroxetine (Paxil) 
Sertraline (Zoloft)
Citaloproam
Fluvoxamine (also NA effects -> anxiety)
50
Q

What are SSRIs most commonly used for?

A

Fear responses - sudden, immediate and unconsidered, sometimes anxiety
sometimes compulsive disorders

51
Q

Which response is NA responsible for?

A

Panic/stress

52
Q

What is serotonins role?

A

Anti depressive, antianxiety

53
Q

What is the time until therapeutic onset of SSRIs?

A

Long - 3/4 weeks

54
Q

What may occur with short term SSRI use?

A

^anxiety due to v 5HT (negative feedback of serotinergic auto receptors)
with longterm use v anxiety due to receptor (up?) regulation and ^ [5HT]

55
Q

How may the initial antigenic properties of SSRIs be combatted?

A

Short course benzodiazepenes

56
Q

Where other than the CNS are serotinergic pathways found? How does this impact side effects?

A

The gut
-GI irritability
(can be reduced by gradual increase of dose)

57
Q

What other side effects of SSRIs?

A

Insomnia, sedation, potential for human misuse

58
Q

Which SSRI is licensed for separation anxiety?

A

Fluoxetine “Reconcile” (USA)
- long half life active metabolite
- rapid onset side effects
>GI irritation, inappetance , lethargy, nervousness

59
Q

What kind of molecule are all NTs?

A

Monoamines

60
Q

How do MAO inhibitors work?

A

Prevent mono amine oxidase working to break down generalised NTs in synaptic clefts -> ^[NT]
- NTs include NA, Adrenaline, DA, 5HT, tyramine

61
Q

What are the 2 different forms of MAO inhibitors?

A

MAO a - inhibtis all monoamines, has dietary requirements - no tyramine containing foods (not used in dogs therefore)
MAO b - inhibits all monoamines except 5HT, NO dietary requirements

62
Q

Give an example of a MAOb inhibitor. Is it licensed?

A

Selegeline

  • licensed in Europe (disorders of emotional origin) and USA(cognitive dysfunction=alzheimers)- different purposes
  • some evidence of neuroprotective effect
63
Q

What should Selegeline never be given in conjunction with?

A

SSRIs, TCAs or St Johns Wort- Serotonin syndrome can be fatal
Remember long half life (20d!)

64
Q

Give 4 antipsychotics/neuroleptics (=tranquillisers/anti-scizophrenics)

A

ACP (acepromazine)
Chlorpromazine
Haloperidol (parrots feather plucking, lots of side effects)
Risperidone

65
Q

How do antipsychotics work?

A

Block DA receptors (and newer compounds may also have 5HT antag)

66
Q

Are antipyschotics used regularly in animals?

A

No because of side effects

Although still used a bit in Europe

67
Q

What are the side effects of antipsychotics?

A

^PRL (-> milk production)
Seizures
Sedatino and anticholinergic effects
Extra-pyramidal symptoms eg. muscle tremor (due to blocking of DA receptors in basal nuclei, controlling motor function) - seen more in high potency neuroleptics eg. haloperidol

68
Q

Give some examples of low potency antipsychotics

A

Chlorpromazine, acepromazine

- low specificity, hence many side effects

69
Q

Give some examples of high potency antipsychotics

A

Haloperidol, azaperone (eg. Suicalm, give to pigs before mixing)

  • more specific
  • less sedation but greater risk of extra-pyramidal effects
70
Q

Give some examples of atypical neuroleptics/antipsychotics

A

Clozapine, ripseridone

- newer, potentially better, less side effects

71
Q

Is ACP recommended for tranquillising anxious animals?

A

NO - provides motor sedation but no anxiolytic effect

72
Q

Give some examples of anticonvulsants

A

RARELY USED (Antiepileptics)

  • Phenobarbitone (Epiphen)
  • Phenytoin (Epanutin)
  • Primidone (Mysolene)
  • Carbamazepine (Tegretol)
73
Q

When may carbamazepine be used?

A

Peripheral sensory neuropathy/ectopic firing

eg. Burmese cats with facial pain where scratching -> neuralgia
- erratic absorption so best administered with food

74
Q

What types of partial seizures are possible?

A

Anywhere in the brain eg. visual (fly snapping)
Motor/central brain (absent seizure)
Amygdala/limbic system (sudden emotional response/jump up)

75
Q

Which drug is advocated for use with motor partial seizures? What must be wary of?

A

Phenobarbitone
(used to be used more widely but effect due to sedation only)
- regular blood monitoring to check hepatotoxicity

76
Q

What is the action of Phenytoin?

A

Reduces spread of focal seizures

- used extensively in humans

77
Q

How does the pharmacokinetics of phenytoin differ in cats and dogs?

A

Dogs - metabolised very rapidly, high and frequent dosing needed
Cats - metabolised slowly, problems with toxicity

78
Q

What is the effect of progestagens?

A

Anti-testosterone, secondary sedative effect - non-specific

79
Q

Are progestagens advocated? What are the side effects?

A 
NO
common and severe side effects 
- ^apetetie, weight gain 
- hyperglyceamia
- diabetes
- lethargy
- poor cognitive function
- mammry hyperplasia
- adencarcinoma (mammary)
- endometrial hyperplasia
- pyometra
- aspermatogensis
- adrenocroticol supression
- bone marrow suppression
-retinal detachment
80
Q

Are progestagens licensed?

A

Yes unfortunately

  • dogs
  • also advocated for use in cats
  • sometimes used to test for effect of castration
  • > beware secondary sedative effect which may mean castration doesnt have same impact
  • testosterone driven tumours may shrink with progestagen use - if this proves true then castration will hope treat tumour
81
Q

Give 4 treatments of age related changes

A
  1. selegeline
  2. A antag
  3. Xanthine derivative
  4. Dietary intervention
82
Q

Give a common drug combination

A

Benzodiazepenes and TCAs to manage acute episodes in dogs

83
Q

What does polypharmacy increase the risk of?

A

Side effects and problems with long term use

84
Q

What should be carried out throughout pharmacological treatment?

A

Blood monitoring (prior to starting medication swell to check for normal levels)

85
Q

Can off label drugs be used?

A

Yes providing informed consent is given

BVetMed - Animal Behaviour (35 decks)

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