Psychopharmacology Flashcards
Why do we use behavior drugs?*
- If the animal is too scared and anxious, they are not very teachable or able to learn new coping skills
Common Classes of Behavior Management Drugs
- Tricyclic Antidepressancts (TCAs)
- Selective Seratonin Reuptake Inhibitors (SSRIs)
- Sertonin (5-HT) Agonists
- Monoamine Oxidase Inhibitors (MAOIs)
- Phenothiazines
- Benzodiazepines
- Seratonin Antagonist and Reuptake Inhibitors (SARI)
- GABA receptor partial agonist
- Alpha-2 Adrenergic Agonist
- Synthetic Opioid, Opioid Partial Agonist
- Opiate Patial Agonist
- NMDA-Receptor Agonist
Most Common Long-Acting Medications
- Clomipramine
- Amitriptyline
- Fluoxetine
- Buspirone
- Selegiline
Most Common Short-Acting Medications
- Acepromazine
- Alprazolam
- Trazodone
- Gabapentin
- Dexmedetomidine
- Butorphnol
- Buprenorphine
- Ketamine
- Diazepam
- Clonidine
- Imepitoin (Pexion)
Drug Monitoring
- It is good practice to perform a baseline CBC, chemistry profile, +/- urinalysis prior to starting any long-term medication and periodically (every 6-12 months) thereafter
- Baseline ECGs, Blook pressure, thyroid testing, etc. may be indicated for some drugs as well
- Screening depends on possible adverse effects
Serotonin Syndrome
- a drug-induced syndrome due to elevated serotonin levels in the CNS
- Common Canine Clinical Signs:
- Vomiting
- Diarrhea
- Seizures
- Hyperthermia
- Hyperesthesia
- Depression
- Mydriasis
- Vocalization
- Death
- Blindness
- Hypersalivation
- Dyspnea
- Ataxia/paresis
- Disorientation
- Hyperreflexia
- Coma
Common Causes of Serotonin Syndrome
- Dextromethorphan (cough suppressent - Kennel cough treatment)
- Mirtazapine (appetite stimulant)
- Monoamine Oxidase Inhibitors (Selegiline, Amitraz)
- Opioids (Buprenorphine, Butorphanlol, fentanyl, methadone, morphine)
- Selective Serotonin Reuptake Inhibtor (Fluoxetine, Paroxetine, Sertaline)
- Tramadol (pain medication)
- Trazodone
- TCAs (Clomipramine, Amitrytpyline)
- Nutraceuticals (L-tryptophane (turkey), SAM-e)
- Linezolid
- Meperidine
Tricyclic Anidepressants (TCAs)
- Increases seratonin and Norepinephrine
- affect other neurochemicals involved in emotional reactivity
- Common for Dogs:
- Amitriptyline (Elavil, Tryptanol)
- Clomipramine (Clomicalm, Anafranil)
- Imipramine (Antideprin, Deprenil)
- Desipramine (Norpramin, Pertofrane)
- Nortriptyline (Sensoval)
- Doxepin (Aponal)
Clomipramine HCL
Clomicalm, Anafranil
- Class: TCAs
- Use:
-
Labled:
- Dogs - Seperation Anxiety
-
Extra label:
- Dogs - Compulsiv disorders and noise phobias
- Cats - Spraying
-
Labled:
- FDA approved Dogs
- Axiolytic
- Non-analgesic
- Administration: PO +/- food
- Slow onset, several weeks for full effects
- Won’t work for immediate events
Amatryptyline
- Class: TCAs
- Use: Antidepressant, Antipruritic, Neuropathic Pain Modifier
- Dogs: Seperation anxiety, generalized anxiety, pruritis
- Cats: Excessive grooming, spraying, pica
- Not FDA approved
- Anxiolytic
- Analgesic - chronic neuropathic pain
- Administration: PO with food for absorption
- Slow onset, several weeks for full effect
TCAs Contraindications
-
Do NOT use concurrently or within 14 days with MAOIs
- (selegiline or amitraz, including collars (Flea/tick)and demodex dip)
-
Contraindicated with history of seizures
- or with drugs that lower seizure thershold
- Use cautiously if hyperthyroid or with thyroid supplementation
- hyperthyroidic itself, make underlying issue worse, double up on meds
- Use with caution in animals with decreased GI motility, urinaty retention, cardiovascular disease, narrow angle glaucoma, or increased intraocular pressure
- Taper off slowly to minimize withdrawal
TCAs Adverse Drug Reactions
- Risk of Seratonin Syndrome
- Clonidine
- may increase bp
- Enalapril
- clomipramine toxicity
- Levothyroxine
- increases therapeutic and toxic effects of both levothyroxime and clomipramine
- NSAIDS
- increased risk for bleeding
TCAs Adverse Effects
- Can occur early on before therapeutic effects are observed
- Dogs:
- anorexia, emesis, diarreha
- dry mouth, elevation of liver enzymes, sedation/lethargy/depression
- Cats:
- Anticholinergic effects (dry mouth, mydriasis, urine retention, constipation)
- Sedation, diarrhea
-
more susceptible
- slower elimination of active metabolite
Fluoxetine
Prozac, Reconcile
- Class: SSRI
- Highly selective inhibitor or the presynaptic reuptake of serotonin
- Use:
- Dog: Seperation anxiety, stereotypic behaviors, compulsive behaviors agreesion, axiety
- Cats: steriotypic behaviors, compulsive behaviors, inappropriate elimination, aggression, anxiety
- FDA approved (dogs)
-
Anxiolytic and anti-compulsive
- decreases reactivity
- Administration: PO, +/- food
- Slow onset, weeks to months
- Taper off 3-5 weeks when used long term
Fluoxetine Contradindications
-
Caution when using in animals with
- Diabetes melitus
- seizure disorders
Fluoxetine Drug Interactions
-
Seratonin Syndrome
- Tramadol, Trazadone, St. John’s Wort, Clomipramine, amitriptyline, bussiprone, Isoniazid
-
MAOIs: long wash-out period
- Amitraz, selegiline
- 6 week washout after fluoxitine discontinued
- 2 week washout after MAOI discontinued
- NSAIDS, Aspirin
- may increase risk for GI ulceration and bleeding
Fluoxitine Adverse Effects
-
Dogs:
- Anorexia, Lethargy, GI effects
- anxiety, irritability, insomnia, hyperactivity, panting, agression
-
Cats:
-
Behavior changes
- anxiety, irritability, sleep disturbances, anorexia, changes in elimination paterns
-
Behavior changes
Buspirone HCL
Buspar
- Class: Seratonin (5-HT) Agonist and Agonist/Antagionist of Dopamine (D2) Receptors
- Use: Anxioselective agent
- Dogs: phobias, especially social interaction phobias
- Cats: phobias, especially social interactions, Spraying, intercat aggression, psychogenic alopecia, motion sickness
- 50% show improvement in spraying
- More effective in multicat households
- Not FDA approved
- Anxiolytic
- Non-analgesic
- Administration: PO, +/- food
- Slow, 7-30 days
- Often combined with TCAs and SSRIs
Buspirone HCL Contraindications
- Should not be used as the sole therapy for situational anxieties due to slow onset
- Caution with aggressive animals
- may blunt disinhibitory neural processes (worsen aggression)
-
Treated cats tend to be more outgoing and less anxious but are still treated as victims by other cats
- may lead to agonistic encounters (cat fights)
Busprione HCL Drug Interactions
- Many
- MAOIs
- L-tryptophan
- possible interference with thyrod medication in cats
Buspirone HCL Adverse Effects
- Usually minimal
- Dogs:
- Sleep disturbances, restlessness, loss of appetite
- Cats:
- Bradycardia/tachycardia, nervousnes, GI disturbances, stereotypic behaviors, increased affection
- Increased assertiveness and aggression
- best to use on victim
Selegiline HCL
L-deprenyl, Anipryl, Eldepryl
- Class: MAO-B inhibitor, MAOI
- Increases dopamine levels
- Use:
- Dogs: Canine cognitive dysfunction syndrome (CDS)
- Chronic anxiety
- Combined with benzodiazepine and a beta blocker to treat social or noise phobias
- Cats: Cognitive dysfunction
- Dogs: Canine cognitive dysfunction syndrome (CDS)
- FDA approved for Dogs
- Anxiolytic
- Non-analgesic
- Administration: PO, +/- food
- Slow onset, several weeks
Selegiline HCL Contraindications/DrugInteractions
- Contraindicated with meperidine or TRAMADOL
- Do NOT us concurrently with TCAs, SSRI, or Alpha-2 agonist
- 14 day washout after discontinuing selegiline
- 5 week washout after discontinuing Fluoxitine
- Do NOT use concurrently with another MAOI
- Do NOT administer 1 day prior or post anesthesia or tranquilization with a alpha-2 agonist (dexdom)
Selegiline HCL Adverse Effects
- Dogs:
-
Vomiting, diarrhea, CNS effects
- restlessness, disorientation, agression, repetative movement, lethargy , salivation, anorexia, diminished hearing/deafness, pruritis, licking, shivers/trembles/shakes
- Observe animals carefully
- Best given in morning - stimulant can make agitation worsen
- May cause increased agression
- Not recommended for treatment of aggression
-
Vomiting, diarrhea, CNS effects