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Drugs > Trazodone > Flashcards

Trazodone Flashcards

1
Q

How often does anxiety occur in humans in ICU?

A

85%

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2
Q

Name 2 indication of trazodone?

A
  • anxiety
  • calmer environment for other patients
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3
Q

Name 2 routes of administration for trazodone?

A
  • PO
  • PR
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4
Q

What were the main findings of Gruen ME et al in JAVMA 2014 “Use of trazodone to facilitate postsurgical confinement in dogs”?

A
  • 89% of owners reported that trazodone had a moderate or extremely positive effect on their dog’s tolerance of confinement or level of calmness when trazodone was administered at dosages from 3.5 to 10 mg/kg every 8–12 hours.
  • trazodone worked promptly between 30 and 45 minutes following oral administration (owners report)
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5
Q

What were the findings of Orlando et al JFMS in 2015 “Use of oral trazodone for sedation in cats: a pilot study”?

A
  • 100 mg/cat of trazodone significantly reduced signs of transport and examination-related anxiety
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6
Q

What effects did trazodone have on echocardiographic and hemodynamic variables in healthy cats according to Fries RC et al in JFMS in 2018?

A
  • 50 mg per cat did not alter echocardiographic variables in a clinically relevant manner
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7
Q

What are trazodone’s mechanisms of action?

A
  • 5-HT2A and 5-HT2C antagonist
  • inhibits both the serotonin transporter + serotonin type 2 receptor –> inhibition of the reuptake of serotonin + induces changes in the presynaptic 5-HT receptor –> down regulation of the 5-HT receptor
  • blocks histamine H1 receptors
  • blocks alpha-1 adrenergic receptors (hypnotic and sedative effects?)
  • blocks T-type calcium channels
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8
Q

Name 3 side effects of trazodone and how often they occur?

A
  • vomiting
  • nausea
  • diarrhoea

< 1% of dogs in a retrospective study (Jay AR et al in Am J Vet Res 2013)

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9
Q

Name x side effects of trazodone?

A
  • vomiting
  • nausea
  • diarrhoea
  • ataxia
  • sedation
  • hypotension through vasodilation
  • transient tachycardia (IV + PO)
  • idiosyncratic reactions such as aggression, excitement, and behavior disinhibition (mainly if given IV; not seen in PO)

In people many of these signs are attributed to trazodone’s primary metabolite metachlorophenylpiperazine

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10
Q

Name trazodone’s primary metabolite in people?

A

metachlorophenylpiperazine

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11
Q

Name one relative contraindication for trazodone and discuss why?

A

Glaucoma: trazodone may dilate the pupils, which can trigger an acute crisis

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12
Q

How is trazodone metabolised?

A

hepatic metabolism

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13
Q

Discuss important interactions of trazodone with other drugs?

A

concurrent administration with CYP inhibitors (e.g. azole antifungals, macrolide antibiotics, phenothiazines) may lead to increased plasma concentrations of trazodone

concurrent administration of trazodone and digoxin in people leads to increased plasma concentrations of digoxin (not been shown in dogs)

cisapride, ondansetron, and fluoroquinolones: QT prolongation

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14
Q

Name 8 drugs that may increase the risk of serotonin syndrome, if trazodone is administered concurrently?

A
  1. Linezolid
  2. Methylene blue
  3. Monoamine oxidase inhibitors
  4. Metoclopramide
  5. SSRI antidepressants
  6. Tricyclic antidepressants
  7. Fentanyl
  8. Tramadol
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15
Q

Name 16 clinical signs of serotinin syndrome?

A
  1. vomiting
  2. diarrhea
  3. seizures
  4. hyperthermia
  5. hyperesthesia
  6. depression
  7. mydriasis
  8. vocalization
  9. blindness
  10. hypersalivation
  11. dyspnea
  12. ataxia
  13. disorientation
  14. hyperreflexia
  15. coma
  16. death
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16
Q

Name one drug that has been demonstrated to prevent death in rats with serotonin syndrome according to Nisijima K et al in Brain Res 2001?

A
  • Cyproheptadine: histamine-1 receptor antagonist with nonspecific antagonist properties at 5-HT1A and 5-HT2A
  • 1 mg/kg PO or PR q4-8h
17
Q

Discuss the developement of serotinine syndrome?

A

use of serotonergic drugs and overactivation of peripheral and central postsynaptic 5-HT1A and 5-HT2A receptors

18
Q

Discuss the dosage regimes of trazodone for anxiety disorders, PRN dosing for anxiety, at-home confinement, hospital confinement and PR administration in dogs?

A
  • anxiety disorder: 2.5–5 mg/kg PO q12-24h for 3 days and then gradually increase up to 19.5 mg/kg/day if necessary
  • PRN dosing: 2–5 mg/kg PO q8-12h; maximum dose of 14 mg/kg/day or 8-10mg/kg PR q8-12h
  • At-home confinement: 3.5mg/kg PO q12h increasing up to 8mg/kg PO q12-24h
  • Hospital confinement: 4mg/kg PO q8-12h with dose increasing up to 12mg/kg or 8-10mg/kg PR q8-12h
  • PR: 8-10mg/kg q8-12h
19
Q

Discuss the dosage regime of trazodone in cats as an anxiolytic?

A

50–100 mg/cat given 60–90 minutes prior to vet visit

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