Week 7 - Behavior Modifying Drugs - Part 1 Flashcards

1
Q

The only two FDA-approved drugs used in veterinary medicine for _____ only.
▪ “Reconcile” (_______) for dogs with separation _____
▪ “Clomicalm” (______) for dogs w/ separation ____
▪ “Anipryl” (______ or ___-_____) for canine _____ dysfunction
▪ “Sileo” (_______ transmucosal gel) for dogs w/ ____ aversion

A

dogs, fluoxetine, anxiety, clomipramine, anxiety, Selegiline, L-deprenyl, cognitive, dexmedetomidine, noise

What does FDA approved mean? Approved by the food and drug administration. Very long process and expensive.

Most psycho-active drugs we use are extra-labeled b/c cheaper.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is it important that we communicate with our clients if the drug we are used are Extra-label ?

A

(most psychoactives used)
▪ VCPR
▪ Veterinarian - why not using FDA-approved choice
▪ Inform client and consent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why use psycychotropics in vet med?
▪ Reduce underlying emotional _____ (?) that contributes to ______ behaviors.
▪ Almost always an ______ to behavioral modification. Don’t just prescribe a drug to a patient without addressing a behavior.
▪ ___/_____ interferes with learning or other
normal behaviors
▪ Reduce ____ → better learning
▪ Improve ____ of life for pet AND owner

A

arousal, fear,
anxiety, stress, undesirable, ADJUNCT, Fear, anxiety, FAS, quality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Mental health is important for… _____

A

WELFARE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
A

Mental state = green box

Four feeds into the five

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
A

Affective states = green box

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When to use psychotropics
▪ _____
▪ After rule-out of _____ medical causes/etiology
▪ After thorough behavior history → _____ diagnosis
▪ AWB recall: _____ description of behaviors
▪ _____ / ____ with behavioral modification
▪ AWB recall: counter-conditioning, systematic
desensitization, positive reinforcement, etc.

A

VCPR (veterinary client patient relationship), underlying, behavioral, OBJECTIVE, ADJUNCT, COMBO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List the Biogenic amine transmitters/ neurotransmitters?

A
  1. Serotonin (see L12, L16; more now)
  2. Dopamine (see L16)
  3. Norepinephrine (see L14, 17 and Physio)
  4. Acetylcholine (L12 and Physio)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List the Amino acid neurotransmitters

A
  1. GABA (gaba-aminobutyric acid) (L14, 15)
  2. Glutamate (L13)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Serotonin aka ?
▪ In CNS – regulates ?
▪only __-___% in brain; most in ___ nervous system

A

5-HT or 5-Hydroxytryptamine, mood, appetite, sleep, and some cognitive functions, 1-2, enteric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

_______ ______ → 5-hydroxytryptamine
(serotonin)

A

Dietary tryptophan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

At rest, serotonin stored in vesicles of _______ neurons
▪ Stimulation → serotonin released into
synapses → binds to _______ receptor
→ activation

A

presynaptic, postsynaptic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Action of serotonin ends _____ high-affinity reuptake of serotonin into presynaptic
terminal – by ?

A

d/t serotonin transporter (SERTs)
proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

2 Major Categories
1. ___-term or “_____” for chronic use
▪ Takes _____ to take effect
2. ___-term or “____” medication for acute use
▪ ______ events
▪ ____ onset, last for ___ # of hours
▪ Sometimes daily as ______/____-therapy.
A few of the short-term meds can also be used ____-term but not the first choice use for long term.

A

Long, Daily, weeks, Short, Event, Stressful, Quick, set, multimodal, poly, long

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Indications for long-term (daily)
▪ ________ anxiety
▪ ____ behavior leading to ____ aggression
▪ _____-____ conflict
▪ ______ anxiety
▪ ______ _____ Syndrome
▪ ____ marking (vertical) in cats
▪ _____ related house soiling
▪ _____ behaviors (Compulsive
disorders, e.g., spinning, licking, fly-biting, etc)

A

Generalized, Fearful, potential, Inter-pet, Separation, Cognitive Dysfunction, Urine, Stress, Repetitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

List the Common classes: Long-term psychoactives

A
  1. Selective serotonin reuptake inhibitors (SSRIs)
    ▪ Fluoxetine, Paroxetine, Sertraline
  2. Tricyclic antidepressants (TCAs)
    ▪ Clomipramine, amitriptyline
  3. Azapirones (Serotonergic)
    ▪ Buspirone
  4. Monoamine oxidase inhibitors (MAOIs)
    ▪ Selegiline
  5. Selective serotonin/norepinephrine reuptake inhibitors (SNRIs)
    ▪ Venlafaxine (not commonly used; not discussed)
    ALL of the drugs that will be discussed in this section of long-term psychotropic
    medications are ORALLY administered
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

List three examples of SSRI’s used for behavior modification.
1. Who are these drugs most commonly used by?
2. Preferable due to _____
and ___ side effects
(transitory)

A

Fluoxetine, Paroxetine, Sertraline
1. Most commonly used by behaviorist
2. efficacy, few

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

SSRIs
Mechanism of action: _____ reuptake of
serotonin by blocking ____ transporter
(SERT) for serotonin →
serotonin molecules act for _____ periods of time = _____ in serotonergic
neuro-transmission

A

Inhibits, reuptake, longer, INCREASE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

SSRI’s initial actions
Initially: serotonin
floods ___ of its
receptors b/c reuptake
is _____; different
subtype serotonin
receptors get saturated
→ leading to ___ ____

A

ALL, blocked, side, effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SSRI actions
▪ Most receptors
downregulate over __-___ weeks → side effects ____
▪ BUT _____
auto receptor does
NOT down regulate
as much; becomes ___ active with
time → therapeutic
effect

A

4- 6, wane, Postsynaptic, MORE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

SSRI actions
▪ Takes __-___ weeks to work
▪ Once the presynaptic
serotonin autoreceptor is
activated → _____ _____ synthesis and _____ release from the
axon
▪ So have to wait for ______ of serotonin autoreceptor which takes _____ weeks.

A

3-6, inhibits, serotonin, decreases, desensitization, several

23
Q

SSRI Clinical Overview
▪ Classified as ______
▪ Other properties: (3)?
▪ Common, preferred, selective

Uses / Indications:
▪ _______ ____ disorders
▪ ______ ____ or
repetitive/stereotypic behaviors
▪ Urine ___
▪ Some _____ behaviors (caution:
assess, safety, etc.)
▪ In conjunction w b-mod and can be used w acute/event drugs

A

antidepressant, anxiolytic, anti-compulsive, some anti-aggression, Generalized anxiety, Obsessive compulsive, marking, aggressive

24
Q

SSRI Efficacy onset:
▪ Onset of improvement is ___: takes _-__ weeks
▪ Response can’t be evaluated until at least __ month
▪ Can NOT be used “___ _____”
→ INEFFECTIVE

A

slow, 3-6, 1, as needed

25
Q

SSRI Pharmacologic:
▪ Metabolized in ___; Excreted through ____
▪ No relationship between ____ levels of SSRIs and ____.

A

liver, kidneys, plasma, response

26
Q

SSRI Dosing: (refer to “Optional Resources” for doses)
▪ Doses given ____, once ___, typically
▪ Do NOT _____ discontinue ; _____ to stop

A

orally, daily, abruptly, taper

27
Q

Adverse / side effects
▪ ______ appetite or GI ___
(initially, transient)
▪ Mild sedation, lethargy, decreased
grooming in cats (?)
▪ ______, _____ (_____, ______ consider dosage)
▪ Decreased _____ motivation

Very Rare/very uncommon but
important/caution:
▪ Urine _____
▪ ________
▪ ________

A

Decreased, upset, initially,
transient, Anxiety, restlessness, initially, transient, sexual, retention, Seizures, Aggression

28
Q

Contraindications / Caution
▪ Competitive inhibitor of _______ ______ liver
enzyme
▪ if using med metabolized
by _____ liver enzymes → _______ levels
▪ Animals with diabetes b/c
may alter ____ ____
concentrations
▪ Dogs with _____ or
history of ______ disorders
▪ Animals with severe ____ impairment

A

cytochrome, P450, P450, elevated, , blood, glucose, epilepsy, seizure, hepatic

29
Q

Serotonin syndrome (Caution for all)
▪ Serotonin syndrome: due to taking ______ quantities of meds
that increase serotonin levels or impact serotonin metabolism
▪ Do NOT combine SSRIs with ?
▪ Clinical signs (appear within __ hour or up to ______ days):
▪ _____cardia
▪ Muscle ______ or muscle ______
▪ Restless, panting, pacing, agitated
▪ Disorientation, confusion
▪ Seizures
▪ Death

A

excessive, TCAs, MAOIs (incl Amitraz), serotonin precursors (tryptophan), St. John’s Wort, and others (ALWAYS CHECK CURRENT PLUMB’S!)

1, several, Tachy, tremors, rigidity

30
Q

SSRI: Fluoxetine (Prozac®)
▪ Most _______ used SSRI; many studies
▪ Indications/Uses:
▪ ______ ______ anxiety (Reconcile® FDA-
approved) w/ b-mod
▪ _______ behaviors/ ______/ _______ behaviors
▪ Generalized anxiety
▪ Urine _____/ _____ in cats,
house-soiling
▪ May help lessen, manage some
aggression

A

commonly, Canine, separation, Repetitive, stereotypies, compulsive, marking, spraying

31
Q

SSRI: Fluoxetine (Prozac®)
▪ Pharmacologic
▪ Highly selective _____ of _____ reuptake
▪ Well absorbed after ___ administration
▪VERY _____ bioavailability w/ transdermal (~10% of oral)
– do ___ recommend

A

inhibitor, serotonin, ORAL, POOR, NOT

32
Q

Paroxetine
▪ No dog/cat ______-_____ clinical trials
▪ Maybe _______ enhancing
▪ Mild _______ effects
→ constipation
▪ ______ half-life
→ dosing sometimes __x/day

A

placebo-controlled, appetite, anticholinergic, Shorter, 2

33
Q

Sertraline
▪ No dog/cat _____-____ clinical trials
▪ Primarily ____ excretion, skips ___
→ safer for ___ animals
▪ Used in human pts w ____ disease
▪ Maybe safest if animal has _____

A

placebo-controlled, fecal, kidney, CKD, hepatic, epilepsy

34
Q

TCAs MOA
▪ Similar to SSRI but inhibits both _______ AND ______ → incr availability of __ in
synapses
▪ _________ (block some histamine receptors as well), _______.

Chronic administration → _______ #’s and altered function of ______ receptors in forebrain → significant _____ changes evolving over time.

A

serotonin, norepinephrine, NT, Antihistaminic, Anticholinergic, decreased, serotonin, behavior

35
Q

TCA Overview
▪ Classified as _______
▪ Other properties: ?
▪ _______ effects can lead to more calming
▪ Much ___ selective than SSRIs d/t Anticholinergic effects → higher ___-effect profile
▪ Uses / Indications:
▪ ______ anxiety disorders
▪ Urine ____
▪ Some ______ behaviors (caution: assess, safety, etc.)
▪ Efficacy onset
▪ _____ days to ___ weeks
▪ Dosing: Start ___ and ___ up

A

antidepressants, anxiolytic, anti-compulsive, some anti-aggression, Antihistamine, less, side, Generalized, marking, aggressive, Several, several, low, titrate

36
Q

List TCAs used for Behavior modification

A

▪ Clomipramine (ClomiCalm®: FDA-
approved)
▪ Amitriptyline
▪ Others: Doxepin, Imipramine,
Nortriptyline (not discussed)

37
Q

TCA: Clomipramine
▪ Most _______-specific of the
veterinary TCAs
▪ Indications / Uses:
▪ _____ ____ anxiety (______® FDA-approved) w/ b-mod
▪ ____ marking in cats (Canadian
label)
▪ _______ disorders
▪ Noise ______
▪ ______ anxiety

A

serotonin, Canine separation, Clomicalm, Urine, Compulsive, aversions, Generalized

38
Q

Clomipramine
Side effects
▪ _______ (anti_____)
▪ Moderate _______ effects
▪ Dry ___, urine _____, ______
▪ _______ (longer __-wave
duration)
▪ Lowering of _____ threshold
▪ Uncommon, but important!: Severe urine retention →
________ _____
▪ Testicular ______

A

Sedation, histamine, anticholinergic, eye, retention, constipation, Arrhythmogenic, p, seizure, functional blocking, hypoplasia

39
Q

Clomipramine
Contraindications / Cautions
▪ AVOID in pets with:
▪ hx of ?
▪ __ compromised
▪ ______ or epilepsy
▪ _____ males
▪ ______ syndrome if used
with MAOIs, SSRIs or other
serotonin drugs
▪ Do NOT abruptly ____; ______ to stop

A

constipation, KCS,
glaucoma, CV, Seizures, Breeding, Serotonin, discontinue, taper

40
Q

TCA: Amitriptyline Indications / Uses:
▪ ____ typically 1st choice for anxiety disorders
▪ Maybe _______ pain and _____ _____ in dogs
▪ Some use it for cats with _____ _____ _____ and house-_____ in cats, but “old school”

A

NOT, neuropathic, acral, lick, feline interstitial cystitis, soiling

41
Q

TCA: Amitriptyline Pharmacologic
▪ _______ absorption of transdermal is _____. Do ____ use transdermal

A

Systemic, POOR, NOT

42
Q

TCA Amitriptyline Additional Side effects (plus all from Clomipramine)
▪ Moderate to severe _____ (___ “zombies”)
▪________ (decreased Q-T interval)

A

sedation, Arrhythmogenic

43
Q

Azapirone: Buspirone Mechanism of action
▪ ______ 1A _____ agonist
▪ Binds at ___-_____ serotonin autoreceptor → blocks → increases
serotonin production
▪ Binds at post-synaptic
serotonin autoreceptor
→ mimics effects of
serotonin
▪ Decreases _____
▪ Increases ________

A

Serotonin, partial, pre-synaptic, anxiety, BOLDNESS

44
Q

Azapirone: Buspirone Overview
▪ Only azapirone available in US
▪ The “bravery” drug
▪ Uses / Indications
▪ Fearful, NON-aggressive pets
▪ Anxious cats that are regular recipients (“victims”) of aggression
▪ Generalized anxiety disorder; globally fearful dogs
▪ Urine marking / spraying in cats (fluoxetine MUCH better results)
▪ 50% of cats respond, whereas 90-100% of cats on fluoxetine
▪ Separation anxiety disorder
▪ Motion sickness in cats?

A
45
Q

Azapirone: Buspirone Overview
▪ Efficacy onset:
▪ 1-4 weeks, but might be rapid response
▪ Daily medication, NOT “as-needed”
▪ Dosing:
▪ Usually 2-3 x/day orally
▪ Transdermal in cats? Recommendation: do NOT
use/prescribe transdermal
▪ None detectable in blood (Mealey et al 2004)
▪ Clinical efficacy in cats? (Chavez et al 2016)

A
46
Q

Buspirone: Contraindications, Side Effects
Side effects
▪ Increased ______ in cats
▪ More ______ social
interactions
▪ Exacerbation of existing ______
–> Rare/uncommon side effects?

A

friendliness, assertive, aggression,
▪ Sedation
▪ Agitation
▪ Bradycardia
▪ GI issues
▪ Stereotypic behaviors

47
Q

Buspirone: Contraindications, Side Effects
Contraindications / Caution
▪ _____ and ____ disease

decreased clearance and
higher levels
▪ Serotonin syndrome if used
with ____, _____, or other ____ drugs
▪ Use with caution in animals
with ______ behaviors

A

Liver, kidney, MAOIs, SSRIs, serotonin, aggressive

48
Q

MAOIs
▪ In many tissues incl CNS, monoamine oxidase (MAO) enzymes catabolize
oxidative deamination of (3)→ breaks them down.
▪ Mechanism of action of MAOIs: Prevent action of _____ enzymes (?) → accumulate
NTs (?)
▪ Also enhance activity of _______.

A

dopamine, NE, serotonin, MAO, MAO-A, MAO-B, or both, d, s, ne, catecholamines

49
Q

MAO-B Inhibitor: Selegiline (_____®)
As dogs age:
▪ Decrease in _____
production in brain
▪ ___ ____ (highly
reactive, unstable molecules
with unpaired electron

cell damage) or their
damage might also increase
in the brain

A

Anipryl, dopamine, Free radicals

50
Q

MAO-B Inhibitor: Selegiline (Anipryl®)
Mechanisms: many
▪ ______ inhibitor of MAO, ____ (high affinity) for MAO-
B → increase ____
▪ 2 of 3 metabolites of selegiline are CNS ______:? → may contribute to
efficacy and side effects
▪ Selegiline reduces ______ stress caused by _____ degradation
▪ Selegiline increases levels of ______ _____ (which reduces ____ _____ formation) → _______

A

Irreversible, selective, dopamine, stimulants, amphetamine, methamphetamine, oxidative, dopamine, superoxide dismutase, neuroprotective

51
Q

Selegiline
▪ Uses / Indications:
▪ Canine _____ dysfunction
(_____® FDA-approved)
▪ Used off-label for cognitive
dysfunction in ___
▪ Chronic anxiety?
▪ Noise aversion?

A

cognitive, Anipryl, cats

52
Q

Selegiline
Efficacy onset
▪ May require __-___ weeks of
administration for clinical
improvement

A

2-6

53
Q

Selegiline
Side Effects (Uncommon):
?

A

▪ GI upset
▪ Lethargy or restlessness
▪ Irritability
▪ Caution:
▪ Serotonin syndrome
▪ Drug interactions