Behavior Modification, Pt. 2 Flashcards
What are 8 indications for short-term psychotropics?
- veterinary visits
- car travel
- separation anxiety (+ long-term meds)
- visitors
- noise aversion
- new baby/family members
- bridge medication (switch from one medication to another)
- adjunct to daily medication
What are 5 common classes of short-term psychotropics?
- serotonin antagonist and reuptake inhibitors (SARIs) - Trazodone
- α2 agonists - Dexmedetomidine gel (Sileo)*, Clonidine
- GABA analogues - Gabapentin, Imepitoin (not in US)
- benzodiazepines - Diazepam (Valium), Alprazolam (Xanax), Clonazepam (Klonipin), Lorazepam (Ativan)
- phenothiazine neuroleptics - acepromazine (PromAce)
What is the mechanism of action of SARIs?
(Trazodone)
blocks serotonin 2A and 2C receptors and blocks serotonin reuptake
What receptor does Trazodone have an affinity for? What is it a partial agonist for?
5-HT2A receptor
- histamine H1 receptors
- α1 adrenergic receptors
- 5-HT1A**
What are the 4 most common situations that Trazodone is used for? 2 additional?
- situational fear and anxiety
- event stress (vet visit, thunderstorm, fireworks)
- noise aversion
- bridge - immediate relief while waiting on SSRI/TCA
- post-op confinement (keep pets from hurting themselves after surgery)
- stress in shelters
How many/what percent of dog owners seek treatment for their dog for noise aversion (storm phobia, fireworks, etc.), per recent studies?
a. nearly all or most (>75%)
b. many (51-75%)
c. half (~50%)
d. some (25-40%)
e. few (<20%)
f. none (0%)
E
Trazodone can be used as an adjunct with SSRIs and TCAs (careful: serotonin syndrome!). How is this possible?
antagonizes 5-HT2 receptors, which augments efficacies of SSRIs
(can be long-term, but not typically first choice)
How is Trazodone classified? What other effect does it have?
atypical antidepressant (via SERT inhibitor, which increases serotonin)
sedation due to antihistaminic, α1 adrenergic antagonist
Why is Trazodone recommended to be given with food?
slows down absorption —> sticks around
Why isn’t Trazodone commonly used in cats?
large, bitter pills
What is Trazodone’s efficacy onset?
quick —> 30-45 mins
duration —> 4+ hours
Why is Trazodone so commonly used in dogs?
well-tolerated with high margin of safety
- 5-HT2A/C antagonism = less side effects
- fewer anticholinergic effects
- lower seizure risk
- less cardiac issues
What are 3 less common adverse effects of Trazodone?
- GI - vomiting, hyporexic, diarrhea
- tachycardia, increased anxiety
- behavior disinhibition, aggression
In what 3 cases should Trazodone use be avoided? What is a common drug interaction?
- severe cardiac disease
- hepatic and renal impairment, glaucoma
- those taking MAOIs
Fluoxetine
What is the most common use of Dexmedetomidine orotransmucosal (Sileo)? What else can it be used for?
(α2 agonist)
noise aversion in dogs
reduce fear/anxiety during vet visits
How is Dexmedetomidine dosed? What happens if it is swallowed?
applied to gums - orotransmucosal gel
- no treats within 15 mins
- administer 30-60 mins before adverse stimulus
loss of absorption/efficacy
What are 3 side effects of Sileo? What are 3 important aspects owners should know about?
- sedation
- emesis
- depression of CNS (peripheral and cardiac vasoconstriction, bradycardia, respiratory depression)
- adjust dose stopper BEFORE dispensing
- wear gloves
- tube only lasts 4 weeks once opened
What is the reversal of Sileo (Dexmedetomidine)?
Atipamezole
What is the mechanism of action of Clonidine? What are 2 common uses?
α-2A and imidazoline receptor agonist
- fear-based behavior problems and anxiety in dogs
- quick calming in overly hyperkinetic dogs
What are 5 possible adverse effects of Clonidine?
- high sedation
- α2: transient hyperglycemia, dry mouth, constipation
- aggressive behavior
- hypotension, collapse, bradycardia
- gradual reduction over 2-4 days due to withdrawal symptoms (agitation, nervousness, hypertension)
What is Gabapentin? What are 4 uses/indications?
GABA analogue —> anti-convulsant, treats chronic and neuropathic pain (spinal chord injuries, limb amputation)
- high doses: sedative, anxiolytic
- reduce fear responses associated with handling and vet clinic visits in cats**
- storm phobia in dogs, but must be dosed earlier than storm
- long-term/chronic pain
When does Gabapentin reach peak plasma concentrations?
1-2 hours after administration
- half-life of 2-4 hours
Why should Gabapentin not be used in patients with kidney disease? What are 2 possible adverse effects?
eliminated exclusively via kidneys —> adjust dose
(generally low side effect profile)
1. sedation and ataxia in higher doses
2. cats: hypersalivation and vomiting
Gabapentin, controlled drug:
