Behaviour modifying drugs

Question 1

What are serotonergic drugs?

Answer 1

SSRIs
increase serotonin by blocking the reabsorption of serotonin and noradrenaline into neurons.

Question 2

What is amitriptyline?

Answer 2

serotonergic drug
SRI:NRI 1:4

used for anxiety and pain
has a poor side effect profile

Question 3

What is clomipramine?

Answer 3

serotonergic drug
SRI:NRI 5:1

used for anxiety and compulsion (impulse control, repetitive behaviours)
risk of discontinuation syndrome

Question 4

What is fluoxetine?

Answer 4

serotonergic drug
SRI:NRI 15:1

used for anxiety, compulsion, impulsivity, aggression
risk of anorexia
anti-compulsive drug of choice

Question 5

What is Selegiline?

Answer 5

dopaminergic drug
enzyme breaks down dopamine

used for cognitive impairment, specific fear, compulsion, avoidance, fear-related aggression
risk of aggressiveness and confrontation

Question 6

What is Mirtazapine?

Answer 6

noradrenergic and specific serotonergic antidepressant
axiolytic
increases motivation, appetite, makes reinforcement easier

used in ppl for GAD, social anxiety, OCD, panic disorder, insomnia, inappetance
risk of discontinuation syndrom and increasing chase behaviour

Question 7

What is important to consider when prescribing a dopaminergic drug?

Answer 7

there must be 2 weeks between it and the last serotonergic drug
needs behavioural support as well

Question 8

When is mirtazapine mostly prescribed?

Answer 8

failed response to SSRI
SSRI caused anorexia
generalised anxiety
panic
specific fear

Question 9

What is Imepitoin?

Answer 9

partial benzodiazepine receptor antagonist

an anti-epileptic that is also used as an axiolytic (mixed evidence)

Question 10

What is the onset of action of amitriptyline?

Answer 10

3-4 weeks

Question 11

What is the onset of action of Clomipramine?

Answer 11

3.5 to 5 weeks

Question 12

What is the onset of action of fluoxetine?

Answer 12

4-8 weeks

Question 13

What is the onset of action of selegiline?

Answer 13

8-10 weeks

Question 14

What is the onset of action of mirtazapine?

Answer 14

1.5-4 weeks

Question 15

What is the onset of action of Imepitoin?

Answer 15

1-6 weeks

Question 16

What are the main interactions with Selegiline?

Answer 16

SRI/SSRI/TCA
amitraz

Question 17

What are the main interactions with Clomipramine?

Answer 17

selegiline
amitraz

Question 18

What are the main interactions with fluoxetine?

Answer 18

selegiline
amitraz
NSAIDs (clotting)

Question 19

What are the common adverse effects of SRI/SSRI/TCA?

Answer 19

usually seen in first 7-10 days
increased anxiety
sedation
anorexia
irritability

Question 20

How can we help manage the adverse effects of SRI/SSRI/TCA?

Answer 20

add appetite stimulant
use anti-nausea
OR
change administration:
- morning vs night
- with a meal
- reduce dose
- switch drug

Question 21

What are the signs of serotonin syndrome?

Answer 21

clonus
agitation
tremor
hyperreflexia
hypertonicity
hyperpyrexia
coma, death

Question 22

What is the use of augmentation drugs and the common vet med ones?

Answer 22

when mainline drug isn’t doing what we want it to do

trazodone
alpha2adrenoreceptor agonist
gabapentin
B-adrenoreceptor antagonist (propranolol)
memantine

Question 23

What is Trazodone?

Answer 23

serotonin receptor agonist and reuptake inhibitor

adjunct therapy for many problems but NOT aggression
short term anxiolytic

Question 24

What is Clonidine?

Answer 24

alpha2 adrenoreceptor agonist

potential augmentation therapy with SSRIs especially for short planned events
no effect on appetite

Question 25

What is Demedetomidine?

Answer 25

alpha2 adrenoreceptor agonist minimal sedation, no effect on cognition

Question 26

What is Propranolol?

Answer 26

beta adrenoreceptor blocker useful for situational anxiety and social phobia commonly used adjunct therapy no effect on appetite

Question 27

What is Memantine?

Answer 27

antagonist of glutamatergic NMDA receptors used for tx of pain and alzheimers improves attention and cognition used as an augmentation for OCD most effective with fluoxetine for compulsive behaviour

Question 28

What is Gabapentin?

Answer 28

GABA analogue used for pain, anxiety, acute anxiety

Question 29

When would you decide to use a combination of drugs?

Answer 29

when onset of action of main drug is too slow or to deal with high intensity events main drug isnt working well enough add effect that main drug doesn't produce

Question 30

How can diet help when the main drug isn't working well enough?

Answer 30

can affect efficacy fibre level (high fiber reduces absorption) protein:carbohydrate balance fish oil content (DHA)

Question 31

How do we evaluate if main drug isn't working well enough?

Answer 31

misdiagnosis? new problem? health problem? stressors? diet change? review response every 60 days no effect: switch drugs partial effect: increase dose or add drug good effect: continue drug

Question 32

How can we properly explain behavioural improvement expectations to clients?

Answer 32

increase monitoring and recording events set realistic expectations for the drug ask to evaluate key masures: % of events dog reacts to, severity of response