Psychoactive medications Flashcards Preview

Neurology > Psychoactive medications > Flashcards

Flashcards in Psychoactive medications Deck (58):
1

What is ultimate behaviour/ emotionality a product of?

personality traits and learning from life experiences

2

What is a normal emotional state?

- well-adapted
- good emotional homeostasis

3

What is an abnormal emotional state?

- poorly adapted
- poor emotional homeostasis

4

What might life events be?

- experiences of threat/fear
- situations of emotional conflict or frustration
- conditioned contextual associations with anziety

5

What does an event in an animal's life cause?

additive effect of arousal and emotional responses --> animal emotional state becomes closer to the threshold

6

What are long term psychoactive drugs used for?

improves response to an event

7

WHat are short term psychoactive drugs used for?

to suppress memory of an event

8

Aims of psychoactive drugs

- reduce general anxiety
- reduce situational anxiety
- reduce fearfulness
- suppress memory of events
* changes only happen as a result of experience and medication

9

Why use psychoactive drugs?

- specific drug indication (separation anxiety)
- if emotion is so intense that it is interfering with therapy (intense anxiety/fear, phobia and risk to animal/ person/ property)
- animal's suffering or distress could be alleviated with drug therapy
- if prognosis can be improved or improvement speeded up

10

3 phases of psychoactive drug therapy

- initiation
- maintenance
- withdrawal

11

What is initiation?

- first stage of psychoactive drug tx
- risk of adverse effects (may predispose aggression)
- changed emotionality (may make behaviour unpredictable, increased confidence/ disinhibition)
- delay in onset of main effects (can take 4-8 weeks)

12

What is maintenance?

- 2nd stage of psychoactive drug tx
- treatment continued until:
- end of period for which drug is licensed
- there is a period of normal behavior
- there is an indication that emotional component is less significant and behavioural modification alone will be successful

13

What is drug withdrawal?

- 3rd and final phase of psychoactive medication
- no info on datasheets for this
- unpleasant side effects well known in man (discontinuation syndrome is common with TCA/ SRI/ SSRI) that have a short half-life = clomipramine
- potential for recidivism if drug withdrawn suddenly

14

Name a drug class that has recidivism

Benzodiazepines: 80% cats have recidivism

15

How long should you reduce a drug dose for before finally stopping tx?

- 6 month tx = 6 weeks withdrawal
- 8 months tx = 8 weeks withdrawal, this is maximum amount of time for withdrawal (i.e. tx for more months than 8 should also have a 8 week withdrawal)

16

What are hazards of using medication?

- adverse effects
- therapeutic failure
- disinhibition (especially benzodiazepines, also TCA, SRI, SSRI drugs and acepromazine)
- excessive confidence and assertiveness (selegiline)
- owner overdependence (where they prioritise drugs over behavioral tx)

17

Adverse effect - clomipramine

- sedation

18

Name 3 psychoactive drug classes

- serotonergic
- dopaminergic
- gaba-ergic

19

Outline serotonergic reuptake inhibitor (SRI) psychoactive drugs

In anxiety and depression synaptic serotonin i slow, and receptors and up-regulated.
- IMMEDIATE EFFECT: increase the number of activated receptors on dendrite post-synaptic membrane, increase serotonin concentration
- DELAYED EFFECT: decrease post-synaptic receptors and pre-synaptic receptors and increase serotonin concentration (which causes behavior changes)
- DRUG WITHDRAWAL: persistent increased synaptic serotonin suppresses receptor expression

20

Name 4 serotonergic drug examples

- amitriptyline
- clomipramine
- fluoxetine
- sertraline

21

Action - TCA/ SRI/ SSRI drugs

They not only alter serotonin and noradrenaline reuptake, they also antagonise a range of other receptors causing adverse effects (e.g. antagonism of H1, M1 and alpha 1)

22

What do most psychoactive drugs have a balance between?

SRI and NRI

23

What is NRI?

Noradrenaline Reuptake Inhibitor

24

What is amitriptyline?

- a serotonergic drug
- a tricyclic antidepressant
- antagonises H1, M1, alpha1 (--> many side effects)
- SRI: NRI of 1:4
- USED for: anxiety, pain

25

Side effect - H1 antagonism

- weight gain
- sedation

26

Side effect - M1 antagonism

- constipation
- dry mouth
- urinary retention

27

Side effect - alpha1 antagonism

- hypotension
- sedation

28

What is clomipramine?

- a serotonergic drug
- a SRI and also a TCA
- antagonises H1, M1 and alpha1
- SRI: NRI of 5:1
- USE: anxiety, compulsive disorders

29

What is fluoxetine?

- a serotonergic drug
- an SSRI
- antagonises H1, M1 and alpha1
- SRI: NRI of 15:1
- USES: anxiety, compulsion, impulsivity, aggression

30

Define SSRI

Selective Serotonin Reuptake Inhibitor

31

What is feline hyperaesthesia syndrome?

- dilated pupils
- tail swishing
- shakes head
- bit and lick at flank when twitching
- apparent hallucinations
- run round house madly

32

Tx - feline hyperaesthesia syndrome

clomipramine

33

What is Fluoxetine?

commercial name for fluoxetine

34

What do you treat impulse aggression with?

fluoxetine (to ensure dog growls before biting/ attacking so less aggression is not impulsive and is actually warned first)

35

What is sertraline?

- a serotonergic drug
- SSRI
- SRI: NRI of 150:1 (increasingly selective but much reduced range of situations where they will be effective)

36

Specific use - amitriptyline

feline interstitial cystitis

37

Specific use - clomipramine - 5

- generalised anxiety
- separation anxiety
- compulsive disorder
- indoor spray marking (cats)
- feline hyperaesthesia syndrome

38

Specific uses - fluoxetine

- generalised anxiety
- separation anxiety
- compulsive disorder
- indoor spray marking (cats)
- impulsive aggression (e.g. owner directed)
- frustration-related aggression (cats)

39

Specific uses - sertraline

- generalised anxiety
- noise phobias

40

Adverse effects - amitripyline

- irritability
- agitation
- tachydysrhythmia

41

Adverse effects - TCA

- corneal drying
- TCAs that are strongly noradrenergic can cause explosive emotional reactions in man

42

Serotonergic drug interactions

* amitraz (v. strong reaction)
- opioids (respiratory dysfunction)
- MAOIs (selegiline)
- phenothiazines

43

Common adverse effects - serotonergic drugs - man

- headache
- abdominal pain
- mm rigidity

44

Serotonergic specific medical cautions

- CV dz (arrhythmias)
- Diabetes (TCA/ SRI are hyperglycaemic)
- Thyroid disease (altered TCA metabolism)
- Epilepsy
- narrow angle glaucoma

45

What is Trazodone?

- a serotonergic drug, an SARI
- not used on own but as a supplement to dogs on tx with clomipramine or fluoxetine which haven't responded
- NL in dogs
- adjunct tx with dogs with noise phobia
- widely used as adjunct tx in people but risk of serotonin syndrome requires caution

46

Define SARI

Serotonin Receptor agonist and reuptake inhibitor (e.g. trazodone)

47

What is serotonin syndrome?

where there is excess serotonin that can --> coma, death

48

What is an example of a dopaminergic drug?

selegiline

49

What is selegiline?

- a dopaminergic drug
- a selective MAOIb = monoamine oxidase b inhibitor (drug blocks R on this molecule), but does has v low level of MAOIa inhibition
- can be given without dietary modification needed with MAOIa drugs
- other MAOI drugs cannot be subsitituted for selegiline

50

Main effects - selegiline/ dopaminergic drug

- mild anxiety reduction
- improved conditionability (even normal animals)
- increased exploratory and risk taking behaviour
- reduced fearfulness

51

Indications - dopaminergic drug (selegiline)

- CCD = canine cognitive dysfunction ('dementia)
- fears and phobias

52

Adverse effects - selegiline/ dopaminergic drugs

- agitation
- GIT signs
- drowsiness
- MAN: headache, abdo pain, hallucinations

53

Drug interactions - selegiline/ dopaminergic drugs

- TCA/ SRI/ SSRI
- phenothiazines (ACP)
- potentiates benzodiazepines
- pethidine

54

Name an example of a GABA-ergic drug

Benzodiazepine

55

How do benzodiazepines work?

- target GABA-A ligand-gated ion channel on post-synaptic membrane --> increased Cl- transfer into post-synaptic cell (d/t secondary binding of the benzodiazpine to the GABA-A-R).

56

Main effects - benzodiazepines

- amnesia (anterograde and retrograde)
- anxiety reduction
- reduction in panic
- increased exploratory and risk taking behaviour

57

Adverse effects - benzodiazepines

- agitation (incl hyperexcitability)
- ataxia
- sedation
- amnesia
- recidivism
- tolerance
- disinhibition (esp aggression)

58

Main indications - benzodiazepines

Acute tx for panic (e.g. noise phobias)