Psychopharmacology Flashcards

1
Q

Why do we use behavior drugs?*

A
  • If the animal is too scared and anxious, they are not very teachable or able to learn new coping skills
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2
Q

Common Classes of Behavior Management Drugs

A
  • Tricyclic Antidepressancts (TCAs)
  • Selective Seratonin Reuptake Inhibitors (SSRIs)
  • Sertonin (5-HT) Agonists
  • Monoamine Oxidase Inhibitors (MAOIs)
  • Phenothiazines
  • Benzodiazepines
  • Seratonin Antagonist and Reuptake Inhibitors (SARI)
  • GABA receptor partial agonist
  • Alpha-2 Adrenergic Agonist
  • Synthetic Opioid, Opioid Partial Agonist
  • Opiate Patial Agonist
  • NMDA-Receptor Agonist
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3
Q

Most Common Long-Acting Medications

A
  • Clomipramine
  • Amitriptyline
  • Fluoxetine
  • Buspirone
  • Selegiline
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4
Q

Most Common Short-Acting Medications

A
  • Acepromazine
  • Alprazolam
  • Trazodone
  • Gabapentin
  • Dexmedetomidine
  • Butorphnol
  • Buprenorphine
  • Ketamine
  • Diazepam
  • Clonidine
  • Imepitoin (Pexion)
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5
Q

Drug Monitoring

A
  • It is good practice to perform a baseline CBC, chemistry profile, +/- urinalysis prior to starting any long-term medication and periodically (every 6-12 months) thereafter
  • Baseline ECGs, Blook pressure, thyroid testing, etc. may be indicated for some drugs as well
  • Screening depends on possible adverse effects
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6
Q

Serotonin Syndrome

A
  • a drug-induced syndrome due to elevated serotonin levels in the CNS
  • Common Canine Clinical Signs:
    • Vomiting
    • Diarrhea
    • Seizures
    • Hyperthermia
    • Hyperesthesia
    • Depression
    • Mydriasis
    • Vocalization
    • Death
    • Blindness
    • Hypersalivation
    • Dyspnea
    • Ataxia/paresis
    • Disorientation
    • Hyperreflexia
    • Coma
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7
Q

Common Causes of Serotonin Syndrome

A
  • Dextromethorphan (cough suppressent - Kennel cough treatment)
  • Mirtazapine (appetite stimulant)
  • Monoamine Oxidase Inhibitors (Selegiline, Amitraz)
  • Opioids (Buprenorphine, Butorphanlol, fentanyl, methadone, morphine)
  • Selective Serotonin Reuptake Inhibtor (Fluoxetine, Paroxetine, Sertaline)
  • Tramadol (pain medication)
  • Trazodone
  • TCAs (Clomipramine, Amitrytpyline)
  • Nutraceuticals (L-tryptophane (turkey), SAM-e)
  • Linezolid
  • Meperidine
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8
Q

Tricyclic Anidepressants (TCAs)

A
  • Increases seratonin and Norepinephrine
  • affect other neurochemicals involved in emotional reactivity
  • Common for Dogs:
    • Amitriptyline (Elavil, Tryptanol)
    • Clomipramine (Clomicalm, Anafranil)
    • Imipramine (Antideprin, Deprenil)
    • Desipramine (Norpramin, Pertofrane)
    • Nortriptyline (Sensoval)
    • Doxepin (Aponal)
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9
Q

Clomipramine HCL

Clomicalm, Anafranil

A
  • Class: TCAs
  • Use:
    • Labled:
      • Dogs - Seperation Anxiety
    • Extra label:
      • Dogs - Compulsiv disorders and noise phobias
      • Cats - Spraying
  • FDA approved Dogs
  • Axiolytic
  • Non-analgesic
  • Administration: PO +/- food
  • Slow onset, several weeks for full effects
    • Won’t work for immediate events
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10
Q

Amatryptyline

A
  • Class: TCAs
  • Use: Antidepressant, Antipruritic, Neuropathic Pain Modifier
    • Dogs: Seperation anxiety, generalized anxiety, pruritis
    • Cats: Excessive grooming, spraying, pica
  • Not FDA approved
  • Anxiolytic
  • Analgesic - chronic neuropathic pain
  • Administration: PO with food for absorption
  • Slow onset, several weeks for full effect
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11
Q

TCAs Contraindications

A
  • Do NOT use concurrently or within 14 days with MAOIs
    • (selegiline or amitraz, including collars (Flea/tick)and demodex dip)
  • Contraindicated with history of seizures
    • or with drugs that lower seizure thershold
  • Use cautiously if hyperthyroid or with thyroid supplementation
    • hyperthyroidic itself, make underlying issue worse, double up on meds
  • Use with caution in animals with decreased GI motility, urinaty retention, cardiovascular disease, narrow angle glaucoma, or increased intraocular pressure
  • Taper off slowly to minimize withdrawal
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12
Q

TCAs Adverse Drug Reactions

A
  • Risk of Seratonin Syndrome
  • Clonidine
    • may increase bp
  • Enalapril
    • clomipramine toxicity
  • Levothyroxine
    • increases therapeutic and toxic effects of both levothyroxime and clomipramine
  • NSAIDS
    • increased risk for bleeding
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13
Q

TCAs Adverse Effects

A
  • Can occur early on before therapeutic effects are observed
  • Dogs:
    • anorexia, emesis, diarreha
    • dry mouth, elevation of liver enzymes, sedation/lethargy/depression
  • Cats:
    • Anticholinergic effects (dry mouth, mydriasis, urine retention, constipation)
    • Sedation, diarrhea
    • more susceptible
      • ​slower elimination of active metabolite
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14
Q

Fluoxetine

Prozac, Reconcile

A
  • Class: SSRI
    • ​Highly selective inhibitor or the presynaptic reuptake of serotonin
  • Use:
    • Dog: Seperation anxiety, stereotypic behaviors, compulsive behaviors agreesion, axiety
    • Cats: steriotypic behaviors, compulsive behaviors, inappropriate elimination, aggression, anxiety
  • FDA approved (dogs)
  • Anxiolytic and anti-compulsive
    • decreases reactivity
  • Administration: PO, +/- food
  • Slow onset, weeks to months
  • Taper off 3-5 weeks when used long term
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15
Q

Fluoxetine Contradindications

A
  • Caution when using in animals with
    • Diabetes melitus
    • seizure disorders
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16
Q

Fluoxetine Drug Interactions

A
  • Seratonin Syndrome
    • Tramadol, Trazadone, St. John’s Wort, Clomipramine, amitriptyline, bussiprone, Isoniazid
  • MAOIs: long wash-out period
    • Amitraz, selegiline
    • 6 week washout after fluoxitine discontinued
    • 2 week washout after MAOI discontinued
  • NSAIDS, Aspirin
    • may increase risk for GI ulceration and bleeding
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17
Q

Fluoxitine Adverse Effects

A
  • Dogs:
    • Anorexia, Lethargy, GI effects
    • anxiety, irritability, insomnia, hyperactivity, panting, agression
  • Cats:
    • Behavior changes
      • anxiety, irritability, sleep disturbances, anorexia, changes in elimination paterns
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18
Q

Buspirone HCL

Buspar

A
  • Class: Seratonin (5-HT) Agonist and Agonist/Antagionist of Dopamine (D2) Receptors
  • Use: Anxioselective agent
    • Dogs: phobias, especially social interaction phobias
    • Cats: phobias, especially social interactions, Spraying, intercat aggression, psychogenic alopecia, motion sickness
      • 50% show improvement in spraying
      • More effective in multicat households
  • Not FDA approved
  • Anxiolytic
  • Non-analgesic
  • Administration: PO, +/- food
  • Slow, 7-30 days
  • Often combined with TCAs and SSRIs
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19
Q

Buspirone HCL Contraindications

A
  • Should not be used as the sole therapy for situational anxieties due to slow onset
  • Caution with aggressive animals
    • may blunt disinhibitory neural processes (worsen aggression)
  • Treated cats tend to be more outgoing and less anxious but are still treated as victims by other cats
    • may lead to agonistic encounters (cat fights)
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20
Q

Busprione HCL Drug Interactions

A
  • Many
    • MAOIs
    • L-tryptophan
    • possible interference with thyrod medication in cats
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21
Q

Buspirone HCL Adverse Effects

A
  • Usually minimal
  • Dogs:
    • Sleep disturbances, restlessness, loss of appetite
  • Cats:
    • Bradycardia/tachycardia, nervousnes, GI disturbances, stereotypic behaviors, increased affection
    • Increased assertiveness and aggression
      • best to use on victim
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22
Q

Selegiline HCL

L-deprenyl, Anipryl, Eldepryl

A
  • Class: MAO-B inhibitor, MAOI
    • ​Increases dopamine levels
  • Use:
    • Dogs: Canine cognitive dysfunction syndrome (CDS)
      • Chronic anxiety
      • Combined with benzodiazepine and a beta blocker to treat social or noise phobias
    • Cats: Cognitive dysfunction
  • FDA approved for Dogs
  • Anxiolytic
  • Non-analgesic
  • Administration: PO, +/- food
  • Slow onset, several weeks
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23
Q

Selegiline HCL Contraindications/DrugInteractions

A
  • Contraindicated with meperidine or TRAMADOL
  • Do NOT us concurrently with TCAs, SSRI, or Alpha-2 agonist
    • 14 day washout after discontinuing selegiline
    • 5 week washout after discontinuing Fluoxitine
  • Do NOT use concurrently with another MAOI
  • Do NOT administer 1 day prior or post anesthesia or tranquilization with a alpha-2 agonist (dexdom)
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24
Q

Selegiline HCL Adverse Effects

A
  • Dogs:
    • Vomiting, diarrhea, CNS effects
      • restlessness, disorientation, agression, repetative movement, lethargy , salivation, anorexia, diminished hearing/deafness, pruritis, licking, shivers/trembles/shakes
    • Observe animals carefully
    • Best given in morning - stimulant can make agitation worsen
    • May cause increased agression
      • Not recommended for treatment of aggression
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25
Q

Acepromazine

Acetylpromazine, Ace, ACP, Promace

A
  • Class: Phenothiazine neuroleptic agent
  • Use:
    • long-acting sedative/traquilizer
      • ​mild to moderate
      • unpredictable
    • Often used multimodal
  • FDA approved
  • Non-anxiolytic
  • Non-analgesic
  • Administration: IV, IM, PO, Transmucosal
  • Slow onset, give at home prior to visit
26
Q

Acepromazine Contraindication

A
  • Hypotensive effects:
    • contraindicated for patients with significant cardiac disease, hypovolemia, marked dehydration, hypotension, shock
  • Cardiovascular collapse due to bradycardia and hypotention
  • General reduced does when used with an opiate
  • Dogs with MDRI gene mutation may develop pronounced sedation that persists longer than normal
    • reduce does by 25% for heterozygous dogs
    • reduce does by 50% for homozygous dogs
  • Dogs may be more prone to startel and react to noises or other sensory inputs
  • Geriatric patiens: low doses associated ith prolonged effects
  • Giant breeds and greyhounds extremely sensitive
27
Q

Alprazolam

Xanax

A
  • Class: Benzodiazepine (DEA schedule IV)
  • Use:
    • Dogs: Adjunctive therapy in anxious or aggressive dogs
      • Dogs demonstrating panic reations
      • manging anxiety while term-use drug
    • Cats:
      • adjuntive treatment of anxiety disorders, inappropriate elimintion
        • ​Not implicated causing Liver failure in cat
  • Not FDA approved
  • Anxiolytic
  • Non-angiolitic
  • Administration: PO
  • Fast onset, 30-60 minutes as treatment
28
Q

Alprazolam Contraindications

A
  • Contraindicated in aggressive dogs
    • anxiety may restrain dog from agressive tendencies
  • TCAs
    • may increase level of drugs
    • Clinical signs is not known and hve been used together with no issue
    • Concurent use my increase risk for CNS and/or respiratory depression

29
Q

Alprazolam Adverse Effects

A
  • Sedation, increased appetite, and transiet ataxia
  • Cats may exhibit changes in behavior
30
Q

Diazepam

Valium, Diastat

A
  • Class: Benzodiazepine (DE schedule IV)
  • Use:
    • situational anxiety, anxiety-related disorders
  • NOT FDA approved
  • Anxiolytic
  • NOT analgesic
  • Administration: PO, IV
  • Fast onset (30-60 min)
    • does not work in the moment
31
Q

Diazepam Contraindicatinos

A
  • Use cautiously in aggressive patients
  • Cardiovascular or respiratory support may be necessay
  • Rapid injectino may case hypotension or cardiotoxicity secondaary to propylene glycol formation
32
Q

Diazepm Adverse Effects

A
  • Dogs:
    • Sedation, increased appetitie, agitation, ataxia, and agression
    • Sedation and tranquilization in dogs can be variable when used alone
  • Cats:
    • Changes in behavior (irritability, depression, aberrant demeano)
    • Idiosyncratic hepatic failure
33
Q

Benzodiazepines

A
  • May impede learning
  • May impair abilities of working animals
  • Can cause paradoxical exicement in dogs
  • May cause additive cardiorespiratory and CNS depression
  • Caution is advised in debilitated or geriatric parients and patients with hepatic or renal disease or narrow angle glaucoma
  • Chronic use may induce physical dependence
    • Animls appear to be less likely to develop physical dependance on normal dosages
  • Controlled substances with potential for human abuse!
  • Chlordiazepoxide, Lorazepam, Clonazepam
34
Q

Clonidine

Catapres, Kapvay, Clorpres, Duraclon, Nexiclon

A
  • Class: Alpha-2 drenergic agonist
    • activate adrenergic receptors
  • Use:
    • Dogs: severe panic and anxiety, fear-based behavioral problems (phobias and aggresion)
      • ​​Analgesic, anesthetic, sedative
  • Not FDA approved
  • Anxiolytic
  • Analgesic
  • Administration: PO, injection, transdermal patches
  • Relatively Fast onset (1.5-2 hours)
35
Q

Clonidine Contraindications

A
  • Phrmacological response to A2-adrenergic agents can be reduced or absent in animals that are nervous agitate, or excited due to high levels o endogenous catecholamines
    • allow highly aggitated patients to rest quitely before and after
  • Use with caution in patients with pre-existing cardiovascular disease
  • Co-adminsistration with MAOIs may result in hypertension or other sympathominetic effects
  • TCAs may reduce hypotensive effect
36
Q

Clonidine Adverse Effects

A
  • A2-agonists can decrease GI motility, predispose to ileus
  • A2-agonists can increase urine output
  • Dry mouth (40%)
  • Drowsiness (33%)
  • Dizziness (16%)
  • Constipation (10%)
  • Sedation (10%)
37
Q

Trazodone

Desyrel

A
  • Class: Serotonin (5-HT2A) Antagonist/Reuptate Inhibitor (SARI)
  • Use:
    • Dogs: anxiety or phobia related behavior disorders, facilitate postoperative or other confinement
    • Cats: Transport and examination anxiety
  • Not FDA approved
  • Anxiolytic
  • non-analgesic
  • Administration: PO +/- food
  • Relatively fast onset
    • Full calmin may take up to 2 weeks of routine use
    • Abrupt withdrawal has been associated with anxiety, agitation, and sleep disturbances - Gradual withdrawal recommened
38
Q

Trazodone Crontraindications/Warnings/Drug interations

A
  • Contraindicated in those receiving, or have recently used, MAOIs
    • ​Do not use within 14 days of these meds
  • Cauting in patiens with severe cardiac disease, hepatic or renal impaiment, and hypotension
  • May dilate pupils, could trigger acute crisis in patients with angle-closure glaucoma
  • Caution when giving to working/service dogs
    • may be unable to perform duties
  • Don’t confuse traZODone and traMADol
  • Many drug interaction
39
Q

Trazodone Adverse Effects

A
  • Dogs:
    • GI disturbances (nausea, vomiting, darrhea, colitis), ataxia, and sedation
    • Tachycardia, increased anxiety, behavior disinhibition, and agression
    • Unlikely to cause Serotonin Syndrome as clinically used dosages
      • Possible when used with other serotonergic drugs
  • Cats:
    • Drowsiness, paradoxical agitation, vocalization
40
Q

Gabapentin

Neurontin

A
  • Class: Antivonculsant, Neuropathic Pain Analgesic
  • Use:
    • Cats: Decrease fear response and anxiety associated with transport and exams, hyperesthesia syndrome
    • Dogs: Adjunt to other meds to decrease anxiety and fear response with transport and exam
    • Other: Used for suspected alodynia, adjunctive med for control of seizures and neuropathic pain
  • Not FDA approved
  • Anxiolyti
  • Analgesic, primarily for chronic pain
  • Administration: PO +/- food
  • Relatively fast onset (2 hours)
41
Q

Gabapentin Contraindications / Warnings / Drug Interactions

A
  • Use of xylitol-containing oral liquid should not be used in dogs
    • Causes hypoglycemia
  • Abrupt discontinuation has led to withdrawal-precipitated seizures
  • Oral antacids may decrease oral bioavalability by 20%
    • Administration of antacids should be seperated by at least 2 hours
  • Concurrent use of opioid agonists and gabapentin may result in an increased risk for sedation
42
Q

Gabapentin Adverse Effects

A
  • Sedation or ataxia
  • Administration 3x a day in dogs or cats may be problematic for pet owners
  • Cats: Hypersalivation and vomiting
    • resolve within 8 hours
43
Q

Imepitoin

Pexion

A
  • Class: GABAA receptor partial agonist
    • anticonvulsant, centrally- acting
  • Use:
    • Dogs: reduction of anxiety/fear with noise phobia
      • reduction in frequency of generalized seizures due to idiopathic epilepsy (EU & UK)
  • FDA approved
  • Anxiolytic
  • Non-analgesic
  • Administration: PO
    • Start 2 days prior to event and continue through
    • Give on empty stomach every 12 hours
  • Relatively slow onset
44
Q

Imepitoin Contraindication / Warning / Drug interactions

A
  • Do not use in patients with severely impaired hepatic function or severe renal or cardiovascular disorders
  • Safety not tested in dogs less than 5kg or in dogs with renal, liver, cardiac, GI, or other diseases
  • No harmful clinical interactions with concurrent jphenobarbital
  • Flumazenil: Could antagonize the anxiolytic and anticonvulsant effects
  • Because of short half-life, avoid abrupt discontinuation
    • could cause mildbehavioral or muscular signs in epileptic dogs
  • Anxiolytic drugs acting at GABA receptors may lead to disinhibition of fear-based behaviors and may result in increased or decreased aggression levels
    • Careful risk-benefit analysis prior to treating dogs with a history of agressive episodes
45
Q

Imepitoin Adverse Effects

A
  • Well-tolerated in dogs
    • side effects: somnolence, ataxia, polyphagia, polyuria, polydipsia
  • Aggression toward children and/or other dogs
46
Q

Dexmedetomidine

Dexdomitor, Sileo

A
  • Class: Alpha-2 Adrenergic Agonist
  • Use:
    • Sedation and analgeesia for clinical exam/procedures
    • Dogs: Noise aversions (Sileo)
    • Cats: emetic (Fern!)
  • FDA approved for all except emetic use
  • Anxiolytic
  • Analgesic
  • Administration: IV or IM, oralmucosal - Sileo
  • Fast onset : IV, IM, transmucosal (slowest)
47
Q

Dexmedetomidine Contraidications / Warnings / Drug Interactions

A
  • Pronounced cardiovascular effects, only use in CLINICALLY healthy dogs and cats
    • Do not administer with preexisting hypotension, hypoxia, or bradycardia
  • Pharmacological response can be reduced or absent if animals are nervous, agitate, or excited
    • High levels of endogenous catecholamines
    • Allow gitated patients to rest quitely before and after use
  • Co-administration of A2-adrenergic agonists with MAOIs may result in hypertension or other sympathometic effects
  • Additive or synergistic effects are possible when co-administered with other sedative or analgesic drugs
    • Increse risk of overdose
48
Q

Dexmedetomidine Adverse Effects

A
  • Dogs:
    • Cardiac arrythmias (17.9%)
    • ineffectiveness (2.8%)
    • Severe hypothermia (1.9%)
    • Severe bradycardia requiring treatment
    • Apnea requiring treatment
    • slow onset of sedation
    • prolonged recovery
  • Cats:
    • Vomiting (57%)
    • Urinary incontinence (4.9%)
    • Hypersalivation (3.3%)
    • Involuntary defecation (3.3%)
    • Hypothermia (1.6%)
    • Diarrhea (1.6%)
  • Prolonged sedation, paradoxical excitation, hypersensitivity, apnea, and death from circulatory failure may occur but are rare
49
Q

Dexmedetomidine Oralmucosal Gel - Sileo

A
  • Not intended to be swallowed
    • placed on mucous membranes between cheek and gums
    • may not be effective if swallowed, wait to repeat for at least 2 hours
  • No food within 15 minutes of administration
  • Partially used syringes can be used again within 2 weeks if there is enough for a complete dose
    • minimize incorrect dosing - do not use partial syringes if they do not contain a complete dose
50
Q

Dexmedetomidine Additional Information

A
  • Analgesic propertes, sedation can outlast
    • have plans for additional pain control
  • Reversal agents given IM
    • Given IV in emergencies
    • Have pre-drawn with clear labeling
  • Loud noises can startle patients
    • on low doses or without additional sedatives
  • Walk patients to urinate before loading in OW vehicle
    • diuretic properties
  • Durg is absorbed through the skin, eyes, and mouth
    • ​Wear gloves when administering
51
Q

Butorphanol

Stadol, Torbutrol, Torbugesic

A
  • Class: Synthetic Opioid, Opioid Partial Agonist
    • DEA Schedule IV
  • Use:
    • Sedative for neontes and geriatiric patients
    • Minimal cardiovascular and respiratory depression
    • Works synergistically with other sedatives
      • allows for lower doses of A2-agonists and acepromazine for short procedural sedation in otherwise healthy animals
  • FDA approved
  • Non-anxiolytic
  • Analgesic in Cats
    • minimal in dogs
  • Administration: IV, IM
  • Faster onset when used IV
52
Q

Butorphanol Contraindications / Warnings / Drug Interactions

A
  • TCAs (amitriptyline, clomipramine)
    • Concurrent use may increse risk for CNS and respiratoty depression, constipation, urinaty retention
  • Reduce dose in dogs with MDR1 (ABCB-1) mutation
53
Q

Butorphanol Adverse Effects

A
  • Sedation, respiratory depression, mydriasis, disorientation, excitment
  • hypersalivation, ataxia, vomiting, anorexia, diarrhea (rare)
  • Cats ONLY:
    • better analgesia from butorphnol
    • less likely to et dysphoric from butorphanol than other mu-agonist opioids
54
Q

Buprenorphine

Buprenex

A
  • Class: Partial mu-opioid agonist
    • ​DEA Schedule III
  • Use:
    • Analgesic for mild to moderate pain
    • Combination in preanesthetic or sedation drug combinaitons in SA
      • Help lower dose of other drgs and potentially decrease adverse effects
      • Can be cost/volume prohibitive in large dogs
  • FDA approved for cats
  • Non-anxiolytic
  • Analgesic
  • Administration:
    • Injection - short acting (D&C) long acting (C)
    • Buccal - cats
  • Slow onset, long onset of action even if given IV peak at 45-60 min
55
Q

Buprenorphine Contraindications

A
  • Use cautiously in patients with compromised crdiopulmonary function
56
Q

Buprenorphine Adverse Effects

A
  • Respiratory depression (rare) major adverse effect
  • Dogs:
    • Salivation, bradycadia, hypothermia, agitation, dehydration, miosis, tachycardia, vomiting, and high bp
  • Cats:
    • Mydriasis and behavioral effects
      • excessive purring, pacing, rubbing, hiding
    • Vomiting, salivation, anorexia, and hyperthermia (rarely)
  • Difficult to reverse compared to other opioids
57
Q

Opioid Precautions

A
  • Must be used with extreme caution in patients with head trauma, increased intracranial pressure, or other CNS dysfunction (Ex: coma)
  • Serotonergic agents (Ex: clomipramine, fluoxetine, mirtazapine, trazodone)
    • Concurrent use may increase the risk for Serotonin Syndrome
  • MAOIs (Ex: selegiline, amitraz)
    • Possibe additive effects or increased CNS depression
  • Most common drug-drug interactions occur when combined with trnquilizer/sedatives used to increase sedation
    • Ex: anesthetic agents, antihistamines, barbiturates, benzodiazepines, phenothiazines, tranquilizers
    • May cause increased NDS or cardiorespiratory depression
58
Q

Ketamine

Ketaset, Ketaflo, Vetalar

A
  • Class: NMDA-Receptor Antagonist
    • DEA schedule III
    • Analgesic/antihyperalgesic
    • General anesthetic
    • Immobilizing agents
  • Use:
    • Adjunctive sedative and pain relief
    • Often combined with A2-agonists, benzodiazepines, and opioids
  • FDA approved in Cats
  • Non-anxiolytic
  • Analgesic
  • Administration: IM (painful) IV, PO, Rectal, Epidural and CRI
  • Fast onset (IV
59
Q

Ketamine Contraindications / Warnings / Drug Interactions

A
  • Increased CSF pressure, head trauma
  • Cardiovascular and respiratory depression can be increased with the concurrent administraion of other CNS depressants
  • Caution:
    • Significant hypertension
    • heart failure
    • hypertrophic cardiomyoptathy
    • hyperthyroidism
    • hepatic or renal insufficiency
    • Seizure disorders
    • Arterial aneurysms
60
Q

Ketamine Adverse Effects

A
  • Hypertension, hypersalivation, spastic jerking movements, seizures, hypertonicity, opisthotonos, cardiac arrest, pain with IM injection
  • Respiratory depression, hyperthermia, emesis, vocalization, erratic and prolonged recovery, dyspnea, muscle tremores
  • Cats eyes remain open - must use ocular lubricants
  • Reactivity to stimuli: minimize exposure to handling or loud noises during the recovery period
    • Continue to monitor until complete recovery