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Applied Animal Behavior > Psychopharmacology > Flashcards

Psychopharmacology Flashcards

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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
**Acepromazine** **Acetylpromazine, Ace, ACP, Promace**
* 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
**Acepromazine Contraindication**
* 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
**Alprazolam** Xanax
* 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
**Alprazolam Contraindications**
* **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** ## Footnote **​**
29
**Alprazolam Adverse Effects**
* **Sedation, increased appetite,** and transiet ataxia * Cats may exhibit changes in behavior
30
Diazepam Valium, Diastat
* 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
**Diazepam Contraindicatinos**
* 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
Diazepm Adverse Effects
* 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
**Benzodiazepines**
* **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
Clonidine Catapres, Kapvay, Clorpres, Duraclon, Nexiclon
* 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
Clonidine Contraindications
* 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
Clonidine Adverse Effects
* 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
**Trazodone** Desyrel
* 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
**Trazodone Crontraindications/Warnings/Drug interations**
* 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
**Trazodone Adverse Effects**
* 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
**Gabapentin** Neurontin
* 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
**Gabapentin Contraindications / Warnings / Drug Interactions**
* 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
**Gabapentin Adverse Effects**
* **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
Imepitoin Pexion
* 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
Imepitoin Contraindication / Warning / Drug interactions
* 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
Imepitoin Adverse Effects
* Well-tolerated in dogs * side effects: somnolence, ataxia, polyphagia, polyuria, polydipsia * **Aggression toward children and/or other dogs**
46
**Dexmedetomidine** Dexdomitor, Sileo
* 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
**Dexmedetomidine Contraidications / Warnings / Drug Interactions**
* **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
**Dexmedetomidine Adverse Effects**
* 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
**Dexmedetomidine Oralmucosal Gel - Sileo**
* **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
**Dexmedetomidine Additional Information**
* 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
**Butorphanol** Stadol, Torbutrol, Torbugesic
* 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
**Butorphanol Contraindications / Warnings / Drug Interactions**
* **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
**Butorphanol Adverse Effects**
* **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
**Buprenorphine** Buprenex
* 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
**Buprenorphine Contraindications**
* Use cautiously in patients with **compromised crdiopulmonary function**
56
**Buprenorphine Adverse Effects**
* **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
**Opioid Precautions**
* 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
**Ketamine** Ketaset, Ketaflo, Vetalar
* 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
**Ketamine Contraindications / Warnings / Drug Interactions**
* **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
**Ketamine Adverse Effects**
* **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

Applied Animal Behavior (13 decks)

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