6 Nervous System Drugs Overview II

a. benzodiazepines

d. Buspirone

Select the anxiolytic drugs:

a. benzodiazepines

b. TCA (tricyclics)

c. SSRI (selective serotonin reuptake inhibitors)

d. Buspirone

e. MAOI (Monoamine Oxidase Inhibitors)

f. SNRI (selective serotonin/norepinephrine reuptake inhibitors)

b. TCA (tricyclics)

c. SSRI (selective serotonin reuptake inhibitors)

e. MAOI (Monoamine Oxidase Inhibitors)

f. SNRI (selective serotonin/norepinephrine reuptake inhibitors)

Select the antidepressant drugs:

a. benzodiazepines

b. TCA (tricyclics)

c. SSRI (selective serotonin reuptake inhibitors)

d. Buspirone

e. MAOI (Monoamine Oxidase Inhibitors)

f. SNRI (selective dual serotonin/norepinephrine reuptake inhibitors)

1. Noise phobia

2. Separation anxiety

3. aggression

4. compulsive disorder

5. inappropriate elimination behavior

6. cognitive dysfunction

Name the problem behavioral issues in small animals:

b. Clomipramine (ClomiCalm)

Select the Tricyclic antidepressants:

a. Fluoxetine (Reconcile)

b. Clomipramine (ClomiCalm)

c. Selegiline (Anipryl)

d. Dexmedetomidine (SILEO)

a. Fluoxetine (Reconcile)

Select the Selective Serotonin Reuptake Inhibitor antidepressants:

a. Fluoxetine (Reconcile)

b. Clomipramine (ClomiCalm)

c. Selegiline (Anipryl)

d. Dexmedetomidine (SILEO)

c. Selegiline (Anipryl)

Select the Monoamine Oxidase Inhibitors antidepressants:

a. Fluoxetine (Reconcile)

b. Clomipramine (ClomiCalm)

c. Selegiline (Anipryl)

d. Dexmedetomidine (SILEO)

d. Dexmedetomidine (SILEO)

Select the centrally acting 2A agonist:

a. Fluoxetine (Reconcile)

b. Clomipramine (ClomiCalm)

c. Selegiline (Anipryl)

d. Dexmedetomidine (SILEO)

DOGS ONLY = no FDA approved meds for cats

Clomipramine (ClomiCalm), Fluoxetine (Reconcile), and Selegiline (Anipryl) are all examples of FDA approved antidepressants for WHAT ANIMAL?

Benzodiazepines

This anxiolytic drug binds GABA A receptor to increase affinity of GABA binding

Calming, anxiolytic, sedation, seizure treatment and panicolytic

Name some indications for benzodiazepines:

Benzodiazepines

Unwanted effects of this drug include excessive sleepiness, loss of cognitive and motor function, and *paradoxical excitement* (loss of inhibition causes aggression)

Do NOT use in household that have addiction or substance abuse issues. This is a class IV controlled substance

When should you NOT prescribe benzodiazepines to animal patients? (has to do with human household)

Diazepam

Which drug has hepatic necrosis in cats when given by mouth?

Chlordiazepoxide

Which benzo causes liver dysfunction and is commonly used in zoo animals?

Alprazolam

note: Dexmedetomidine, SILEO transmucosal is ALSO a panicolytic but it an alpha 2 agonist

What benzo do you use if you need a fast acting panic reducer?

Benzodiazepines

What fast acting medication (broad) would you use as a panic reducer before a veterinary visit?

Dopamine, Serotonin, and Norepinephrine

Name the 3 monoamines that play a center role in the expression of mood:

Monoamines: dopamine, serotonin, and norepinephrine

Impaired activity of WHAT chemicals leads to depression, but increased activity leads to mood elevation?

TRUE

TRUE OR FALSE: antidepressants take time (weeks) to take CLINICAL effect and are not to be used for acute depression

1. reuptake inhibitors

2. monoamine oxidase inhibitors

What are the two main mechanisms of action of different antidepressants:

Reuptake inhibitors

This MOA of antidepressants inhibits pre-synaptic reuptake to make MORE serotonin and norepinephrine AVAILABLE

Monoamine oxidase inhibitors

This MOA of antidepressants inhibits monoamine oxidase enzyme to DECREASE the DEGRADATION of serotonin and norepinephrine

INCREASE = they block serotonin reuptake channels

SSRI's *increase or decrease* serotonin availability

INCREASE = they block norepinephrine and serotonin reuptake channels

SNRI's *increase or decrease* serotonin and norepinehprine availability

Tricyclic antidepressants

Which antidepressant acts on: histamine receptor, alpha 1 receptor, muscarinic receptor, AND stops norepinephrine and serotonin reuptake?

Clomipramine (Clomicalm)

What is the only FDA approve tricyclic antidepressant in dogs?

Separation anxiety: inappropriate barking, destructive behavior and inappropriate elimination, salivation

What is Clomipramine (Clomicalm) normally used to treat in dogs?

Clomipramine (Clomicalm) (a tricyclic antidepressant)

Which antidepressant should not be used in male breeding dogs, in dogs with seizures (lowers threshold), or in combination or within 14 days of monoamine oxidase inhibitors.

Tricyclic antidepressants

In humans, this medication causes blurred vision, dry mouth, and constipation when bound to the muscarinic receptor

1. cardiovascular issues

2. narrow angle glaucoma

3. Keratoconjunctivitis Sicca (aka dry eye)

4. seizures

Name the contraindications for using tricyclic antidepressants in animals:

Fluoxetine (Reconcile)

What is the FDA approved SSRI antidepressant for dogs?

Separation anxiety and destructive behavior

What is the indication for using SSRI Fluoxetine (Reconcile) in dogs?

Do not use in dogs with histories of seizures or in combination with other drugs that lower the seizure threshold and DO NOT combine with MAOI or TCA antidepressants

SSRIs should not be used in which type of dogs? What are contraindications?

Causes serotonin syndrome = excessive levels of serotonin

What happens when you mix SSRIs with MAOIs or TCAs?

SEROTONIN SYNDROME

A dog presents with confusion and anxiety, ataxia, tremors, myoclonus, hypertension, tachycardia, nausea, diarrhea and excessive salivation. You see in his chart that another hospital has the dog on Reconcile and Colmicalm for his separation anxiety. What are you thinking?

Selegiline (Anipryl)

What is the FDA approved MAOI antidepressant in dogs for Cognitive Dysfunction?

Anipryl (Selegiline), an MAOI

This medication is a selective monoamine oxidase B inhibitor, which enhances catecholamine neuron activity and increases dopamine levels in dogs

MAO inhibitors

This drug inhibits the enzyme that breaks down norepinephrine and serotonin

MAOi

Which drug has metabolites which include amphetamine and methamphetamine which cause hyperactivity and has stimulant ability in some dogs?

DO NOT combine with TCA, SSRI, or other MAOi antidepressants. Do NOT USE with alpha 2 agonists

What are some contraindications for MAOI antidepressants?

Dexmedetomidine (SILEO)

Which medication is FDA approved and used for noise aversion in dogs?

Alpha 2 agonist (dexmedetomidine)

This medication is a sedative, analgesic, anxiolytic/emetic in cats and noise aversion in dogs that binds to pre-synaptic alpha 2 receptors to decrease sympathetic outflow and transmission in CNS

Alpha 2 agonists (dexmedetomidine, SILEO)

Which medication should you NOT use if an animal is vomiting, cardiovascular depression, those with heart disease, respiratory, liver, kidney disease, shock, or if pregnant

a. amitriptyline

b. nortriptiline

e. imipramine

f. doxepin

Select the NON FDA approved tricyclic antidepressants:

a. amitriptyline

b. nortriptiline

c. sertraline (zoloft)

d. fluvoxamine

e. imipramine

f. doxepin

a. citalopram

c. sertraline (zoloft)

d. fluvoxamine

f. esitalopram

Select the NON FDA approved SSRIs:

a. citalopram

b. nortriptiline

c. sertraline (zoloft)

d. fluvoxamine

e. imipramine

f. esitalopram

a. venalafaxine

e. duloxetine

Select the NON FDA approved SNRIs:

a. venalafaxine

b. nortriptiline

c. sertraline (zoloft)

d. fluvoxamine

e. duloxetine

f. esitalopram