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July/August 2014 Today's Veterinary Practice 67 On YOur BesT BehaViOr | Q & a: The use Of MedicaTiOns in BehaViOr TheraPY tvpjournal.com WhaT OTher facTOrs shOuLd Be cOnsidered? Management Changes It is sometimes too easy to think that a medication or combination of medications will do most of the work, when in fact management changes, safety practices, and re-learning are needed for a successful outcome. Unfor- tunately, administration of a behavior drug often pushes these efforts to the back of the line. Follow-Up Follow-up is critical in management of behavior cases, not only for dose adjustment and changes in choice of drug, but also for feedback on modification, implemen- tation, and progress. Client Expectations Behavioral drug use in pets is common enough that clients may ask specifically for medication ("puppy Prozac") for a variety of problems. Before accommodating that request, however, consider these recommendations: • Remember that behavioral medication use is deter- mined by the veterinarian per the Animal Medicinal Drug Use Clarification Act (avma.org/KB/Resources/ Reference/Pages/AMDUCA.aspx) • Review the indications and mechanisms of action • Be familiar with potential contraindications and adverse effects • Address any confounding or comorbid medical prob- lems associated with the behavior problem, includ- ing pain, sensory decline, or hypersensitivity. The client should also be forewarned that patience will be needed, especially while waiting for the drug to "load" over the course of 1 to 2 months. If the medication is being administered at the correct therapeutic doses, and there still is no measurable change—decreased frequency or intensity of the problem behavior—it may be necessary to taper and discontinue that medication; then begin a new one and start the wait again. This lag period can be helped by use of a more immediately ef- fective anxiolytic, such as trazodone, but con- sider educating clients that the beginning of drug administra- tion can mimic a long ride on a slow-motion roller coaster. in suMMarY B ehav ior a l med i- cations can make a significant difference in the management of a variety of problems. The ac- cessibility of information about their use, and growing choices of the medications themselves, increase their convenience. Most important, they can facilitate a posi- tive outcome in otherwise complicated behavior cases. Medications are now a conventional option for manage- ment of behavioral problems rather than a "last resort." fda = food and drug administration; Prn = as need- ed; ssri = selective serotonin-reuptake inhibitor; Tca = tricyclic antidepressant; MaOi = monoamine oxi- dase inhibitor Case Application: Buttercup Buttercup's lunging and snapping behavior significantly decreased after 2 months of: 1. Treatment with fluox- etine 2. consistent effort by the owner to counter- condition her to visi- tors (seated a "safe" distance away) 3. creation of a separate "safe haven," where she could indulge in feeder toys. Ilana Reisner, DVM, PhD, Diplomate ACVB, is a veterinary behaviorist and consultant in Media, Pennsylvania. She has served as the director of the Vet- erinary Behavior Clinic at University of Pennsylvania Veterinary Hospital and as- sistant professor of behavioral medicine at Penn's School of Veterinary Medicine. She is past president of the American Veterinary Society of Animal Behavior. She received her DVM from Oregon State University and her PhD from Cornell University. The Special Case of Aggression human-directed aggression is the most common canine behavior complaint; fear or self-defense is the most frequent reason for aggression. although clients may naturally assume that anti-anxiety medication can resolve this problem, remind them—ideally in a written document—that there is no reliable "cure" for aggressive behavior, and no drug will prevent biting. More important than any medication is the need for clients to understand safety recommendations, avoidance of triggers of aggression, and the application of behavior modification, including both classical and operant conditioning. it should be emphasized that punishment or other harsh training methods, including shock collars and outdated "dominance" exercises, can backfire by increasing defensiveness and the likelihood of further biting. in any animal with a history of biting, the risk for future bites can never be entirely elimi- nated. Owners may not want to face the prospect of permanent caution, but nevertheless it is important to emphasize safety and preventive measures. read Dog Bites: Protecting Your Staff & Clients (november/ december 2011) for further informa- tion, available at tvpjournal.com .