Pharmacy Procedures

Michael Lavoie6/13/12

Veterinary Assistant ProgramMiddlesex Community College

Reading a Prescription

Often abbreviated Rx The prescription is the type of

medication, amount of medication, and directions of use for the medication

Prescription is determined by the veterinarian, and we are there to put the prescription together.

Several parts to a prescription Medication name Medication strength Method of administration Amount to be administered Frequency of the medication Length of use Amount to be dispensed Special instructions Number of refills Veterinarian name

Labeling a Prescription

Purpose is to indicate to the owner how to properly give the medication and identify the medication in the container

When a label is prepared it should be legible if handwritten, clean and understandable

The following information should be on a label: Veterinary facility name, address and

phone number Name of the prescribing veterinarian Client name Client address, if it is a controlled

substance

Patient name or ID number Medication name Medication strength Quantity dispensed Expiration date of the medication Number of refills Amount per treatment or use Route of use

Frequency of treatments Length or duration of use Special instructions

Additional labeling can use used, such as warning labels in sticker form.

Some stickers you may use

“keep refrigerated” “give with food” “for the eye” “for the ear” “shake well before using” “give by mouth only”

Labeling Each container should be labeled for

veterinary use only When labeling directions for medication

use regular wording for the clients Medical abbreviations should be

avoided Recheck the label for accuracy, and go

over with the client, so they understand the directions as well

Dispensing medications Every medication

needs to have a childproof container

Only exception is for clients who ask for one that isn’t due to medical reasons making it difficult to open the lid

Dispensing medications

It is important to explain that there is always the possibility of children or pets getting into a non child proof container

Be sure to mark in the medical record that the owner requested a non child proof cap

Medication Containers

Plastic vials and bottles are commonly used with a twist off or snap off lid

Size of the container is measured in drams

Proper sized vial should be used to hold the amount of medication dispensed

Vials are usually amber colored

Medication containers

The reason is to keep the medication for degrading in sunlight

Vials are used for pills and capsules

Bottles are used for liquid medications

Drug Identification

Proper dosage and strength are selected by veterinarians.

We need to make sure that the drug we are dispensing is correct

A patients condition may worsen or not improve if the wrong drug, or concentration is given

Drug Identification Many drugs have similar names Compare the spelling of the drug with

the drug on the drug label Also drugs come in different

concentrations so always make sure you have the right concentration

Drug strengths can be written in milligrams (mg), millimeters (ml), cubic centimeters (cc), or grains (gr).

Drug Identification Never dispense a drug that is expired. Can find the expiration date on the

bottle or lid of the drug bottle Check these for accuracy:

Right patient Right drug Right strength Right quanitity Right frequency

Amount to be Dispensed

May be listed on the prescription or may need to be calculated by the veterinary assistant

Requires a knowledge of pharmacy abbreviations and basic math

Lets work on an example

Amoxicillin 250 mg PO BID X 14

Determine how often the drug is given

Determine how long the drug is to be given

Multiply the number of doses per day by the duration of treatment

Locate the strength of the drug as closely as possible to the prescription

Determine how many units per dose are needed

Multiply the number of tablets per dose by number of doses

Pill counting tray Is a device that

has a flat area for medicine to be placed and a channel or funnel like area to place medication that has been counted

Types of medication Divided into three categories

Over the counter medications: can be purchased by any one at a human pharmacy

Prescription drugs: ordered or scripted by veterinarians

Controlled substances: prescription drugs that can have the potential for addiction or abuse

Types of medications

Controlled drugs are regulated by the DEA

Have specific regulations and guidelines for ordering, storing, and dispensing

Veterinarian must have a controlled substance license

Controlled Substances Only person who can order and

prescribe controlled drugs are licensed veterinarians

Licenses are issued by the DEA and renewed every three years

Must legally be stored behind 2 locks Access to the controlled substances

are limited to one or two people on shift

Controlled Substances

Must be logged in the controlled substance log

Written entries are required for every substance dispensed by the facility

Must be recorded in blue or black ink and records need to be kept for 2 years

Varies from state to state

Information for Controlled Substances

Name of controlled substance Drug strength Drug form (tablet, capsule, liquid, injection,

etc.) Quantity dispensed Quantity on hand Date dispensed Time dispensed Client name and address Patient name Animal breed/species Initials of person dispensing

Educating Clients on Medication Use

The veterinary assistant should be able to review all medication instructions before the client and patient leave the facility

Should be urged to call with any questions

Some clients will receive a handout about how to give the medication with examples or diagrams on how to give

It is important for the veterinary assistant to be able to review or show the client how to give the medication Why the medication is administered How the medication is to be administered How much is to be administered When the medication is to be administered

Administering Oral Medications Administered by mouth Can be tablets, capsules, or liquids Small animals like dogs and cats

require the mouth to be opened and medication to be placed in the back of the mouth

Larger animals like live stock may require more power to hold and give medications to

Instrument use Some animals may require pet pillers

or other medication aids A pet piller is a small device, usually

made of plastic, that has a long thin handle with a plunger on the end

The plunger holds the medication and the handle is used to throw the medication to the back of the mouth

Large animals may require a balling gun which is a metal device that has a long handle and a plunger at the base

Disposition of the animal also plays a part in how the medications are delivered.

When administering medication it is important to consider the drug used

Tablets and capsules can be given in peanut butter or a bit of cheese

Also, a product called pill pockets can be used in dogs and cats that have various flavors that appeal to the animal.

Tablets and capsules can be crushed into a powder and administered in water using an oral dosing syringe

A mortar and pestle can be used to grind down the medication into a fine powder

Pastes can also be made to administer medication (usually done at a compounding pharmacy

Administering Oral Medications in Dogs

1. Apply gloves2. Elevate head upward3. Open mouth at side by pressing

between the upper and lower jaw joint by cheek

4. Place medicine between index finger and thumb of free hand

Administering Oral Medications in Dogs

5. place middle finger of same hand at front of mouth and apply pressure to open mouth wide

6. Drop the tablet or capsule at the back of the throat

7. If safely able to use index finger of free hand, push the medication deeply into the throat

Administering Oral Medications in Dogs

8. Close the mouth and hold until patient swallows

9. Gently blow on face or rub throat to stimulate swallowing

10. Monitor for any signs of the medication not being ingested

Administering oral medications in cats

1. Apply gloves2. Have someone hold front feet and

body while pilling3. Elevate the head upward4. Open mouth by pressing at the

side between the upper jaw and lower jaw joint by cheek

Administering Oral Medication in Cats

5. Place medicine between index finger and thumb of free hand

6. Place middle finger of the same hand at front of mouth and apply pressure to open mouth wide

7. Drop the tablet or capsule at the back of the throat

Administering Oral Medication to a Cat

8. If safely able to use index finger of free hand, push the medicine deeply into the throat

9. Close the mouth and hold until the patient swallows

10. Gently blow on face or rub throat to stimulate swallowing

11. Monitor for any signs of the medication not being ingested

Using a Pet Piller or Balling Gun

1. Apply gloves2. Place pill in the end of the plunger

of the pet piller or balling gun3. Apply the end of the piller or balling

gun into the side of the mouth between the upper and lower teeth

4. Once in the mouth, push plunger to release medicine to back of the throat

Using a Pet Piller or Balling Gun

5. Remove the balling gun or pet piller and immediately elevate head upward

6. Blow on nose or rub neck to stimulate swallowing

7. Check to make sure the medicine was swallowed

8. Disinfect items and put away

Administering liquids and pastes

1. Apply gloves2. Elevate head upwards3. Insert syringe or paste tube in side

of the mouth between the upper and lower teeth

4. Press the plunger to the desired amount into the back of the throat

Administering liquids and pastes

5. Remove syringe or tube and continuing elevating the head upwards

6. Blow on nose or rub throat to stimulate swallowing

7. Keep mouth held shut until swallowing occurs

8. Disinfect any tools and put away

Administering Aural Medications

Are placed in the ear and may be used for ear infections, ear cleaners or ear mites

The opening of the ear canal includes the tragus

Area located caudally and with no har is the pinna

Aural Medications Internal ear canal is L-shaped Ear canal is made of cartilage Treated for many reasons, most

common is ear infections Long eared dogs have ears that do

not allow for good ventilation and moisture and bacteria may easily build up in the canal

Some dog breeds such as poodles and bichons have hair that grows in the canal which may prevent proper ventilation from occurring

All animals are susceptible to ear mites

Flies and mosquitoes may bite the ear flaps such as in large animals which can cause crusting and bleeding on the ear edges

Wax and other debris can be lodged in the are causing trauma and irritation

Hematomas

Hematomas can be made by damage to the ear or excessive head shaking

When an animal shakes its head severely it may cause blood vessel to rupture and the pinna to fill with blood

Aural Medications

Are usually in liquid form Can be either a drop or ointment Some medications can be packaged

in bottles or tubes Many tubes are meant for multiple

uses Often ears need to be cleaned

before applying medications

Aural Medications The veterinary assistant can be

asked to show the clients how to properly apply ear medications at home

Gloves should be worn to prevent contamination

Also tops to ear medications should be cleaned between ears to prevent contamination

Administering Aural Medications

1. Apply gloves2. Clean ears as recommended by

the veterinarian3. Place medication into dropper or

tip deep inside the ear canal only to the depth of the start of the vertical portion of the L-shape

Administering Aural Medications

4. Apply the proper amount of medication into the ear as noted by the veterinarian. This is usually in drops that are counted according to the veterinarian’s label

5. Remove the medication dispenser from the ear

Administering Aural Medications

6. Massage the base of the outside of the ear canal. This will create a swishing sound caused by the medication moving around the ear canal

7. Wipe any solution that may have leaked onto the outside of the ear flap of hair

8. Disinfect the medication dispenser with alcohol and place in appropriate area

Administering Topical Medications

Topical medication is a substance applied to the outside of the skin coat on an external body surface

Topical medications may include antiseptics, flea and tick medications, or wound treatments

Topical medications

Areas of wounds or abrasions should be soaked prior to applying the medication

Can be done by soaking with warm water or surgical scrub

Some topical medications can come in a single use container or in a large volume meant for multiple uses

Topical medications Flea and tick medications should be

applied according to label medications Each product treats specific animals for

specific reasons Some topicals treat fleas only, others

ticks Gloves should be worn when applying

these medications because of the various chemicals in them

Administering Topical Medications

1. Apply gloves2. Clean area as necessary3. Use a tongue depressor to transfer an

amount of topical medication if the container is for multiple uses

4. Apply to ointment onto the area in a circular motion, starting at the center of the wound and gently working outward

Administering Topical Medication

5. Do not contaminate the medication by touching items that have touched the animal. Flea and tick medications should be applied as directed on the instructions

6. Separate hair from skin and apply as directed

7. Clean area and put items away

Ophthalmic medications Are ointments or solutions that are

applied to the eyes May be used to treatment of an

eye condition or used prior to bathing or grooming to protect the cornea from damage

Avoid the contact of the applicator with the eye

Ophthalmic ointment

Touching the tip to the eye will not only contaminate the medication but may also cause trauma to the eye

Wear gloves when applying eye medication

Eye will need to be held open for a better view

Ophthalmic medications

Eye drops can be dropped into the eye by holding the bottle over the open eye

Ointments can be applied by a thin layer over the lower eyelid and allow the animal to blink several times to move the substance throughout the eye

Administering Ophthalmic Medication

1. Apply gloves2. Wipe any discharge from the

patient’s eye using a gauze sponge3. Open the end of the ophthalmic

medicine and hold in one hand4. Using the free hand, use the index

finger and thumb to pull the upper and lower lids apart to see the eye

Administering Ophthalmic Medication

5. The thumb pulls the lower lid down, the index finger pulls the upper lid upwards

6. The other finger may rest on the head of the animal

7. Gently tilt the head upwards8. Apply the drops or ointment gently into

the eye, counting each drop and applying the proper amount. Do not touch the surface of the eye with the dispenser

Administering Ophthalmic Medications

9. Apply the ointment over a thin layer on the lower lid. Do not touch the surface of the eye with the dispenser

10. Release the eyelids11. Allow the animal to blink to move the

medication through the eye12. Clean the dispenser with a small

amount of alcohol on a gauze sponge

Medication Storage

Medications have an expiration date and should be monitored for proper dating prior to dispensing

Medications in the pharmacy should be stored with the oldest dates being used first to use up the products that will expire the fastest

Medication Storage Expiration date is located on the

bottle Must be included on the pharmacy

label when dispensing medication All outdated medication should be

removed from the shelves Drugs typically arrive with an insert

within the container that details the actions and use of the drug

Medication Storage

Storage information is also located on the insert

Some items are stored at room temperature, other may need refrigeration

Biologicals, like vaccines, are stored under refrigeration

Medication Storage

Some drugs need to be stored in a dark place and kept away from direct light

These drugs lose their efficacy when exposed to light.

All drugs without information on storage should be kept at room temperature in a clean dry area.

Medication Storage Most veterinary pharmacies keep

medications stored on shelves in alphabetical order for ease of locating

All controlled items are kept in the controlled substance lock box

All items after being opened need to be sealed tight and replaced in their proper pharmacy location

Pharmacy shelves should be cleaned on a regular basis to keep dust and debris from bottles.

QUESTIONS?