CHAPTER 1CHAPTER 1Dr. Dipa Brahmbhatt VMD MpH, MSDr. Dipa Brahmbhatt VMD MpH, MS
[email protected]@yahoo.com
BOOKS
Objectives
• Why does vet tech need to be a pharmacist• Different types of drug names: nonproprietary• Different formulations: solids and liquids• Sources of drug information• Drug terminology• Criteria for extra label use of drugs• Adverse drug reactions reporting
WHY
• ‘Veterinary Technician must understand why the diagnosis was made, why the surgery was performed, why the prognosis was rendered and why the treatment was prescribed’
• Independent: assess and monitor patients, implement therapeutic protocols, obtain and perform dx. Protocols
• “know and think” and ‘do’
Medication Error
“Medication error as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer” June 2010
Commonly Misinterpreted Abbreviations
Abbreviation used Intended as Misread as
U Units 0 (zero)
IU International Units IV (intravenously)
mcg or µg Microgram mg (milligram)
SID Once daily BID (twice daily) and QID (four times daily)
TIW Three times a week Three times daily
Qhs At bedtime Every hour
Iatrogenic?
First responders
• Anaphylactic reaction• Phone conversation for
digoxin toxicity– Anorexia, vomiting,
diarrhea– Bradycardia– Arrhythmias esp.
hypokalemia (diuretics)
• Food animal and drug residues
• Client information: SE
Veterinary technician, Lauren Campbell, carefully inserts a feeding tube into Theros' mouth.© Dina Warren - The Marine Mammal Center
ALL DRUGS ARE POISONS
• Safety and Efficacy is dependent on DOSE, MODE OF ADMINISTRATION and INDIVIDUAL patient
characteristics
– Tylenol (acetaminophen) safe for humans, tolerated in dogs and DEADLY IN CATS
– Intranasal IBR given Subcutaneous
– Underweight or dehydrated patients
– Immiticide (arsenic) in dogs
– Drug is a substance used to tx, prevent or dx. Dz. In animals
Top Pet Toxin of 2008: Medications
• In 2008, human medications like ibuprofen, acetaminophen, decongestants, cold medicines and anti-depressants topped the ASPCA's list of most common pet poisons
http://www.suite101.com/content/most-common-pet-poisons-according-to-aspca-a87882
DEFINITION• Veterinary Pharmacology: ‘The STUDY and USE of drugs in
animal healthcare • Goal of veterinary clinical pharmacology is to optimize
therapy (individual, herd, flock, etc )
BRIEF HISTORY
• 5000 B.C.: India hospital for horses and elephants
• 1700’s: Cattle epidemic in Europe
• 1760’s: France began opening veterinary colleges
• 1860’s: First veterinary school in Philadelphia
SOURCES OF DRUGSDrug Source Example
Minerals Sulfur, iron, electrolytes
Botanicals: Plants, Molds, Bacteria Digitalis, antibiotics
Animal Insulin, TH, Lanolin
Synthetic (manmade/engineered)Laboratory via chemical reaction
Greater purity
Aspirin, steroids, procaine (novocain)
PHARMACOLOGY TERMS
‘Pharmaco’Drug / Medicine
‘Pharmacotherapeutics’ Tx of disease with
Medicine
‘Pharmacokinetics’Study of absorption,
Blood levels, distribution,Biotransformation,
excretion
‘Pharmacodynamics’’MOA of drug
Effects: Biological and physiological
PHARMACOLOGY TERMS
PHARMACOLOGY TERMSCHEMICAL
NAME
NONPROPRIETARY NAME/
GENERIC NAME
Active ingredient
PROPRIETARY/
TRADE NAME
D(-)-alpha-amino-p-hydroxybenzyl-penicillin
trihydrate
amoxicillin Amoxi-Drop® (Pfizer)
Biomox® (Virbac)
Robamox-V® (FD)
((3-phenoxyphenyl) methyl cis-trans-3-(2,2-
dichloroethenyl)-2,2-dimethylcyclopropanecarbox
ylate))
permethrin insecticide Atroban®
Defend®
Flysect®
Dl 2-(o-chlorophenyl)-2-(methylamino) cyclohexanone hydrochloride
ketamine hydrochloride Ketasat®
Vetalar®
registered trademark and cannot be used by other manufacturers
Dosage Forms
• Physical appearance/ type of drug• Tablets, capsules, solutions, liniments
Enteral Administration:Oral Route (PO)
Solid Dosage Forms - PO
• TABLETS– Enteric-coated: Don’t break– Sustained-release (SR)
• Pills with flecks (in SI)• Don’t break
– Scored– MOLDED TABLETS:
heartguard chews• CAPLETS: tablet/capsule
easily swallowed; glossy/ sugar coated
Scored
Powdered drugs compressed into disks/ capsule shaped tablets
Solid Dosage Forms - PO
• GEL CAPS: CAPSULES– Pwdr. Drug in gelatin
capsule > soft and release in stomach
– Pills with pellets• LOZENGES/ Troches: sugar,
not used in vet med
Sustained-release (SR)
• Sulfamethazine: BRDC, e.coli, foot rot
SuppositoriesALTERNATIVE for delivering
drugs to animals that present dangers to the vet staff or animals in very poor condition where other methods of admin. are not practical.
Anticonvulsants, analgesics, antiemetics
Local irritation is a potential side effect of rectal drug therapy.
Liquid Dosage Forms
• Given via dropper, syringe, or drench or mixed with food: solution/ suspension
• Solutions: completely dissolved– Syrups: dissolved in sugar
H2O (85% sucrose)– Elixirs: drug w/ alcohol
(not palatable for animals)
– Tinctures: alcohol, application on skin
Liquid Dosage Forms
• Suspensions: drug particles suspended; settle down– Emulsion: drug w/ liq. fat
or oil– Liniments: drugs
dissolved/suspended in oil base applied w/ friction
– Lotion: drugs dissolved/suspended dab/drip/brush no rubbing: poison IVY
Solution, Emulsion: oil/H20, Suspension
Topical Dosage Forms
Topical Dosage Forms
Comparison of Common Parenteral Routes of Drug Administration
Intramuscular 90
Subcutaneous45
Intravenous25
Intradermal10–15
Muscle
Epidermis
Dermis
Subcutaneous tissue
Injectable Dosage Forms
• Ampules– Once
• Vials– Glass bottle with
rubber stoppers– Multi dose
• Ab, anesthetic, antiinflammatory
• Sterile needle, keep stopper clean
– Single dose• vaccines
Injectable Dosage Forms: Repository/ Depot
• Implants• Under the skin• Release medicine over
extended periods of time: wks. > months
Controlled Internal Drug Release: Intravaginal progesterone
Extract
• Specially prepared plant/animal parts
• TG, pancreatic enzymes, insulin
• May be less expensive but not as consistent as when manufactured
Sources of drug information
• Drug package inserts• Publications
– Out of date q 4-6 months– Formularies
• Veterinary pharmaceuticals and Biologicals, Mosby’s veterinary Drug Reference, Compendium of Veterinary products, Veterinary Drug Handbook
Vet drug: drug has been tested and approved for use in animals
• Drug References– Bound book of information on package inserts
• Physician’s Desk Reference (PDR): Yearly, human-approved drugs. Humans, vets use this for crossover info
United States Pharmacopoeia (USP): Updated yearly
• Drug label must contain:– Drug names (generic and trade)– Drug concentration and quantity (500 ml)– Name and address of manufacturer:
Roxanne– Manufacturer’s control or lot number– Expiration date of drug– Withdrawal time (if warranted only food
animals)– Controlled substance status of drug (if
warranted): higher # less potential for abuse
– Rx: prescription/ order of licensed vet.– USP: standards for safe and consistent
effect
Controlled: Class 4
Drug label/ Extra label
• FDA approved– Specific:Species, Disease, Dose
• Rimadyl in cats is used by a number of veterinarians. – However the U.S. label states:
“WARNINGS: Keep out of reach of children. Not for human use.
Consult a physician in cases of accidental human exposure.
For use in dogs only. Do not use in cats.”
Extra - label/ Off - label– Vet discretion
– Not indicated by labeling by FDA: different dose/ species/ route of administration, other indication e.g. human phenobarbital
– ANIMAL MEDICINAL DRUG USE CLARIFICATION ACT (AMDUCA) - 1994
• Extra label by OR order of licensed veterinarian
• VCPR
• NO DRUG RESIDUES IN FOOD ANIMAL
• Extra label not allowed in FEED ADDITIVES
• Code of Federal Regulations: DRUGS cannot be used• http://cpharm.vetmed.vt.edu/vm8784/default.htm
VCPR
1. Animal has been examined by a veterinarian who assumes responsibility for making judgments about the animal’s health and the need for treatment
2. Client agrees to follow the given
Instructions
3. Veterinarian is available for follow-up4. http://www.avma.org/animal_health/vcpr_poster.pdf
Jane R. Shaw, DVM, PhD
Regulation of Drug Products• The Food and Drug Administration (FDA) became a
government agency to enforce the federal Pure Food and Drug Act of 1906– The Pure Food and Drug Act established standards for drug strength,
purity, and guidelines for drug labeling• Until the late 1930s, the FDA had little power to determine
and enforce correct drug dosage information• In 1938, Congress passed the federal Food, Drug, and
Cosmetic Act (FDCA), which required that a drug be adequately tested to demonstrate its safety when used as its label directs
• In 1972, the FDCA was amended to include many more protections
Copyright © 2011 Delmar, Cengage Learning
Regulation of Drug Products
• The FDA is headed by a commissioner and organized into a number of different centers
• The FDA’s Center for Veterinary Medicine (CVM) ensures that approved veterinary medicines will not harm animals
• The FDA-CVM prohibits the sale and use of a drug that would cause animals to suffer serious health problems
• The 1968 amendments to the FDCA made drug manufacturers specify drug withdrawal periods and detection methods for determining drug residues in animal foodstuffs
• Details: Figure 1-1
Copyright © 2011 Delmar, Cengage Learning
Reporting Adverse Reactions
• Table 1-1• SE/ ADR
– Precautions: rare ADR/ mild SE– Warnings: More serious or frequent SE– Contraindications: Don’t use with ….malpractice
• Overdose information• Benefit outweigh potential SE: e.g slight GI
upset ok if treats severe FRDC/ CRDC
FDAhttp://www.fda.gov/downloads/AnimalVeterinary/NewsEvents/
FDAVeterinarianNewsletter/UCM236854.pdf
YES NO MAYBE SO
Animal Drugs Vaccines (USDA) Pharmacies
Banned turtles under 4 inches
Salmonella carriers
Antibodies (USDA) Practice of Vet Med.
Extra label use
Animal Devices: if adulterated/ misbranded
Toxoids (USDA)
Flea and Tick products
FDA/EPA
Animal Feed: safe ingredients, human food
safety
NO REGULATION
cat litter, pet accessories (toys, bed, crates),
grooming aids
FDA: milk, milk products (cheese,
cream, and ice cream) and
“Shell eggs” (eggs
inside their shells)
USDA: egg products
meat, poultry, and catfish
Medical Calculation 1
• Trade name: ‘Clavamox’• Generic: Amoxicillin-Clavulanic acid• Broad spectrum bacterium• DOSAGE: 13.75 mg/ kg BID PO X 14 days
1) How many tablets for a 15.5 lbs. dog per day• Concentration: 62.5 mg, 125 mg, 250 mg, 400 mg
tablets
2) How many total tablets dispensed to the owner
References
• Romich, J.A. Pharmacology for Veterinary Technicians, 2nd edition. 2010.
• Bill, R.L. Clinical Pharmacology and Therapeutics for the Veterinary Technician, 3rd edition. 2006.
• http://cpharm.vetmed.vt.edu/vm8784/default.htm
References
• Dave Sobecki, Allan G. Bluman, Angela Schirck-Matthews. Math in our World. McGraw-Hill Companies,Inc. 2010
• http://www.msnbc.msn.com/id/35286379/ns/health-pet_health/t/when-vets-make-mistakes-pets-pay-price/
• http://www.fda.gov/AnimalVeterinary/ResourcesforYou/ucm214772.htm