CHAPTER 1CHAPTER 1Dr. Dipa Brahmbhatt VMD MpH, MSDr. Dipa Brahmbhatt VMD MpH, MS

dbrahmbh@yahoo.comdbrahmbh@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