Chapter 5 Veterinary Drug Use, Prescribing, Acquisition, and Pharmacy Management Copyright © 2011 Delmar, Cengage Learning

Brand Name (®) or Not? Chemical name: –Provides scientific and technical information –Is a precise description of the substance –Example: 7-chloro-1,3-dihydro-1-methyl-5-phenyl-2H-1,4- benzodiazepin-2-one Copyright © 2011 Delmar, Cengage Learning

Brand Name (®) or Not? Generic (nonproprietary) name: –Official identifying name of the drug (assigned by the U.S. Adopted Names Council) –Describes the active drug –Written using lowercase letters –Example: diazepam Copyright © 2011 Delmar, Cengage Learning

Brand Name (®) or Not? Brand (trade, proprietary) name: –Establishes legal proprietary recognition for the corporation that developed the drug –Is registered with the U.S. Patent Office and is used only by the company that registered the drug –Is written in capital letters or begins with a capital letter and has a circled, superscript R by its name –Example: Valium  Copyright © 2011 Delmar, Cengage Learning

Compounding Occurs when health professionals prepare a specialized drug product to fill an individual patient’s needs when an approved drug is not available Copyright © 2011 Delmar, Cengage Learning

Compounding Uses of compounding –Creating discontinued drugs –Creating dosages and strength specific to a dog’s weight and health –Creating alternative dose forms such as liquids, ointments, or chewable tablets –Adding flavoring to drugs to make them more appealing to animals –Customizing formulas that combine multiple drugs for one dose administration Copyright © 2011 Delmar, Cengage Learning

Compounding Concerns –Small compounding changes may turn an FDA approved drug into an unapproved drug –Compounded drugs are made without FDA oversight and may pose a risk to the patient –Compounded drugs may not be sterile and can cause infections to patients that use them –Errors in preparing compounded drugs may result in disease or death in patients who use them Copyright © 2011 Delmar, Cengage Learning

Sources of Drug Information United States Pharmacopoeia (USP) –Publication that is the legally recognized drug standard of the United States –Describes the source, appearance, properties, standards of purity, and other requirements of the most important pure drugs –The FDA requires that all drugs meet USP standards of purity, quality, and uniformity Copyright © 2011 Delmar, Cengage Learning

Sources of Drug Information Drug label must contain: –Drug names (generic and trade) –Drug concentration and quantity –Name and address of manufacturer –Manufacturer’s control or lot number –Expiration date of drug –Withdrawal time (if warranted) –Controlled substance status of drug (if warranted) Copyright © 2011 Delmar, Cengage Learning

Sources of Drug Information Package insert –Provided with drugs to meet regulatory requirements Registered trade name, generic name, controlled substance notation if warranted Description or composition statement Clinical pharmacology, actions, or mode of action Indications and usage Contraindications Precautions Warnings Adverse reactions or side effects Overdosage information Dosage administration Storage How supplied Copyright © 2011 Delmar, Cengage Learning

Sources of Drug Information Drug References –Bound book of information on package inserts Physician’s Desk Reference (PDR): human-approved drugs Veterinary Pharmaceuticals and Biologicals (VPB) Compendium of Veterinary Products (CVP) Copyright © 2011 Delmar, Cengage Learning

Expiration Dates Expiration date is the date before which a drug meets all specifications and after which the drug can no longer be used Expiration dates are assigned based on the stability of or experience with the drug Expiration dates for drugs that are mixed in the clinic vary depending on the reconstitution and refrigeration status of the drugs Copyright © 2011 Delmar, Cengage Learning

Dispensing vs Prescribing Veterinary drugs are those approved only for use in animals Human drugs are approved by the FDA and guidelines for their use in food-producing animals are provided in the Compliance Policy Guide A veterinarian/client/patient relationship must be established before any medication is prescribed for an animal –For guidelines for veterinarian/client/patient relationships refer to Table 5-2 in your textbook Copyright © 2011 Delmar, Cengage Learning

Veterinary/Client/Patient Relationship Veterinary prescription drugs are labeled for use only by or on the order of a licensed veterinarian A veterinary/client/patient relationship (VCPR) exists when the following conditions have been met: –The veterinarian has assumed responsibility for making clinical judgments and the client has agreed to follow –The vet has sufficient knowledge of the animal to at least make a preliminary diagnosis Copyright © 2011 Delmar, Cengage Learning

Veterinary/Client/Patient Relationship –The veterinarian is readily available for follow-up evaluation in the event of adverse reaction or failure of the treatment regimen Veterinary prescription drugs must be properly labeled before being dispensed Dispensing and treatment records must be maintained Drugs should be dispensed only in quantities required for the treatment of the animals Copyright © 2011 Delmar, Cengage Learning

Prescriptions A prescription is an order to a pharmacist, written by a licensed veterinarian, to prepare the prescribed medicine, to affix the directions, and to sell the preparation to the client Copyright © 2011 Delmar, Cengage Learning

Label on the Prescription The label on the prescription should be complete and contain: –The name and address of the dispenser –The client’s name (+/- address) –The animal’s name and species –The drug name, strength, and quantity –The date of the order –Directions for use –Any refill information (if warranted) Copyright © 2011 Delmar, Cengage Learning

Parts of a Prescription Label Copyright © 2011 Delmar, Cengage Learning

Dispensing Drugs Prescription drugs may be dispensed by pharmacists or trained veterinary staff Veterinary prescription drugs should be properly labeled when dispensed Remember that veterinary staff members cannot refill or dispense medications without veterinarian approval Medications must be dispensed in childproof containers Labels with cautionary statements may also be used on the prescription Copyright © 2011 Delmar, Cengage Learning

Electronic and Paperless Record Keeping Veterinarians write the medication order in a paper file or type it into an electronic record As the medication is it recorded into the medical record with the date, time, and the initials of the person giving the drug The numbers of veterinary hospitals that utilize a completely paperless electronic medical record system is increasing Copyright © 2011 Delmar, Cengage Learning

Electronic and Paperless Record Keeping Advantages of using an electronic system include: –Improved efficiency No lost records Immediate access to records Ability to pull up all prescriptions on one screen –Space saving No file cabinets, storage boxes –Cost saving Less filing No time needed to retrieve records Copyright © 2011 Delmar, Cengage Learning

Electronic and Paperless Record Keeping –Avoidance of errors Prompts for patients with allergic reactions Information on drug interactions Identification of clients with special considerations –Automated input Laboratory data automatically transfers into patient record Prescription instructions can be entered into the computer in advance Copyright © 2011 Delmar, Cengage Learning

Pharmacy Economics Maintaining a pharmacy is a business that depends on charging and collecting a fee for services to continue providing medical care Copyright © 2011 Delmar, Cengage Learning

Pharmacy Economics Inventory and Control Maintenance –Time invested in maintenance of appropriate stock levels benefits the overall business health of the veterinary practice –The goal is to stock quantities of each item as low as possible to reduce overhead and inventory costs, but now low enough to have a shortage –The longer inventory sits on the shelf, the longer it costs the practice in hidden costs –Too much inventory also ties up money that could be invested and earning Copyright © 2011 Delmar, Cengage Learning

Pharmacy Economics Inventory Purchasing –Direct marketing is when a drug is purchased directly from the company that manufacturers it –Distributors or wholesalers are agencies that purchase the drug from the manufacturers and resell it to the veterinarians –Other sources of drugs include veterinary practices, buying groups of several veterinary practices, and pharmacies Copyright © 2011 Delmar, Cengage Learning

Pharmacy Economics Inventory Management –Managing pharmaceuticals includes Maintaining an adequate stock Organizing so items are easy to locate Identifying products that need to be reordered Receiving and inspecting shipments Rotating stock and monitoring expiration dates Copyright © 2011 Delmar, Cengage Learning