Veterinary Drug Use, Prescribing, Acquisition, and Pharmacy Management L. VanValkenburg, RVT, BASVT

 Chemical name: ◦ Provides scientific and technical information ◦ First name received during drug development ◦ Is a precise description of the substance ◦ Example: 7-chloro-1,3-dihydro-1-methyl-5-phenyl-2H-1,4-benzodiazepine-2-one

 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: carprofen

 Brand (trade, proprietary) name: ◦ Establishes legal proprietary recognition for the corporation that developed the drug ◦ Registered with U.S. Patent Office; approved by FDA ◦ Used only by company that registered the drug ◦ Written in capital letters or begins with a capital letter and has a circled, superscript R by its name  Example: Rompun 

 Occurs when health professionals prepare a specialized drug product to fill an individual patient’s needs when an approved drug is not available

 Uses of compounding ◦ Creating discontinued drugs ◦ Creating dosages and strength specific to patient’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

 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

 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

 Package insert ◦ Provided with drugs to meet regulatory requirements. Includes:  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 See pgs

 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)

 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)

 Expiration date is the date before which a drug meets all specifications and after which the drug can no longer be used.  Assigned based on the stability of or experience with the drug  Vary for drugs that are mixed in the clinic depending on the reconstitution and refrigeration status of the drugs

 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 (CPG)  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

 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

◦ 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

You are responsible for knowing ALL abbreviations and meanings listed!!!

 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.

 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)

 Prescription drugs may be dispensed by pharmacists or trained veterinary staff.  Veterinary prescription drugs should be properly labeled when dispensed.  Staff members cannot refill or dispense medications without DVM approval.  Medications must be dispensed in childproof containers.  Labels with cautionary statements should also be used on the prescription. See pg. 110 for some examples.

 The medication order is written in a paper file or typed into an electronic record.  The medication is recorded along with date, time, and the initials of the person dispensing the drug.  The numbers of veterinary hospitals that utilize a completely paperless electronic medical record system is increasing.

 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

◦ 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

 Maintaining a pharmacy is a business that depends on charging and collecting a fee for services to continue providing medical care.

 Inventory and Control Maintenance ◦ 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 used for earnings.

 Inventory Purchasing ◦ Direct marketing ◦ Direct marketing is when a drug is purchased directly from the manufacturing company. ◦ Distributorswholesalers ◦ 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 (vet or human)

 Inventory Management 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 ◦ Maintaining and organizing MSDS sheets