1. Pharmacy Procedures Michael Lavoie 6/13/12 Veterinary Assistant Program Middlesex Community College

2. 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.

3. 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

4. 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

5. 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

6. 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

7. Frequency of treatments Length or duration of use Special instructions Additional labeling can use used, such as warning labels in sticker form.

8. Some stickers you may use “keep refrigerated” “give with food” “for the eye” “for the ear” “shake well before using” “give by mouth only”

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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).

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. Administering Oral Medications in Dogs 1. Apply gloves 2. Elevate head upward 3. 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

33. 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

34. 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

35. Administering oral medications in cats 1. Apply gloves 2. Have someone hold front feet and body while pilling 3. Elevate the head upward 4. Open mouth by pressing at the side between the upper jaw and lower jaw joint by cheek

36. 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

37. 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

38. Using a Pet Piller or Balling Gun 1. Apply gloves 2. Place pill in the end of the plunger of the pet piller or balling gun 3. 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

39. 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

40. Administering liquids and pastes 1. Apply gloves 2. Elevate head upwards 3. 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

41. 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

47. 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

48. 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

49. 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

50. 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

51. 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

52. 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

53. Administering Aural Medications 1. Apply gloves 2. Clean ears as recommended by the veterinarian 3. 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

54. 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

55. 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

60. 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

61. 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

62. 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

63. Administering Topical Medications 1. Apply gloves 2. Clean area as necessary 3. 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

64. 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

65. 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

66. 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

67. 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

68. Administering Ophthalmic Medication 1. Apply gloves 2. Wipe any discharge from the patient’s eye using a gauze sponge 3. Open the end of the ophthalmic medicine and hold in one hand 4. Using the free hand, use the index finger and thumb to pull the upper and lower lids apart to see the eye

69. 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 upwards 8. 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

70. 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 eyelids 11. Allow the animal to blink to move the medication through the eye 12. Clean the dispenser with a small amount of alcohol on a gauze sponge

71. 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

72. 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

73. 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

74. 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.

75. 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.

76. QUESTIONS?