Transcript Chapter1finalnewbook - Dr. Brahmbhatt`s Class Handouts

CHAPTER 1
Dr. Dipa Brahmbhatt VMD MpH, MS
[email protected]
BOOKS
Objectives
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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
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‘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-poisonsaccording-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 DRUGS
Drug 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
DOSAGE
• Amount given over time;1 ml/lb, as directed by vet
• Doxycycline: 10mg/kg (for 5 kg dog DOSE is 50 mg)
• Dosage regimen: 13.5mg/kg every 12 hours for 14 days
(Clavamox)
DOSE
• Amount of drug administered at one time to patient
• 1 ml, 2 tablets
PHARMACOLOGY TERMS
CHEMICAL
NAME
NONPROPRIETARY
NAME/
GENERIC NAME
Active ingredient
PROPRIETARY/
TRADE NAME
D(-)-alpha-amino-phydroxybenzyl-penicillin
trihydrate
amoxicillin
Amoxi-Drop® (Pfizer)
Biomox® (Virbac)
Robamox-V® (FD)
((3-phenoxyphenyl) methyl
cis-trans-3-(2,2dichloroethenyl)-2,2dimethylcyclopropanecarbox
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)
 Delivers drug directly to the GI tract
 Most
route of admin.; LEAST LIKELY to
cause adverse reactions
onset of action;
duration of activity
 Absorption is not always predictable.
 Affected by GI disease, A&P of digestive tract
 Before entering the bloodstream, an oral drug must be:
1. released from the dose form
2. transported across the GI tract
3. passed through the liver
Solid Dosage Forms - PO
• TABLETS
Scored
– Enteric-coated: Don’t break
– Sustained-release (SR)
• Pills with flecks (in SI)
• Don’t break
– Scored
– MOLDED TABLETS:
heartguard chews
Powdered drugs compressed into disks/
• CAPLETS: tablet/capsule
capsule shaped tablets
easily swallowed;
glossy/ sugar coated
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
Suppositories
 ALTERNATIVE 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 medication goes on the surface of skin or
mucous membrane
systemic absorption rate
 Used for
treatment
 Fur and feathers inhibit good skin contact.
 Includes OPHTHALMIC and OTIC medications.
Topical Dosage Forms
SUSPENSIONS
• Gel: semi solid/ jelly:
toothpaste.
• Ointment: semi solid, lipid
base, melts room temp.
• Cream: water/oil emulsion or
semi-solid. melts room temp
• Paste: semi solid retains state
body temp. dewormers.
Comparison of Common Parenteral
Routes of Drug Administration
Intramuscular
90°
Subcutaneous
45°
Intravenous
25°
Intradermal
10°–15°
Epidermis
Dermis
Subcutaneous tissue
Muscle
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
Controlled: Class 4
• 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
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-up
4. 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
FDA
http://www.fda.gov/downloads/AnimalVeterinary/NewsEvents/FDAVeterinarianNewsletter/UC
M236854.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
FDA: milk, milk products
NO REGULATION
(cheese,
cat litter, pet accessories
cream, and ice cream) and
(toys, bed, crates),
“Shell eggs” (eggs
grooming aids
inside their shells)
USDA: egg products
meat, poultry, and catfish
Medical Calculation 1
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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-makemistakes-pets-pay-price/
• http://www.fda.gov/AnimalVeterinary/Resour
cesforYou/ucm214772.htm