Transcript Presentation

Veterinary Pharmacy
During Disaster
CDR Shayne Blackmon, PharmD
Federal Detention Center – Honolulu, HI
LT Selena Ready, PharmD
Winslow Indian Health Care Center – Winslow, AZ
Introduction
• Over half of American families are pet-owners.
• Oftentimes, pet-owners will refuse to leave their
pets during a disaster.
• It is estimated that 100,000 animals, pets and
livestock are separated from their owners and/or
lost during a major natural disaster.
Animal Care and Handling:
Stressed or Injured Animals
Animal Care and Handling:
Stressed or Injured Animals
Animal Care and Handling:
Stressed or Injured Animals
U.S. Pets Evacuation and
Transportation Standards Act (PETS)
• In the fall of 2006, Congress passed H.R. 3858, the
Pets Evacuation and Transportation Standards Act
of 2006 (PETS Act). On Friday, October 6, 2006,
President Bush signed the PETS Act into law.
• What does the PETS Act do?
• When is the PETS Act in operation?
• How does the PETS Act work operationally?
Objectives
After this presentation, the audience should be able to:
• Have a basic understanding of the supportive care necessary
for animal patients during a disaster setting
• Understand how to assist with the triage and physical
assessment of an animal patient
• Have a basic knowledge of common veterinary drugs and disease states
used in a disaster
• Have a basic knowledge of how to administer drugs to an animal patient
• Be able to identify additional sources of information regarding veterinary
emergency preparedness
Animal Care and Handling:
During Disaster
• Recent Scenarios
▫ Extreme Weather
 Mongolia
▫ Flooding
 Tennessee
▫ Earthquakes
 Haiti
 Chile
Triage and Physical Assessment
• Personal Protection
▫ Wear gloves when handling sick or wounded
animals.
▫ Consider use of goggles or face protection if
splashes from contaminated surfaces may occur
 Do not allow rescued animals to “kiss” you or lick
your face.
▫ Whenever possible, caretakers should have
completed a 3-dose prophylactic vaccination
series for rabies.
Triage and Physical Assessment
• Basic Triage and Physical Assessment
▫
▫
▫
▫
ABCs
Broken Appendages
Sources of Hemorrhage
Levels of Consciousness
Common Veterinary Drugs Used During
Disaster
Records of individual animal treatments should be kept
and include:
• Animal identification
• Date of treatment
• Name of product
administered
• Name of the individual
administering the
product
• Name of the supervising
veterinarian
Common Veterinary Drugs Used During
Disaster
•
•
•
•
•
•
•
Vaccinations
Flea and Tick Treatments
Diarrheal Disease
Disinfectants and Antiseptics
Pain Management
Behavioral Meds
Euthanasia
Common Veterinary Drugs Used During
Disaster
• Core Vaccinations
• Dogs
▫ Rabies
 Personnel should be aware that rabies vaccines may
take as long as 28 days to become effective.
▫ Distemper, Hepatitis, and Parvovirus
▫ Kennel Cough Vaccination (intranasal)
 Against Bordatella bronchisepta and parainfluenza
Common Veterinary Drugs Used During
Disaster
• Cats
▫ Viral Rhinotracheitis, Panleukopenia and
Calicivirus
▫ Feline leukemia
• Leptospirosis risk
▫ Higher in flood-ravaged areas
▫ Zoonotic
▫ Adverse reactions may be higher than for some
other vaccines
Common Veterinary Drugs Used During
Disaster
• Diarrheal Disease
▫ Separate from healthy animals
▫ Nosocomial agents of concern that may be
transmitted by feces include parvovirus,
panleukopenia, Giardi, and intestinal parasites.
▫ Zoonotic agents of concern for small animals
include Campylobacter and Salmonella, which are
highly infectious and have been associated with
outbreaks in shelters and veterinary clinics.
Common Veterinary Drugs Used During
Disaster
• External and Internal Parasite Treatment
▫ Ectoparaciticides and Anthelmintics
▫ Flea, tick, and worm coverage
 Spot-on, injectible, and oral formulations
Common Veterinary Drugs Used During
Disaster
• Antiseptics and Disinfectants
▫
▫
▫
▫
▫
Rubbing Alcohol
Chlorhexidine
Iodine Tincture
Povidone-Iodine
Hydrogen Peroxide 3%
Common Veterinary Drugs Used During
Disaster
• Pain Management
Dosage
Dogs
Cats
Buprenorphine
0.01-0.02 mg/kg,
SC,BID
0.005-0.01 mg/kg, SC
or IM, BID
Butorphanol tartrate
0.2-0.4 mg/kg, IM or
SC; 0.55 mg/kg, PO,
every 4 hr
2-10 mg/kg, IM or SC,
every 2 hr
0.1-0.2 mg/kg, IV; 0.20.4 mg/kg, IM or SC,
every 4 h
2-10 mg/kg, IM or SC,
every 2 hr
Opioid Analgesics
Meperidine
hydrochloride
Morphine sulfate
0.22-0.88 mg/kg, IM or 0.1 mg/kg, IM or SC, as
SC, every 4-6 hr as
needed
needed
Common Veterinary Drugs Used During
Disaster
Dosage
Dogs
Cats
Nalbuphine
0.5-2.0 mg/kg, SC,
every 4-8 hr
1.5-3.0 mg/kg, IV,
every 3 hr
Oxymorphone
hydrochloride
0.22 mg/kg, IV, IM, or
SC, SID
0.1-0.2 mg/kg, IV, IM,
or SC,SID
Pentazocine lactate
2-3 mg/kg, IM, every 4 2.2-3.3 mg/kg, IV, IM,
hr; 15 mg/kg, PO,TID
or SC
Opioid Analgesics
Common Veterinary Drugs Used During
Disaster
• Anti-inflammatory Agents
Drug
Dosage
Asprin
Dogs: 10-40 mg/kg, PO, BID-TID. Horses : 10 mg/kg SID. Cats : (anti-platelet
effects in thromboembolic disease)10 mg/kg, PO, q48 hrs, to allow for
prolonged metabolism.
Acetaminophen
Dogs : 10-15 mg/kg, PO, TID. Toxic to cats!
Phenylbutazone
Dog/Bovine/Equine: 1-5 mg/kg PO, IV SID-BID.
Flunixin Meglumine
Cats/Dogs/Bovine: 1.1 mg/kg IV, IM, PO SID.
Highly effective NSAID. Potential for hepatotoxicity, gastrointestinal
ulceration. May dilute with Vit. B12 inj. to reduce pain on IM or SQ injection.
Carboprofen
(Rimadyl)
Dogs/Cats: 4mg/kg PO SID
NSAID with a wide safety margin in dogs. Limited potential for GI ulceration,
hepato or nephrotoxicity compared to other NSAIDs.
Common Veterinary Drugs Used During
Disaster
Drug
Dosage
Ketoprofen
Dog/Bovine: 2.2 mg/kg IV, IM
Derocoxib (Deramaxx)
Dog: Osteoarthritis - 1-2 mg/kg,
PO, SID
Firocoxib (Previcox)
Dog: Osteoarthritis - 5 mg/kg, PO, SID
Other NSAID info – DO NOT USE
Dogs – Indomethacin, naproxen,
ibuprofen, piroxicam highly toxic to GI
tract
Common Veterinary Drugs Used During
Disaster
• Behavioral Medications
Drug
Dosage
Alprazolam
0.01-0.1 mg/kg, PO, as needed for phobic or panic attacks‡; start with 1-2 mg for a
25 kg dog
Amitriptyline
1-2 mg/kg, PO, bid to start
Buspirone
1 mg/kg, PO, sid-tid (mild anxiety); 2.5-10 mg/dog, PO, sid-tid (mild anxiety); 10-15
mg/dog, PO, bid-tid (severe anxiety)
Carbemazepine
4-8 mg/kg, PO, bid; 0.5-1.25 mg/kg, PO, tid; 4-10 mg/kg/day, divided tid
Chlordiazepoxide
2.2-6.6 mg/kg, PO, as needed
Clomipramine#
1-2 mg/kg, PO, bid; increase to 3 mg/kg, bid if necessary
Alprazolam
0.01-0.1 mg/kg, PO, as needed for phobic or panic attacks‡; start with 1-2 mg for a
25 kg dog
Drug
Dosage
Clorazepate
0.125-1.0 mg/kg, PO, bid; range 0.01-1.0 mg/kg, PO, as needed for phobic or panic
attacks
0.5-2.2 mg/kg, PO, at least 1 hr before provocative stimulus; repeat every 4-6 hr as
needed; 11.25-22.5 mg/large dog; ~11.25 mg/medium dog; ~5.6 mg/small dog
Diazepam
0.5-2.2 mg/kg, PO, at least 1 hr before provocative stimulus; repeat every
4-6 hr as needed
Doxepin
3-5 mg/kg, PO, bid-tid
Fluoxetine
1 mg/kg, PO, sid-bid
Fluvoxamine
1 mg/kg, PO, sid-bid **
Imipramine
2.2-4.4 mg/kg, PO,sid-bid ; 1-2 or 2-4 mg/kg, PO, sid-bid (start low)
Nortriptyline
1-2 mg/kg, PO, bid
Oxazepam
0.2-1.0 mg/kg, PO,sid-bid
Paroxetine
1 mg/kg, PO, sid
Protriptyline
5-10 mg/dog, PO,sid-bid (narcolepsy)
Selegiline
0.5-1.0 mg/kg, PO, sid
Sertraline
1 mg/kg, PO, sid
Clonazepam
Common Veterinary Drugs Used During
Disaster
Euthanasia
• In regard to animals -the act of killing an animal
in a humane manner.
• The primary objectives of animal euthanasia are:
▫ relieving pain and suffering of the animal(s) to be
euthanized
▫ minimizing the pain, anxiety, distress, and fear the
animal experiences before consciousness is lost
▫ inducing a painless and distress-free death
Common Veterinary Drugs Used During
Disaster
• Cats and Dogs
▫ Barbiturates, inhalant anesthetics, CO2, CO, potassium
chloride in conjunction with general anesthesia
• Birds
▫ Barbiturates, inhalant anesthetics, CO2, CO, gunshot
(free-ranging only), N2, argon, cervical dislocation,
decapitation, thoracic compression (small, freeranging only)
• Horses
▫ Barbiturates, potassium chloride in conjunction with
general anesthesia, penetrating captive bolt
Vet Medication Administration
Techniques
• Wrapping in a blanket or towel is a great
restraint technique
• Marshmellows, peanut butter, or cream cheese
• Pill gun
• Oral Syringe
Veterinary Pharmacy Resources
• Handbook of Veterinary Drugs – for PDAs,
Smartphones, iPhones
• The Merck Veterinary Manual
• VMAT information
References:
• http://www.avma.org/disaster/emerg_prep_resp_guide.pdf
• http://veterinarynews.dvm360.com
• http://news.nationalgeographic.com/news/2005/09/photogalleries
/hurricane_katrina_pets/index.html
• http://www.avma.org/disaster/petsact_faq.asp
• http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/16
0201.htm
• http://animalsindisasters.typepad.com/wspa/animals-in-disasters/
• http://www.petalk.com/drug-dosages.html#Code
USPHS LCDR Lauren Davidson
Arctic Crossroads 2009
Arctic Crossroads 2009
• USCG/PHS mission to Barrow, AK, and
surrounding villages
• Rabies prophylaxis and vet care provided
• 5 North Slope Borough village trips
• 113 vet clinical appts. seen
• Approx. 300 rabies vaccinations and 150
distemper/parvovirus vaccines given
• 26 surgeries performed
Arctic Crossroads 2009
• 9 euthanasia procedures/3 after hr. emergenc.
• Pharmacist assistance provided by PHS CAPT
Paulson, USCG
• Primary meds used
▫
▫
▫
▫
Isoflurane – gas anesthesia
Tiletamine/zolazepam (Telazol) – inj. anesth/tranq
Pentobarbital/phenytoin - euthanasia i.v. soln.
Praziquantel/pyrantel (Drontal Plus) – int. parasites
Operation Pacific
Angel 2010
Phase 1 - Philippines
Operation Pacific Angel
• 13th AF joint op. with the Phil. armed forces,
national police, civilians, and non-gov orgs
• Two mobile veterinary services teams served 41
local villages
• Provided vet. care to 3360 animals/ incl. deworming and vitamin vacc. to more than 3300
cattle, goats, and caribou
Operation Pacific Angel
• Primary meds used
▫ Ketamine (Ketalar, Ketaject) 100mg/ml general
anesthetic; high conc. for cattle, swine, etc.
▫ Zinc gluconate (Neutersol) – chemical castration
▫ Albendazole, atovaquone, ivermectin, quinacrine antiparasitics
Pacific Partnership 2008
PP08 Team in Timor-Leste
• USPHS, U.S. Marines, Navy, Army, Air Force,
Navy civilian mariners
• Armed forces of Australia, Canada, India,
Indonesia, Portugal, & Republic of Korea
USPHS CDR
John Gibbon
with Indian
Army
colleagues
1
VIETNAM
19-29 Jun
PHILIPPINES
29 May-17 Jun
2
5
MICRONESIA
22 Aug-1 Sep
USNS Mercy
3
TIMOR LESTE
12-25 Jul
4
PAPUA NEW GUINEA
4-17 Aug
PACIFIC PARTNERSHIP 2008
USPHS LCDR Bryan Buss
Continuing Promise 2009
USNS Comfort
Continuing Promise 2009
• PHS, Navy, & Army joint op. with military and
govt. officials of Haiti & Dominican Republic
• On-site trng. of college students & local vets.
• Provided host nation vets. disease-specific
presentations on 40 animal dz of importance
• 43 general audience presentations – zoon. dz
• Provided vet. care to 1849 animals/12 species
• Performed 6366 procedures
Continuing Promise 2009
• Primary meds used
▫ Pyrantel (Strongid T, Nemex) – deworming for
dogs/cats
▫ Rabies, Distemper/Parvo vaccines
 Exotic Newcastle Disease (PMV-1) vaccine (poultry)
▫ Fipronil (Frontline) – fleas and ticks
▫ Ivermectin – orally for internal and external
parasites (poultry), horses; inj. form for
goats/swine/rabbits
▫ Hog Cholera (Classical Swine Fever) vaccines
Continuing Promise 2009
• Primary meds used (cont.)
▫
▫
▫
▫
▫
▫
Vaccination for Clostridium C and D, & Tetanus
Vitamin ADE, B12, and iron inj. – goats and swine
Anesthetic premedication and anesthesia
Tetanus toxoid – horses
Leptospirosis vacc. – cattle
Moxidectin (Cydectin) – top. for int/ext parasites
cattle
▫ Brucella abortus vaccine – heifers 3-8 months
Lessons Learned:
Be flexible – systems will be
overwhelmed; human/animal pts.
 Disaster/humanitarian
missions
 Demand for services ↑↑↑
 People love their pets
Train, train, train – Ft AP Hill 09,
RDF 2010, Humanitarian missions
Vets, pharmacists get involved
earlier in the planning process –
pre-deployment site survey teams,
etc
 Advanced look at zoonotic dzs
in the region (rabies,
brucellosis, tuberculosis,
tularemia, etc.)
 Helps avoid supply
shortages/expired meds –
common problem (AC09,
CP09, etc.)
Engage host nation representatives
as to their needs/wishes for the
mission
Lessons Learned:
Establish partnerships – DOD,
state MRCs (locals - lay of the land)
 U.S. Army Vet Corps PACOM –
Dev. inventory templates for
regions throughout the Pacific
Plan early – many
pharmaceutical needs are unique
to veterinary medicine and cannot
be easily obtained thru normal
military supply channels
 Ex. High conc. Ketamine (100mg/ml)
– pigs, buffalo
Pack light
Bring tools
 Plumb’s Veterinary Drug
Handbook
http://www.cdc.gov/nczved/
http://www.aavpt.org/
Questions?