Pharmacists' Knowledge of Veterinary Pharmacotherapy and the Impact of an Educational Intervention.

Background: To date, there is very limited data regarding pharmacists' preparedness to handle animal prescriptions. No previous studies exist examining the impact of a veterinary-pharmacy-focused educational intervention. Objective: To assess pharmacists' baseline knowledge of veterinary pharmacotherapy, as relevant to their professional responsibilities, and assess the impact of a piloted educational program. Methods: Two studies were conducted. The first study involved a statewide assessment of pharmacists' knowledge of veterinary pharmacotherapy; the second study assessed the impact of an educational intervention to improve pharmacists' veterinary pharmacotherapy knowledge base. Participants in the pilot study were assessed via pretest and posttest. Results: The statewide sample of participants (n = 602) received a mean score of 5.9 (SD = 2.6) on a 17-item questionnaire. There were no discernible differences in participants' knowledge based on the subject matter of the question (pathophysiology, dosing, counseling, compounding, legality, and toxicology). Using the same 17-item questionnaire, pilot study participants (n = 60) received a mean score of 5.2 (SD = 2.4) on the pretest and 16.6 (SD = 0.7) on the posttest. Conclusion: The findings of this study suggest that a substantial portion of pharmacists lack the knowledge needed to process and dispense the veterinary prescriptions most commonly encountered in community pharmacies. Furthermore, this study shows that implementation of an educational intervention can increase pharmacists' knowledge of core concepts necessary to safely care for animal patients.

Baseline knowledge of potential pet toxins: a survey of pharmacists

Background: Consumer expenditures on their family pets are rapidly increasing, part of which can be attributed to prescription and OTC medications. In turn, community pharmacies are seeking and receiving an increased number of prescriptions for animals. Community pharmacists’ ability to safely care for animal patients is relatively unexplored. Human medications, their normal dosing and even medication excipients could be lethal in some animal patients. Objective: The overarching objective of this study was to assess pharmacists’ baseline knowledge of potential pet poisons. Methods: The sample consisted of licensed pharmacists registered with the North Carolina Board of Pharmacy. The Pet Toxins Survey (PTS), a survey consisting of 25 potential pet toxins, was administered during October and November 2015. Analyses consisted of calculating descriptive statics (including graphical summaries to test for normality), and inferential statistics (two-tailed t-tests and ANOVAs) to compare responses across demographic variables. Results: A 6.3% response rate was obtained. After selecting either a dog or a cat to establish a frame of reference, participants in this study were able to correctly identify 15 of the 25 listed items as toxic to a pet (60% accuracy). Participants did not express adequate concern for the ingestion of several potential toxins. This includes potential excipients found in medication formulations such as xylitol, tea tree oil and caffeine. Female participants and those age 50 years and older were more likely to indicate concern for each potential toxin. There was no significant difference observed in responses based on the pharmacists’ work setting. Conclusions: The findings of this investigation suggest that pharmacists are deficient in their understanding of veterinary toxicology. Given the rise of community pharmacists caring for animal patients, it’s paramount that pharmacists be able to confidently distinguish potential pet toxins from non-toxins. It is also important that pharmacists receive a better understanding of what exposures require immediate action and what action should be taken (AU)

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Baseline knowledge of potential pet toxins: a survey of pharmacists.

BACKGROUND: Consumer expenditures on their family pets are rapidly increasing, part of which can be attributed to prescription and OTC medications. In turn, community pharmacies are seeking and receiving an increased number of prescriptions for animals. Community pharmacists' ability to safely care for animal patients is relatively unexplored. Human medications, their normal dosing and even medication excipients could be lethal in some animal patients. OBJECTIVE: The overarching objective of this study was to assess pharmacists' baseline knowledge of potential pet poisons. METHODS: The sample consisted of licensed pharmacists registered with the North Carolina Board of Pharmacy. The Pet Toxins Survey (PTS), a survey consisting of 25 potential pet toxins, was administered during October and November 2015. Analyses consisted of calculating descriptive statics (including graphical summaries to test for normality), and inferential statistics (two-tailed t-tests and ANOVAs) to compare responses across demographic variables. RESULTS: A 6.3% response rate was obtained. After selecting either a dog or a cat to establish a frame of reference, participants in this study were able to correctly identify 15 of the 25 listed items as toxic to a pet (60% accuracy). Participants did not express adequate concern for the ingestion of several potential toxins. This includes potential excipients found in medication formulations such as xylitol, tea tree oil and caffeine. Female participants and those age 50 years and older were more likely to indicate concern for each potential toxin. There was no significant difference observed in responses based on the pharmacists' work setting. CONCLUSIONS: The findings of this investigation suggest that pharmacists are deficient in their understanding of veterinary toxicology. Given the rise of community pharmacists caring for animal patients, it's paramount that pharmacists be able to confidently distinguish potential pet toxins from non-toxins. It is also important that pharmacists receive a better understanding of what exposures require immediate action and what action should be taken.

Assessment of in vitro release of carboplatin from six carrier media.

OBJECTIVE To investigate in vitro carboplatin release from 6 carrier media. SAMPLE 6 carboplatin-containing carrier media. PROCEDURES An in vitro release study was performed with 6 commercially available carrier media: a hemostatic gelatin sponge, a poloxamer copolymer gel, and 2 sizes (3 and 4.8 mm in diameter) of beads molded from each of 2 commercial calcium sulfate products. All carrier media contained 10 mg of carboplatin. Carrier media specimens were placed in 37°C PBS solution for 96 hours. Carboplatin concentrations in PBS solution were measured by use of high-performance liquid chromatography at 15 time points to calculate the amount and proportion of carboplatin released from each specimen. RESULTS Peak release of carboplatin from the poloxamer copolymer gel and hemostatic gelatin sponge were achieved after 4 and 20 hours, respectively. Maximum release did not differ significantly between the poloxamer copolymer gel and hemostatic gelatin sponge, but both released significantly more carboplatin within 96 hours than did both of the commercial calcium sulfate products. The poloxamer copolymer gel released 99% of the carboplatin, and the hemostatic gelatin sponge released 68.5% of the carboplatin. Peak release of carboplatin from the calcium sulfate beads was not reached within 96 hours. CONCLUSIONS AND CLINICAL RELEVANCE In this study, carboplatin release from the hemostatic gelatin sponge was incomplete. The poloxamer copolymer gel and hemostatic gelatin sponge released carboplatin rapidly in vitro, whereas calcium sulfate beads did not.

To compound or not to compound: a veterinary transdermal discussion.

Administering chronic medications to feline patients without the daily battle of oral and injectable medications is the holy grail of veterinary pharmacotherapy. For some medications, the transdermal route may be the solution. However, there are many considerations for determining if a medication will be safe for the patient and caregiver as well as effective when administered transdermally. A comprehensive checklist to assess the appropriateness of transdermal therapy is provided.

Doxycycline concentration over time after storage in a compounded veterinary preparation.

OBJECTIVE: To determine the concentration of doxycycline compounded from doxycycline hyclate tablets into liquid formulations for oral administration in veterinary species and stored for 28 days. DESIGN: Evaluation study. SAMPLE: Doxycycline hyclate tablets (100 mg) crushed and mixed with a 50:50 mixture of syrup and suspension vehicles for oral administration to produce 3 batches each of 2 doxycycline formulations: 33.3 and 166.7 mg/mL. PROCEDURES: Formulations were stored, protected from light, at room temperature (22° to 26°C [71.6° to 78.8°F]) and at a controlled cold temperature (refrigerated 2° to 8°C [35.6° to 46.4°F]). Doxycycline was extracted from the formulations, and concentration was measured by high-pressure liquid chromatography on days 0 (date of preparation), 1, 4, 7, 14, 21, and 28. Concentrations were compared with those of a US Pharmacopeial Convention reference standard. Formulation quality at each point was also assessed through color change, formulation consistency, and suspension uniformity. RESULTS: On days 0, 1, 4, and 7, the concentration of each formulation was within 90% to 110% of the reference standard (range, 93% to 109%), which was deemed acceptable. However, doxycycline concentrations had decreased dramatically by day 14 and remained low for the duration of the study period. Doxycycline concentrations on days 14, 21, and 28 were all < 20% (range, 14% to 18%) of the reference standard, and the quality of the formulations decreased as well. No effect of storage temperatures on doxycycline concentration was identified. CONCLUSIONS AND CLINICAL RELEVANCE: The concentration of doxycycline, compounded from commercial tablets in the vehicles evaluated to yield doses of 33.3 and 166.7 mg/mL, cannot be assured beyond 7 days.

Ronidazole pharmacokinetics after intravenous and oral immediate-release capsule administration in healthy cats.

Ronidazole (RDZ) is an effective treatment for feline Tritrichomonas foetus infection, but has produced neurotoxicity in some cats. An understanding of the disposition of RDZ in cats is needed in order to make precise dosing recommendations. Single-dose pharmacokinetics of intravenous (IV) RDZ and immediate-release RDZ capsules were evaluated. A single dose of IV RDZ (mean 9.2mg/kg) and a 95mg immediate-release RDZ capsule (mean 28.2mg/kg) were administered to six healthy cats in a randomized crossover design. Plasma samples were collected for 48 h and assayed for RDZ using high pressure liquid chromatography (HPLC). Systemic absorption of oral RDZ was rapid and complete, with detection in the plasma of all cats by 10 min after dosing and a bioavailability of 99.64 (±16.54)%. The clearance of RDZ following IV administration was 0.82 (±0.07) ml/kg/min. The terminal half-life was 9.80 (±0.35) and 10.50 (±0.82) h after IV and oral administration, respectively, with drug detectable in all cats 48h after both administrations. The high oral bioavailability of RDZ and slow elimination may predispose cats to neurotoxicity with twice-daily administration. Less frequent administration should be considered for further study of effective treatment of T foetus-infected cats.

Evaluation of intermittent infusion of bupivacaine into surgical wounds of dogs postoperatively.

Thirty-one dogs were randomised to receive intermittent wound infusion of bupivacaine or saline after surgery. Wound pressure sensitivity, pain scores, body temperature, heart rate, respiratory rate, analgesic drugs administered, time to walking and time to eating after surgery were recorded. Plasma bupivacaine concentrations were measured. The relative frequency distributions of the non-interventional and interventional pain scores, but not the relative frequency distributions of palpation pain scores or wound pressure sensitivity, were significantly different between groups following surgery. There was a significant difference between groups in the time to eating and in the amount and timing of analgesic drugs administered. Measured plasma bupivacaine concentrations demonstrated systemic absorption of the drug. Bupivacaine infusion into surgical wounds after surgery may improve post-operative recovery, but no effect on wound tenderness was demonstrated in this study.

Evaluation of a midhumeral block of the radial, ulnar, musculocutaneous and median (RUMM block) nerves for analgesia of the distal aspect of the thoracic limb in dogs.

OBJECTIVE: To evaluate a technique for midhumeral peripheral nerve blockade in the dog. STUDY DESIGN: Cadaveric technique development; in vivo placebo-controlled, prospective crossover study. ANIMALS: Canine cadavers (n=38) and 8 clinically healthy, adult hound dogs. METHODS: A technique for peripheral block of the radial, ulnar, musculocutaneous, and median nerves (RUMM block) was evaluated using cadaver limbs. Eight purpose-bred, research dogs were anesthetized; a RUMM block was performed on each thoracic limb. One limb from each dog randomly received 0.5% bupivacaine and the opposite limb was assigned to receive sterile saline solution as a control. After recovery from anesthesia, skin sensation at selected dermatomes was evaluated for 24 hours using a mechanical stimulus. Weight-bearing, conscious proprioception, and withdrawal reflex were also evaluated. One month after initial testing, each dog was reanesthetized and each limb received the opposite treatment. RESULTS: Sensory thresholds were significantly increased over baseline measurements when compared with control limbs for all nerves. Complete sensory block was achieved in radial (15/16), ulnar (3/16), musculocutaneous (8/16), and median (11/16) nerves, using a mechanical stimulus of analgesia. Complete simultaneous block of all nerves was only obtained in 1 of 16 limbs. CONCLUSION: RUMM block resulted in desensitization of the skin in the associated dermatomes for 4-10 hours. Complete sensory block of the dermatomes supplied by the radial nerve was most consistent. CLINICAL RELEVANCE: RUMM block may be an effective technique to provide adjunctive analgesia for dogs undergoing surgery of the distal aspect of the thoracic limb.

Assessment of clotrimazole gels for in vitro stability and in vivo retention in the frontal sinus of dogs.

OBJECTIVE: To evaluate the stability and retention of viscous formulations of the antifungal drug clotrimazole in vitro and to evaluate retention times, absorption, and histologic response to these compounds when placed in the frontal sinus of dogs. ANIMALS: 6 male Beagles. PROCEDURES: 1% clotrimazole gels were formulated with hydroxypropyl cellulose, poloxamer, and carboxymethylcellulose sodium bases. Commercially available 1% clotrimazole creams were also evaluated. Each compound was incubated at 37 degrees C in a funnel. Volume retained and clotrimazole stability were evaluated for 4 weeks. Six compounds were then chosen for in vivo evaluation. The frontal sinuses of 6 dogs were filled with 1 of the 6 compounds. Computed tomographic evaluation was performed weekly for up to 4 weeks to evaluate gel retention. Blood samples were collected to evaluate clotrimazole absorption. Following euthanasia, sinuses were examined histologically. RESULTS: Commercially available clotrimazole creams were not retained in funnels in vitro. In vivo, hydroxypropyl cellulose- and carboxymethylcellulose-based gels resulted in the most severe inflammatory response and were retained the longest. Poloxamer-based gels had a shorter retention time and were associated with less inflammation. Clotrimazole was minimally absorbed. Despite a marked inflammatory response to several of the clotrimazole-containing gels, no notable adverse clinical responses were observed. CONCLUSIONS AND CLINICAL RELEVANCE: Poloxamer gels had the most promise for improving drug contact within the frontal sinus of dogs, while limiting the inflammatory response. Poloxamer gels have the additional benefit of improved handling as a result of reverse gelation (ie, they gel when warmed to 37 degrees C).

Effects of compounding and storage conditions on stability of pergolide mesylate.

OBJECTIVE: To determine the effects of temperature and light over a 35-day period on stability of pergolide mesylate after compounding in an aqueous vehicle. DESIGN: Evaluation study. PROCEDURES: Pergolide was compounded into a formulation with a final target concentration of 1 mg/mL. Aliquots of the formulation were then stored at -20 degrees, 8 degrees, 25 degrees, or 37 degrees C without exposure to light or at 25 degrees C with exposure to light for 35 days. Samples were assayed in triplicate by means of high-pressure liquid chromatography immediately after compounding and after 1, 7, 14, 21, and 35 days of storage. RESULTS: Mean+/-SD concentration of pergolide in the formulation immediately after compounding was 1.05+/-0.086 mg/mL. Samples exposed to light while stored at 25 degrees C had undergone excessive degradation by day 14, samples stored at 37 degrees C had undergone excessive degradation by day 21, and samples stored at 25 degrees C without exposure to light had undergone excessive degradation by day 35. The decrease in expected concentration corresponded with the appearance of degradation peaks in chromatograms and with a change in color of the formulation. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that pergolide mesylate was unstable after compounding in an aqueous vehicle and that storage conditions had an effect on stability of the compounded formulation. Compounded pergolide formulations in aqueous vehicles should be stored in a dark container, protected from light, and refrigerated and should not be used >30 days after produced. Formulations that have undergone a color change should be considered unstable and discarded.

Canine public servants: caring for drug detection dogs.

Dogs are utilized more and more to seek out illicit and hazardous substances under the guidance of humans. Therefore, veterinarians, dog handlers, and pharmacists must all collaborate to ensure adequate protection, treatment, and care for detection dogs in the line of duty. Ideally, veterinarians and pharmacists can work together to train and equip dog handlers with state of the art instructions and animal emergency kits that can provide life-saving decontamination at the site of exposure. Pharmacists can collaborate with veterinarians to provide animal emergency kits containing essential treatment aids such as apomorphine, hydrogen peroxide, activated charcoal/sorbitol cathartic suspension, ocular irrigants, and instructions and associated devices for administration. Immediate intervention provides the best prognosis for canine heroes that suffer exposure to occupational toxicological hazards.

Veterinary compounding for myasthenia gravis.

Myasthenia gravis is a neruomuscular disease commonly encountered in veterinary medicine. With accurate diagnosis, treatment, and compliant caregivers, the prognosis for remission and a normal life is good. Unfortunately, drugs used to diagnose and treat myasthenia gravis are frequently unavailable due to manufacturer shortages. During these periods, compounding pharmacists can play a valuable role in maintaining a good quality of life for these patients by providing compounded versions of drugs that are commercially unavailable.

Equine anesthesia: triple drip.

Anesthetization of large animals, such as the horse, is a challenge for veterinarians and compounding pharmacists. This article discusses the technique of intravenous anesthesia by using a combination of xylazine and ketamine in the horse for short-term unconsciousness; a combination of xylazine, diazepam, and ketamine, for improved sedation and muscle relaxation; and a combination of xylazine, ketamine, and guaifenesin, referred to as Triple Drip, for the maximum 1-hour duration of unconsciousness. Compounding pharmacists that have the facilities and training required to prepare sterile compounds can greatly assist equine surgeons in the treatment of veterinarians' most challenging patients.

Submitting compelling case reports for drug therapy in veterinary patients.

When peer reviewed scientific information is not available, veterinarians and pharmacists often turn to their colleagues seeking evidence based upon clinical experience in order to devise a treatment plan for a patient. Compounding pharmacists who provide care and compounds for veterinary patients have vast clinical experience of great educational value. Using specific guidelines, compounding pharmacists can prepare useful case reports and/or case series by proactively collecting clinical data, carefully selecting a case for presentation, and collating the details into a compelling story with a clear message that can survive editorial triage and contribute to the advancement of veterinary medical care.

Including pets in diabetic care.

Pharmacists can play a valuable role in providing care and preparations for all species of patients with diabetes. Practical knowledge of the differences in diabetes between animals and humans is essential to providing diabetic care to multiple species. Pharmacists should familiarize themselves with the clinical signs of hyperglycemia and hypoglycemia in various species and be prepared to provide appropriate counseling, information, preparations, devices, and referral when signs of inadequate glycemic control arise. Pharmacists also should develop awareness of potential problems associated with the use of human diabetic preparations in animal patients. By maintaining a current knowledge of care for diabetic pets, including the significance of the patient's dietary habits, medical history, and genetics, and species-specific drug reactions, the compounding pharmacist can contribute, through collaboration with veterinarians and pet caregivers, to optimal patient outcomes when providing care for pets with diabetes.

Compounding for feline herpetic keratitis.

Feline herpetic keratitis (infectious keratoconjunctivitis), an infection of the conjunctiva and cornea that is common in cats, involves a three-pronged treatment approach: (1)antiviral therapy, (2)immunomodulatory therapy, and (3)antibacterial therapy. Since very few agents have been approved for the treatment of feline herpetic keratitis, and many of the drugs that were approved at one time for this indication can no longer be purchased, compounding pharmacists can play a vital role in the prevention and treatment of this infection. Investigators at the Colorado State University College of Veterinary Medicine and Biomedical Science evaluated the effect of a new antiviral agent, cidofovir, for ophthalmic use in treating feline herpetic keratitis. Researchers concluded that application of cidofovir significatnly decreased the clinical signs of acute ocular infection in cats with feline herpesvirus type 1, one of the primary causes of feline herpetic keratitis. Working with veterinary ophthamologists, compounding pharmacists can develop other treatment options in patient-speciic dosages and dosage forms to ensure that treated cats have an excellent response to therapy.

Ronidazole in the treatment of trichomonad infections in cats.

Tritrichomonas foetus, a microscopic single-celled flagellated protozoan parasite, traditionally identified as a cause of reproductive disease in cattle, has been demonstrated as an important cause of diarrhea in cats. Until recently, an effective antimicrobial treatment for feline Tritrichomonas foetus had not been idnetified. Since recommended dosages of antimicrobial drugs have failed in cats infected with Tritrichomonas foetus and in vitro studies have revealed multiple drug resistance, investigations continue in the effort to find an effective treatment. One particular study by Dr.Jody Gookin noted no clinicopathological abnormalities or adverse effects with the use of ronidazole, and the research concluded that ronidazole administered at 30 to 50 mg/kg orally twice daily for 2 weeks was capable of resolving diarrhea and eradicating infections of Tritrichomonas foetus in cats. Clinical use of ronidazole has revealed a reversible, possibly dose-related, neurotoxicity. Cats receiving ronidazole should be monitored for signs of nystagmus, ataxia, or behavior change, and ronidazole should be discontinued immediately if any of these signs are observed. Many compounding pharmacists have begun stocking pure ronidazole powder to prepare veterinarian prescriptions for the treatnment of Tritrichomonas foetus. Doses of ronidazole are usually prepared as capsules, the most desirable dosage form because (1)the capsules mask the extremely bitter taste of ronidazole, (2)exact dosing reduces the risk of neurotoxicity that has been reported at higher doses, and (3)the owner can be assured that the entire dose is ingested by the cat after administration of a capsule.

Application of sildenafil for pulmonary hypertension in canines and foals.

Pulmonary arterial hypertension is the most commonly recognized form of pulmonary hypertension in canines. Persistent pulmonary hypertension is a life-threatening condition in neonatal foals. Treatment of pulmonary hypertension in both canines and neonatal foals has focused on the correction of hypoxia and acidosis, not on the pulmonary hypertension itself. Identification of pulmonary hypertension in canines and foals has been made easier with the new diagnostic technologies that are being employed by veterinarians. Although retrospective reviews and studies have been published on the use of sildenafil, which is used primarily for the treatment of human erectile dysfunction, to treat pulmonary hypertension in human neonates, and the pharmacodynamics of sildenafil have been examined in various species, sildenafil has not been used widely in dogs or foals. Therefore, the adverse effects of sildenafil in canines and foals have not been determined. Until the stability of sildenafil in suspension has been determined, it is recommended that dose-specific capsules be prepared by compounding pharmacists utilizing lactose as a diluent and that veterinarians be encouraged to prescribe small quantities of capsules until a maintenance dose has been achieved.