Evaluation of gastroprotectant administration in hospitalized cats in a tertiary referral hospital.

OBJECTIVES: The primary objective of this study was to evaluate the prescription patterns and appropriateness of the use of gastroprotectant medication in cats. METHODS: Pharmacy dispensation logs from an academic tertiary referral center were reviewed between 1 January 2018 and 31 December 2018. Cats that were administered proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), sucralfate, misoprostol, antacids or a combination were included. Data regarding medication, dosage, formulation, duration of administration, completeness of discharge instructions and clinical rationales for administration were obtained from medical records. The appropriateness of gastroprotectant use was assessed according to the American College of Veterinary Internal Medicine consensus statement guidelines. RESULTS: Of the 110 cases, 67 (60.9%) were prescribed a gastroprotectant medication without an appropriate indication. The most common reason for prescription was acute kidney injury in 26/67 (38.8%). PPIs were the most common gastroprotectant medication administered in 95/110 (86.3%) cats, followed by sucralfate in 18/110 (16.4%) and H2RAs in 11/110 (10%). Of the 35 cases in which gastroprotectant therapy was indicated, the medication chosen or dosage administered was considered suboptimal in 16 (45.7%). Instructions regarding the duration of administration, potential adverse effects and timing of administration in relation to meals or other medications were inconsistently provided in discharge instructions to pet owners. Of the 29 cases discharged with omeprazole, only 13 (44.8%) instructions included a duration of administration, while 6 (20.7%) recommended continuing gastroprotectants indefinitely until further notice, 16 (55.2%) discussed the timing of the administration in relation to a meal and six (20.7%) mentioned potential adverse effects; none advised tapering of omeprazole before discontinuation. CONCLUSIONS AND RELEVANCE: When prescribed, gastroprotectant medications were frequently prescribed injudiciously to cats in this referral population over a 12-month period. Discharge instructions to pet owners also often lacked information and recommendations regarding optimal administration, potential adverse effects, and tapering or discontinuation of the medications.

Bioencapsulation is a feasible method of terbinafine administration in Emydomyces testavorans-infected western pond turtles (Actinemys marmorata).

OBJECTIVE: To evaluate the pharmacokinetics of terbinafine administered to western pond turtles (Actinemys marmorata) via oral gavage and bioencapsulated in earthworms. ANIMALS: 7 western pond turtles. PROCEDURES: A randomized complete crossover single-dose pharmacokinetic study was performed. Compounded terbinafine (25 mg/mL; 30 mg/kg) was administered through oral gavage (OG) directly into the stomach or bioencapsulated (BEC) into an earthworm vehicle. Blood (0.2 mL) was drawn from the jugular vein at 0, 0.5, 1, 2, 4, 8, 12, 24, 48, 72, and 120 hours after administration. Plasma terbinafine levels were measured using high-performance liquid chromatography. RESULTS: Peak plasma terbinafine concentrations of 786.9 ± 911 ng/mL and 1,022.2 ± 911 were measured at 1.8 ± 2.8 and 14.1 ± 12.3 hours after OG and BEC administration, respectively. There was a significant (P = .031) increase in area under the curve with BEC compared to OG. Using steady-state predictions, with once-daily terbinafine administration, 3/7 and 7/7 turtles had plasma concentrations persistently greater than the minimum inhibitory concentration (MIC) for Emydomyces testavorans for the OG and BEC administration routes of administration, respectively. With administration every 48 hours, 3/7 turtles for the OG phase and 6/7 turtles for the BEC phase had concentrations greater than the E. testavorans MIC throughout the entire dosing interval. CLINICAL RELEVANCE: Administration of terbinafine (30 mg/kg) every 24 or 48 hours via earthworm bioencapsulation in western pond turtles may be appropriate for the treatment of shell lesions caused by E. testavorans. Clinical studies are needed to assess the efficacy of treatment.

The Current Landscape of Veterinary Compounding in the Veterinary Setting.

Compounding for veterinarians is regulated by the U.S. Food and Drug Administration, but day-to-day regulation is deferred to the state authorities. Veterinarians must meet certain standards when prescribing or dispensing a compounded medication. Veterinarians are expected to maintain current knowledge of the benefit of compounded preparations and prescribe and dispense in keeping with the best evidence related to animal and human health. Whether veterinarians recognize or adhere to these standards is unknown. A self-administered survey was distributed electronically to 30,000 email addresses on record with the Veterinary International Network. The survey asked questions about the regulations and standards associated with the use of or prescription of compounded medications. Of the distributed surveys, 1,520 survey responses were received, for a 5.1% response rate. All surveys were included in the final analysis. Respondents with a higher training level in compounding had a greater perceived skill level regarding compounding of medications (r = 0.26, P<0.0001). Similarly, respondents with a higher training level had a greater knowledge of state laws and regulations (r = 0.14, P<0.0001). Those with formal training had better scores on the assessment questions than those with informal or no training (P=0.01). Approximately one-third of the respondents felt that they were not knowledgeable at all about compounding rules and regulations. The most common compounded medications used in practice by veterinarians are methimazole, metronidazole, and doxycycline. Veterinarians mostly recognized that compounding backordered, commercially available products is permitted. Formal training improves familiarity with compounding rules, regulations, and current practices. Therefore, efforts should be directed at improving veterinary knowledge of laws and regulations surrounding the practice of compounding medications.

The Current Landscape of Veterinary Compounding in the Pharmacy Setting.

Medicating animals poses unique challenges that are often best dealt with via compounding. Pharmacists receive compounding training while in pharmacy school, but this training is not veterinary specific. Pharmacists are expected to have enough knowledge to properly verify prescriptions that are received at their practice site while keeping with the most up-to-date guidelines related to animal and human health. Whether pharmacists have the proper training to verify and/or compound veterinary specific medications is unknown. A self-administered survey was distributed electronically to 4,550 email addresses on record with the American College of Veterinary Pharmacists, the International Academy of Compounding Pharmacists, and the Society of Veterinary Hospital Pharmacists. The survey asked questions about regulations and standards associated with the use of prescription or compounded medications. Of the 4,550 distributed surveys, 153 were received, for a 3.4% response rate. Of the responses received, only 131 were used in the final data analysis. Most respondents correctly answered the assessment question regarding the ability to compound backordered, commercially available products. A majority of respondents incorrectly answered the question regarding the proper flavoring for a medication for a ferret. Those with more training perceived themselves to have a higher level of skill (r = 0.41, P<0.001). Similarly, those with formal veterinary training had better scores on Question 4 of the assessment questions, which requires knowledge of feline toxicities (P=0.029). The most common compounded medications dispensed in practice by pharmacists are methimazole, metronidazole, and gabapentin. Pharmacists mostly recognized that compounding backordered, commercially available products is permitted. Formal training improves familiarity with current compounding rules, regulations, and best practices. Formal training in veterinary pharmacy and veterinary compounding should be promoted and encouraged. Efforts should also be made at improving pharmacists' understanding of both veterinary and compounding laws and regulations.

Effects of a single preappointment dose of gabapentin on signs of stress in cats during transportation and veterinary examination.

OBJECTIVE To determine the effects of oral gabapentin administration prior to veterinary examination on signs of stress in cats. DESIGN Randomized, blinded, crossover clinical trial. ANIMALS 20 healthy pet cats with a history of fractious behavior or signs of stress during veterinary examination. PROCEDURES Cats were scheduled for 2 veterinary visits 1 week apart and randomly assigned to receive a capsule containing 100 mg of gabapentin (13.0 to 29.4 mg/kg [5.9 to 13.4 mg/lb]) or placebo (lactose powder) prior to the first visit and the opposite treatment prior to the second visit. Owners were instructed to administer the assigned capsule orally 90 minutes prior to placing the cat into a carrier and transporting it to the veterinary hospital. Standardized physical examinations and blood pressure readings were performed. Owners assigned a cat stress score during transportation and examination, and the veterinarian assigned a compliance score at the visit. Scores were compared between treatments, controlling for various factors. RESULTS Owner-assessed cat stress scores during transportation and veterinary examination and veterinarian-assessed compliance scores were significantly lower when cats received gabapentin than when they received the placebo. Sedation was a common effect of gabapentin administration, and ataxia, hypersalivation, and vomiting were also reported. All effects resolved within 8 hours after gabapentin administration. CONCLUSIONS AND CLINICAL RELEVANCE Owners' perception of stress in their cats is a primary reason for failing to seek veterinary care. Results of this study suggested that gabapentin is a safe and effective treatment for cats to help reduce stress and aggression and increase compliance for transportation and veterinary examination.