Download Ch2 pharm student

CH 2
Pharmacy Procedures and Dosage
Calculations
PHARMACY VS. PHARMACOLOGY
• _______________________: the study of how drugs work
• _______________________: the art and science of preparing
and dispensing medications
• LVTs must know how to prepare and administer their
patient’s medications and be aware of the effects that the
medication will have on the body.
HOW TO AVOID PHARMACY DISASTERS:
• The drug order or prescription has to come from a
____________.
• The order or prescription has to be ________________ and
interpreted correctly.
• The LVT must correctly ____________________ the patient’s
dose and dispense it in the correct dosage form. This includes
dispensing the proper amount of medication to last the
duration of treatment.
• The LVT must administer the correct drug, via the correct
route, to the correct patient, at the correct interval.
• The LVT must be able to instruct the __________________ on
how to administer the medication.
DRUG ORDER VS. PRESCRIPTION
• _____________________________: a request by a
veterinarian to dispense or administer a drug
within a hospital
– May be verbal or written, but should always be noted
in the patient’s chart
– “Send Chili home with 500 mg Cephalexin to take by
mouth twice daily for 14 days.”
In Chili’s chart under today’s date write:
Cephalexin 500 mg PO BID x 14d
DRUG ORDER VS. PRESCRIPTION
• _____________________________: a
drug order sent from a
veterinarian to a pharmacy to be
filled by a pharmacist
– It is illegal to fill a prescription
from another veterinary practice.
– A prescription is a legal document.
– In addition to the info that must be
included on labeled dispensed
medication, prescriptions must
also include Rx, sig, and the
veterinarian’s signature
CONTROLLED SUBSTANCES
• AKA _______________________ drugs
• Drugs that have potential for physical addiction,
psychological addiction, and/or abuse
• Regulated by the ___________.
• The original container must have a capital ______ and
________________ ______________________ indicating its
schedule
• A veterinarian must be registered with the DEA to
purchase, dispense, or prescribe controlled substances.
– Registration # must be on all CS prescriptions and order forms.
– Registration is valid for three years
CONTROLLED SUBSTANCE RESTRICTIONS
•C-______ drugs cannot be prescribed to animals.
•C-______ drugs must have written prescriptions, a
special form is required, and the script cannot
include refills.
•Controlled substances must be dispensed in childproof containers that read “Caution: Federal law
prohibits the transfer of this drug to any person
other than the patient for whom it was prescribed.”
•Expired or damaged controlled substances should
be disposed of via “reverse distributors”.
CONTROLLED SUBSTANCES
C-I: extreme potential for abuse, no approved veterinary purpose (heroin,
LSD, marijuana, ecstasy)
C-II: high potential for abuse/dependence (hydrocodone, cocaine, morphine,
pentobarbital, Ritalin, Adderall, Demerol, OxyContin)
C-III: some potential for abuse/low moderate dependence (ketamine, Tylenol
with codeine, anabolic steroids)
C-IV: low potential for abuse/limited dependence (butorphanol, Valium,
Tramadol, Ambien, Xanax)
C-V: lowest potential for abuse. Antitussives and Antidiarrheals (Lomotil,
Robitussin AC, Lyrica)
• Must be stored in a __________________ _________________ of
substantial construction
–Glass front, lightweight portable safes, and locked tackle
boxes are not sufficient
–Key must not be freely accessible
–Farm-call vehicles may have a steel toolbox attached to the
vehicle
–Convicted felons whose crime is related to controlled
substances are banned from having access to the clinic’s CS.
–Prescription pads for CS should also be locked.
CONTROLLED SUBSTANCE RESTRICTIONS
• Number each bottle of meds
as it enters the clinic.
Include the bottle number in
the log.
• Log of ordering, receiving,
and dispensing must be
kept for ___ years (include
stolen, spilled, lost).
–Bound pages
sequentially numbered
–Write in ink
–Computer records must
not allow much editing
–Remember to write the
meds in patient’s
record as well!
–Take inventory once a
month
CONTROLLED
SUBSTANCE
LOG
Dose vs Dosage
DOSAGE is used to determine the DOSE.
_______________= mass of drug needed per unit of weight of animal.
15 mg/kg, 10 g/lb
 A range is often listed, such as 20-50 mg/kg
_______________= amount of drug administered to a patient at one time.
Stated in units of mass (mg, g, gr, etc. ), NOT tablets or milliliters.
50 mg
Dosage continued
• Dosage _________________: mass + route + interval + duration
• Dosage _________________: is the physical form of the drug to
be administered.
• Dose _________________: time between doses or number of
doses per day
SYSTEMS OF MEASUREMENT
• ______________________
– Gram, meter, liter
• ______________________
– Teaspoon, tablespoon, cup, pint, gallon, pound
• ______________________
– Grain, dram, minim
COMPOUNDING
DEFINITION:
___________________________________________
___________________________________________
Examples:
Flavoring to improve palatability
Diluting drugs with saline
Crushing a tablet into a liquid
Mixing drugs together in a syringe or vial
AMDUCA rules of compounding
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A valid VCPR must exist
The animal’s health or life is threatened without compounding
No FDA approved drug exists in the desired formulation
Can only be done by using FDA-approved drugs
Can only be done by a veterinarian or pharmacist
The compounded drug must meet safety and efficacy standards
A new withdrawal time must be established if the compounded
drug is given to food animals
Cannot put the general public at risk
Drug must be fully labeled
Cannot be made for anyone outside the practice
Records must be maintained
Must be done for a specific patient, as needed
Labels from veterinary hospitals should
contain:
• Name of prescribing veterinarian
• Name, address, and phone
number of clinic
• Name of patient or ID of patient
with and client’s last name
• Drug name, concentration, and
number of units dispensed
• Date (also thorough to have
expiration date)
• Refills
• Dose, frequency, route of
administration, duration of
treatment
• Cautionary statements
• Withdrawal or discard times (food
animals)
Containers and Storage
Childproof containers vs. Pill envelopes
Temperature of storage environment must be
observed
Cold: below 46 F
Cool: 46- 59 F
Room Temp 59- 86 F
Warm 86- 104 F
Excessive Heat: above 104 F
Amber bottles
Silica packets
Reconstituted meds and bacterial growth
CYTOTOXIC AND HAZARDOUS DRUGS
 Cytotoxic drugs- antineoplastic and antifungal
drugs that destroy mammalian cells
 _______________________/_____________________
effects- birth defects (not only in the patient, but also
in the person dispensing the drug)
 _____________________________ effects- cancerous
or preneoplastic changes
 OSHA has guidelines for the safe use, storage, and
disposal of these drugs
Cytotoxic drug exposure routes:
• Absorption through the skin when drug
spills/drips
• Inhalation of aerosolized drug when needle is
removed from pressurized bottle, when tablet
is being crushed/broken, or when ampules
are broken.
• Ingestion of food contaminated with the drug
• REMEMBER:
• Store your lunch in a refrigerator that only
contains food!
• Don‘t place lunch on a counter where meds
are placed.
• Wash your hands!
• Every hazardous material should have an
MSDS, package insert, and a hospital policy
procedure sheet for spills and disposal of
equipment.
Cytotoxic drug safety
Properly train all staff on the safe handling and storage of
hazardous drugs
Store cytotoxic drugs separately from other drugs and
clearly label them.
Prepare the drug just prior to administration in a low traffic,
well-ventilated area.
Wear protective gear: mask (not surgical), gloves (multiple
pairs if latex), gown with long sleeves and cuffs, goggles.
Cytotoxic drug safety
 Use screw-on syringes and IV lines.
Recheck calculations.
Insure catheter placement is correct.
Place all equipment in sealable plastic bags immediately after
use and into a leak and puncture proof hazardous waste
container.
Clean up properly after use. Do not allow maintenance staff to
handle cleaning
Chemotherapy spill kits are available