Download Veterinary Compounding

Veterinary Compounding
Skip Lenz, Pharm. D,
F.A.C.V.P., F.A.S.C.P
Veterinary Compounding
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Introduction
The Regulations
The Interaction with Vets/Vet Techs/Receptionist and
Clients
The Patients/Clients
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Large Animal/Food Animals/Zoo animals
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Companion Animals
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Canine
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Feline
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Exotics
The Training/Equipment/Chemicals
Resources and References
Introduction
 Compounding can be characterized as any manipulation to
produce a dosage form other than manipulations that is provide
for in the directions for use on the labeling of an approved drug
product. This is to say that mixing a pediatric liquid antibiotic
is not compounding, but making a sterile inject able from nonsterile materials is the most difficult form of compounding.
Introduction
 Compounding should be the ultimate expression of
Pharmaceutical Care. In order to practice good Veterinary
Pharmaceutical Care the individual will have to broaden his/her
skills beyond human pharmacology. The diversity of issues
involved with the myriad of species requiring pharmaceutical
interventions is legend.
Introduction
 Using the ADME model in human patients requires the
practitioner to investigate each step as a consequence of
multiple pathologies, using the same model in the veterinary
population requires an understanding of the species-specific
anatomy, physiology, bio-chemistry, velocity of metabolism to
name just a few confounds
Introduction
 The office based vet is a recent phenomenon. Historically
veterinarians necessarily dispensed medications from their own
dispensary. Classically the vet traveled from farm to farm
plying their skills which involved not only diagnostics but also
creating dosage forms out of readily available materials. To
this day the pharmaceutical industry pays vague lip-service to
the veterinarian industry.
Introduction
 The research and development costs involved with bringing a
veterinary new drug to the market-place sometimes exceed the
cost of bringing the very same drug to the human market-place.
As a matter of course, there are several exotic species with no
approved drug. This yields a very fertile field for cultivation
by an appropriately trained pharmacist.
Introduction
 The fundamental relationship in veterinary compounding
pharmacy is the Patient-Physician-Pharmacist triad. The
addition of the owner can complicate the triad or it can
facilitate providing good Pharmaceutical Care. We have seen
the complications that the inter-net has created in human
medicine, one can expect the same uneducated and sometimes
dangerous interventions in veterinary medicine. It is the
responsibility of each of us to ensure that our patients will
receive the best that our profession provides to the human
population
The Regulations
The Rules and Common Sense
Compounding can be characterized as
any manipulation to produce a dosage
form other than manipulations that is
provide for in the directions for use on the
labeling of an approved drug product.
Florida Board of Pharmacy Chapter 465
59X-27.700 Definition of Compounding:
 “Compounding is the professional act by a pharmacist or
other practitioner authorized by law, employing the science or
art of any branch of the profession of pharmacy, incorporating
ingredients to create a finished product for dispensing to a
patient or for administration by a practitioner or his agent; and
shall specifically include the professional act of preparing a
unique finished dosage form containing any ingredient or
device by sections 465:003(7).
Florida Board of Pharmacy Chapter 465
59X-27.700 Definition of Compounding
 Compounding includes:
 The preparation of drugs or devices in anticipation of
prescriptions based on routine, regularly observed
prescribing patterns
 The preparation pursuant to a prescription of drugs or
devices which are not commercially available
 The preparation of commercially available products from
bulk when the prescribing practitioner has prescribed the
compounded product on a per prescription basis and the
patient has been made aware that the compounded product
will be prepared by the pharmacist
 The preparation of drugs or devices for sale or transfer to
pharmacies, practitioners, or entities for purposes of
dispensing or distribution is not compounding.
Florida Board of Pharmacy Chapter 465
59X-27.700 Definition of Compounding:
 Animal Medicinal Drug use Clarification Act of 1994
(AMDUCA)
 Extra label Drug Use (ELDU) is the actual or intended use of a
drug in an animal that is not in accordance with the FDAapproved labeling.
 This includes any deviation from FDA- approval for
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indications
dosage levels
frequencies.
routes of administration
species
Florida Board of Pharmacy Chapter 465
59X-27.700 Definition of Compounding
 The Duck Rule of Compounding versus Manufacturing
 Volume
 Equipment
 Drug Pirates
 Patient/Physician/Pharmacist Triad
 .Veterinary compounding DOES NOT excuse the
requirements of consulting.
 Internet prescribing is a No No.
Interaction with Vets
 You are the drug experts!
 Logic Disconnect: Who knows?
 You don’t know everything, get a book
 Just because you can do it, doesn’t mean you
should.
 Vets are really nice people
Interaction with Vets
 Vet Techs are the gate keeper.
 Vet techs can be your best friends.
 Vet techs can be your worst nightmare.
 Vet techs want to learn.
 Receptionists are not Vet Techs
 Some Vet techs are not Vet techs
 Some “nurses” are vet techs, some nurses are
nurses and some nurses aren’t .
Interaction with Vets
 Clients are the owners, patients are the animals
 SID means once a day, don’t argue you won’t win.
 The pharmacological argument. Win, lose or draw.
 Don’t mess it up for the rest of us
 Just say No.
The Patients/Clients
 The patient is the animal, the client is the
owner/guardian.
 Large Animals /Food Animals/ Zoo animals
 Probably not the best place to start..
 Dr. Midnight Milk Cup
 The squirt gun approach
The Patients/Clients
 Companion Animals
 You wouldn’t believe what some people have as pets.
Aardvarks to zebras, really.
 Gerbils, turtles, snakes, butterflies, lizards, large predator
cats, elephants, ennui’s, swans, storks, flamingoes, fish,
frogs, goats, pigs, foxes, hedgehogs, wolves, foxes,
The Patients/Clients
 Canine
 There are many breeds but they are all canines.
 There are many genetic specific predominant.
 The new pocket breeds are fraught with genetic
problems
 Dogs eat rocks
 Idiopathic Canine Epilepsy
 Thunderstorm Phobias
 Dry Eye
 Ear Grunge
The Patients/Clients
 Feline
 Cats are finicky, prissy, compulsive, passive
aggressive.
 Pilling cats ain’t fun
 You can trick them a couple of times, but plan on
them catching on.
 Mega colon
 Hyperthyroidism
 Hypertensive
 Psychotic
The Patients/Clients
 Compounded Companion Animal Dosage Forms
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Tablet Triturates
Flavored Liquids
Treats
Transdermals
Flavored pastes
Capsules
The Training/Equipment/Chemicals/
Formulae
 Training
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Professional Compounding Centers of America
American College of Veterinary Pharmacist
National Association of Compounding Pharmacist
Septrum
Creighton University School Of Pharmacy and Health
Professions.
 Medisca
 Gallipot (Secundum Artum)
The Training/Equipment/Chemicals/
Formulae
 Equipment
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Professional Compounding Centers of America
Septrum
Galipot
Hawkins
Medisca
The Training/Equipment/Chemicals/
Formulae
 Chemicals
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Professional Compounding Centers of America
Septrum
Galipot
Hawkins
Medisca
The Training/Equipment/Chemicals/
Formulae
 Formulae
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Professional Compounding Centers of America
Septrum
Galipot
Hawkins
Medisca
Drug Topics
Internal Journal of Compounding Pharmacy
The internet, but be very careful.
Resources and References
 Veterinary Information Network
 A great reference source and a place to interact with vets. You
will need to have a vet sponsor and probably will have to
advertise.
 http://vin.com/
 Plumb’s
 This is the ubiquitous green book. (although it’s red now) This
is the definitive handbook on veterinary pharmaceutics. It can
be accessed via VIN.
 Plumb's Veterinary Drug Handbook, Fifth Edition, Donald
C. Plumb
Resources and References
 Mc Gavin’s
 This is the Depiro of veterinary pharmacology. Great basic
book. The fourth edition is current.
 Pathologic Basis of Veterinary Disease, Fourth Edition, Mc
Gavin, Donald etal. Moby.
 ACVP
 The pre-eminent society of Veterinary Pharmacists. The put out
a newsletter on a regular basis. They also have a Dear Doc
letter that can be used in marketing your practice.
Resources and References
 American College of Veterinary Pharmacists
Research and Education Resource Center
2830 Summer Oaks Drive
Bartlett, TN 38134-3811
 Phone: 877-VETMEDS Fax:901-383-8882
 Email: [email protected]
 Your Local Veterinary Society.