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Module 4: Veterinary Drug Information Resources

INTRODUCTION

Pharmacists are trained to critically evaluate published literature for accuracy, clinical significance, and credibility to support judicious drug therapy in humans. That skill is put into use in evidence-based medicine when pharmacists formulate a question, search for related information, evaluate the information, and ultimately apply the information to a specific patient. Likewise, veterinary pharmacists and pharmacy technicians must often seek drug information support in verifying the medication orders and prescriptions that they have received for individual patients.

Pharmacists, pharmacy technicians, and veterinary technicians should take a similar evidence-based approach to evaluating veterinary information and applying the information to non-human patients. When reviewing published veterinary studies, pharmacists and pharmacy technicians must be able to identify the purpose and relevance of the investigation; determine whether investigative methods, study groups, and endpoints are appropriate; and decide whether the statistical analysis of results supports the stated conclusions. Pharmacists and pharmacy technicians also must be able to assess the credibility and reliability of information sources such as textbooks, materials supplied by pharmaceutical manufacturers, websites, organizational message boards, and formularies.

The National Association of Boards of Pharmacy (NABP) recognizes the need for pharmacists and pharmacy technicians to have access to veterinary drug information resources. A resolution passed at the NABP 110th Annual Meeting in 2014 directs pharmacists to “have access to resources necessary to appropriately dispense and provide care” for veterinary patients.1

This module introduces pharmacists, pharmacy technicians, and veterinary technicians to the most commonly used information sources for veterinary medicine. A comprehensive review of all relevant veterinary information resources is beyond the scope of this module; the information sources discussed here provide an excellent foundation upon which to build a veterinary drug information library. Pharmacists and pharmacy technicians must exercise great care when extrapolating information from human information resources as species-specific factors discussed in Module 1 (Anatomical and Physiological Considerations for Drug Therapy in Non-Human Species) and Module 2 (Principles of Toxicology in Non-Human Species) may result in drug dosages and regimens that are significantly different in animal patients compared to humans.

VETERINARY PROFESSIONAL CREDENTIALS

A critical evaluation of primary health care literature and information resources must include an assessment of the credentials and experience of the authors. Pharmacists and pharmacy technicians may not be familiar with the academic degrees and certifications earned by veterinary professionals. Table 1 lists some of the most frequently encountered veterinary credentials.

Table 1. Commonly Encountered Veterinary Professional Credentials
Abbreviation Credential Description
Veterinarians
DVM Doctor of Veterinary Medicine Graduation from a US college of veterinary medicine (usually a 4-year graduate program)
VMD Veterinary Medical Doctorate Graduation from the University of Pennsylvania College of Veterinary Medicine (4-year graduate program)
BVSc Bachelor of Veterinary Science Graduation from a college of veterinary medicine in the United Kingdom (Bristol*) or Australia
Dipl. Diplomate Certification by one or more of 20 specialty boards currently recognized by the American Veterinary Medical Association (usually 3–5 years of postgraduate specialty training plus certification by examination)
Veterinary Technicians
CVT

RVT

LVT
Certified veterinary technician

Registered veterinary technician

Licensed veterinary technician
A veterinary technician who has earned a degree from an accredited veterinary technician school
* Each of the 8 colleges of veterinary medicine in the United Kingdom has a different name and abbreviation for the degree awarded.

Pharmacists and technicians should keep in mind that author credentials and related experience are more important than the number of authors. Some well-respected veterinary information resources are written by one, two, or three authors; others have many contributing authors.

Case Study 1: Veterinary Credentials

You are searching the web for information about canine hyperadrenocorticism. You find an informative article by an author with the following credentials: VMD, Dipl., ACVIM.

Analysis

VMD is the degree conferred on graduates of the University of Pennsylvania College of Veterinary Medicine, so the author is a veterinarian. “Dipl.” signifies that this veterinarian has achieved board certification status in a veterinary specialty. ACVIM is the American College of Veterinary Internal Medicine. You conclude that this author is a board-certified veterinarian who has achieved specialty status in the American College of Veterinary Internal Medicine; these are appropriate credentials for the author of an article on canine hyperadrenocorticism.

VETERINARY DRUG INFORMATION REFERENCE BOOKS AND DATABASES

Drug dosing in non-human patients is not as straightforward as it is in human patients. Dosing in animals often is species-specific or indication-specific. Consequently, it is imperative that pharmacists and pharmacy technicians have access to current and credible veterinary drug information resources. This section discusses reference books and databases most likely to be of value to practicing pharmacists and pharmacy technicians.

Reference books are an important source of veterinary drug information. As with all reference books, the length of time required for publication often renders content outdated or irrelevant by the time the book is printed. When consulting veterinary references, pharmacists are well advised to determine the most recent publication date and consider the frequency with which the material is revised.

Many new veterinary information reference books and databases are published each year. The most efficient cataloging of new veterinary information can be found on the websites of two publishers:

Wiley also publishes a Veterinary Clinical Digest, available free of charge at www.veterinaryclinicaldigest.com/.

Pharmacotherapeutics for Veterinary Dispensing

Published in 2019, Pharmacotherapeutics for Veterinary Dispensing is edited by Dr Katrina Mealey, a pharmacist who is also a board certified veterinary pharmacologist veterinarian. Dr Mealey and all contributors are well-known authorities in veterinary pharmacy and pharmacology. This textbook is an essential reference for anyone who dispenses drugs for veterinary patients. Available in both hard copy and electronic formats, this textbook is the first to combine the expertise of both veterinarians and veterinary pharmacists to enable pharmacists to apply their knowledge and skills to assure optimal therapeutic outcomes for patients of all species. This textbook describes information needed to safely dispense prescription and over-the-counter (OTC) drugs for veterinary patients; comprehensive pharmacotherapy for canine, feline and equine therapeutics; pharmacogenomic and breed-related drug sensitivities; and detailed descriptions of veterinary drug law and regulation. This book was written with the goal of integrating pharmacists into the veterinary health care team. Pharmacotherapeutics for Veterinary Dispensing is currently published by Wiley-Blackwell and is available through a variety of outlets for approximately $100.

Pharmacotherapeutics for Veterinary Dispensing (print and electronic)
Katrina L. Mealey, DVM, PhD 
Wiley-Blackwell 
2019 (First edition) 
Hard copy, paperback, and electronic versions available

Plumb’s Veterinary Drug Handbook/Plumb’s Veterinary Drugs

The resource known familiarly as “Plumb’s” actually comprises two reference products: the print Plumb’s Veterinary Drug Handbook and the electronic Plumb’s Veterinary Drugs. The author (Donald C. Plumb, PharmD) and contributors all are well-known authorities in the field.

Plumb’s Veterinary Drug Handbook is in its 8th edition. It is available in desk-size and pocket-size print formats. Plumb’s contains comprehensive drug monographs consisting of prescriber highlights, uses, indications, pharmacology, actions, pharmacokinetics, contraindications, precautions, warnings, adverse effects, reproductive and nursing safety, overdosage, acute toxicity, drug interactions, laboratory considerations, dosages by species, monitoring, client information, chemistry, synonyms, storage, stability, compounding information, available dosage forms, regulatory status, and a comprehensive list of references. The appendices provide valuable information that includes:

  • Species-specific charts for converting weight to body surface area
  • List of prescription abbreviations
  • Association of Racing Commissioners International (ARCI) drug classifications
  • Toxin tables
  • Considerations for compounding ophthalmic medications
  • Comprehensive drug-specific veterinary medication guides for pet owner education

Plumb’s Veterinary Drugs is the most up-to-date and easily accessible veterinary drug reference product. It replaced Plumb’s Online as the official digital version of Plumb’s Veterinary Drug Handbook. Plumb’s Veterinary Drugs is accessed online at www.plumbsveterinarydrugs.com; it also is available as a mobile application for most handheld devices. The information is updated in real time. Useful features include the ability to click on “favorites,” which catalogues the most commonly accessed drugs in one location. Users also are able to make “notes” on each drug, facilitating entry of updated or personalized information about use of each drug.

Print copy or online subscription to Plumb’s Veterinary Drugs are available for approximately $85 each for individual users. Students may subscribe for $4.99 per year.

Plumb’s Veterinary Drug Handbook (print)
Donald C. Plumb, PharmD 
Wiley-Blackwell 
February 2018 (9th edition) 
Desk-size and pocket-size formats available

Plumb’s Veterinary Drugs (electronic) 
www.plumbsveterinarydrugs.com

Desktop, smartphone, tablet versions available

Saunders Handbook of Veterinary Drugs: Small and Large Animal

Saunders Handbook of Veterinary Drugs: Small and Large Animal is written by board-certified veterinary pharmacology expert Mark G. Papich. It currently is in its 4th edition.

“Saunders” is available in both traditional print and e-book formats. It includes 550 comprehensive drug monographs and a number of clinically useful appendices. A companion website provides access to more than 150 customizable education handouts for pet owners.

Saunders Handbook of Veterinary Drugs: Small and Large Animal
Mark G. Papich, DVM, MS, Dipl., ACVCP 
Elsevier 
November 2015 (4th edition)

Exotic Animal Formulary

Exotic Animal Formulary, currently in its 5th edition,is the only drug formulary created solely for the treatment of exotic animals. It is written by clinical and research veterinarian James W. Carpenter, with contributions from more than 20 expert veterinary authors.

Exotic Animal Formulary addresses the most common questions and medical situations encountered in treating exotic animals, including birds, fish, amphibians, reptiles, primates, wildlife, and small mammals. The nearly 200 tables provide current recommendations on drugs, indications, and dosages, including biological tables with details on therapies and diets, normal blood parameters of common species, venipuncture sites, differential diagnosis, and medical protocols for common conditions. The Exotic Animal Formulary is currently available for approximately $50.

Exotic Animal Formulary
James W. Carpenter, MS, DVM, Dipl., DACZM 
Elsevier 
October 2017 (5th edition)

BSAVA SMALL ANIMAL FORMULARY

The British Small Animal Veterinary Association Small Animal Formulary 9th edition contains 2 parts: Part A, which is dedicated to dogs and cats, and Part B, which covers small mammals, birds, reptiles, fish, and amphibians. It includes doses and other species-specific information, with references (where available) and useful appendices including sedation and chemotherapy protocols. It also contains downloadable client information handouts. The BSAVA Small Animal Formulary is available online for an annual subscription fee of approximately $250.

BSAVA Small Animal Formulary
Ian Ramsey, BVSc, PhD, DSAM, DipECVIM-CA, FHEA, MRCVS, Editor in Chief
Wiley
August 2014 (9th edition)

COMPENDIUM OF VETERINARY PRODUCTS

The Compendium of Veterinary Products (CVP) is a comprehensive collection of veterinary product information, including FDA-approved labeling for veterinary drugs available free of charge online after registration. The searchable electronic database (https://www.bayerdvm.com/education/compendium-of-vet-products/) includes more than 5900 products, organized by product/trade names (alphabetically), companies (with their products listed alphabetically), product categories, product uses (labeled indications), and ingredients. It is possible to compare products by use, category, and ingredient. The site also includes charts covering anthelmintics and parasiticides, veterinary biologicals (vaccines), and withdrawal times for drugs used in food-producing animals. Mobile applications currently are available free of charge for Apple devices, Android (Google Play), and BlackBerry.

CVP is particularly helpful for pharmacists and pharmacy technicians who are seeking to associate brand names with generic contents for veterinary drugs.

Compendium of Veterinary Products 
https://www.bayerdvm.com/education/compendium-of-vet-products/

The Merck Veterinary Manual

The Merck Veterinary Manual is part of the Merck Manuals series of medical information resources. It is available in both print and electronic versions. The print version is in its 11th edition.

The first half of The Merck Veterinary Manual is arranged into anatomic systems, with specific conditions located in the system that is primarily affected. Conditions that may affect multiple systems are covered in a section titled Generalized Conditions. The second half of the manual covers special topics or disciplines. Pharmacists will find the Pharmacology section to be especially useful; it categorizes drugs used in animals by therapeutic class and provides comprehensive dosing and indication tables as well as information monographs.

The online version of The Merck Veterinary Manual is available free of charge at www.merckvetmanual.com. The content can be searched or browsed by section. A multimedia section provides access to audio files, videos, and photographs. A mobile application is available for Apple and Android devices through a partnership with Unbound Medicine for $49.99.

The Merck Veterinary Manual (print) 
Merck & Co, Inc 
July 2016 (11th edition)

The Merck Veterinary Manual (electronic) 
www.merckvetmanual.com

INTERNATIONAL VETERINARY INFORMATION SERVICE

International Veterinary Information Service (IVIS) is a not-for-profit organization established to provide information to veterinarians, veterinary students, technicians, and animal health professionals worldwide. IVIS was founded in 1998 at the Cornell University College of Veterinary Medicine in Ithaca, NY, by academic faculty from veterinary colleges and veterinary research institutes in North America and Europe. The IVIS website provides free access to online veterinary books, journals, proceedings of veterinary meetings (presentations and posters), and short courses.

Although access to IVIS content is free, site registration is required. Voluntary donations of financial support are solicited through a yearly campaign.

International Veterinary Information Service 
www.ivis.org

Veterinary Pharmacology & Therapeutics

Veterinary Pharmacology & Therapeutics is the veterinary equivalent of Goodman & Gilman’s The Pharmacological Basis of Therapeutics for human medicine. It currently is in its 10th edition and is available in both traditional print and e-book formats.

Veterinary Pharmacology & Therapeutics represents the gold standard for basic pharmacology. The current edition provides a more contemporary blending of pharmacological principles with clinical therapeutics. Pharmacists who wish to achieve a deep understanding of the pharmacologic basis of veterinary therapeutics will benefit from reading this book.

Veterinary Pharmacology & Therapeutics
Jim E. Riviere, BS, MS, DVM, PhD, DSc and
Mark G. Papich, DVM, MS, Dipl., ACVCP, editors 
Wiley-Blackwell 
December 2017 (10th edition)

Food Animal Residue Avoidance Databank

As discussed in greater detail in Module 3 (“Regulatory and Ethical Issues in Veterinary Pharmacy”), the online Food Animal Residue Avoidance Databank (FARAD) is of critical importance to veterinarians and pharmacists who provide drug products and care for food-producing animals. FARAD is a congressionally mandated drug residue avoidance risk management program supported by the US Department of Agriculture. Its primary mission is to provide scientifically based expert advice to help mitigate unsafe chemical residues (eg, drugs, pesticides, biotoxins) in products derived from food animals.

FARAD is maintained by a consortium of universities, including the University of California-Davis, University of Florida, Kansas State University, and North Carolina State University. The program employs veterinary pharmacologists and veterinary pharmacists to evaluate drug depletion profiles in edible animal products.

Food Animal Residue Avoidance Databank 
www.farad.org

VETERINARY JOURNALS

As with human medicine, new and emerging information in veterinary medicine is published in primary literature (ie, journals). This section discusses veterinary journals most likely to be of value to practicing pharmacists.

Pharmacists likely are accustomed to seeing impact factors reported for health care journals. The impact factor reflects the average number of citations received per paper published in that journal during the two preceding years (eg, a journal’s 2015 impact factor is the average number of citations from that journal in 2013 and 2014). Impact factors were designed to indicate the quality of journals. For example, the New England Journal of Medicine had an impact factor of 59.558 in 2015, considered to be the highest among general medicine journals.2

Impact factors are difficult to apply to veterinary journals. In 2018-2019, the Journal of Veterinary Internal Medicine—one of the most widely read and respected veterinary journals—had an impact factor of 2.286 (compared to an impact factor of 1.821 in 2015). This most likely is attributable to the fact that human journals are focused on intensive research for specific diseases in a single species. Veterinary journals publish research for hundreds of diseases in dozens of species, so multiple citations of any one article are less likely. To the point, an impact factor of 1.5–2 is considered to be excellent for a veterinary journal. Impact factors for some leading veterinary journals are listed in Table 2. Current impact factors for veterinary journals can be checked at Scimago Journal& Country Rank accessible at https://www.scimagojr.com/journalrank.php?category=3401.

Table 2. Impact Factors of Selected Veterinary Journals
Title Impact Factor
American Journal of Veterinary Research 1.335
Canadian Journal of Veterinary Research 1.02
Journal of the American Veterinary Medical Association 1.557
Journal of Veterinary Internal Medicine 2.286
Journal of Veterinary Pharmacology and Therapeutics 1.175
Research in Veterinary Science 1.504
The Canadian Veterinary Journal 0.516
Today’s Veterinary Practice NR*
Veterinary Clinics of North America 0.82
* New journal (not yet rated)

Journal of Veterinary Pharmacology and Therapeutics

The Journal of Veterinary Pharmacology and Therapeutics is published bimonthly by John Wiley & Sons Ltd. It is an international journal dedicated to pharmacology in veterinary medicine and serves as a forum for scientific papers in the basic and clinical aspects of veterinary pharmacology, toxicology, and therapeutics. Pharmacists will find this journal useful in evaluating peer-reviewed evidence for safety, efficacy, and pharmacokinetic parameters for drugs used in animal species.

Additional information is available at https://onlinelibrary.wiley.com/journal/13652885#main-content.

Journal of the American Veterinary Medical Association

The Journal of the American Veterinary Medical Association (JAVMA) is the official journal of the American Veterinary Medical Association (AVMA) in Schaumburg, IL. It is a peer-reviewed, general scientific journal that includes reports of clinical research, feature articles, and regular columns of interest on current events in veterinary medicine. JAVMA is published twice monthly in print and online formats.

In addition to finding peer-reviewed scientific evidence, pharmacists who consult this journal are likely to gain an appreciation for current thinking on political and social issues in veterinary medicine and associated AVMA guidelines. For example, JAVMA publishes position statements and proposed guidelines on issues such as compounding, euthanasia, animal welfare, antimicrobial use, and use of medications in non-racing horses.

Additional information is available at http://avmajournals.avma.org/loi/javma.

American Journal of Veterinary Research

The American Journal of Veterinary Research (AJVR) is another official AVMA journal. It is published monthly in print and online formats. AJVR include news of interest to veterinary researchers and peer-reviewed reports of applied research in veterinary medicine and associated biological sciences. As with the Journal of Veterinary Pharmacology and Therapeutics, pharmacists and pharmacy technicians will find this journal useful in evaluating peer-reviewed evidence for safety, efficacy, and pharmacokinetic parameters for drugs used in animal species. The results of investigations regarding safety, efficacy, and stability of compounded formulations also appear frequently in this journal.

Additional information is available at http://avmajournals.avma.org/loi/ajvr.

Journal of Veterinary Internal Medicine

The Journal of Veterinary Internal Medicine (JVIM) is the official publication of research and communications of the American College of Veterinary Internal Medicine, the European College of Veterinary Internal Medicine, the European College of Veterinary Neurology, and the European College of Equine Internal Medicine. It is published bimonthly as an online-only, open-access journal. Pharmacists may find this peer-reviewed monthly journal particularly useful for the Consensus Statements published by the representative specialty colleges, on topics such as seizure management in dogs, treatment and prevention of uroliths (bladder stones) in dogs and cats, therapeutic antimicrobial use and emergence of antimicrobial resistance in small animals, and diagnosis and treatment of heart and valvular disease in dogs.

Additional information is available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1939-1676.

Research in Veterinary Science

Research in Veterinary Science is the official journalof the Association for Veterinary Teaching and Research Work, which is affiliated with the British Veterinary Association. It is published bimonthly by Elsevier.

Research in Veterinary Science is an international journal that publishes original articles, reviews, and short communications relevant to a high-quality practice of the veterinary sciences. As veterinary drugs trend toward gaining approval in Europe before they are approved in the United States, pharmacists may find articles in this journal that provide in-depth information about veterinary drugs still in the FDA pipeline.

Additional information can be found at www.journals.elsevier.com/research-in-veterinary-science.

Canadian Journal of Veterinary Research

The Canadian Journal of Veterinary Research/Revue Canadienne de Recherche Vétérinaire is a quarterly, peer-reviewed, online-only publication of the Canadian Veterinary Medical Association in Ottawa, Canada. It currently is Canada’s only veterinary research publication. Pharmacists and pharmacy technicians who practice in states near the United States–Canada border may find this publication to be particularly useful as a source of evidence-based information about therapies approved for use in Canada (but not in the United States).

Additional information can be found at www.canadianveterinarians.net/science-knowledge/cjvr.

Veterinary Clinics of North America

The Veterinary Clinics of North America are a series of peer-reviewed journals published by Elsevier Saunders. They cover 4 practice areas:

Veterinary Clinics of North America: Small Animal Practice currently is published bimonthly; the other journals are published 3 times a year.

Each issue of Veterinary Clinics of North America is devoted to state-of-the-art reviews on a single topic (eg, equine pharmacology, small animal obesity), prepared under the direction of an experienced guest editor. Pharmacists will find this journal to be particularly useful for achieving an understanding of current thinking about the diagnosis, treatment, and monitoring of specific diseases in individual animal species.

Today’s Veterinary Practice

Today’s Veterinary Practice is anofficial peer-reviewed journal of the North American Veterinary Community in Gainesville, FLThis bimonthly publication provides information on a wide variety of clinical topics, as well as industry information important to contemporary veterinary practice.

Subscriptions (print, online, or both) to Today’s Veterinary Practice are available free of charge to veterinary professionals (including pharmacists). The current issue also can be accessed and read online at http://todaysveterinarypractice.navc.com/. Pharmacists will find the comprehensive reviews and graphic design to be helpful in achieving an understanding of current therapy for veterinary disease states.

CRITICAL EVALUATION OF PUBLISHED VETERINARY LITERATURE

Given the significant shortage of approved drugs for all needs in veterinary medicine, veterinarians frequently seek pharmacist assistance in evaluating and providing novel drug therapies for animal patients. Pharmacists and pharmacy technicians must be capable of reviewing and evaluating published literature to support the use of novel therapies in animals, rather than merely reading and accepting investigator conclusions. Accordingly, pharmacists and pharmacy technicians should possess a basic knowledge of study design and article structure. They also must be familiar with the intent and validity of statistical presentations, as well as possible sources of error and limitations for the investigation.

It is important to note that many of the assumptions for the validity of human trials—for example, rational selection of cohort size—do not necessarily apply to animal studies. Because animal subjects do not “volunteer” for investigational studies as humans do, Institutional Animal Care and Use Committees (IACUCs) must ensure that a sufficient number of animals is included to accomplish investigator aims without using animals unnecessarily. This requires careful balancing of multiple considerations:

  • Rational selection of group size (pilot study, power analysis)
  • Careful experimental design
  • Maximizing use of each animal
  • Minimizing loss of animals
  • Ethical considerations to minimize pain and stress
  • Efficient statistical analysis (maximum information from minimum number of animals)

Pharmacists and pharmacy technicians must appreciate these limitations when they evaluate veterinary research.

Pharmacists and pharmacy technicians also should consider the following key areas when evaluating veterinary research.

Purpose. What was the study question/purpose? The aim of the study should be stated clearly in the abstract and introduction.

Design. What was the design of the study? Was it prospective, randomized, controlled, double-blind? Was it a retrospective data analysis? Uncontrolled, nonblinded, or retrospective analyses are inherently fraught with bias.

Inclusion/Exclusion Criteria. What were the inclusion and exclusion criteria for study subjects? If the study is a meta-analysis or a systematic review, what were the eligibility criteria, search strategy, study selection, and data for inclusion?

Endpoints. What were the primary endpoints? Did the study have any secondary endpoints?

Methods. Were the methods rational, reproducible, and valid? Were the subjects randomized? If so, by what logic and method? Was the randomization blinded? Were baseline characteristics of the study groups (eg, median age, weight, breed, sex, clinical signs) described? Were they similar? Were there any dropouts in the study? If so, why? What were the treatment arms of each group? Were they described adequately? Were they treated equally?

Statistical Analysis. What statistical tests were used to analyze the data (eg, chi-square test, Student’s t test, Fisher’s exact test)? Were they appropriate for the data analyzed? How were the patients analyzed—for example, exactly “per protocol” or as “intention to treat” because of deviations from protocol? Did the investigators use power calculations (ideally ≥ 80%)? If so, did they meet enrollment requirements?

Results. What were the results of the study? Did the investigators address adverse events? If so, how did the adverse events affect the validity and interpretation of outcomes? Did the results reflect the stated purpose of the study?

Conclusions. What conclusions did the investigators draw from the study results? Are those conclusions supported by the results?

Limitations. What study limitations were identified by the investigators?

Benefits. How do the benefits of therapy compare to risk of harm? Are the benefits worth the cost?

Validity. What is the external validity of the study results?Are the results applicable to real patients seen in clinical practice? Can the results change the standard of practice?

Case Study 2: Evaluation of Use of Enrofloxacin Injection by the Oral Route in Horses

A local equine veterinarian has contacted you about compounding an oral gel using enrofloxacin injection 100 mg/mL. You locate an article that describes the preparation of the gel and experience administering it to horses.

Analysis

As described in the article, the gel is prepared by adding several grams of poloxomer powder to enrofloxacin injection. The article reports the final concentration of the gel as 100 mg/mL, despite the addition of poloxomer powder. You are skeptical that it is possible to add mass to a solution without changing the final concentration of the solution.

As you read further into the methods and results, you discover that several of the horses treated with the compounded gel suffered from oral lesions and went off feed. You look up the pH of enrofloxacin injection; you learn that it is highly alkaline (pH > 10) and often causes injection site reactions. You suspect that the compounded oral gel has a similarly high pH and is causing the oropharyngeal mucosal lesions. You also note that no stability-indicating assay was performed on the compounded gel to determine how long it retains potency after compounding.

Your evaluation leads you to recommend against preparing this gel. You consult with the veterinarian to discuss other oral dosage forms of enrofloxacin that could be compounded for his equine patients.

REGULATORY INFORMATION RESOURCES

As discussed in greater detail in Module 3 (Regulatory and Ethical Issues in Veterinary Pharmacy”), pharmacists and pharmacy technicians who provide pharmaceutical care, products, and counseling for non-human patients must keep current on important statutes, regulations, rules, practice acts, and guidance for drug use in those species. Table 3 provides information for accessing websites of important veterinary regulatory agencies.

Table 3. Veterinary Regulatory Agencies
Regulatory Agency Website
American Association of Veterinary State Boards www.aavsb.org
Drug Enforcement Administration www.dea.gov
Environmental Protection Agency www.epa.gov/pesticides
Food and Drug Administration Center for Veterinary Medicine www.fda.gov/AnimalVeterinary
National Association of Boards of Pharmacy www.nabp.net
United States Department of Agriculture Animal and Plant Health Inspection Service www.aphis.usda.gov

VETERINARY PROFESSIONAL ORGANIZATIONS

Pharmacists and pharmacy technicians who serve populations of non-human patients are well advised to consult or join veterinary professional organizations. Although many veterinary professional organizations limit active voting membership to practicing veterinarians, many also have associate membership categories that provide pharmacists and pharmacy technicians with networking opportunities and help them keep current on veterinary medical issues. Some organizations—notably, the Society of Veterinary Hospital Pharmacists and the American College of Veterinary Pharmacists—are intended primarily for pharmacists and pharmacy technicians.

SOCIETY OF VETERINARY HOSPITAL PHARMACISTS

The Society of Veterinary Hospital Pharmacists (SVHP) is an organization of pharmacists who work exclusively in the veterinary field, primarily at veterinary teaching hospitals in colleges of veterinary medicine. Membership is international; the United States, Canada, the Netherlands, Denmark, South Africa, Australia, and New Zealand all are represented. The SVHP membership meets annually to participate in ACPE-accredited continuing education activities and exchange ideas and information about veterinary pharmacy practice.

Membership as a Fellow is restricted to licensed pharmacists who practice in nonprofit veterinary institutional settings providing professional service, teaching, or research (or some combination thereof) for at least 20 hours per week or are currently participating in an International College of Veterinary Pharmacy (ICVP) veterinary pharmacy PGY1 residency. Associate membership is open to pharmacists, pharmacy technicians, veterinarians, students, and other animal health professionals who have an interest in veterinary pharmacy.

The International College of Veterinary Pharmacy is the certification board of SVHP. Fellows who meet requirements and complete examinations are eligible to become Diplomates of ICVP.

Additional information is available at www.svhp.org.

AMERICAN COLLEGE OF VETERINARY PHARMACISTS

The American College of Veterinary Pharmacists (ACVP) was established to support the efforts of independent pharmacists in (1) developing and strengthening the services they provide for animals and (2) strengthening the support services they provide for veterinarians. ACVP is committed to helping pharmacists develop a successful veterinary compounding practice (it is affiliated with the American College of Apothecaries). Pharmacist membership is open to any licensed pharmacist meeting ACVP Practice Standards, as well as pharmacy technicians, pharmacy students, and corporate affiliates. Pharmacists also may apply for full Fellowship status; applicants must complete a veterinary compounding course by a recognized provider (or have sufficient practical or educational experience) and fulfill an interview requirement.

ACVP develops and disseminates ACPE-accredited educational materials and programs (including compounding courses), serves as an information resource, and works closely with allied organizations to enhance the veterinary pharmacy care offered by pharmacy practitioners. ACVP also encourages interaction and exchange of ideas among pharmacists and provides networking opportunities and specialty services for members.

Additional information is available at www.vetmeds.org.

AMERICAN VETERINARY MEDICAL ASSOCIATION

The American Veterinary Medical Association (AVMA) represents more than 88,000 veterinarians who work in private and corporate practice, government, industry, academia, and uniformed services. The AVMA acts as a collective voice for its membership and for the profession.

Voting membership in AVMA may be granted to any individual who (1) has earned a professional degree in veterinary medicine from a school or college of veterinary medicine and (2) supports and abides by the association’s purposes, principles, and policies. Affiliate membership is available for non-veterinarians who teach veterinary medicine, or the sciences allied to veterinary medicine, and those engaged in veterinary research. Candidates for affiliate membership must submit a completed membership application along with additional required documentation:

  • A cover letter indicating the reason for interest in AVMA-affiliate membership
  • A complete curriculum vitae
  • Letters of recommendation from 2 active AVMA members or members of an organization represented in the AVMA House of Delegates

Additional information is available at www.avma.org.

The AMERICAN ACADEMY OF VETERINARY PHARMACOLOGY AND THERAPEUTICS (AAVPT)

The American Academy of Veterinary Pharmacology and Therapeutics (AAVPT) was founded in 1977 and consists of approximately 300 veterinary pharmacology trained professionals from more than 20 countries. Members of AAVPT share a common interest in research and teaching in veterinary pharmacology. The Academy’s stated objectives are to support and promote the education and research in comparative pharmacology, clinical veterinary pharmacology, and other aspects of pharmacology of interest to the veterinary profession; to sponsor a journal publishing related pharmacology manuscripts; to provide educational meetings and symposia in veterinary pharmacology and therapeutics; to enhance the exchange of educational materials and ideas among veterinary pharmacologists; and to organize advisory committees of experts to address problems in veterinary therapeutics. The AAVPT has been very supportive to veterinary pharmacists since its inception and has welcomed many of them into its membership.

THE AMERICAN COLLEGE OF VETERINARY CLINICAL PHARMACOLOGY (ACVCP)

Similar to the relationship between SVHP and ICVP, the American College of Veterinary Clinical Pharmacology (ACVCP) originated from the AAVPT in 1990 as an AVMA-recognized board specialty in veterinary clinical pharmacology. The logo of ACVCP demonstrates the college’s commitment to advancing the practice of clinical pharmacology in veterinary medicine: “To cure with compassion, knowledge, and diligence.” More than 60 veterinary pharmacologists have achieved diplomate status in ACVCP with many more pursuing certifications. ACVCP- boarded pharmacologists often work collaboratively with veterinary pharmacists in veterinary teaching hospitals and many routinely provide clinical pharmacology support to community veterinarians and pharmacists seeking their expert knowledge of clinical veterinary therapeutic strategies.

REFERENCES

  1. National Association of Boards of Pharmacy. Veterinary pharmacy education (Resolution 110-5-14). May 30, 2014. https://nabp.pharmacy/veterinary-pharmacy-education-resolution-110-5-14/. Accessed October 20, 2019.
  2. The New England Journal of Medicine. Media Center fact sheet. http://www.nejm.org/page/media-center/fact-sheet. Accessed October 20, 2019.

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