In this episode, TRC Healthcare editor, Don Weinberger, PharmD, PMSP, explores how to avoid medication mishaps with pet prescriptions. Learn about common pitfalls, species-specific risks, and best practices for pharmacists and technicians.
This is an excerpt from our December 2024 Pharmacy Essential Updates continuing education webinar series.
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Transcript:
This transcript is automatically generated.
0:00:03 Narrator
Welcome to Clinical Capsules, your go-to podcast and trusted source for quick, evidence-based insights from TRC Healthcare.
0:00:11 Narrator
For four decades, we’ve been keeping healthcare professionals at the forefront of drug information and medical knowledge, and now we’re bringing these vital clinical updates right to your ears with new episodes every 2nd and 4th Tuesday – delivering practical, actionable takeaways in bite-sized episodes.
0:00:29 Narrator
Today, Associate Editor and Clinical Pharmacist Don Weinberger explores how to avoid medication mishaps with pet prescriptions in an excerpt from our popular Pharmacy Essential Updates webinar series. Let’s dig in…
00:00:47 Don Weinberger
And our article says. You’re in a key spot to keep your furry patient safe. When dispensing human meds for pets.
00:00:56 Don Weinberger
I’ll try to keep the dog and cat puns to a minimum, but maybe a little rough.
00:01:03 Don Weinberger
We’re just going to focus on cats and dogs and for any other animal it’s recommended to reach out to the veterinarian for guidance.
00:01:11 Don Weinberger
Now let’s start us off with a patient case.
00:01:15 Don Weinberger
Patient comes to your pharmacy with their service dog, a German Shepherd named Cupcake.
00:01:19 Don Weinberger
Her dog has been having diarrhea lately, and she thinks it’s due to a new brand of food she is using.
00:01:26 Don Weinberger
The pet owner has used loperamide for herself or diarrhea in the past, and said has worked great.
00:01:32 Don Weinberger
She wants to try it for Cupcake’s, diarrhea situation and wants to know what you think.
00:01:38 Don Weinberger
What should be told to the patient to treat Cupcake’s diarrhea?
00:01:43 Don Weinberger
we’ll swing back to this towards the end of the webinar.
00:01:48 Don Weinberger
Safety for all patients, including furry ones, is our main goal as pharmacy professionals.
00:01:55 Don Weinberger
And while we try our best to prevent mishaps when dispensing meds, sometimes they do indeed slip through.
00:02:01 Don Weinberger
In a recent case, a dog was given five times the intended dose of meloxicam suspension.
00:02:09 Don Weinberger
Since the dosing spoon used was calibrated for human consumption and not for pets.
00:02:15 Don Weinberger
Unfortunately, the dog suffered A gastrointestinal bleed and needed emergency care.
00:02:21 Don Weinberger
While stories like this are regrettable, use them to help ensure your dispensing the right meds every time.
00:02:28 Don Weinberger
Let’s quickly go over some concerns with pet meds.
00:02:33 Don Weinberger
As you know, there are many different species and sizes of pets which can impact the safety and efficacy of when they take a medication.
00:02:42 Don Weinberger
One example includes animals metabolized drugs differently than humans.
00:02:46 Don Weinberger
Like dogs can clear meds faster with their kidneys than humans.
00:02:52 Don Weinberger
And cats have limited or deficient metabolic pathways used to eliminate drugs.
00:02:57 Don Weinberger
Remember that human doses of medication often are not the same as pet doses.
00:03:03 Don Weinberger
Let’s take a look at a few examples now.
00:03:06 Don Weinberger
We have a great chart on this that might help you follow along, look for that link in the show notes… but I’ll go through some highlights now.
00:03:14 Don Weinberger
the vast majority of human meds used for pets are weight based.
00:03:18 Don Weinberger
And most are in kilograms per pound, but, Dimenhydrinate is in pounds.
00:03:26 Don Weinberger
And some dosing will vary on whether the weight reaches a certain threshold, or a specific species.
00:03:33 Don Weinberger
With chlorpheniramine a weight below 20 kilograms is a straight dose.
00:03:37 Don Weinberger
But above 20 milligrams in body weight it becomes a weight-based dose.
00:03:41 Don Weinberger
And fexofenadine dosing in dogs is weight based, but for cats is a straight dosing.
00:03:49 Don Weinberger
Let’s take a Look at the other medications section.
00:03:52 Don Weinberger
For levothyroxine that the dose is 20 to 40 micrograms per kilogram, which is actually much higher than humans.
00:04:00 Don Weinberger
This is because the drug is cleared from a dog’s body much faster than a human.
00:04:05 Don Weinberger
And for amlodipine, the dose for a cat is 0.25 to 1.25 milligrams per day.
00:04:13 Don Weinberger
Which tends to be much lower than humans.
00:04:17 Don Weinberger
So what should your patients consider before using human OTC medications and prescriptions for pets?
00:04:24 Don Weinberger
Let’s dive into some specific examples of this.
00:04:31 Don Weinberger
Acetaminophen is contraindicated in cats because they can’t metabolize it and could lead to toxicity.
00:04:36 Don Weinberger
Acetaminoipehn can be used in dogs.
00:04:39 Don Weinberger
The careful dosing consideration of periodic lab monitoring with chronic use may be needed.
00:04:46 Don Weinberger
Non steroidal anti-inflammatory drugs or NSAIDs like ibuprofen may not be safe.
00:04:52 Don Weinberger
For example, aspirin is metabolized fairly slowly in cats.
00:04:57 Don Weinberger
That can accumulate and cause toxicity.
00:04:59 Don Weinberger
And in dogs and cats.
00:05:01 Don Weinberger
Even low doses of certain NSAIDs, like ibuprofen or naproxen, can lead to serious gastrointestinal bleeding and or kidney problems.
00:05:11 Don Weinberger
Loperamide should not be used for some herding dog breeds.
00:05:15 Don Weinberger
For example, like Collies, Australian Shepherds, Old English Sheepdogs and German Shepherds.
00:05:21 Don Weinberger
Without genetic testing.
00:05:23 Don Weinberger
These breeds may experience toxicity.
00:05:25 Don Weinberger
Signs include excessive salivation and inability to stand or walk. If they take loperamide.
00:05:33 Don Weinberger
And loperamide cats may cause hyper excitements.
00:05:37 Don Weinberger
If they weren’t excited enough already.
00:05:40 Don Weinberger
And higher risks of colon impaction.
00:05:45 Don Weinberger
Oral steroids, like Prednisone or Prednisolone, can be used in dogs.
00:05:51 Don Weinberger
But prednisolone alone is preferred in cats.
00:05:54 Don Weinberger
The reason why is because cats aren’t able to convert Prednisone to Prednisolone which is the active form.
00:06:01 Don Weinberger
Let clients know about the acronym BEST, to know when to call the vets.
00:06:08 Don Weinberger
So have them watch for behavioral changes.
00:06:11 Don Weinberger
Eating less, skin renos or scabs.
00:06:15 Don Weinberger
Tarry stools, nausea or vomiting.
00:06:18 Don Weinberger
These could be all signs that they’re not taking the medication well and that should be called.
00:06:26 Don Weinberger
Potential toxicity doesn’t stop with active ingredients.
00:06:30 Don Weinberger
Inactive ingredients also need to be on our radars when dispensing meds for pets.
00:06:35 Don Weinberger
Reminder to point to product labels and package inserts to spot potential harmful ingredients.
00:06:41 Don Weinberger
For example, animals are very susceptible to the effects of alcohol.
00:06:47 Don Weinberger
Which can lead to serious effects like dangerous drops in blood glucose, blood pressure and body temperature. If consumed by pets.
00:06:54 Don Weinberger
Xylitol, also known as Birch sugar, is a common sugar substitute.
00:06:59 Don Weinberger
Xylitol can be harmful to dogs by causing low blood sugar and liver failure.
00:07:04 Don Weinberger
But keep in mind xylitol does not seem to be dangerous for cats.
00:07:10 Don Weinberger
Example of products that may contain xylitol include certain suspensions.
00:07:15 Don Weinberger
Some human meloxicam suspensions.
00:07:18 Don Weinberger
Liquids like gabapentin formulations and some chewables.
00:07:23 Don Weinberger
But keep in mind other sugar alcohols, like sorbitol, is generally safe in dogs and cats as long as it’s not consumed in large amounts.
00:07:37 Don Weinberger
Now that we’re all pharmacology experts on pet meds, let’s take a look at some best practices when dispensing prescriptions for pets.
00:07:45 Don Weinberger
Follow your pharmacies policy when setting up pet profiles.
00:07:49 Don Weinberger
Such examples include adding cat or dog to the patient’s name the species code, for example, a canine or feline.
00:07:58 Don Weinberger
Adding for veterinary use in the dosing instructions.
00:08:03 Don Weinberger
Also verify you have selected the correct patient profile before entering Rxs.
00:08:07 Don Weinberger
Pets in their owners profile usually have the same last name, address and phone number.
00:08:13 Don Weinberger
Generally, avoid dispensing pet Rxs under the owner’s name.
00:08:17 Don Weinberger
This can lead to confusion or possible fraud if the RX is accidentally billed to the owner’s insurance.
00:08:23 Don Weinberger
Lastly, confirmed medication histories.
00:08:26 Don Weinberger
Some pet meds do slip into owners lists sometimes, and there has been cases where outpatient pet meds auto populated the electronic Med list of the pet owner when admitted to the hospital.
00:08:38 Don Weinberger
Stay alert for potential red flags, since there has been cases that an owner may be misusing or diverting control substances prescribed for their pets.
00:08:47 Don Weinberger
Examples include multiple veterinary prescribers, several pets getting controlled substances from different clinics, owners and pets prescribe the same controlled substance, early refills.
00:08:59 Don Weinberger
That you have to check manually for these though, as some systems do not check for refill too soon, rejects on pet prescriptions.
00:09:08 Don Weinberger
Also keep in mind that you may be required to report controlled substance, prescription dispensed to pets to prescription monitoring programs in your state or province.
00:09:19 Don Weinberger
You can go about some additional resources if needed when dispensing medication for pets, including information like uses, precautions, adverse effects and interactions.
00:09:29 Don Weinberger
For instance, Plumb’s Veterinary Drugs.
00:09:33 Don Weinberger
The Merck Veterinary Manual, and Animal Poison Control Center all can help and kind of keep that number in mind.
00:09:40 Don Weinberger
That 888-426-4435.
00:09:43 Don Weinberger
Just keep mind that animal poison Control Center hotline may charge your consultation fee.
00:09:49 Don Weinberger
You may want to consider keeping a list of local emergency animal clinics that are open after hours for referral to pet owners.
00:09:57 Don Weinberger
Lastly, remember to provide administration devices designed just for animals.
00:10:02 Don Weinberger
These include special dosing spoons, oral syringes, which usually come with the medication.
00:10:09 Don Weinberger
Remember to dispense correct insulin syringes, since many pet insulins are less concentrated than human insulin.
00:10:17 Don Weinberger
And inhaler spacers like AeroKat are specifically designed for pets that make them handy when giving them inhaler.
00:10:28 Don Weinberger
OK, let’s go ahead and go back to our patient and her dog, Cupcake.
00:10:34 Don Weinberger
Now that you’re all experts, what should this pet owner know?
00:10:38 Don Weinberger
So as you learned, loperamide is toxic for herding breeds like German shepherds and could be harmful to Cupcake.
00:10:46 Don Weinberger
This patient should be referred to their vet for advice.
00:10:53 Don Weinberger
Go and dig into our clinical resource, Med considerations for cat and dogs for more dosing and dispensing tips to help keep pets safe.
0:011:02 Narrator
We hope you enjoyed and gained practical insights from listening to this presentation!
0:11:07 Narrator
Be sure to follow or subscribe, rate, and review this show in your favorite podcast app. Or find the show on YouTube by searching for ‘TRC Healthcare’ or clicking the link in the show notes. While you’re there, check out our other TRC podcasts like Medication Talk and Rumor vs Truth.
0:11:24 Narrator
Also in the show notes, we’ve linked directly to a few of the excellent resources mentioned today available to subscribers of Pharmacist’s Letter, Pharmacy Technician’s Letter, or Prescriber Insights. On those websites you’ll also find a lot more evidence-based, concise, yet comprehensive resources on this and other medication therapy topics. And don’t forget to check out our full Pharmacy Essential Updates webinar series for deeper dives into topics that matter to your practice.
0:11:52 Narrator
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0:12:06 Narrator
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0:12:29 Narrator
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0:12:33 Narrator
You can also reach out to provide feedback or make suggestions by emailing us at [email protected].
0:12:41 Narrator
Thanks for listening, stay sharp, stay current, and we’ll catch you next time on Clinical Capsules!
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