Principles of Pharmacology

Session 3
Elizabeth Young, Pharm.D. FSVHP
Wasson Veterinary Pharmacy Resident
January 25, 2018
Review from Last Week

1. The active ingredient of a medication is also commonly called:

a) Chemical name
b) Generic name
c) Proprietary name
d) Brand name
Review from Last Week

1. The active ingredient of a medication is also commonly called:

a) Chemical name
b) Generic name
c) Proprietary name
d) Brand name
Review from Last Week

2. What are the components of a drug regimen?

I. Medication name
II. Dosage
III. Dosing Interval
IV. Route of Administration

a) III & IV
b) II, III, & IV
c) I, III, IV
d) All of the above
Review from Last Week

2. What are the components of a drug regimen?

I. Medication name
II. Dosage
III. Dosing Interval
IV. Route of Administration

a) III & IV
b) II, III, & IV
c) I, III, IV
d) All of the above
Review from Last Week

3. Which of the following dosage forms can be scored? (select all that apply)
a) Capsules
b) Tablets
c) Suspensions
d) Caplets
Review from Last Week

3. Which of the following dosage forms can be scored? (select all that apply)
a) Capsules
b) Tablets
c) Suspensions
d) Caplets
Objectives

• Learn how to write a prescription.

• Talk about drug information resources.
• Describe the education most pharmacists have regarding veterinary
medications.
• Discuss generic equivalents.
• Introduce the concept of compounding.
Write a Prescription

• My dog Tucker (73 lbs) has been under the weather

and you as the veterinarian decide to prescribe
cephalexin. I (Elizabeth Young) want to get it filled
at my local Walgreens.

• What are some resources that you can use to find

the correct dosage?
Drug Information Resources
• Plumb’s Veterinary Drug Handbook
• Written by a Pharm.D.
• Book, online, mobile app
• www.plumbsveterinarydrugs.com
• Free for students for 1 year

• Saunders Handbook of Veterinary Drugs (Papich)

• Written by a DVM
• Book format only
• Includes basic clinical information
Drug Information Resources
• FDA Green Book
• Includes all FDA approved animal drugs
• Searchable database
• Used to determine if a drug is approved in a certain
species or used extra-label
• Merck Vet Manual
• Searchable by drug and disease state
• Contains concise summaries
• Includes photographs and illustrations
• www.merckvetmanual.com
Additional Drug Info Sources
• AVMA
• Compendium of Veterinary Drugs
• Facts and Comparisons
• Trissel’s Stability of Compounded Formulations
• Trissel’s Handbook of Injectable Drugs
• USP (United States Pharmacopeia)
• National Formulary (NF)
• Veterinarian’s Pharmacopeia
Write a Prescription
5 – 10 minutes

• My dog Tucker (73 lbs) has been under the weather and you as the
veterinarian decide to prescribe cephalexin. I (Elizabeth Young) want to
get it filled at my local Walgreens.

• What are some resources that you can use to find the correct dosage?
• Plumbs:
https://www.plumbsveterinarydrugs.com/#!/monograph/uW02zxOqcV/
Strengths available:
Capsules: 250 mg and 500 mg
What is a “Prescription”?
What is a “Prescription”?

• “Prescription” refers to the piece of paper a licensed practitioner fills out and
gives to the owner to take to a pharmacy so that a licensed pharmacist can
dispense the medication.
Dr. John Smith
625 Harrison St., West Lafayette, IN 47907
DEA# AB1234567 • Prescriptions can
be hand written,
Name: Jane Doe, “Spot” (Canine) Date: 1/25/18 typed/printed, or
Address: 123 Sesame St, West Lafayette, IN 47906 _ faxed.
• They can also be
Rimadyl (Carprofen) 25 mg caplets #14 given verbally or
Give 1 tablet by mouth every 12 hours. electronically
(varies state to
Refill: NR 1 2 3 4 5 Void After__________ state)

_______________________ _____Dr. John Smith DVM_

Dispense as Written May Substitute
Here in the Hospital we use

Non-Controlled Substances Controlled Substances

 In the state of Indiana…
• “All controlled substance
prescriptions written by Indiana
licensed practitioners must be
issued on approved security
feature prescription pad paper in
order for their prescriptions to be
accepted for filling in Indiana
licensed pharmacies.”

https://www.in.gov/pla/3017.htm
 What is required on a prescription?
• According to Federal and Indiana law each prescription must contain the
following:
1. Name of the owner & patient 9. Directions for use
2. Address of the patient 10.Quantity to dispense
3. Species of the patient 11.Number of refills (if any) authorized
4. Prescriber’s name 12.Prescriber’s DEA number (if
5. Prescriber’s address prescribing a controlled substance)
6. Drug name 13.Date of issue
7. Drug strength 14.Signature of prescriber
8. Dosage form

• There are also recommended items that can be included on a prescription

1. Weight of the patient 2. Dosage (mg/kg) 3. Length of therapy
Drug Enforcement Agency http://www.deadiversion.usdoj.gov/pubs/manuals/pract/section5.htm
Indiana Code 25-26-13-2 Definition of “Prescription”
1. Name of the owner & patient
2. Address of the patient
3. Species of the patient
Dr. John Smith
625 Harrison St., West Lafayette, IN 47907
DEA# AB1234567

Jane Doe “Spot” (Canine)

Name:_________________________________Date: ________
Address: 123 Sesame St, West Lafayette, IN 47906
_____________________________________________

Refill: NR 1 2 3 4 5 Void After__________

_______________________ _______________________
Dispense as Written May Substitute
4. Prescriber’s name
5. Prescriber’s address

Dr. John Smith

625 Harrison St., West Lafayette, IN 47907

Jane Doe “Spot” (Canine)

Name:_________________________________Date: ________
Address: 123 Sesame St, West Lafayette, IN 47906
_____________________________________________

Refill: NR 1 2 3 4 5 Void After__________

_______________________ _______________________
Dispense as Written May Substitute
6. Drug name 9. Directions for use
7. Drug strength 10.Quantity to dispense
8. Dosage form
Dr. John Smith
625 Harrison St., West Lafayette, IN 47907

Jane Doe “Spot” (Canine)

Name:_________________________________Date: ________
Address: 123 Sesame St, West Lafayette, IN 47906
_____________________________________________

Rimadyl (Carprofen) 25 mg caplets #14

1Give
tab 1PO
tablet
q12hby mouth every 12 hours.
Refill: NR 1 2 3 4 5 Void After__________

_______________________ _______________________
Dispense as Written May Substitute
Directions for Use

• Must include:
Dose/Units: 1, 5, 0.4
• Dose/Units Dosage form: tablet, capsule, mL
• Dosage form Route: PO, IV, etc.
Frequency: q12h, once daily, etc.
• Route of administration
• Frequency
Always include leading zeros, but
• Can also include: never include trailing zeros!
• Duration of therapy Do This Don’t do This
• Indication •0.4 mL •.4 mL
•5 mL •5.0 mL
11. Number of refills (if any) authorized
• Number allowed differs depending on the type
of medication
Dr. John Smith
625 Harrison St., West Lafayette, IN 47907

Jane Doe “Spot” (Canine)

Name:_________________________________Date: ________
Address: 123 Sesame St, West Lafayette, IN 47906
_____________________________________________

Rimadyl (Carprofen) 25 mg caplets #14

1 tab PO q12h

Refill: NR 1 2 3 4 5 Void After__________

_______________________ _______________________
Dispense as Written May Substitute
 How many refills can you prescribe?

• CII – cannot be refilled.

• Federal and State Law agree
• Indiana Code
• CIII – CV – can be refilled up to 5 times in 6 months
• Federal Law
• CIII – CIV – can be refilled up to 5 times in 6 months
• CV – may be refilled as authorized by the practitioner
https://www.deadiversion.usdoj.gov/faq/prescriptions.htm
https://www.in.gov/pla/3017.htm
12. Prescriber’s DEA number 13. Date of issue
(if prescribing a 14. Signature of prescriber
controlled substance)
Dr. John Smith
625 Harrison St., West Lafayette, IN 47907
DEA# AB1234567

Jane Doe “Spot” (Canine)

Name:_________________________________Date: 1/25/18
________ If you are typing out
Address: 123 Sesame St, West Lafayette, IN 47906
_____________________________________________ a prescription, you
have to actually sign
Rimadyl (Carprofen) 25 mg caplets #14 the form when you
1 tab PO q12h print it out.

Refill: NR 1 2 3 4 5 Void After__________

_______________________ Dr. John Smith DVM

_______________________
Dispense as Written May Substitute
Dispense as Written vs. May Substitute

• Dispense as Written (DAW) – the pharmacist needs to dispense the exact

medication that is written on the prescription
• May Substitute – the pharmacist can substitute a generic form of the
medication that is written on the prescription
• A clinician writes Lasix, the pharmacist can dispense furosemide

• Typically this does not apply to veterinarians.

Generic Drugs

• ”Medication created to be the same as an already marketed

brand-name drug in dosage form, safety, strength, route of
administration, quality, performance characteristics, and intended
use.
• These similarities help to demonstrate bioequivalence, which
means that a generic medicine works in the same way and
provides the same clinical benefit as its brand-name version. In
other words, you can take a generic medicine as an equal
substitute for its brand-name counterpart.”

https://www.fda.gov/Drugs/ResourcesForYou/Consumers/QuestionsAnswers/ucm100100.htm
Generic Drugs
• So what’s the difference?
• Generic drugs are not truly identical to the parent drug
• they can have different excipients
• Generics are cheaper
• They didn’t have to go through full FDA testing and approval

• In regards to Food animals – the amount of drug residue left

after the withdrawal time can be no more than the original
parent drug
• Residue = amount of drug left in the the meat, eggs, or milk
How do we distinguish brand name from
generic on a label (stock bottle)
Why would Dispense as Written vs. May
Substitute not apply to veterinarians?
• Pharmacists aren’t trained in veterinary medicine.
• Bioavailability of drugs are usually different in veterinary patients
compared to humans and between different brands/generics
 How does one become a pharmacist?

Undergraduate Graduate Post-doctoral Education

• Bachelor’s degree (4- • Doctor of Pharmacy • Human residency

years) (Pharm.D.) (4-years) programs  emergency,
• Pre-pharmacy program • Biochemistry, internal medicine, critical
(2-years) pharmacology, care, pediatrics,
pharmacokinetics, oncology, many more
therapeutics in humans (up to 3 years)
• Compounding • Veterinary-specific
• Veterinary Pharmacy residencies  3
elective courses at programs in the US
select schools • Continuing education
• Veterinary Pharmacy (“CE”)  required by all
Clinical Rotation (4-6 states for practicing
weeks) pharmacists.
 Recommended Items to include on a Rx
1. Weight of the patient 2. Dosage (mg/kg) 3. Length of therapy

Dr. John Smith

625 Harrison St., West Lafayette, IN 47907 Why should a veterinarian
DEA# AB1234567 include this information?
Jane Doe “Spot” (Canine)
Name:_________________________________Date: 1/25/18
________
Address: 123 Sesame St, West Lafayette, IN 47906
_____________________________________________ So that a pharmacist can
check the dose!
Rimadyl (Carprofen) 25 mg caplets #14
Pharmacists have the
1 tab PO q12h for 7 days Wt: 11kg
responsibility to ensure all
Dosage: (2.2 mg/kg)
Refill: NR 1 2 3 4 5 Void After__________ prescriptions filled are
accurate and safe.
_______________________ Dr. John Smith DVM
_______________________
Dispense as Written May Substitute
If you were writing a prescription for a rabbit,
what else would you need to include?
Dr. John Smith
625 Harrison St., West Lafayette, IN 47907
DEA# AB1234567

Jane Doe “Hopper” (Rabbit)

Name:_________________________________Date: 1/25/18
________
Address: 123 Sesame St, West Lafayette, IN 47906
_____________________________________________
#1 – 15 mL
Meloxicam 1.5 mg/ml oral suspension
bottle
1.7 mL PO SID Wt: 2.5kg Dosage: (1 mg/kg)
Refill: NR 1 2 3 4 5 Void After__________ WDT: meat = ___ days

_______________________ Dr. John Smith DVM

_______________________
Dispense as Written May Substitute
How long is a prescription valid?

• Indiana law requires that a prescription for a schedule II

prescription must be filled within one (1) year of being signed.
• This varies state to state!!

• Schedule III, IV, and V controlled substances shall be filled or

refilled no more than six (6) months after the date on which
such prescription was issued.
Write a Prescription

• My dog Tucker (73 lbs) has been under the weather

and you as the veterinarian decide to prescribe
metronidazole. I (Elizabeth Young) want to get it
filled at my local Walgreens.

15 mg/kg every 12 hours

https://www.plumbsveterinarydrugs.com/#!/search/metronidazole
Check yourself!
Label Requirements

• Name and address of the dispensing • Directions for use

location (the clinic or pharmacy)
• Refills
• Name of client and patient to be treated
• Prescribing clinician’s name
• Species of patient
• Rx number
• Date dispensed
• Discard After Date
• Name of drug (medically active
• Cautionary statements, if needed
ingredients)
• WDT’s if necessary
• Quantity dispensed
Auxiliary Labels
 Label Example

• Name and address of the

dispensing location (the clinic
or pharmacy)
• Name of client and patient to
be treated
• Species of patient
• Date dispensed
 Label Example

• Name of drug (medically

active ingredients)
• Quantity dispensed
• Directions for use
• Refills
• Prescribing clinician’s name
• Rx number
• Discard After Date
Questions Pharmacists may have for you

• Abbreviations
• SID

• Dosing
• Many medications are dosed at a much higher rate in veterinary
medicine than in human medicine.
• Levothyroxine – usually dosed in microgram increments in humans
compared to milligrams in animals
• Tramadol – most humans only take 1 tablet at a time, dogs can take
multiple tablets at once
Numbers Pharmacists May Ask For
• NPI numbers  national provider identifier
• Only applies to providers that are performing a service billable under HHS
(Medicare, Medicaid)
• **You will NOT have a NPI number**
• License number
• Most veterinarians have a license number provided by the state
• Exception: If you are working at a veterinary teaching hospital a license
number may not be required (varies by state)
• DEA number:
• If using/prescribing controlled substances, you should have one (again may
not be required if working at a veterinary teaching hospital)
Compounding
 What is Compounding?

• Take approved drugs or active pharmaceutical ingredients

(APIs) and modified them into a dosage form or strength that is
better suited for the patient than what is commercially
available.
• Examples:
• Making a gabapentin suspension from the capsules
• Using piroxicam powder to create different size capsules
• Can be sterile or non-sterile
 What is Compounding?
Compounded Products
• Patient Specific
• Made in small amounts
• Regulated by state boards of
pharmacy
• Made by a licensed
pharmacist or clinician
• Always ELDU
Manufactured Products
• Not patient-specific
• Mass produced
• FDA approved
• Made by drug companies
• Distributed to veterinarians
offices to dispense.
Why Compound?

• Individualize the dose

• Variety of formulations and flavors
• Capsules • Ophthalmics
• Suspensions • Otics
• Solutions • Pastes
• Transdermals • Treats
• Injectables
Concerns about Compounding

• Quality & Consistency

• Stability
• BUD
• Safety
• Sterile vs. Non-Sterile
• Efficacy
• Bioavailability
 Does every pharmacy compound
medications?
• How do you find a good compounding pharmacy?
• Use the State Board of Pharmacy and the FDA
• Independent 3rd Party Groups
• Pharmacy Compounding Accreditation Board (PCAB)
• Word of Mouth
• Where do they get their formulas?
• Trissel’s Stability of Compounded Formulations
• Professional Compounding Centers of America (PCCA)
• Do they follow USP standards?
What is missing from the following prescription?

Dr. John Smith

625 Harrison St., West Lafayette, IN 47907
DEA# AB1234567

Name: Jane Doe, “Buddy” Date: 1/25/18

Address: 123 Sesame St, West Lafayette, IN 47906 _

Rimadyl (Carprofen) 25 mg caplets #14

Give 1 tab q12h

Refill: NR 1 2 3 4 5 Void After__________

_______________________ ________________________
Dispense as Written May Substitute
What is missing from the following prescription?

Dr. John Smith

625 Harrison St., West Lafayette, IN 47907
DEA# AB1234567

Name: Jane Doe, “Buddy” Date: 1/25/18 1. Species of patient

Address: 123 Sesame St, West Lafayette, IN 47906 _ 2. Route of administration
3. Clinician Signature
Rimadyl (Carprofen) 25 mg caplets #14
Give 1 tab q12h

Refill: NR 1 2 3 4 5 Void After__________

_______________________ ________________________
Dispense as Written May Substitute
Summary

• Be able to write a prescription and determine what is missing from a

prescription.
• Know what compounding is and reasons why you can’t compound.
• Know what the concerns are with compounding.
Principles of Pharmacology
Session 3
Elizabeth Young, Pharm.D. FSVHP
Wasson Veterinary Pharmacy Resident
January 25, 2018
young481@purdue.edu
Resources

• http://news.vin.com/vinnews.aspx?articleId=22939
• https://www.avma.org/KB/Resources/FAQs/Pages/Prescriptions-and-
Pharmacies-Veterinarian-FAQs.aspx
• https://www.avma.org/KB/Resources/Reference/Pages/Pharmacy.aspx
• http://www.pharmacytimes.com/resource-centers/veterinary-
pharmacy/understanding-the-veterinary-patient
• https://www.fda.gov/AnimalVeterinary/ResourcesforYou/ucm214772.htm
• samples.jbpub.com/9781284035667/9781449685362_CH02_Sample.pdf