MeetYourPharmacy Flipbook

INFORMATIVE.

EDUCATIONAL.

DR. SAM IS BRILLIANT!

STARRING DR. SAM LANE COMMON DRUGS | VACCINES | ANTIBIOTICS | PAIN CONTROL | ALLERGIES GUEST STARRING HOLLY MORRIS PRESCRIPTION REFILL REQUEST MEET YOUR PHARMACY

EPISODE 2 | VACCINES

PHARMACY MEET YOUR Wondering what a medication is for?

Vaccine Theory We want to make sure we are timing the vaccines appropriately. Puppy/kitten vaccines should be started at 7-8 weeks of age and boosted every 3-4 weeks. We want to make sure we are boosting them as their mom’s antibodies are decreasing. They get their mom’s antibodies from their mom’s milk. We are increasing their antibodies with vaccines. We would like them to be vaccinated through the ages of 15 to 17-weeks old, regardless of the number of vaccines they received in the past. Booster Series: • Adult booster series is usually a 2 to 4-week booster schedule. • Puppies booster series is usually 3 to 4-week booster schedule. Vaccine Reactions: Usually rare but they do happen • Symptoms in dogs can be a swollen face, difficulty breathing, GI upset like vomiting or diarrhea. • If they have a swollen face or difficulty breathing we would want them to come in for a Benadryl shot or a steroid shot or both. • If severe, they may need fluids. • Cats can get GI upset or become lethargic.

• DHPP Vaccine – Can also be called DAPP which is the same exact thing. Includes: Canine Distemper Virus, Adenovirus (Hepatitis Virus), Parainfluenza, Parvovirus. One of the first vaccines puppies get at about 8 weeks of age. • Leptospirosis Vaccine: Highly recommend this annual vaccine. A very serious condition; if a dog gets infected, it can cause kidney failure. It can also be transmitted to people. The bacteria are spread by infected urine from raccoons, foxes, coyotes and other wildlife which is usually found in soil and water. • Bordetella Vaccine: Highly recommended. This is given to puppies in the form of an oral vaccine. They get boosted with an injectable vaccine. Bordetella is commonly referred to as kennel cough, kind of like saying your dog has a cold. Even if a dog has had the vaccine, they may still come down with some other respiratory disease. • CIV Vaccine is the influenza vaccine. This is given as a booster series. Give one shot and then boost again in 2 to 4-weeks. • Rabies: The only vaccination that is regulated by our county to make sure all pets are vaccinated. Rabies is carried by different wildlife. The most common rabies here is carried by skunk, as well as raccoons, bats and that sort of animal. Rabies can be transmitted to people through a bite from a dog and can be fatal. One vaccine is given as a puppy usually at the end of their vaccine series between 15 and 17-weeks of age. It is a year long vaccine. After that, they will get a 3 year vaccine. • Rattlesnake Vaccine: We give this to dogs that are at a high risk of getting bit by a rattlesnake. It is an optional vaccine. This vaccine does not make the dog immune to a bite, so if they are bit by a rattlesnake they need to come in as an emergency and be given the anti-venin, and we still treat them like any other dog. Hopefully the vaccine reduces the severity of the bite and they will recover quicker. It is the most reactive of our vaccines (i.e., causing a short-lived lump at the vaccine site), these lumps will usually resolve on their own. • FVRCP Vaccine is a core vaccine for cats commonly referred to as the feline distemper vaccine. It is a 3-way vaccine. Rhinotracheitis (Herpes virus), Calicivirus, and Panleukopenia (Parvovirus). Give to all kittens through 15 to 17-weeks of age. It will turn into a 3-year vaccine. • Feline Leukemia Vaccine Given to at-risk cats that run outside or in multi-cat household. The only way a cat can catch this is by interaction with another cat, or anything from sharing a water bowl, sharing a food bowl, grooming each other or mating. it is not airborne. This is boosted on a yearly basis.

Watch these informative videos of Dr. Sam explaining the medications we use in our hospital and how they help our patients feel better.

EPISODE 1 | COMMON DRUGS

• Apoquel is a medication used for dogs to manage itchiness caused by allergies. Can be used long-term. • Cefpodoxime is an antibiotic that is commonly used to treat skin infections in dogs. • Clavamox is an antibiotic that is commonly used in dogs and cats to treat infections, which may include urinary, respiratory, or skin infections. • Fluoxetine is an anti-anxiety medicine used to treat anxiety in dogs. It is generic Prozac. • Gabapentin is commonly used in dogs as a pain medication. It is used more often for chronic pain like arthritis or back pain. Works well with other pain medications. • Metronidazole is a gastrointestinaal (GI) antibiotic. Great to treat diarrhea, inflammatory bowel disease, or infections. • Rimadyl is a nonsteroidal anti-inflammatory drug, or NSAID, that’s used to reduce pain and inflammation (soreness) due to osteoarthritis and surgery in dogs. It is the dog version of Ibuprofen. Dogs like that it is chewable. • Carprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used to reduce pain and inflammation (soreness) due to osteoarthritis and pain following surgery in dogs. It is the generic form of Rimadyl, but it does not come in a chewable form.

Veterinary pharmacies play a vital role in ensuring medication safety. They have stringent quality control measures in place to guarantee that the medications they dispense are of the highest quality.

Medications that do not need a prescription or Dr. approval

• FortiFlora is a probiotic supplement. Helps improve gut flora and helps with diarrhea. • Bravecto is for flea and tick prevention. It is a prescription, but it is okay to give owner without consulting the doctor. Make sure to take the correct dosage. Comes in 1 month and 3-month versions. • Aurocin Ear Cleanser works to enhance ear health while cleaning the ear canals of canines.

Golden Paws Animal Hospital | Pharmacy Education

EPISODE 3 | ANTIBIOTICS

EPISODE 4 | PAIN CONTROL

Antibiotics (antimicrobials) are medications we use to kill bacterial infections. Reasons why we choose a certain type of antibiotic • Expense of antibiotic • Where in the body is the disease Types of antibiotics The difference for the owner is how often they are dosing it. • Concentration dependent antibiotic you usually give once daily • Time dependent antibiotic usually give 2 to 3 times daily What bacteria are we trying to fight off? 4 Classifications of Bacteria • Gram + Aerobic • Gram + Anaerobic • Gram - Aerobic • Gram - Anaerobic When an owner asks, Can I stop a medication? Our general response is going to be no. You do not want to stop an antibiotic. If you stop too soon, you could have batted down part of the infection but not gotten rid of all of the infection. That is how you have resistant bugs that will be less responsive to antibiotics. Please tell the owners it is important to finish all the antibiotics We may not have them finish it if the pet is having GI issues, diarrhea, vomiting, or allergic reaction.

• Albon If we have a dog with Coccidia, which is a protozoa, not a bacteria, that is found on a fecal test, we will be giving the dog Albon. Coccidia is common in puppies and in our rescue patients. The dosage is very specific, we typically give a double dose for the first dose and thereafter 1/2 of that dose for 9 days. • Amoxicillin is a penicillin and is a first line antibiotic. It is relatively inexpensive. It can be used for many things such as a urinary infection, skin infections and various infections of that nature. • Clavamox is a potentiated penicillin. It has both amoxicillin and clavulanic acid. The acid makes this medicine more potent. It is the same medicine we use for people called Augmentin. Clavamox is used for bladder and skin infections, and is considered a broad-spectrum antibiotic. It will kill all four types of bacteria. • Cefpodoxime is an antibiotic that is commonly used to treat skin infections in dogs. This is given once daily. Is in the same category as Cephalexin. • Cephalexin is in the same family of antibiotics called cephalosporins. It is given 2 to 3 times a day. • Clindamycin is good against anaerobic bacteria. Used a lot for dental issues, and a very good bone antibiotic. It is dosed out as twice a day in capsule form. • Antirobe Aquadrops Liquid is the brand name for Clindamycin. In a liquid form so it is used more for small dogs and cats. • Doxycycline is first line for respiratory infections. It is very effective against mycoplasma that we see in respiratory infections. Also good against kennel cough, tick-borne diseases and Leptospirosis disease. • Marboquin and Orbax Given once a day. Second line antibiotic. Used to treat urinary tract, ear, and kidney infections. • Metronidazole is a very good GI antibiotic. It is an antibiotic to treat diarrhea in dogs and cats. Also has good anti-inflammatory affects. There is a liquid version for cats. • Sulfamethoxazole/Trimethoprim may be effective against resistant bacteria, urinary tract infections and it is not very expensive.

Non-Steroidal Anti Inflammatory Drugs (NSAID) These are not steroids. These have both pain and anti-inflammatory benefits. The number one side effect is an upset stomach. (Symptoms: stop eating, vomiting.) • Do not give to a pet that is dehydrated. • Do not give this medication if the pet has chronic kidney disease. It can make the kidney disease worse. • Liver reactions are very uncommon. Dr. Sam has never diagnosed liver cirrhosis from being on a longtime NSAID. Can I stop giving NSAIDs to my dog because he doesn’t seem in pain? There is still a benefit for the anti-inflammatory effect, especially after surgery or if they have arthritis. For arthritis, the pet should be on this long-term, so it treats the underlying condition and continues to reduce inflammation. Studies show that therapeutic benefits increase over time as they continue to give this medication daily. This medication is less effective if owners stop and start it, or only use it periodically. Cats traditionally do not metabolize NSAIDs as well as dogs do. They are more likely to have side effects if they are on it too long.

• Gabapentin is a very common pain medication, it is a generic version of a medication called Neurontin. Primary use is for pain in both dogs and cats and it can be added to a pain regimen if already on Carprofin, or we may use it alone. Used a lot for back pain. Very commonly used for anti-anxiety or sedation for cats. Comes in a liquid version or a capsule which can be crushed and sprinkled over food. If you have an anxious cat, we may suggest using Gabapentin before coming in for a visit or a home visit. • Side effects: Can cause sedation or make your cat seem a little drunk. • Dogs seem to tolerate it well. • This medication can be stopped cold turkey. • There is no benefit to continue using it if you feel your pet’s pain has gone away. • Galliprant (NSAID) is the newest medication in the NSAID category of drugs. We believe the side effect profile may be less than the other NSAIDs. It may have less side effects on the stomach, kidney and liver. It is more expensive. There is not a generic version of this medication. • Metacam (NSAID) used to relieve pain, inflammation, and fever in dogs and cats. It is also used to treat pain associated with surgery. Side effects are GI related. Dosage is in a liquid form given in a syringe. If a dog weighs 20 pounds, you give it up to the 20 pound mark. If a dog weighs 60 pounds you give it up to the 60 pound mark. Cats traditionally do not metabolize NSAIDs as well as dogs do. They are more likely to have side effects if they are on it too long. • Onsior (NSAID) in a pill form and in an injectable form for surgical procedures. It is a good anti-inflammatory for cats and has limited side effects. • Rimadyl (NSAID) This is the most commonly used NSAID. The branded form has flavored tablets. Carprofen is the generic version of this drug. It is less costly than Rimadyl so we use this a lot for dogs who need to be on it long term. It is important to carefully read the label the doctor prints up when scripting this medication so that you fill the proper form. • Methocarbamol is muscle relaxant used for back pain. Side effects are sedation or pet can seem a little drunk. You can stop this medication at any time. INJECTABLES • Solensia for cats, Librela for dogs are both month long pain medications. These are game changers as well. Since you give an injectable once a month, you do not need to give daily pills. Type of drug is Monoclonal antibodies, which are super targeted, goes right at pain mediator in the body and doesn’t have other effects on other organs. Side effect profile goes way down. Some reactions similar to a vaccine reaction. Owner must come in monthly or can be taught to administer at home. CONTROLLED DRUGS (Kept in safe) • Tramadol used to be used more often. It has unpredictable efficacy. This means that it will relieve pain well in some dogs and be ineffective in others. There is a large dose range for this drug. • Buprenorphine for cats, it is an Opioid medication. Some GI side effects (constipation) and sedation side effects. You can stop it if your cat is not in pain or you do not like the side effects. It is a controlled drug so it is in the safe and need a DEA license to distribute it. Very good pain medication, used a lot after surgeries.

Golden Paws Animal Hospital | Pharmacy Education

EPISODE 5 | ALLERGIES

EPISODE 6 | PRESCRIPTION REFILL REQUEST

Practice Manager Holly walks us through the steps to follow when a customer requests that we fill a prescription.

Allergies in dogs manifest in different ways, the main way they manifest is through skin issues:

• Prednisone Vs Prednisolone: Cats: Typically like to treat them with Prednisolone. The reason being that there is a subset of cats that are unable to change Prednisone into its active form in the body called pregnisalin. Dogs: Can get either medication Please make sure to check the labels to make sure you are giving the correct medicine, especially to cats. These medicines cannot be stopped at anytime, you must wean off of them. • Apoquel and Cytopoint These medicines really changed the world of allergies for dogs. Important technology behind these medications found out is they are directed at a particular mediator of itch in the body called Interleukin-31. We know that causes itch in dog and is the main reason why dogs itch and lick with allergies. Apoquel: Pill and chewable form, dose it out as one pill 2X a day for about 2 weeks. Then go down to one pill once a day usually in the evening to help with nighttime itching. Minor side effects can be GI upset, but we rarely see that. It does have some immuno-suppressive effect, the reason we don’t like to stay on it at the higher dosing of twice a day is that long term, we could see immuno suppression. Apoquel can be stopped at anytime. Cytopoint is an injectable monoclonal antibody that is directed against Interleukin-31 which is the mediator of itch in the body. Very effective, a dose can last up to 6 weeks. Side effect profile on monoclonal antibodies is lower, the reason being is we are directing just against one element in the body. The reason you may give Apoquel more than Cytopoint is that Apoquel has more anti inflammatory characteristics so it brings down some of the inflammation, where Cytopoint would not. • Cefpodoxime is an antibiotic. A lot of dogs will get skin infections and allergies will be the underlying cause. So they get the allergy first, which causes inflammation, breaks the integrity of the skin, bacteria moves in, now they have a skin infection. If Apoquel or Cytopoint aren’t working there is a good chance there is an infection which needs to be treated with an antibiotic or an anti-yeast medication. Continue the full course of the antibiotic. • Ketoconazole is an anti-yeast medication. Yeast is also an infection that animals who have allergies may get. Many times yeast infections on the skin or in the ears are going to be secondary to the allergies. • Otomax is an ear medication. If a dog has chronic yeast infections or chronic ear infections, many times the underlying cause is allergies. The reason the ear infections keep coming back is the underlying cause is not being treated, which is the allergies. It is not because the medicine is not working. • Derm Complete is a food allergy prescription diet. If the animal has a food allergy, we are going to cure it by having them on a hypoallergenic diet. A hypoallergenic diet can come in different forms, sometimes it’s what’s called a hydrolyze diet, which means the molecules of the allergen are cut down into very small molecules and that the body can’t react to it. So you could have a dog who has a chicken allergy, but is on a diet with hydrolyzed chicken and they’re going to be fine. Then there are novel protein diets, meaning proteins they haven’t been exposed to before and doesn’t promote an allergy response. We carry Derm Complete, DD for both dogs and cats, ZD which is a hydrolyzed diet. These are called novel protein diets, we want them on the diet for about 6 to 8-weeks, not getting anything else except the diet.

Filling a prescription request

• Itching their skin • Licking their skin

• Pull up patient name on the Portal. Up in the corner across from their name is going to be a refill button. Click on Refill. If there are no refills: Make sure that you go to the doctor and make sure that refill _ is OK. A lot of the doctors will want to know who the patient is, why they are refilling, and was the medication they were on helping or not. If the doctor refills the prescription, he/she will put it in the Plan. • Go to the patient refills, click on the particular medication, then click on “Record and go to plan” This will put the refill into the plan for you. If they were here picking it up, you can put it in the cart and then print the label for the technicians in the back. • To send the prescription to the technicians in the pharmacy: Click on your medication and then click on the small printer icon (the one on the top). This will pull up an image of the label. Then you will print it from the printer icon in the upper right corner, use the printer drop down menu to make sure you are printing it to the DYMO LabelWriter. This will send the prescription label to the back so technicians can fill it for you.

80% of allergies are environmental, something in the air causing the allergies and triggering

an allergy in the dog 20% food allergies

Steroid medications are super effective anti-itch medications and anti- inflammatories so they are very effective against allergies. Side effects of steroids: • Drinking more water

• Urinating more • Panting more • Higher food drive

If you cannot find the prescription up front in the box

• Come back to the pharmacy. If the prescription is sitting here, you can take it as long as there are two initials on the label. • If there are not two initials , you’re going to find a technician and make sure that they check you and put those two initials on that label. Once the initials are on it you can take the prescription upfront to the owner. Controlled substances • Controlled substances are kept in the lock box. You will need to find Holly, Dr. Sam or any of the surgery technicians to come over to the lock box and put in the code. As they take the medication out of the lock box they will check it to make sure it is the correct medication being dispensed.

Steroids are the main medication to treat allergies in dogs. Cats can tolerate steroids better than dogs, so they do not suffer many of the side effects. Food Allergies The good news about a food allergy is that if a pet has it, it is something that can potentially cured because you can put them on Derm Complete and all of their allergy signs go away. Unfortunately 80% of the time there’s an environmental component.

Golden Paws Animal Hospital | Pharmacy Education

Golden Paws Animal Hospital 701 Pine Ridge Rd., Golden, Colorado 80403 720-307-7297 | goldenpawsvet.com

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