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Rusbridge C. Neuropathic pain in cats: Mechanisms and multimodal management. J Feline Med Surg 2024; 26:1098612X241246518. [PMID: 38710218 PMCID: PMC11156241 DOI: 10.1177/1098612x241246518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
PRACTICAL RELEVANCE Chronic pain is a significant welfare concern in cats, and neuropathic pain, which arises from aberrant processing of sensory signals within the nervous system, is a subcategory of this type of pain. To comprehend this condition and how multimodal pharmacotherapy plays a central role in alleviating discomfort, it is crucial to delve into the anatomy of nociception and pain perception. In addition, there is an intricate interplay between emotional health and chronic pain in cats, and understanding and addressing the emotional factors that contribute to pain perception, and vice versa, is essential for comprehensive care.Clinical approach:Neuropathic pain is suspected if there is abnormal sensation in the area of the distribution of pain, together with a positive response to trial treatment with drugs effective for neuropathic pain. Ideally, this clinical suspicion would be supported by confirmation of a lesion at this neurolocalisation using diagnostic modalities such as MRI and neuroelectrophysiology. Alternatively, there may be a history of known trauma at that site. A variety of therapies, including analgesic, anti-inflammatory and adjuvant drugs, and neuromodulation (eg, TENS or acupuncture), can be employed to address different facets of pain pathways.Aim:This review article, aimed at primary care/ general practitioners, focuses on the identification and management of neuropathic pain in cats. Three case vignettes are included and a structured treatment algorithm is presented to guide veterinarians in tailoring interventions.Evidence base:The review draws on current literature, where available, along with the author's extensive experience and research.
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Affiliation(s)
- Clare Rusbridge
- BVMS, PhD, DipECVN, FRCVS School of Veterinary Medicine, The University of Surrey, Guildford, Surrey, UK; and Wear Referrals Veterinary Specialist & Emergency Hospital, Bradbury, Stockton-on-Tees, UK
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2
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Dantas LMS, Ogata N. Veterinary Psychopharmacology. Vet Clin North Am Small Anim Pract 2024; 54:195-205. [PMID: 37648610 DOI: 10.1016/j.cvsm.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The stress response affects the central nervous system and multiple other systems in the body. Chronic mental and behavioral pathologies are associated with inflammation, dysfunctions in the immune response and an increased risk for other chronic inflammatory and metabolic diseases. Psychiatric treatments alleviate fear, stress and anxiety, increase the qualify of life and lifespan for dogs and cats. Multiple safe psychoactive medications that can be used in association are available to help veterinary patients. Clinicians should understand the function of neurotransmitters and hormones on emotional processing, cognition and behavior, and drug mechanism of action so medication selection is appropriate for each individual patient.
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Affiliation(s)
- Leticia M S Dantas
- American College of Veterinary Behaviorists, Certified Fear Free Professional; Department of Biomedical Sciences, Behavioral Medicine Service, University of Georgia Veterinary Teaching Hospital, 501 D.W. Brooks Drive, Athens, GA 30602, USA.
| | - Niwako Ogata
- American College of Veterinary Behaviorists, Certified Fear Free Professional; Department of Clinical Sciences, Veterinary Behavior Medicine, Purdue University, 625 Harrison Street, West Lafayette, IN 47907, USA.
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3
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Aldrich LA, Roush JK, KuKanich B. Plasma concentrations of tramadol after transdermal application of a single metered dose of a compounded tramadol gel to cats. Am J Vet Res 2021; 82:840-845. [PMID: 34554876 DOI: 10.2460/ajvr.82.10.840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine plasma tramadol concentrations in cats following a single dose of oral and transdermal formulations and the pharmacokinetics for and the concentration of tramadol in the transdermal formulation. ANIMALS 8 healthy client-owned domestic shorthair cats. PROCEDURES 1 cat was orally administered 1 dose of tramadol (2 mg/kg), and 7 cats received 1 dose of a proprietary compounded tramadol gel product (median actual dose, 2.8 mg/kg) applied to their inner pinnae. Plasma tramadol concentrations were measured with high-performance liquid chromatography-mass spectrometry at fixed times over 24 hours. RESULTS Plasma tramadol concentrations were undetectable or much lower (range, < 1 to 4.3 ng/mL) following application of the transdermal formulation, compared with those following oral administration (maximum plasma tramadol concentration, 261.3 ng/mL [at 4 hours]). Tramadol pharmacokinetics for the transdermal formulation could not be determined. Tramadol concentrations of the transdermal gel product exceeded the estimated label dose in all analyzed gel samples, with concentrations greater than the 90% to 110% United States Pharmacopeia standard for compounded drugs. CONCLUSIONS AND CLINICAL RELEVANCE Application of 1 dose of the proprietary transdermal formulation did not yield clinically relevant plasma tramadol concentrations in cats. Although this proprietary formulation is currently available to prescribing veterinarians, it should be used with caution.
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Tijani AO, Nunez E, Singh K, Khanna G, Puri A. Transdermal Route: A Viable Option for Systemic Delivery of Antidepressants. J Pharm Sci 2021; 110:3129-3149. [PMID: 34089714 DOI: 10.1016/j.xphs.2021.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 12/11/2022]
Abstract
The high rise in the population suffering from depression depicts the need for improved and highly effective treatment options for this condition. Efforts to develop existing drugs into user-friendly dosage forms with a number of advantages in major depressive states, including but not limited to: sustained drug release, reduced drug dosing frequency, improved tolerance and adherence, suitability for use in diverse populations and different treatment scenarios, as well as less central nervous system side effects are required. One such non-invasive drug delivery route that could provide the aforementioned benefits in the treatment of depression is the transdermal route. A number of conventional and emerging transdermal delivery strategies have been investigated for some potent antidepressants and results depict the potential of this route as a viable means for systemic delivery of therapeutically relevant doses of the tested agents, with Emsam®, the commercially available patch of selegiline, being an evidence for the same. The investigated approaches include the formulation of transdermal patches, use of vesicular drug carriers, pro-drug approach, microemulsification, chemical as well as physical enhancement technologies. This review provides a comprehensive account of the rationale, developments made till date, scope and future prospects of delivering antidepressants via the transdermal1 route of administration.
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Affiliation(s)
- Akeemat O Tijani
- Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Estefany Nunez
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA
| | - Karyn Singh
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA
| | - Garima Khanna
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, Punjab 160014, India
| | - Ashana Puri
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA.
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Lautz LS, Jeddi MZ, Girolami F, Nebbia C, Dorne JLCM. Metabolism and pharmacokinetics of pharmaceuticals in cats (Felix sylvestris catus) and implications for the risk assessment of feed additives and contaminants. Toxicol Lett 2020; 338:114-127. [PMID: 33253781 DOI: 10.1016/j.toxlet.2020.11.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 01/25/2023]
Abstract
In animal health risk assessment, hazard characterisation of feed additives has been often using the default uncertainty factor (UF) of 100 to translate a no-observed-adverse-effect level in test species (rat, mouse, dog, rabbit) to a 'safe' level of chronic exposure in farm and companion animal species. Historically, both 10-fold factors have been further divided to include chemical-specific data in both dimensions when available. For cats (Felis Sylvestris catus), an extra default UF of 5 is applied due to the species' deficiency in particularly glucuronidation and glycine conjugation. This paper aims to assess the scientific basis and validity of the UF for inter-species differences in kinetics (4.0) and the extra UF applied for cats through a comparison of kinetic parameters between rats and cats for 30 substrates of phase I and phase II metabolism. When the parent compound undergoes glucuronidation the default factor of 4.0 is exceeded, with exceptions for zidovudine and S-carprofen. Compounds that were mainly renally excreted did not exceed the 4.0-fold default. Mixed results were obtained for chemicals which are metabolised by CYP3A in rats. When chemicals were administered intravenously the 4.0-fold default was not exceeded with the exception of clomipramine, lidocaine and alfentanil. The differences seen after oral administration might be due to differences in first-pass metabolism and bioavailability. Further work is needed to further characterise phase I, phase II enzymes and transporters in cats to support the development of databases and in silico models to support hazard characterisation of chemicals particularly for feed additives.
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Affiliation(s)
- L S Lautz
- Radboud University Nijmegen, Houtlaan 4, 6525 XZ Nijmegen, the Netherlands
| | - M Z Jeddi
- European Food Safety Authority, Scientific Committee and Emerging Risks Unit, Via Carlo Magno, 1A, 43126 Parma, Italy
| | - F Girolami
- University of Torino, Department of Veterinary Sciences, Largo P. Braccini 2, 10095 Grugliasco, Italy
| | - C Nebbia
- University of Torino, Department of Veterinary Sciences, Largo P. Braccini 2, 10095 Grugliasco, Italy
| | - J L C M Dorne
- European Food Safety Authority, Scientific Committee and Emerging Risks Unit, Via Carlo Magno, 1A, 43126 Parma, Italy.
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6
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Lilly ML. Animal Behavior Case of the Month. J Am Vet Med Assoc 2020; 257:493-498. [DOI: 10.2460/javma.257.5.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
PRACTICAL RELEVANCE Urine spraying (synonymous terms include urine marking or scent marking) is commonly described as urine deposited on vertical surfaces while the cat is in a standing position. With the increasing trend of keeping cats indoors in some countries and the potential resultant increase in frustration-related behaviors, urine spraying may occur in the home. Although also a normal feline behavior, it is usually not deemed acceptable when the cat targets household possessions. Urine spraying is a common behavioral complaint that practitioners receive from cat owners and has the potential to disrupt the human-cat bond. In fact, feline elimination issues are a frequent reason cited by owners when they relinquish their cats to shelters and rescue organizations. CLINICAL CHALLENGES While the location of the deposited urine should be diagnostic, this is not always the case. Urine marking can occur on horizontal surfaces, thus complicating the diagnosis. Urine spraying by intact males and females is used to signal availability for mating but the behaviour can also be exhibited by neutered animals. Multiple factors including medical problems can trigger the onset and maintenance of urine spraying, and correct identification of these is necessary for treatment to be most successful. EVIDENCE BASE This review draws on information from multiple studies that have been published on the normal aspects of urine spraying in cats, the frequency as reported by owners, the relationship of urine spraying to intercat aggression and various treatment options including behavior modification, pheromone therapy and use of psychoactive medication.
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Abstract
Neuropathic pain represents the extreme in maladaptive pain processing. In itself, it is a disease in which pain has become exaggerated in some combination of scope, severity, character, field, duration, and spontaneity. It is almost certainly an underappreciated, underdiagnosed cause of possible significant patient morbidity in cats. This article explores the basic mechanisms, recognition, known and suspect syndromes, and prospective treatment of feline maladaptive and neuropathic pain.
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Affiliation(s)
- Mark E Epstein
- TotalBond Veterinary Hospital, c/o Forestbrook, 3200 Union Road, Gastonia, NC 28056, USA.
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Abstract
When humans decide to live with another species, certain considerations must be made: the first being that this other species has a repertoire of species-specific and species-normal behaviors, some of which may be annoying or objectionable to the humans. Many cat behaviors are understood but many still are not. Five of the common problem behaviors in cats are house soiling, scratching, climbing and jumping up on things, howling, and hunting. By understanding the normal behaviors of cats, it may be easier to work out compromises so that the human and feline species can live together in harmony.
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Affiliation(s)
- Terry Marie Curtis
- University of Florida College of Veterinary Medicine, Gainesville, FL, USA.
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10
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Denenberg S, Dubé MB. Tools for Managing Feline Problem Behaviours Psychoactive medications. J Feline Med Surg 2019; 20:1034-1045. [PMID: 30375944 DOI: 10.1177/1098612x18806760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PRACTICAL RELEVANCE When a cat is presented for evaluation of a problem behaviour, it is likely that the cat's wellbeing is negatively affected by the condition. In addition, the owners and any other animals around the cat may also be experiencing negative consequences. When managing these cases, it is important to consider all options (including behaviour modification, environmental changes, medications) that can help to reach an optimal solution. Medication cannot teach the cat how to behave or change a particular behaviour; it can, however, reduce arousal, excitability, reactivity and anxiety. RATIONALE The rationale for using psychoactive medications in behavioural medicine, or veterinary psychiatry, is to increase the wellbeing of the animal and to aid the owner and practitioner in managing problem behaviours. Medications should always be used as an adjunct to behavioural and environmental modification. CLINICAL CHALLENGES Many psychoactive medications cannot be used in the face of certain physical illnesses or concurrently with other medications. Some medications may also have side effects, not be effective at the recommended dose or have a paradoxical effect. Furthermore, success is reliant on the owner being able to administer the medication. AIMS This article aims to guide practitioners by discussing questions such as how to choose the appropriate medication, how to dose it and how long to use it. The psychoactive medications most commonly used in feline medicine are reviewed, as well as some that are newer or less common. EVIDENCE BASE Data for the use of medications in cats is limited, with just a small number of clinical-, species- and problem-directed studies available, and a few more case series and case reports. Where feline-specific research is not available, the authors have drawn upon research published in other species, such as humans, dogs and rats, as well as anecdotal reports and expert opinions.
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Affiliation(s)
- Sagi Denenberg
- North Toronto Veterinary Behaviour Specialty Clinic, Toronto, Canada; Langford Vets, University of Bristol, UK.,Division of Animal Welfare, Veterinary Public Health Institute, Vetsuisse Faculty, University of Berne, Switzerland
| | - Maya Bräm Dubé
- North Toronto Veterinary Behaviour Specialty Clinic, Toronto, Canada; Langford Vets, University of Bristol, UK.,Division of Animal Welfare, Veterinary Public Health Institute, Vetsuisse Faculty, University of Berne, Switzerland
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11
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Barnoski J, Lee-Fowler TM, Boothe DM, Behrend EN. Serum theophylline after multiple dosing with transdermal gels in cats. J Feline Med Surg 2019; 21:329-334. [PMID: 29807504 PMCID: PMC10814641 DOI: 10.1177/1098612x18776853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Our objectives were, first, to determine if therapeutic serum theophylline concentrations could be achieved using long-term, once-daily dosing of transdermal theophylline and, secondarily, to evaluate the difference between two transdermal theophylline formulations. METHODS Seven healthy cats, 1-10 years of age, were evaluated in a two-way, randomized, double-blinded, crossover study. Participants received transdermal theophylline at 15 mg/kg for 21 days in either pluronic lecithin organogel (PLO) or Lipoderm formulation. On day 22, blood was collected 2, 6, 14 and 24 h after dosing. After a 14 day washout period, blood was collected to verify non-detectible theophylline concentrations. The alternate formulation was administered for 21 days, and sampling was repeated. Serum theophylline concentrations were determined using an automated immunoassay. Serum concentrations were compared between formulations using a two-way random-measures ANOVA and over time within a formulation using a repeated-measures ANOVA. RESULTS Therapeutic serum theophylline concentrations were achieved for 2/7 cats in each group. Of 56 serum theophylline measurements obtained, only seven (13%) were within the therapeutic range. No significant difference was detected in drug concentrations achieved by the transdermal formulations at any time point. In addition, no significant difference in serum theophylline concentrations was noted between time points for PLO ( P = 0.751) or Lipoderm ( P = 0.107). CONCLUSIONS AND RELEVANCE Once-daily transdermal dosing of theophylline does not reliably achieve therapeutic concentrations. Individual cats may achieve therapeutic concentrations. No significant difference was noted between PLO and Lipoderm formulations. Therefore, transdermal theophylline formulations should not be considered as a first-line therapy in feline asthma patients.
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Affiliation(s)
- Jacob Barnoski
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Tekla M Lee-Fowler
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Dawn M Boothe
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Ellen N Behrend
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
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12
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Poole M, Quimby JM, Hu T, Labelle D, Buhles W. A double-blind, placebo-controlled, randomized study to evaluate the weight gain drug, mirtazapine transdermal ointment, in cats with unintended weight loss. J Vet Pharmacol Ther 2018; 42:179-188. [PMID: 30506924 PMCID: PMC7379659 DOI: 10.1111/jvp.12738] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 01/09/2023]
Abstract
Mirtazapine is classified as a weight gain drug in cats, and the purpose of this study was to evaluate its efficacy in cats experiencing unintended weight loss. This was a multi-center, double-blind, placebo-controlled, randomized clinical study in client-owned cats ≥1 year of age, weighing ≥2 kg, with a documented loss (≥5%) in body weight. Cats were treated once daily with either 2 mg/cat mirtazapine transdermal ointment (n = 83) or placebo (n = 94) (Per Protocol population) applied to the inner surface of the pinna for 14 ± 3 days. Physical examination, body weight, complete blood count, serum chemistry, and urinalysis were performed prior to treatment and on Day 14. Changes in body weight between the mirtazapine and placebo groups were evaluated from Day 1 to Day 14 and compared using a two-sample t test. The mean percent change in body weight was +3.9% (standard deviation ±5.4%) in the mirtazapine group and +0.4% (±3.3%) in the placebo group (p < 0.0001). The most common adverse event was mild erythema at the application site in 17.4% of placebo and 10.4% of mirtazapine-treated cats. Application of mirtazapine transdermal ointment was well tolerated both topically and systemically and resulted in significant weight gain in cats experiencing unintended weight loss associated with various underlying diseases.
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Affiliation(s)
| | - Jessica M Quimby
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio
| | - Tianhua Hu
- Kindred Biosciences, Inc., Burlingame, California
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13
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Krull DP, Thomovsky SA, Chen AV, Mealey KL, Papich MG. Evaluation of Transdermal Administration of Phenobarbital in Healthy Cats. J Am Anim Hosp Assoc 2018; 55:1-7. [PMID: 30427717 DOI: 10.5326/jaaha-ms-6670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose was to determine the safety and achievable serum concentrations of transdermally administered phenobarbital in healthy cats. The hypothesis was that transdermal phenobarbital would achieve therapeutic serum concentrations (15-45 µg/mL) with minimal short-term adverse effects. Enrolled cats had normal physical and neurologic exams and unremarkable bloodwork. Transdermal phenobarbital in a pluronic lecithin organogel-based vehicle was administered at a dosage of 3.0-3.1 mg/kg per ear pinna (total of 6.0-6.2 mg/kg) every 12 hr for 14 days. Serum phenobarbital concentrations were measured 3-6 hr after dosing at seven different times over 15 days. The mean and median serum concentration of phenobarbital at study completion were 5.57 and 4.08 µg/mL, respectively. Mean peak concentration and mean time to peak concentration were 5.94 µg/mL and 13.3 days, respectively. Mild adverse effects were observed. Potency was analyzed in three replicates of the transdermal phenobarbital gel administered; potencies ranged from 62.98 to 82.02%. Transdermal application of phenobarbital in healthy cats achieves a detectable, but subtherapeutic, serum concentration and appears safe in the short term. The use of therapeutic drug monitoring is recommended when this formulation of phenobarbital is used to ensure therapeutic serum concentrations are achieved.
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Affiliation(s)
- Daniel P Krull
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
| | - Stephanie Ann Thomovsky
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
| | - Annie Vivian Chen
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
| | - Katrina L Mealey
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
| | - Mark G Papich
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
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14
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Buhles W, Quimby JM, Labelle D, Williams VS. Single and multiple dose pharmacokinetics of a novel mirtazapine transdermal ointment in cats. J Vet Pharmacol Ther 2018; 41:644-651. [PMID: 30004120 DOI: 10.1111/jvp.12691] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/04/2018] [Indexed: 11/29/2022]
Abstract
Single and multiple dose pharmacokinetics (PK) of mirtazapine transdermal ointment applied to the inner ear pinna of cats were assessed. Study 1 was a randomized, cross-over single dose study (n = 8). Cats were treated once with 0.5 mg/kg of mirtazapine transdermal ointment applied topically to the inner ear pinna (treatment) or administered orally (control) and then crossed over after washout. Plasma was collected predose and at specified intervals over 96 hr following dosing. Study 2 was a multiple dose study (n = 8). Cats were treated daily for 14 days with 0.5 mg/kg of mirtazapine transdermal ointment applied topically to the inner pinna. Plasma was collected on Day 13 predose and at specified intervals over 96 hr following the final dose. In Study 1, single transdermal administration of mirtazapine resulted in mean Tmax = 15.9 hr, Cmax = 21.5 ng/mL, AUC0-24 = 100 ng*hr/mL, AUC0-∞ = 260 ng*hr/mL and calculated half-life = 26.8 hr. Single oral administration of mirtazapine resulted in mean Tmax = 1.1 hr, Cmax = 83.1 ng/mL, AUC0-24 = 377 ng*hr/mL, AUC0-∞ = 434 ng*hr/mL and calculated half-life = 10.1 hr. Mean relative bioavailability (F) of transdermal to oral dosing was 64.9%. In Study 2, daily application of mirtazapine for 14 days resulted in mean Tmax = 2.1 hr, Cmax = 39.6 ng/mL, AUC0-24 = 400 ng*hr/mL, AUC0-∞ = 647 ng*hr/mL and calculated half-life = 20.7 hr. Single and repeat topical doses of a novel mirtazapine transdermal ointment achieve measurable plasma concentrations in cats.
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Affiliation(s)
| | - Jessica M Quimby
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio
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15
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Powers LV, Davidson G. Compounding and Extralabel Use of Drugs in Exotic Animal Medicine. Vet Clin North Am Exot Anim Pract 2018; 21:195-214. [PMID: 29655467 DOI: 10.1016/j.cvex.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Extralabel drug use is the use of a Food and Drug Administration (FDA)-approved drug in a manner different from what is stipulated on the approved label. Compounding is the process of preparing a medication in a manner not indicated on the label to create a formulation specifically tailored to the needs of an individual patient. Extralabel drug use and compounding are vital aspects of safe and effective drug delivery to patients in exotic animal practice. There are few FDA-approved drugs for exotic animal species, and many approved drugs for other species are not available in suitable formulations for use in exotic animals.
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Affiliation(s)
- Lauren V Powers
- Avian and Exotic Pet Service, Carolina Veterinary Specialists, 12117 Statesville Road, Huntersville, NC 28078, USA.
| | - Gigi Davidson
- College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
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16
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Davidson G. Veterinary Compounding: Regulation, Challenges, and Resources. Pharmaceutics 2017; 9:pharmaceutics9010005. [PMID: 28075379 PMCID: PMC5374371 DOI: 10.3390/pharmaceutics9010005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 12/20/2016] [Accepted: 01/04/2017] [Indexed: 11/16/2022] Open
Abstract
The spectrum of therapeutic need in veterinary medicine is large, and the availability of approved drug products for all veterinary species and indications is relatively small. For this reason, extemporaneous preparation, or compounding, of drugs is commonly employed to provide veterinary medical therapies. The scope of veterinary compounding is broad and focused primarily on meeting the therapeutic needs of companion animals and not food-producing animals in order to avoid human exposure to drug residues. As beneficial as compounded medical therapies may be to animal patients, these therapies are not without risks, and serious adverse events may occur from poor quality compounds or excipients that are uniquely toxic when administered to a given species. Other challenges in extemporaneous compounding for animals include significant regulatory variation across the global veterinary community, a relative lack of validated compounding formulas for use in animals, and poor adherence by compounders to established compounding standards. The information presented in this article is intended to provide an overview of the current landscape of compounding for animals; a discussion on associated benefits, risks, and challenges; and resources to aid compounders in preparing animal compounds of the highest possible quality.
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Affiliation(s)
- Gigi Davidson
- Clinical Pharmacy Services, North Carolina State University, College of Veterinary Medicine, Raleigh, NC 27607, USA.
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Visser M, Ragsdale MM, Boothe DM. Pharmacokinetics of Amitriptyline HCl and Its Metabolites in Healthy African Grey Parrots (Psittacus erithacus) and Cockatoos (CacatuaSpecies). J Avian Med Surg 2015; 29:275-81. [DOI: 10.1647/2014-054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chávez G, Pardo P, Ubilla MJ, Marín MP. Effects on behavioural variables of oral versus transdermal buspirone administration in cats displaying urine marking. JOURNAL OF APPLIED ANIMAL RESEARCH 2015. [DOI: 10.1080/09712119.2015.1091335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hill KE, Mills PC, Jones BR, Bolwell CF, Aberdein D, Chambers JP. Percutaneous absorption of methimazole: an in vitro study of the absorption pharmacokinetics for two different vehicles. J Vet Pharmacol Ther 2015; 38:581-9. [PMID: 25683868 DOI: 10.1111/jvp.12213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/19/2015] [Indexed: 11/27/2022]
Abstract
The use of transdermal medications in cats has become popular in veterinary medicine due to the ease of administration compared to oral medication. However, the research to support systemic absorption of drugs applied to the pinna after transdermal administration in cats is limited. The aim of this study was to characterize the percutaneous absorption pharmacokinetics of methimazole in a lipophilic vehicle compared to methimazole in Pluronic(®) lecithin organogel (PLO) using a finite dose applied to feline ear skin in an in vitro Franz cell model. The two formulations of methimazole (10 mg) were applied to the inner stratum corneum of six pairs of feline ears. The receptor medium was sampled up to 30 h post-administration, and methimazole concentrations were measured using high-performance liquid chromatography (HPLC). Histological examination of all ears was undertaken as small differences in the thickness of ear skin may have contributed to inter-individual differences in methimazole absorption between six cats. Methimazole was absorbed more completely across the pinnal skin when administered in the lipophilic vehicle compared to administration in the PLO gel (P < 0.001).
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Affiliation(s)
- K E Hill
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - P C Mills
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
| | - B R Jones
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - C F Bolwell
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - D Aberdein
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - J P Chambers
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
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Pachel CL. Intercat Aggression: Restoring Harmony in the Home. Vet Clin North Am Small Anim Pract 2014; 44:565-79. [DOI: 10.1016/j.cvsm.2014.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hill KE, Gieseg MA, Bridges J, Chambers JP. The pharmacokinetics of methimazole in a novel lipophilic formulation administered transdermally to healthy cats. N Z Vet J 2014; 62:208-13. [DOI: 10.1080/00480169.2013.875990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Miller R, Schick AE, Boothe DM, Lewis TP. Absorption of Transdermal and Oral Cyclosporine in Six Healthy Cats. J Am Anim Hosp Assoc 2014; 50:36-41. [DOI: 10.5326/jaaha-ms-5970] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cyclosporine is commonly used orally to treat feline dermatoses. Due to difficulties administering oral medications, veterinarians sometimes prescribe compounded transdermal cyclosporine, despite studies showing limited absorption. The study objective was to compare cyclosporine blood concentrations after oral administration to concentrations after transdermal application of cyclosporine (prepared in pluronic lecithin organogel [PLO]) in six cats using a controlled, cross-over design with a 2 wk washout period. Cats were dosed at 5.1–7.4 mg/kg of cyclosporine q 24 hr either per os for 7 days or transdermally for 21 days. Cyclosporine blood concentrations were measured q 7 days and after the washout period. A monoclonal-based immunoassay (lower limit of quantitation was 25 ng/mL) was used. Median concentrations on the seventh day were 2,208 ng/mL (range, 1,357–3,419 ng/mL) 2 hr after orally administered cyclosporine and 37 ng/mL (range, 25–290 ng/mL) 2 hr after transdermally applied cyclosporine. Median concentration on day 21 was 58 ng/mL (range, 51–878 ng/mL) 2 hr after transdermally applied cyclosporine. Concentrations were quantifiable for transdermally applied cyclosporine, but considered therapeutic in only one of six cats. Based on those results, transdermally applied cyclosporine was not recommended in cats because of inconsistent absorption.
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Affiliation(s)
- Rose Miller
- Dermatology for Animals, Salt Lake City, UT, (R.M.); Dermatology for Animals, West Juniper, AZ (A.S., T.L.); and Clinical Pharmacology Laboratory (D.B.), College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Anthea E. Schick
- Dermatology for Animals, Salt Lake City, UT, (R.M.); Dermatology for Animals, West Juniper, AZ (A.S., T.L.); and Clinical Pharmacology Laboratory (D.B.), College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Dawn M. Boothe
- Dermatology for Animals, Salt Lake City, UT, (R.M.); Dermatology for Animals, West Juniper, AZ (A.S., T.L.); and Clinical Pharmacology Laboratory (D.B.), College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Thomas P. Lewis
- Dermatology for Animals, Salt Lake City, UT, (R.M.); Dermatology for Animals, West Juniper, AZ (A.S., T.L.); and Clinical Pharmacology Laboratory (D.B.), College of Veterinary Medicine, Auburn University, Auburn, AL
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KuKanich B. Outpatient Oral Analgesics in Dogs and Cats Beyond Nonsteroidal Antiinflammatory Drugs. Vet Clin North Am Small Anim Pract 2013; 43:1109-25. [DOI: 10.1016/j.cvsm.2013.04.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hill K, Gieseg M, Kingsbury D, Lopez-Villalobos N, Bridges J, Chambers P. The Efficacy and Safety of a Novel Lipophilic Formulation of Methimazole for the Once Daily Transdermal Treatment of Cats with Hyperthyroidism. J Vet Intern Med 2011; 25:1357-65. [DOI: 10.1111/j.1939-1676.2011.00799.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/31/2011] [Accepted: 08/12/2011] [Indexed: 11/29/2022] Open
Affiliation(s)
- K.E. Hill
- Institute of Veterinary and Animal Biomedical Sciences; Massey University; Palmerston North; New Zealand
| | - M.A. Gieseg
- Institute of Veterinary and Animal Biomedical Sciences; Massey University; Palmerston North; New Zealand
| | - D. Kingsbury
- Institute of Veterinary and Animal Biomedical Sciences; Massey University; Palmerston North; New Zealand
| | - N. Lopez-Villalobos
- Institute of Veterinary and Animal Biomedical Sciences; Massey University; Palmerston North; New Zealand
| | - J. Bridges
- Institute of Veterinary and Animal Biomedical Sciences; Massey University; Palmerston North; New Zealand
| | - P. Chambers
- Institute of Veterinary and Animal Biomedical Sciences; Massey University; Palmerston North; New Zealand
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Abstract
PRACTICAL RELEVANCE Long-term pain in cats is an important welfare issue but is often overlooked and undertreated. AUDIENCE All practitioners are faced with cats that require analgesic intervention to improve their quality of life. PATIENT GROUP Any cat may potentially experience long-term pain and discomfort. Degenerative joint disease and diabetic-related pain is more common in middle-aged or older individuals, whereas persistent postsurgical pain can occur at any age and is seen in young cats following onychectomy. EVIDENCE BASE Robust evidence on long-term pain issues in cats - specifically, relating to prevalence, etiology, and treatment protocols and outcomes - is missing from the veterinary literature. The aim of this review is to summarise the current state of knowledge. In doing so, it takes a practical approach, highlighting the obvious, and some not so obvious, causes of long-term pain in cats; some aspects that warrant closer attention; our ability to recognize pain and monitor how this impacts on quality of life; and today's treatment options.
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Grubb T. What Do We Really Know About the Drugs We Use to Treat Chronic Pain? Top Companion Anim Med 2010; 25:10-9. [DOI: 10.1053/j.tcam.2009.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 10/05/2009] [Indexed: 11/11/2022]
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Morales ME, Clarés B, López-Viota M, Ruiz MA. Preparation, characterization, and in vitro release of new transdermal methimazole as alternative to oral delivery. Drug Deliv 2009; 16:1-10. [DOI: 10.1080/10717540802035376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Helms SR. Treatment of Feline Hypertension With Transdermal Amlodipine: A Pilot Study. J Am Anim Hosp Assoc 2007; 43:149-56. [PMID: 17473021 DOI: 10.5326/0430149] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This prospective study evaluated transdermal amlodipine for the control of hypertension in six cats. Cats were treated with oral amlodipine until blood pressures decreased to <180 mm Hg. They were maintained on this dose for 7 days and then administered identical doses of transdermal amlodipine for 7 days. Oral amlodipine decreased pressure by a median of 73 mm Hg, which subsequently increased by 20 mm Hg after 7 days of transdermal amlodipine. Plasma concentrations of amlodipine were measured after oral and transdermal dosing. Additional studies are needed to determine dosing, pharmacokinetics, and efficacy.
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Boothe DM. Veterinary Compounding in Small Animals: A Clinical Pharmacologist's Perspective. Vet Clin North Am Small Anim Pract 2006; 36:1129-73, viii. [PMID: 16984830 DOI: 10.1016/j.cvsm.2006.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The advent and growth of veterinary compounding and the increasing role of the pharmacist in drug dispensing, including compounding, should be embraced by the veterinary profession. For selected patients, extemporaneous compounding of prescriptions is necessary and beneficial for optimal treatment. By its nature, however, compounding is individualized and fraught with risks of failure. Pet owners should be informed of the risks associated with using a compounded product and consent to therapy based on disclosure that the use of the product may be scientifically unproven. As the pharmacy profession increases its efforts to define and ensure its role in veterinary medicine, and as the regulatory agencies consider changes in the regulations that increase the flexibility of animal drug compounding, the veterinary profession must implement actions that protect the patient and the public. It is indeed the responsibility of the veterinarian to ensure the safety and therapy of any prescribed therapeutic intervention, and failure to do otherwise places the patient and pet owner as well as the veterinarian at risk.
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Affiliation(s)
- Dawn Merton Boothe
- Department of Anatomy, Physiology, and Pharmacology, 109 Greene Hall, College of Veterinary Medicine, Auburn University, AL 36849, USA.
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31
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Karriker M, Wiebe V. Pharmacists in veterinary education: bridging the gap. JOURNAL OF VETERINARY MEDICAL EDUCATION 2006; 33:248-52. [PMID: 16849306 DOI: 10.3138/jvme.33.2.248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Veterinary patients stand to benefit greatly from the collaboration of pharmacy and veterinary medicine, and there are many ways pharmacy and veterinary medicine can work in concert. The best efforts to revise and remodel veterinary and pharmacy education to fit an evolving world of clinical practice are grounded in an understanding of each profession. Veterinary education should impart to its students and residents the skills necessary to critically evaluate drug therapy, select therapies based on facts from drug information sources, and operate a veterinary practice that abides by the legal, regulatory, and operational requirements necessary to maintain and dispense drugs. The academic training environment of each profession must include information on the other, in order to better prepare professionals for a realistic practice environment. When armed with an understanding of what pharmacists can provide their patients, veterinarians can demand these skills where appropriate. With the ultimate goal of producing an optimal learning environment, veterinary curricula should allow both pharmacy and veterinary medicine to work together to build a path to quality patient care and educational superiority.
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Affiliation(s)
- Margo Karriker
- Clinical Pharmacy Coordinator, Department of Pharmacy, University of California, Davis, CA 95616, USA.
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