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How to Approach a Veterinary Prescription: Student Summary

  • Client name and contact information on the label
    • DOB may need to be recorded for controlled substances
  • Patient information needed:
    • species, breed, DOB, weight, gender
  • Veterinarians are not legally eligible for a National Provider Identifier (NPI) number
    • DEA numbers should only be requested for controlled substances
    • State medical board license number sufficient to verify authenticity
  • Veterinarian-client-patient relationship (VCPR) must be established

  • Species and breed
  • Age
    • Geriatric patient?
      • Canines: small breeds 10-14 yo, large breeds 8-10 yo
  • Pregnancy
    • Gestational periods differ between species
      • Dogs: 58-68 days
      • Cats: 58-67 days
      • Horses: 11-12 months
  • Job?
    • Pet / companion animal?
    • Food producing animal?
      • No true definition; may vary depending on geographic location
      • In the US, generally includes cattle, swine, chickens, fish and honey bees
      • Must follow rules and regulations of drugs prohibited for extra-label use in this group
      • Withdrawal time must be listed on the prescription (e.g. use of meat, eggs, milk, honey)
        • FARAD (excellent resource to help calculate withdrawal time)
      • Food animal, but job is strictly companion animal?
        • Highly recommend informed consent to keep animal out of food supply chain; consult with veterinarian
    • Performance animal?
      • Racing regulations: horses, greyhounds…
        • Follow Association of Racing Commissioners International (ARCI) guidelines
      • Will drugs affect performance?
      • Will drug affect safety of animal? Of handler/rider?
    • Service animal?
      • Will drug inhibit patient’s ability to perform duties? (e.g. sedatives)
    • Drug detection animal?
      • Watch potential adverse effects for olfactory system and/or auditory abilities

  • Drug appropriate for this species? For this disease state?
  • Dosing usually based on body weight
  • Route of Administration
    • Appropriate for this patient? For this client?
    • Elderly clients may have dexterity issues or trouble seeing increments on syringe
    • Transdermal and topical products – consider cats’ grooming behavior
    • Horizontal orientation of many species – some medications (e.g. doxycycline) might cause erosion if they become lodged in the esophagus
  • Frequency
    • BID or TID dosing possible for client?
  • Duration
    • Remind clients about the importance of adherence
    • Remember antimicrobial stewardship principles
  • Dosing volume
    • < 1mL ideal for most small animals
    • up to 3 mL may be acceptable for larger breed canines
    • 0.1 mL ideal for avian or exotic pets
  • Interactions (often need non human-based drug information database)
    • human focused drug interaction checkers may not take veterinary-only products into consideration
    • always ask about food and OTC supplementation
  • Lifestyle considerations
    • Indoor or outdoor?
    • Outdoor – overheating risks, sun exposure
    • Indoor – sun exposure from sleeping in window seal
  • Patient inappetent?
    • Do not mix medication with food unless all will be consumed
    • Avoid NSAIDs
  • Client lifestyle
    • Frequent traveler? Consider medication storage conditions
  • Flavoring
    • Cats lack taste receptors for sweet flavorings, so organ and meat flavors preferred
    • When in doubt, go with marshmallow (excellent bitterness suppressor)
    • Caution to not cause food aversion! If animal will only eat one type of food, consider avoiding that flavoring

  • Drug selection
    • commercial product may contain inappropriate flavoring (e.g. grape, chocolate)
    • commercial product may contain toxic ingredients (toxic dye, alcohol, xylitol)
    • DailyMed is an excellent resource for checking ingredients
  • Therapeutic failures
    • Important to understand bioavailability of drug in the species being treated
      • e.g. bulk powder itraconazole – failure in many mammalian species
    • Gastrointestinal pH difference between species – some formulations may cause drug to be released too early, or not at all
  • Tolerability of ingredients – e.g. lactose
  • Combination products – e.g. acetaminophen is toxic to feline patients
  • Lack of evidence to support compounded formulation
  • Administration barriers – client limitations, packaging
  • Ensure adequate counseling is provided!