dvm - January 2013 - (Page 8)
NEWS | Associations
Oregon veterinarians tally retail pharmacists’ mistakes
Survey reveals that changes to dosages, products have harmed pets. By Kristi Reimer
he Oregon Veterinary Medical Association (OVMA) recently conducted a survey to determine how often mistakes are occurring when retail pharmacies ﬁll veterinary prescriptions. Te results indicate that these errors are not isolated incidents—in fact, they’ve been observed by more than a third of veterinarians in the state. In the October 2012 issue of Viewpoint, the OVMA’s quarterly newsletter, the organization reports that 35 percent of respondents have had a retail or online pharmacy change a prescribed dosage or medication without their authorization, and 17 percent have had patients experience adverse events as a result.
Te OVMA also asked for examples of cases in which patient health suﬀered because of a retail or online pharmacist’s error. Here are some areas where Oregon veterinarians are seeing problems: • Insulin substitutions. Many respondents say a retail pharmacist substituted one insulin product for another to save the client money, believing the products were interchangeable, the OVMA says. As a result, one patient experienced diabetic ketoacidosis and others received subtherapeutic treatment until a veterinarian discovered the problem.
• Thyroid drug dosage changes. Retail pharmacists also
(hydrocodone bitartrate and homatropine) as a cough suppressant for a patient with a collapsed trachea. Te pharmacy did not carry the product and substituted hydrocodone with acetominophen. “Fortunately the prescription was for a dog and not a cat,” the OVMA says. “High dosages can cause irreversible liver damage [in dogs]. Tere
retail pharmacist gave the client “signiﬁcantly incorrect” dilution instructions. Te patient relapsed and was euthanized. • Incorrect dosages. At his client’s request, a veterinarian called in a prescription to a local pharmacy. Te pharmacist ﬁlled the prescription at 10 times the correct dose. While the patient was receiving this dosage, other
of Oregon veterinarians have had a retail pharmacist change a prescription without their authorization.
are no safe dosages for cats.” In a separate case, a client asked a pharmacist what she could do to relieve her dog’s arthritis pain, and the pharmacist recommended high doses of Tylenol.
• Propylene glycol misinformation. A veterinarian
sometimes lower thyroid medication dosages for pets without consulting the veterinarian. “Evidently, the retail pharmacists are equating an animal’s ability to absorb and metabolize the medication in the same manner as a human,” the report states.
• Phenobarbital dosage changes. One veterinarian
medical and behavioral problems emerged. Te veterinarian tested the patient extensively to uncover the problem, and the client had to pay signiﬁcant fees as a result.
• Disregard for veterinarians’ instruction. Respondents
diagnosed epilepsy in an older dog and prescribed 15 mg of phenobarbital twice daily. Te dispensing pharmacist told the client the dosage was too high and advised her to cut it in half. Te dog continued to have seizures for several weeks until the veterinarian discovered the problem on recheck. Te dog was euthanized.
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• Ringworm treatment substitutions. Another veteri-
to ﬁnd out what the FDA says you can do to minimize mistakes with portable prescriptions .
narian prescribed itraconazole to treat ringworm in a cat. Te retail pharmacy did not carry the medication, so it dispensed a compounded product that’s “unreliable and poorly absorbed in cats,” the report says. Te treatment was unsuccessful.
• Acetominophen unawareness. One practitioner
prescribed propylene glycol for a Labrador retriever with a hyperkeratotic nose problem. Te dog’s owner refused to have the prescription ﬁlled when the retail pharmacist told her that the veterinarian had prescribed antifreeze (ethylene glycol), which would kill the dog. Te veterinarian discovered this when she called the client for a progress report. • Wrong drug dispensed. A dog with autoimmune disease was to be treated with the chemotherapy drug azathioprene. Instead, the retail pharmacist dispensed azithromycin. Te patient relapsed and had to be euthanized.
• Incorrect client instructions. A veterinarian who
indicated that many retail pharmacists changed dosages or medications even when the prescription read, “No substitution.”
• Inappropriate client counseling. Many practices have had
prescribed Hycodan tablets
diagnosed atypical mycobacterium in a cat prescribed a liquid antibiotic for the client to have ﬁlled at a nearby pharmacy. Te
clients frightened out of having prescriptions ﬁlled after pharmacists have explained a particular drug’s human side eﬀects, even though the noted side eﬀects do not occur in animal patients. OVMA Executive Director Glenn Kolb says other state veterinary medical associations have conducted similar research or are considering it. “We want to make sure that if pharmacists have any questions, they contact the veterinarian,” Kolb says. “When a pharmacist counsels clients or makes changes to a prescription beyond the scope of their expertise, they’re in violation of their state practice act.”
8 | January 2013 |
Table of Contents for the Digital Edition of dvm - January 2013
dvm - January 2013
Where did I go wrong?
Pets and Vets
CATalyst survey examines how veterinarians really feel about animal shelters and pet rescue organizations.
What’s new? What’s now?
Employee steals more than $400,000 from clinic
Longtime veterinarian killed in plane crash in California
Canadian SPCA concerned by number of “home neutering” reports
Arrest made in Minnesota veterinary hospital arson
Washington DVM accused of abusing patients, medications
When faced with disaster, practices need a plan
University of Minnesota celebrates 750,000th urolith
Death to debt
Letter of the law
dvm - January 2013