Verifying Aniamal Rx without a database

[DanRPh42]

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Verifying Animal Rx Without a Database?

It was not that many months ago I remember hearing a pharmacy got in trouble for not providng pet dosing databases for pharmacists. The Board (if I remember rightly) concluded that a pharmacist cannot legally verify pet meidcations without a reference database available at the time of verification. A google search for this topic was unhelpful, I kept ending up at the NABP Vet-VIPPS page.

If anybody knows anything about this news or laws please reply, I would greatly appreicate it. I am afraid of putting my license on the line by verifying animal meds I cannot verify a dose for (the company I work for does not provide a pet-dosing database). Thanks in advance!

 

[ravingrabbid]

Haven't heard of that. I've verified pet meds in retail before. I usually do a quick search here if I'm not entirely sure e.g., dose of aspirin for dogs:
http://www.accessdata.fda.gov/scripts/animaldrugsatfda/index.cfm?gb=1&showtype=adv

You can always call the vet if you're not sure

 

[zelman]

I've heard that in MA you don't technically need to be an RPh to dispense medications to animals, so I don't know how much liability there could be. Also, killing a veterinary patient is "destruction of property" not "manslaughter" so it's a much lower stakes endeavor.

 

[DanRPh42]

Also, killing a veterinary patient is "destruction of property" not "manslaughter" so it's a much lower stakes endeavor.

I find your lack of empathy disturbing. The death of a family pet can be a devastating blow to the mental health of all huamns involved. I would not like to be responsible for that much pain and suffering.

To be honest I'm more interested in the legality of this case.

 

[pharmd201389]

What are you talking about? Why would you be "responsible"?The vet would be liable. No one is going to attack you for verifying a script for a DOG that the VET clearly wrote.

 

[zelman]

I find your lack of empathy disturbing. The death of a family pet can be a devastating blow to the mental health of all huamns involved. I would not like to be responsible for that much pain and suffering.

To be honest I'm more interested in the legality of this case.

I was responding to the legality. I have pets and love them more than my patients. The fact that it's destruction of property is a sad fact of the legal system, not my opinion.

 

[Scotttyd]

What are you talking about? Why would you be "responsible"?The vet would be liable. No one is going to attack you for verifying a script for a DOG that the VET clearly wrote.

just in the same way you cannot get in trouble if you verify a med for a person that a doctor clearly wrote?

yes - you would be liable, although like was said earlier, the consequences are much less (and before you attach me - I am an animal lover - just stating what is seen in the eyes of the law)

Remember that case in florida where a decimal point error on selenium killed a bunch of expensive polo horses? I am guessing that cost that pharmacy a bunch of $$$$$.

 

[pharmd201389]

just in the same way you cannot get in trouble if you verify a med for a person that a doctor clearly wrote?

yes - you would be liable, although like was said earlier, the consequences are much less (and before you attach me - I am an animal lover - just stating what is seen in the eyes of the law)

Remember that case in florida where a decimal point error on selenium killed a bunch of expensive polo horses? I am guessing that cost that pharmacy a bunch of $$$$$.

You're comparing a DOG to a human?

You didn't go to veterinary school. You want to pharmacy school for HUMAN BEINGS. Give me a break. You won't get in trouble, I'll guarantee it. Keeping a freaking dog drug reference book is asinine. What is wrong with some of you people? You're turning our profession into more of a joke than it already is.

Instead of running away from liability, you guys automatically assume it.

 

[Scotttyd]

You're comparing a DOG to a human?

You didn't go to veterinary school. You want to pharmacy school for HUMAN BEINGS. Give me a break. You won't get in trouble, I'll guarantee it. Keeping a freaking dog drug reference book is asinine. What is wrong with some of you people? You're turning our profession into more of a joke than it already is.

Instead of running away from liability, you guys automatically assume it.

you are not listening to me - I am not saying I agree with it - but if you make a mistake or fill a rx for any living being - you are responsible for making sure it is correct. We have a vet school with a veterinary trained rph (who was UNC preceptor of the year in her district)- you go to UNMC and I have heard that you are required to do a rotation in animal medicine. Like I said, you might not get in big trouble, but if you kill a prize show dog worth $1000 - get ready to pay for it.

 

[owlegrad]

There is only one standard of practice for pharmacy, it doesn't matter if it is animals or human.

 

[zelman]

There is only one standard of practice for pharmacy, it doesn't matter if it is animals or human.

So, if you get a prescription for a wombat, you would get an Australian veterinary manual before filling it? The expectation that a pharmacist know the biological pathways of every species on the planet is unreasonable. If someone's naked mole rat is having issues with nausea, emend will not work. They do not possess the neurotransmitter "substance p". THERE IS NO REASON FOR A PHARMACIST TO KNOW THAT.

 

[owlegrad]

So, if you get a prescription for a wombat, you would get an Australian veterinary manual before filling it? The expectation that a pharmacist know the biological pathways of every species on the planet is unreasonable. If someone's naked mole rat is having issues with nausea, emend will not work. They do not possess the neurotransmitter "substance p". THERE IS NO REASON FOR A PHARMACIST TO KNOW THAT.

Your post confuses me. All I am saying is this apparent belief of some pharmacists that they have no legal or moral obligation to a nonhuman patient is false. There is one standard of practice for pharmacists. There is no "it doesn't matter, it is for a pet" defense.

 

[zelman]

Your post confuses me. All I am saying is this apparent belief of some pharmacists that they have no legal or moral obligation to a nonhuman patient is false. There is one standard of practice for pharmacists. There is no "it doesn't matter, it is for a pet" defense.

I believe that pharmacists should understand the mechanism of action for the drugs they dispense as well as the role of that mechanism in the biology of a human. Expecting an equivalent knowledge level for completely different biologies is lunacy. You might as well expect me to know how adding atenolol to a watering can will effect the growth rate of tulips. In a perfect world, every drug would be dispensed by only the author of a phase 3 study that led to its approval, but we must consider "reality" in addition to an idealized "standard of practice".

 

[BidingMyTime]

A pharmacist who doesn't fill a prescription correctly, will be liable for that. As mentioned above, with animals, the liability is limited to "destruction of property", unlike with humans. I don't think any state expects a pharmacist to know all about the safety & dosing of every drug in every species. I guess it depends on your area, but the pet prescriptions I've seen are rare & pretty much the same--amoxicillin, alprazolam, phenobarbital, very rarely maybe a Benadryl or Prozac.....I can't think of any other pet prescriptions I've seen. It's not to hard to do a little research and make a quick reference on what the vets in your area prescribe. I can only see an actual pet reference being necessary if a pharmacy is advertising or catering to a large pet population.

 

[owlegrad]

I believe that pharmacists should understand the mechanism of action for the drugs they dispense as well as the role of that mechanism in the biology of a human. Expecting an equivalent knowledge level for completely different biologies is lunacy. You might as well expect me to know how adding atenolol to a watering can will effect the growth rate of tulips. In a perfect world, every drug would be dispensed by only the author of a phase 3 study that led to its approval, but we must consider "reality" in addition to an idealized "standard of practice".

Good straw man argument. 👍

I really am not suggesting that at all. All I am saying is, would you check a prescription for a human without having any idea what the appropriate dose is? Why would that be ok for a pet? IMO, it isn't. I am not suggesting you need to know as much about the biology of a K9 that you do of a human or that you be the author of the phase 3 study that led to its approval. But blindly trusting the vet with the idea that you have no liability is completely false. Don't believe me? Look what happened to the pharmacist that killed those horses. Surprisingly the BOP didn't say "it was just property, no harm done". 😉

 

[All4MyDaughter]

I agree that the legal standard is the same and the liability is there. Use common sense. Consult with the vet if you are unsure of the RX.

 

[woosiecg]

I live in Oregon and am a pharmacy student as well as a Certified Veterinary Technician so this is an area that I have done some research into. In the state of Oregon, it is the position of the Board of Pharmacy that any prescription that comes into the pharmacy regardless of species is required to undergo a complete DUR. This can be done multiple ways: 1) have a drug reference (Plumb is the primary veterinary reference most vets use); 2) call the vet and ask them to send a copy of the information they are using to establish dose (make sure you have a wt, breed, and species); 3) Use the Merck Veterinary Manual online. Just because it is an animal does not mean we do not need to do our due diligence and make sure that dosages appear appropriate based on standard dosing references. If we have a concern because the dose is out of those ranges we should do what we would for a human, call the provider and ask to better understand their rationale for their decision. Also, many of those references have practical information for talking to a patient about the meds so if you are unfamiliar the SE in animals (not always the same as people) then you can utilize the resources to help you with consultations (also required in our state). Hope this is helpful!

 

[xiphoid2010]

Wow, talking about a first world problem. I love my parents' dog which I grew up with, but logically a dog isn't a person or a priority when we got people to worry about... Only in america would this even go to court.

 

[zelman]

Good straw man argument. 👍

I really am not suggesting that at all. All I am saying is, would you check a prescription for a human without having any idea what the appropriate dose is? Why would that be ok for a pet? IMO, it isn't. I am not suggesting you need to know as much about the biology of a K9 that you do of a human or that you be the author of the phase 3 study that led to its approval. But blindly trusting the vet with the idea that you have no liability is completely false. Don't believe me? Look what happened to the pharmacist that killed those horses. Surprisingly the BOP didn't say "it was just property, no harm done". 😉

So, if I have a list of appropriate dosing regimens for medications for humans and zero other knowledge, would it be okay for me to verify prescriptions for humans?

 

[BidingMyTime]

Good straw man argument. 👍
Don't believe me? Look what happened to the pharmacist that killed those horses. Surprisingly the BOP didn't say "it was just property, no harm done". 😉

The problem there was that the pharmacist MISFILLED the prescription the vet had ordered...everyone agrees that pharmacist has a legal duty to fill a prescription as ordered by the doctor (they can refuse to fill it, they can contact the prescriber to change the order, but they can't just change the order on their own, unless they are operating under a protocol order.) The pharmacist didn't get it trouble for not knowing correct dosing in horses, the pharmacist got in trouble for making a math error and overdosing the horses in comparison to what the doctor had ordered.

 

[Scotttyd]

The problem there was that the pharmacist MISFILLED the prescription the vet had ordered...everyone agrees that pharmacist has a legal duty to fill a prescription as ordered by the doctor (they can refuse to fill it, they can contact the prescriber to change the order, but they can't just change the order on their own, unless they are operating under a protocol order.) The pharmacist didn't get it trouble for not knowing correct dosing in horses, the pharmacist got in trouble for making a math error and overdosing the horses in comparison to what the doctor had ordered.

If I remember correctly, the pharmacist did not missfill it - the vet wrote for a 10 fold overdose of selenium (decimal point error) - which a typical rph probably wouldn't catch - I have filled rx's for a horse for 10 plaquneil a day and also gave my horse 2400mg ranitidine bid - would any of us know if that is anywhere close to correct on a big animal? I wouldn't - but I work at a hospital now and the closest thing I get to a horse is a 500lb patient human

 

[pezdispenser]

This was the case in 2009 involving Franck's Compounding Pharmacy in which 21 polo horses died. You can look up their license on the Florida Pharmacy Board website and read the disciplinary case.

It seems the vet asked the pharmacy to compound a product called "Biodyl" because it is not available in the US. It was supposed to contain 100 mg selenium, but they compounded it with 10 grams. Obviously they made a misfill, but the charge seems to indicate that the pharmacy had some responsibility to review the appropriateness of the dose as well. Additional charges were also made relating to selling a compounded drug to the vet, who is not the end consumer, without having a wholesale distributor permit.

In the end, I think they were fined about $15,000 altogether and shut down, at least under the "Franck's Compounding Pharmacy" name.