PVMA Keystone Veterinarian Summer 2020 - 20

PHARMACY HEADACHES PART 3

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Error 4: Owner advised of incorrect side effect
profile
Pharmacists are required to provide information on side effects
to patients; however, side effect profiles can differ between
human and animal patients. The OVMA study documented
numerous cases where clients chose not to fill or administer a
prescribed medication after being advised of severe potential
side effects applicable to human but not animal patients.1,2 In
other cases, the veterinarian may receive a call from a client
who is upset that they were not informed of the potential side
effects before the medication was prescribed.
Prevention of Error:
* Provide clients with information on side effects applicable
to animals prior to them leaving the office.
* Consider donating an old copy of your favorite animal drug
reference to area pharmacies as many do not have access
to an animal formulary.

Error 5: Inappropriate recommendation of OTC
medications
Pharmacists can legally recommend OTC medications to human
patients for their labeled uses. Because the use of human OTC
medications in animals is extra-label drug use, pharmacists
should not make recommendations, though this does happen.
Recommendation of an OTC NSAID or acetaminophen for an
animal is one of the largest concerns, but other OTC products
have the potential to be toxic or contain toxic ingredients.
Prevention of Error:
* Educate clients on the use of OTC medications and train
them to call your office before administering any
medication to their pet.
* Encourage pharmacists to refer client questions regarding
use of OTC medications in their pets to their veterinarian.

Error 6: Medications dispensed containing toxic
ingredients for pets
A recent study of North Carolina pharmacists showed a
concerning lack of awareness of potential pet toxins, with only
60% of substances questioned identified correctly as toxic or
nontoxic.5 Two common pet toxins which are common in human
medications are xylitol and acetaminophen. Many pharmacists
are not aware of the toxicity of xylitol, and while many are aware
of potential acetaminophen toxicity, they are often not familiar
with species-specific differences.5

Prevention of Error:
* Provide an information sheet to local pharmacists regarding
common pet toxins.
* When writing a script for an oral suspension or ODT tablets,
specify "must not contain xylitol" on your script.

What to do when an error occurs
In cases where an error occurs, contact the pharmacy to advise
them of the problem. If the pharmacy staff is not aware there
was an issue, they cannot prevent a repeat of the same error in
the future. Additionally, errors should be reported to the AVMA
and the state pharmacy board.

Conclusion
Ultimately, prevention of errors comes down to clear
communication with pharmacists and clients. While it may seem
time-consuming to have these conversations, the reduction
of errors leading to patient compromise, upset clients and a
frustrated veterinary team is invaluable. Leverage your support
staff to provide client education during your office visits and
make use of written discharge instructions.
We encourage you to take time to build a relationship with
local pharmacists and establish yourself as an expert. We are
all professionals who want the best possible outcome for our
patients and can learn from each other. The time you spend now
reaching out to pharmacies will ultimately save the time you
would have spent correcting errors in the future.
This concludes our series on pharmacy headaches, but our
experts are still available to answer questions submitted through
our online form, available at bit.ly/pharm-headaches.
References
1. Kolb G. Veterinary Prescriptions & Retail Pharmacies Summary
of Membership Survey. Available at: https://www.ftc.gov/sites/
default/files/documents/public_comments/request-comments-andannouncement-workshop-pet-medications-issues-project-no.p121201560891-00569/560891-00569-84588.pdf. First accessed Aug 22, 2018.
2. Fender KR. Oregon veterinarians tally retail pharmacists' mistakes.
Available at: https://www.dvm360.com/view/oregon-veterinarians-tallyretail-pharmacists-mistakes. First accessed Aug 22, 2018.
3. Unpublished data from PA pharmacy survey conducted by Dr. Brian
Langlois, Immediate Past-President of PVMA.
4. Frankel G, Kusno A & Louizos C. Five things every community
pharmacist should know when dispensing for 4-legged patients. Can
Pharm J 2016;149(2):99-106.
5. Young NW, Royal KD & Davidson GS. Baseline knowledge of potential
pet toxins: a survey of pharmacists. Pharmacy Practice 2017;15(4):1058.

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PVMA Keystone Veterinarian Summer 2020

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