Building Relationships with Veterinarians - Amazon S3 · Building Relationships with Veterinarians...

Veterinary

Kevin Oberlander, RPhDeborah Clark, RPhChris Simmons, RPhInternational Seminar

Houston, TXNovember 10‐12, 2016

© 2016. All Rights Reserved. 1

Building Relationships with Veterinarians

Kevin Oberlander, RPh


Understand Companion Animal Owner Compassion

• Are you a pet owner?• Is someone on your staff a pet owner?• Understand $$$$ invested in pets• Sympathetic to loss of companion animals


Become Part of the Companion Animal Community

• Volunteer:– Humane Society– Local zoo– Rescue projects

• Support:– Vet auxiliary schools– Techs– Vet and Pre‐Vet schools


Building Relationships / Trust

• “Do you know your compounder?”• Do you know your veterinarians and their staff?• Do not compete with veterinarians• Offer pharmacy services to veterinarian clinical staff

– Small discounts– Health and wellness services / immunizations

• Be consistent with message and timely with clinic visits• Attend and sponsor state association meetings

– Sponsor / advertise in membership directory


Marketing Ideas

• Video conferencing• Offer to be part of the care team• Social Media

– Facebook– Twitter– YouTube– Instagram


Additional Relationships

• Animal / pet supply stores• Humane Societies• Animal shelters• Animal rescue• Groomers• Rx customers ‐make it known that you compound for animals / pets


Rescued Animals


Patients


Questions?


Veterinary Formulation Challenges:Common Questions to PCD

Deborah H. Clark, RPh


DisclosureDeborah Clark, RPh, and Chris Simmons, RPh, Vice President of Creative Development, are employed by PCCA. Conflict of interest was resolved through peer review of slide content.

Professional Education Services Group staff have no financial interest or relationships to disclose.


Disclosure

This continuing education activity is managed and accredited by Professional Education Services Group. Neither PESG nor any accrediting organization supports or endorses any product or service mentioned in this activity.


Educational Grant Support

This continuing education activity is supported by an educational grant from PCCA.


Learning Objectives

• At the conclusion of this activity, the participant will be able to:– Discuss innovative compounding techniques, formulations, and animal patient case studies.

– Discuss the latest treatment modalities and unique compounded options gleaned from member calls to PCD.

– Describe different dermatological conditions affecting cats and dogs.


Appropriate Use of Oil Vehicles


Number 1 Vet Question in PCD

Would I be able to put _________ in a fixed oil suspension?


Species Where Oral Use Oil Vehicles are Appropriate

• Dogs • Cats• Ferrets• Turtles• Lizards (species specific)


Species Where Oral Administration of Oils is NOT Recommended

• Birds• Rabbits• Gerbils• Guinea pigs• Chinchillas• Horses


Oil Vehicles in Avian Patients

“How can we best compound an oral prednisolone suspension for a bird? Is fixed oil ok to use as a base? We don’t have many birds for patients, so

I’m a little unfamiliar.”


Oil Vehicles in Avian Patients • Usually, aqueous‐based vehicles are preferred for

avian patients due to the risk of aspiration• Oil is not an absolute contraindication, there are

exceptions• Oil can be used in instances where aqueous is not appropriate (i.e.

stability issues) as long as the owner / handler of the bird has a good relationship with the bird and comfort level to be able to safely administer the oil

• There has been success in these patients with oil vehicles. Risk / benefit needs to be assessed in each case. Sometimes oil is a better option than not doing anything.


Potassium Bromide in Oil

• Clumps very easily• Not recommended• Aqueous formulas or treats much better option


Buprenorphine in Oil for Cats

“ Can we put buprenorphine in a fixed oil for a cat or will it affect absorption?”


Omeprazole in Oil

“I see we have multiple formulas for omeprazole in aqueous base. Is there any problem putting it into almond oil? Do I need to worry about pH as we do with an aqueous formula?”


Combination Products


Stability of Ranitidine and Omeprazole in Combination Product

“I received a question regarding the stability of a final compounded product if omeprazole and ranitidine are combined together. The person had heard that, when combined, the ranitidine causes the omeprazole to quickly degrade. Do you have any references about their stability together?”


Absorption / Bioavailability Issues


Transdermal Cautions

• Antibiotics• Thyroid or narrow therapeutic index drugs• Does not work on reptiles


Absorption of Compounded Itraconazole

“There is a great deal of concern in the veterinary community about the absorption of compounded

itraconazole in cats. Just curious if the formula is being altered to allow for better stability and absorption for

felines.”


Absorption of Compounded Itraconazole

• There have been several treatment failures due to improperly compounded itraconazole suspension formulas

• Inappropriate dosing also leads to treatment failures• The commercial products have agents added to them to enhance

bioavailability ‐ starting with a commercial product and then switching to a compounded option usually results in a treatment failure because of the difference in bioavailability in the products

HOWEVER …


Different Results…• Several veterinary compounding colleagues have reported

treatment success initiating therapy with itraconazole in a fixed oil suspension

• It has been shown that the lipids in fatty meals may enhance solubilization of insoluble drugs₁

• Dosing must be done using capsule dosing recommendations per Plumb’s Veterinary Drug Handbook

1. Hong JY, Kim J, Song YK, et al. A new self-emulsifying formulation of itraconazole with improved dissolution and oral absorption. J Controlled Release, volume 110 (2006); 332-338.


Another Option• Itraconazole in a self‐emulsifying drug delivery system (SEDDS)• SEDDS is a mixture of an appropriate oil, surfactant, and sometimes

cosurfactants that form an emulsion under conditions similar to what we see in the GI tract

• In Hong’s study, tocopherol acetate, poloxamer L64, and diethylene monoethyl ether were used due to their maximum solubility of itraconazole compared to other agents. Hydrochloric acid was also added to increase solubility.

• The plasma concentration of the itraconazole in SEDDS was found to be higher when compared to the capsule dosage form

• This may be a good option for veterinary patients


Theophylline / Aminophylline

• To SR or to not SR? That is the question• GI transit times can be a factor• Suspensions?• Using aminophylline in place of theophylline

• Transdermal ‐ yes or no??


Cyclosporine

“We received a prescription for Cyclosporine 65mg capsules to be compounded for a dog. In looking at the formulas, all are oil‐filled capsules. Can we make these as powder‐filled capsules?

“Can we make cyclosporine in a fixed oil suspension?”


Sucrose Octaacetate

“I am using polyox with diphenhydramine 2% and the dog is able to reach the sore with his mouth, so he is licking and chewing it. Is there an ingredient that I can add to make it more bitter or will they just have to use a cone?”


Office Use ‐ Vet• Currently, DQSA (503A) does not apply to veterinary medicine

• Office use compounding is still legal in the veterinary world, as long as state law says it is legal

• Do not compound for dispensing by the veterinarian


Thank you!

Questions?


Dermanimal

Chris Simmons, RPhVP Creative Development


Epidermis Composition

• Keratinocytes • Melanocytes• Langerhans cells• Merkel cells


Hair Follicles

• Simple hair is a single hair = horses / cattle• Compound hair = dogs, cats, sheep, and goats• Follicles have a central hair surrounded by 3‐15 smaller secondary hairs per pore

• Born with simple and develop into compound


Base Selection


Pyotraumatic Dermatitis

• Bacterial skin infection secondary to trauma• Pruritus, erythema, alopecia, exudates• Chlorhexidine wash or shampoo

• Corticosteroids


Avenanthramide Tranilast


Tranilast

• Anti‐allergy agent that inhibits mast cell degranulation

• Shown to have anti‐angiogenesis as well as anti‐inflammatory

• Inhibits fibroblast proliferation• Shown to diminish TNF‐alpha and Interleukin‐1 beta


Hyperkeratosis in Fursons

• Thickening of skin which can occur in cats and dogs on their paws or nose

• Idiopathic hyperkeratosis usually occurs in dogs over the age of 10

• Genetic predisposition in Labrador and Golden Retrievers• Can occur as a symptom of Leishmaniasis, Canine distemper, Zinc responsive dermatosis, or Pemphigus foliaceus


Obtaining CE

If you would like to receive continuing education credit for this activity, please visit:http://pcca.cds.pesgce.com


Building Relationships with Veterinarians - Amazon S3 · Building Relationships with Veterinarians...

Documents

Transcript of Building Relationships with Veterinarians - Amazon S3 · Building Relationships with Veterinarians...