Pharmacy and Medications

What are the 3 main functions of veterinary medicines?

to restore, correct or modify physiological function

to exert a pharmacological, immunological or metabolic action

to make a medical diagnosis

Which legislations affect veterinary medicine prescription and production?

EU directives

UK Veterinary Medicines Regulations

Veterinary Medicines Guidance Notes by VMD

What are the responsibility of the Veterinary Medicines Directorate?

monitoring and acting on reports of adverse events

residue monitoring

authorising companies to sell veterinary medicines

controlling how veterinary medicines are made and distributed

advising government of developing veterinary medicines policy

making, updating and enforcing UK legislation

Which different organisations govern veterinary medicine prescribing?

UK legislation

fair trading requirements

veterinary medicines directorate

competition and markets authority

What are the 4 main categories used to classify veterinary medicinal products?

POM-V (prescription only medicine - vet)

POM-VPS (prescription only medicine - vet, pharmacist, suitably qualified person)

NFA-VPS (non food animals - vet, pharmacist, suitably qualified person)

AVM-GSL (authorised veterinary medicine - general sales list)

How are POM-V medications prescribed?

require a clinical assessment of an animal under a vet’s care by that vet and can only be supplied and prescribed by the vet

How are POM-VPS medications prescribed?

no clinical assessment is required and the animal does not need to be under the prescribers care

can be prescribed by a vet, pharmacist or suitably qualified person

supplied by a registered qualified person

How are NFA-VPS medications prescribed?

only given to non-food animals but does not require a prescription

supplied by registered qualified people

How are AVM-GSL medications prescribed?

any animal can recieve these without a prescription and they can be supplied by anyone

How is a clinical assessment defined by the RCVS?

assessment of the relevant clinical information which may include an examination of the patient

How does the RCVS define a vet having a patient under their care?

vet has been given the responsibility for the health of the patient by the owner or owner’s agent

vet is able to perform a physical exam or visit the premises on a 24/7 basis

vet carries out necessary investigation if the patient doesn’t improve, has an adverse reaction or deteriorates

if the patient is under the care of more than one vet, they must keep the other vets informed

What is a suitably qualified person (SQP)?

a legal category of professionally qualified persons who are qualified to prescribe and supply certain veterinary medicines after taking relevant training and assessment

Which medicines are excluded from controlled drugs?

some drugs for small pet and exotic species

topical and oral medicines only

not antimicrobials or narcotics

What is used to organise controlled drugs into schedules?

therapeutic usefulness

need for legitimate access

potential for misues and harm caused

Which type of controlled drugs are found in schedule 1?

drugs with little or no therapeutic value with a high potential for misuse

not used in veterinary medicines

prohibited except with a home office license

Which type of controlled drugs are found in schedule 2?

drugs with therapeutic value that are highly addictive

Which type of controlled drugs are found in schedule 3?

drugs with therapeutic value and less potential for abuse

Which type of controlled drugs are found in schedule 4?

drugs with reduced potential for abuse

Which type of controlled drugs are found in schedule 5?

drugs which are prepared in low doses

What must an order form for all controlled drugs contain?

name, address and profession of recipient

purpose for which drug is required

total quantity required

signature of the recipient in ink

RCVS registration number of recipient

How must schedule 2 drugs be received?

prescription is valid for 28 days

CD register required

must use an authorised requisition form (cannot be faxed or electronic)

an independent witness must watch the destruction of them if unused

invoice must be kept for 2 years

must be kept in safe custody

How must schedule 3 drugs be received?

must use an authorised requisition form (cannot be faxed or electronic)

prescription is valid for 28 days

invoice must be kept for 2 years

How must schedule 4 drugs be received?

prescription is valid for 28 days

invoice must be kept for 2 years

How must schedule 5 drugs be received?

prescription is valid for 6 months

invoice must be kept for 2 years

How must controlled drugs be stored?

in accordance with manufacturers’ recommendations

must be labelled with opening date

away from excessive light or moisture

no access by unauthorised persons or animals

How must schedule 2 or 3 controlled drugs be stored?

locked cabinet attached to the fabric of the building/mobile practice

only accessed by veterinary surgeon or person authorised by vet

key kepy by one person or a combination box

no indication of what the cabinet contains

clients not allowed in room with cabinet unsupervised

How must you decide what drug to use?

if there is a suitable authorised product available you must use at the manufacturer’s recommended dose

can choose an unauthorised product if an emergency

cannot justify using an unauthorised product due to cost

How do you select a drug if there are no authorised products for the indicated species and condition in the UK?

1. look at authorised medication from northern ireland

2. look for an authorised medication for use in another species or condition

3. look for an authorised medication for human use or for veterinary use outside of the UK

4. veterinary surgeon or properly authorised person in the UK can extemporaneously prepare a medication

What factors may effect your selection of drug?

clinical findings

dosage/administration logistics

individual characteristics

chronic/recurrent issues

build up of resistance

complex conditions

product availability

What conditions must be met when prescribing drugs to food-producing animals?

must be for animals on a single holding

medicine must have maximum residue limit stated

check other provisions listed

vet must specify an appropriate withdrawal period

vet must keep appropriate records

What is the RCVS code of conduct for vets or SQPs prescribing medicines?

must be satisfied that the person who will use the product is competent to do so safely and intends to use it for a use which is authorised

advise the collector on the safe administration of the product

advise on any warnings/contraindications on the label or leaflet

do not prescribe/supply more than the minimum quantity required

must supply products in appropriate containers with appropriate labelling

What information must written prescriptions contain?

name, address and telephone number of the person prescribing

qualifications of the person prescribing

name and address of owner or keeper of animal

full identification of animal/group of animals to be treated

premises at which animals are kept if this is different to the address of the owner

date

signature of person prescribing

name and amount of product prescribed

dose and administration instructions

necessary warnings

withdrawal period if relevant

statement if it is prescribed under the cascade

statement that it is an offence under VMR to alter a prescription

statement that antibiotics have been supplied for prophylactic or metaphylactic purposes if applicable

(good practice to state how long prescription is valid for)

(good practice to state how many times it can be repeated)

What extra things must be included on the written prescription for controlled drugs?

total quantity of drug in words and numbers

name, form and strength of drug

declaration that animal is under veterinary surgeon’s care

specific dosing instructions in words and figures

name of animal

full name of owner

address where controlled drug is to be delivered

cannot be a repeat

What information is on the label of a drug?

name and address of veterinary practice or pharmacy supplying it

name of veterinary surgeon who has prescribed it

name and address of animal’s owner

identification of animal or group of animals

date of supply

batch number and expiry date of medicine

name or description of medicine (including name, strength and quantity of active ingredient)

dosage and administration instructions

any special storage precautions

any necessary warnings

withdrawal period if appropriate

words ‘keep out of reach of children’, ‘for animal treatment only’ and ‘for external use only’ if topical

What criteria allow a veterinary practice to be considered a prescribing premises according to RCVS?

premises from which veterinary surgeons provide veterinary services

advertised as premises of a veterinary practice

open for members of the public to bring animals for veterinary treatment

medicines are delivered wholesale to the premises on the authority of the veterinary surgeon

How long must a record of POM-V, POM-VPS and NFA-VPS medications be kept for?

5 years

What records must be kept by a practice after prescribing POM-V and POM-VPS drugs?

date

identity of medicine including batch numbers

quantity

name and address of supplier or recipient

copy of any prescriptions written

What records must be kept by a practice after prescribing NFA-VPS drugs?

date

name of veterinary surgeon

name and address of owner

identification of animals treated

outcome of clinical assessment

identity of the product including batch number

active ingredients and quantity

amount (dose and duration)

withdrawal period

What information must be kept in records by farms when receiving medications?

date of acquisition

details of drug including batch number

quantity of drug

name and address of supplier

What information must be kept in records by farms when administering medications?

name of vet (if vet administered)

name of product including batch number

date of administration

quantity administered

withdrawal period

identification of animals treated

What information must be kept in records by farms when disposing of medications?

date of disposal

quantity of product

how and where disposed of

What is included in the standard operating procedure of a veterinary pharmacy?

drug categories

guidance on storage

records to be kept

ordering protocols

handling of medications

dispensing

disposal

How can horses recieve medications that would not usually be prescribed to food-producing animals?

they can be signed off from the food chain and declared unfit for human consumption by completing section IX of their passport, then non-food animal cascade rules will apply

What is pharmacovigilance?

activities associated with the detection, assessment, understanding and prevention of adverse events or other medicine-related problems

Who should you report an adverse drug reaction to?

veterinary medicines directorate