Pharmacy Needs In a Disaster: Veterinary Patients

1. Pharmacy Needs In a Disaster:Veterinary Patients Margo Karriker, PharmD Pharmacist, VMAT 3 University of California, Veterinary Medical Center San Diego NDMS Conference Reno, NV April 2006

2. Topics to Cover • Medication issues unique to veterinary patients in a disaster • Introduce items unique to VMAT cache • Familiarize non-VMAT responders with pharmacy cache • Explore ways teams serving each type of patient can interact and understand each other

3. Types of Disasters

4. Specifics for Veterinary Patients • Patient size can vary dramatically • Unique issues to the species • Toxicities, medication sensitivities, administering doses • Similar diagnoses to human patients • Shock, acute traumatic injury, exacerbation of chronic disease

5. Pharmacy Basics in a Disaster • Medications for patient population • Supplies to support administration of medications • Proper storage/security • Logistical support for re-supply

6. How do we anticipate the needs? • Supply a drug cache with drugs and supplies for administration • Try to anticipate our most common patients’ needs • Dogs, cats, horses, livestock (cattle), exotics and small mammals

7. Drugs we need unique to VMAT • Euthanasia solution • Veterinary-labeled anti-inflammatory drugs • Antidotes and reversal agents • Large volume fluids

8. Euthanasia Solution • An unfortunate, but necessary part of the cache • Formulations: • Barbiturates • Preferred for most species • Pentobarbital or • Pentobarbital and Phenytoin • Brand Names: • Beuthanasia-D ® (Schering-Plough) • Euthasol ® (Virbac) • Fatal-Plus ® (Vortech) • Sleepaway ® (Fort Dodge)

9. Anti-inflammatory Drugs • Carprofen (Rimadyl®, Pfizer) • Meloxicam (Metacam®, Merial) • Flunixin (Banamine®, Schering-Plough) • Phenylbutazone (generic, various)

10. Antidotes • Yohimbine (Yobine®, Lloyd) • Reverses sedative/analgesic xylazine (generic, various) • Fomepizole (Antizol-Vet®, Orphan Medical) • Ethylene glycol toxicity • Atipamezole (Antisedan®, Pfizer) • Reverses sedative/analgesic medetomidine (Domitor®, Pfizer)

11. Fluids • Lactated Ringer’s • 5000ml bags • Sodium Chloride 0.9% • 3000ml bags • Ex. Equine fluid rate 1-2L per hour or more

12. Other Medications: • Sedatives/Analgesics • Tiletamine/zolpazem (Telazol®, Fort Dodge) • Antihelmintics/Parasiticides • Topical and oral • Frontline® (fipronil, Merial) • Capstar® (lufeneron, Novartis) • Corid® (amprolium, Merial) • Ivermectin (various) • Permethrin (various)

13. Supplies to Support Pharmacy • Drug References • Veterinary Drug Handbook(D.Plumb, Blackwell Publishing) • North American Companion Animal Formulary(Kuehn, No. Amer. Compendiums) • Compendium of Veterinary Products(No. Amer. Compendiums)

14. Supplies to Support Pharmacy • Documentation • A field ready, feasible system of documenting drug usage • Administration • General hospital equipment • Supplies included with the cache, not just the basic load • IV poles, adequate syringes, catheters, needles, empty sterile vials • Labeling supplies – syringes, medication vials

15. Getting what we need:Improvising when necessary • Some drugs may allow for substitution • Some drugs/patients do not • Having items available that allow for flexibility

16. Team interaction:Treating all the victims of the disaster • When situations/field conditions require it, we may have to rely on each other to help patients • Knowing more about each other will help us all perform better • Likelihood of shared personnel/resources could be high

17. What we can do now • Learn from each other and our deployments • Many common issues • Expand pharmacist membership on VMAT • Continue interactions between all levels of responders and teams • Make sure we have a pharmacy cache that’s optimal and ready to go

18. Questions?