Precision Compounding - Nationwide. The Stokes Difference

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1 TM Precision Compounding - Nationwide. p: f: w: stokespharmacy.com REDEFINING QUALITY The Stokes Difference Specialties Dosage Forms Injectables Medi-Turn Transdermal Pens Petibles Chew Treats Mighty Meds Tablets Additional Mighty Meds Tablets Oral Suspensions and Solutions Cardiology, Neurology and Dermatology Oncology Ophthalmology Quality Assurance Hard to Find Medications Control Drugs for Office Use fll :Electronic Prescribing Why Stokes?

2 Precision Compounding - Nationwide. Stokes provides compounded medications nationwide both direct to client and direct to office when permitted. Stokes is licensed as a non-resident pharmacy in all States that require such licensing.

3 The Stokes Difference We believe that our patients and employees are the most important aspect of our business, not how many prescriptions we process. Since 1975, Stokes has been practicing due diligence in every aspect of our business. Excellent customer service Quality medication we can stand behind Online portal to make ordering easy Fast turnaround time The Stokes Difference Speak to a live Stokes Customer Care Specialist on the phone Brand new facility in which our entire lab (even non-sterile) is designed like a cleanroom and operates at a cleanliness level that exceeds most compounding pharmacy cleanrooms.

4 Specialties Avian & Exotics Behavior Cardiology DENTISTRY Neurology Oncology Ophthalmology Surgery Dermatology Emergency & Critical Care Internal Medicine

5 Nationwide Compounding Dosage Forms Capsules Medi-Turn Transdermal Pens Mighty Meds Tablets Otic Drops and Ointments Petibles Chew Treats Injectables Suppositories Topicals And more... Ophthalmic Drops and Ointments Oral Suspensions and Solutions Specialties Dosage Forms

6 Injectables Safety in compounded medications is always important to ensure quality. When it comes to sterile medications, the stakes are even higher. At Stokes, all of our pharmacists and technicians receive extensive professional education and training created and provided by our experts. Courses cover cleanroom engineering and operation, robust process simulations and aseptic techniques designeds to meet USP and state regulations. Additionally, we have our own strict protocols that are even more demanding than the aforementioned regulations. This sets Stokes Pharmacy apart from other compounding pharmacies in the industry. At the core of USP <797> standards is control of the process environment. To that end, all sterile compounds are prepared using segregated materials on dedicated equipment, in a purpose-built suite of cleanrooms. HEPA filtered air, continuous monitoring of environmental conditions, extensive employee training and rigorous testing of air quality, compounding surfaces, operator hygiene, as well as the final preparations (both in house and by independent labs), are a few of the practices Stokes employs to ensure quality.

7 Most Requested Formulations ACTH Gel Amikacin Sulfate Aminopentamide Hydrogen Sulfate Apomorphine Buprenorphine Butorphanol Calcium Gluconate Chlorpheniramine/Dexamethasone SP Cimetidine Cisplatin Intralesional Cytarabine Dactinomycin Diazepam Dipyrone Doxapram HCL EDTA Estradiol Cypionate Estrone AQ Suspension Furosemide Glycopyrrolate MDV Barcoding Leuprolide Acetate Mechlorethamine Methocarbamol Metoclopramide Pentosan Polysulfate Prednisolone Acetate Protamine Zinc Insulin (Human Origin) Protamine Zinc Insulin 100% Bovine Stanozolol Testosterone Aqueous TPA Vitamin A,D, & E Aqueous Vitamin E Aqueous Name Clarity Highlighted Strength Injectables

8 Medi-Turn Transdermal Pens User friendly applicator No need to read the tiny measurements on a syringe anymore. Just rotate applicator base and apply directly to the inner surface of ear Reduced potential for owner contact with medication Smaller amount of medication needed compared to syringes 1 Dose (0.05 ml) = 2 turns Each Pen has 1.5 ml. equivalent to 30 doses Disclaimer: Stokes makes no claims to the safety or efficacy of transdermal medication.transdermal dosage forms should be used only when traditional oral and injectable routes have not been effective. Prescribed at the discretion of the prescriber.

9 Commonly Prescribed Compounds Amitriptyline Amlodipine Amoxicillin Atenolol Benazepril Buprenorphine Buspirone Cetirizine Chlorpheniramine Ciprofloxacin Cisapride Clindamycin Clomipramine Cyproheptadine Dexamethasone Diazepam Diltiazem Diphenhydramine Doxycycline Enalapril Enrofloxacin Famciclovir Famotidine Fluoxetine Furosemide Gabapentin Glipizide Levothyroxine Marbofloxacin Megestrol Acetate Methimazole Metoclopramide Metronidazole Mirtazapine Phenobarbital Pimobendan Piroxicam Prednisolone Prednisone Propanolol Terbutaline Theophylline Tramadol Other formulations may be available Call (800) for a consult Medi-Turn Transdermal Pens

10 Stokes Petibles Flavored, medicated chewable treats Soft, textured chew for patient compliance Medication evenly distributed throughout treat Scored for easy, accurate dosing No powder mess or medication loss from splitting tablets Tasty Flavor options Beef Chicken Liver Fish Specifically formulated with finicky eaters in mind

11 Commonly Prescribed Compounds Acepromazine Amitriptyline Amlodipine Atenolol Azithromycin Benazepril Budesonide Ciprofloxacin Cisapride Clomipramine Clopidogrel Diazepam Diltiazem Doxycycline Enalapril Enrofloxacin Fluoxetine Gabapentin Glipizide Hydroxyzine Levetiracetam Levothyroxine Marbofloxacin Megestrol Acetate Methimazole Metoclopramide Metronidazole Phenobarbital Phenoxybenzamine Piroxicam Prednisolone Prednisone Sildenafil Theophylline Tramadol Trilostane Ursodiol Petibles Chew Treats

12 TM Tablets Mini-Meds Mini-Meds Multi-Meds Mighty-Bites Mini-Bites Triangles *Actual Size We offer a wide variety of flavored and non-flavored tablets to meet unique pet preferences. Our list of available tablets is growing! Stay up to date stokespharmacy.com/tablets

13 Multi-Meds TM Multi-Dose Meds. Multi-Meds are easy to dose as a complete tablet, or break in half or quarters. The score in the tablet allows for easy dosage tapering. Flavor enhanced with a mutually accepted flavor for both cats & dogs. Amlodipine 1.25 mg Methazolamide 60 mg Sildenafil 20 mg Tramadol 20 mg Mighty Meds Tablets

14 Mini-Meds tablets are small and easy to dose (smaller than Tic Tacs ). A score makes cutting dosages s easier and color-coding makes for clear identification. Budesonide 0.5 mg, 1 mg Cisapride 2.5 mg, 5 mg Clopidogrel mg Doxycycline 80 mg Famciclovir 62.5 mg, mg Gabapentin 25 mg, 50 mg Metronidazole 30 mg, 50 mg, 62.5 mg Mirtazapine 1.8 mg Phenoxybenzamine 2.5mg, 5 mg Piroxicam 2 mg, 3 mg, 4 mg, 5 mg Prazosin 0.5 mg Prednisolone 5 mg Sildenafil 6 mg, 12 mg TheophyLline 50 mg Tramadol 10 mg Trilostane 25 mg Ursodiol 50 mg Mini-Med Triangles tablets are small and easy to dose. A single score makes breaking tablets in half easy and color-coding allows for clear identification. Ursodiol 100 mg

15 Mighty-Bites chewables are flavored triangle shaped tablets packed with flavor that both cats and dogs love. A single score makes breaking tablets in half easy. Doxycycline 150 mg Methimazole 5 mg Piroxicam 6 mg Not true to size Timothy Duffy Mini-Bites chewables are flavored triangle shaped tablets packed with flavor that both cats and dogs love. Small and easy to dose, a single score allows for easily breaking the tablet in half. Trilostane 5 mg, 15 mg, 20 mg, 25 mg, 40 mg, 90 mg Additional Mighty Meds Tablets

16 Oral Suspensions & Solutions Dispensed with an oral syringe and interlocking cap Stokes unique suspensions are formulated for consistency and stability Our Aqueous suspensions last from days and may require refrigeration Many of our Non-Aqueous suspensions last 180 days; no refrigeration required Our most popular flavors Beef Chicken Liver Fish Other FLAVors available Apple Bacon Banana Bubble Gum Cherry Honey Marshmallow Vanilla Orange Peanut Butter Peppermint Pina Colada^ Raspberry^ Spearmint* Strawberry^ Tutti Fruitti Wintergreen* ^ Only available in Aqueous * Only available in Non-Aqueous Stokes bitter-masking Aqueous formulation is available for: Metronidazole Tramadol Enrofloxacin and more!

17 Commonly Prescribed Compounds Amitriptyline Amlodipine Amoxicillin Aspirin Atenolol Azithromycin Benazepril Bethanechol Budesonide Buprenorphine Calcitriol Chlorambucil Chloramphenicol Palmitate Cimetidine Cisapride Clomipramine Clopidogrel Diazepam Diltiazem Doxycycline Enalapril Enrofloxacin Famotidine Fluoxetine Furosemide Gabapentin Glipizide Griseofulvin Itraconazole Ketoconazole Levetiracetam Levothyroxine Lysine Marbofloxacin Meloxicam Oral Suspensions and Solutions Methimazole Methotrexate Metronidazole Mitotane Mycophenolate Phenobarbital Phenoxybenzamine Piroxicam Potassium Bromide Prednisolone Prednisone Sildenafil Theophylline Tramadol Trilostane Tylosin Ursodiol Other formulations available. Call (800) for a consult.

18 Specialty Stokes Pharmacy is a leader in specialty veterinary medicine. Specialty hospitals trust Stokes to prepare medications they need for critical patients. Practitioners choose Stokes for our commitment to quality preparations, precision and dedication to our patients. Stokes is a proud supporter of many specialty education programs including: ACVO, VCS, ACVIM, VECOG, VSPA. Stokes also sponsors many continuing education programs nationally each year. Below are some commonly requested medications prescribed by veterinary specialists. Cardiology Atenolol Benazapril Clopidogrel Diltiazem Enalapril Furosemide Hydrochlorothiazide Mexeletine Pimobendan Propranolol Sildenafil Sotalol Spironolactone Terbutaline Theophylline

19 Neurology Aspirin Butorphanol Chlormaphenicol Diazepam Suppository Fluconazole Gabapentin Levetiracetam Marbofloxacin Mycophenolate Omeprazole Phenobarbital Phenoxybenzamine Potassium Bromide Prednisolone Procarbazine Tramadol Trazadone Zonisamide Dermatology Cetirizine Mycophenolate Chlorpheniramine Pentoxifylline Cyclosporin Prednisolone Dexamethasone Rifampin Diphenhydramine Silver Sulfadiazine/ Doxycycline Dexamethasone Leflunomide Tramadol Marbofloxacin Triamcinolone Minocycline Tylosin Please note: the medications listed do not imply they are used to treat a specific disease state. Cardiology, Neurology and Dermatology

20 Oncology Stokes Pharmacy strives to provide innovative treatment options for animals affected by cancer. When compounding oncology preparations, we take extra safety precautions to minimize the toxicity risk to our staff, your staff, as well as patients and their families. Stokes Pharmacy is committed to providing quality compounded medication. Stokes continues to have every lot of our most commonly prescribed oncology medications (see below) tested by an independent lab to verify the labeled potency. We want you to feel confident that the final preparation is +/- 10% potency as per USP guidelines. Assays of the formulations that we have tested are available upon request. It is important to recognize that quality procedures differ from one pharmacy to the next as do formulations within each pharmacy. Since medications are made in different batches over time, final preparations may yield inconsistent results if the proper quality controls are not established. This is something that Stokes recognizes and continues to improve upon. Most Commonly Prescribed Oncology Capsules Cyclophosphamide 5 mg, 7 mg, 8 mg, 10 mg, 12 mg, 15 mg, 20 mg, 22 mg, 40 mg, 60 mg Lomustine 2.5 mg, 6 mg, 12 mg, 25 mg, 60 mg Chlorambucil 0.5 mg, 1 mg, 1.5 mg, 1.8 mg, 2.2 mg, 3 mg, 4.5 mg, 5 mg

21 Chemotherapy Agents & Commonly Prescribed Compounds ACTH Gel Buprenorphine Butorphanol Carboplatin Chlorambucil Cisapride Cisplatin Cyclophosphamide Cyproheptadine Cytarabine Dactinomycin Doxorubicin Fluorouracil Hydroxyurea Imatinib Lomustine MechlorethaminE Megestrol Acetate Melphalan Mitotane Piroxicam Prednisolone Prednisolone Acetate Prednisone Procarbazine Tramadol Vincristine Oncology

22 Ophthalmology The compounding of ophthalmic medications involves sterile processing procedures that demand expert skill and highly specialized equipment. Veterinary ophthalmologists trust Stokes Pharmacy for their commitment to unsurpassed quality control measures to produce first-rate preparations. Compounded in one of our ISO classed cleanrooms and primary engineering controls Quality testing to ensure potency, ph, sterility and stability Soft bottle with larger dropper for ease of use Special formulations to help alleviate stinging for improved patient compliance Dispensed in an amber vial to protect from light Tacrolimus and Cyclosporin Vehicles Available: Corn Oil MCT/Coconut Oil Aqueous Tacrolimus High Strength Ointment & Drops Available

23 Commonly Prescribed Compounds Acetylcysteine Ophthalmic Solution Cefazolin Ophthalmic Solution Chloramphenicol Ophthalmic Solution & Ointment Cidofovir Ophthalmic Solution Cisplatin Intralesional Emulsion Cyclosporin Ophthalmic Solution & Ointment Cyclosporin/Tacrolimus Ophthalmic Solution & Ointment Demecarium BrOMIDE Ophthalmic Solution Desmopressin Ophthalmic Solution Dipivefrin HCL Ophthalmic Solution EDTA Ophthalmic Solution & Ointment Fluconazole Ophthalmic Solution Flurbiprofen Ophthalmic Ointment and Solution Gentamicin-Betamethasone Ophthalmic Solution Idoxuridine Ophthalmic Solution & Ointment Interferon Alpha 2B Ophthalmic Solution Itraconazole/DMSO Ophthalmic Solution & Ointment Megestrol Acetate Ophthalmic Suspension & Ointment Miconazole Ophthalmic Solution & Ointment Mitomycin Ophthalmic Injection Nalbuphine Ophthalmic Solution Pimecrolimus Ophthalmic Suspension Polidocanol PF Injectable Solution Sirolimus Ophthalmic Solution & Ointment Tacrolimus Ophthalmic Solution & Ointment Tobramycin Fortified Ophthalmic Solution TPA Injectable Solution Vancomycin Ophthalmic Solution Vitamin A Ophthalmic Emulsion Voriconazole Ophthalmic Solution As commercial products become unavailable, you can count on Stokes to formulate a replacement. Ophthalmology

24 Quality Assurance Facility (both sterile an non-sterile labs) were designed and built as a cleanroom and operates to meet both CGMP standards and USP quality standards CGMP standards Process Control- Checkpoints and secure areas Quality Control - A dedicated quality control department Internal Observations - Cameras in areas of storage, preparation and dispensing USP Quality standards Stokes has separate and dedicated facilities - isolated air handling systems and rooms, equipment and materials for nonsterile and sterile compounding. The separation allows sterile and non-sterile operations to be isolated, as well as isolating hazardous drugs from non-hazardous drugs. Hazardous drugs are categorized by area at all stages of storage and use, far exceeding the requirements of USP <800> and sets the standards for best practices. This essentially eliminates the risk of hazardous drug residue contamination in other preparations. Extensive preparation, facility and personnel testing utilizing in-house & independent laboratories including: USP <71> Sterility USP <85> Bacterial Endotoxin Post-filtration integrity testing Environmental monitoring of both non-sterile and sterile labs Cleanroom surface and air sampling Personnel competency evaluations and continuous microbial monitoring, ph, weight, volume, density and yield as appropriate Finished preparation purity and quality Database containing the provenance of every compounded preparation including: Personnel Equipment Materials Weights Volumes Our goals are consistency, safety, quality and customer satisfaction. We Continue to invest in equipment, staff And Training to meet those outcomes.

25 Maintaining and reviewing master formulas and lot-specific database records; making refinements based upon internal and external experiences Applying the guidelines of the United States Pharmacopeia (USP) governing sterile compounding Following the American Society of Health-System Pharmacists (ASHP) Guidelines on Quality Assurance for Pharmacy-Prepared Sterile Preparations Adhering to Good Compounding Guidelines set forth by USP as well as New Jersey State Board of Pharmacy compounding pharmacy laws, regulations and guidelines as well of those of other states Performing biannual independent certification of our HEPA filtered ISO classed rooms, ISO classed cleanrooms and ISO classed engineering controls Operating a sterile compounding environment that is separate from the general laboratory following USP Cleanroom Guidelines Training all of our compounding pharmacists and pharmacy technicians on current compounding pharmacy quality standards Going beyond initial staff educational requirements with specialized training and rigorous continuing education in compounding pharmacy Committing in writing our specific policies and procedures for preparing, compounding and dispensing all of our preparations Purchasing from FDA-licensed raw materials suppliers used in the preparation of our compounded preparations Participating in the programs and practices of leading professional societies, such as the International Academy of Compounding Pharmacists, Professional Compounding Centers of America, The American College of Apothecaries and The American College of Veterinary Pharmacists Quality Assurance

26 Hard to Find Medications Apomorphine Budesonide Calcitriol Cisapride Dexamethasone Diazepam Suppositories Diethylstilbesterol(DES) Fludrocortisone Griseofulvin Leflunomide Does your patient need a specific medication that is no longer commercially available? Speak to one of our pharmacists today Commonly Requested Formulations Mitotane Phenoxybenzamine Piroxicam Potassium Bromide PZI Theophylline Theophylline/Ephedrine/ Hydroxyzine(Marax) Trilostane Ursodiol Looking for an item on backorder? With the ever changing availability of commercial products, Stokes strives to provide options during manufacturer backorders. Our hope is to minimize any disruption to your in-house regimen so that patient care remains consistent. Our excellent team of pharmacists will go above and beyond to research, test and formulate preparations at a veterinarian s request. We work with referring veterinarians, oncologists, ophthalmologists, surgeons, internal medicine veterinarians as well as specialty veterinary hospitals to understand which preparations they need in order to provide the best care to their patients.

27 TM TM ifill Stokes Electronic Prescribing Online Secure Quick Accurate Direct to client or office ifill is a secure, web-based prescription management system that allows participating practices to prescribe compounded medications online securely, quickly, and accurately. fll Prescribing through ifill allows you to ship medications directly to your client or office if permitted in your State. Highlights of prescribing with ifill: Access to pricing & shipping costs Faster turnaround time No phone calls No more faxing Detailed prescription and order histories Shipping and quantity discounts Patients get a text/ with link to payment Compliance with the state laws Reduced medication inventory Learn more ifill.stokespharmacy.com register your practice, please visit register.myifill.com Hard to Find Medications fll :Electronic Prescribing

28 Compounded Control Drugs for Office Use Stokes holds a DEA manufacturer license which allows us to compound controlled medications to be sold and administered in a hospital or veterinary practice in States that permit office use. Preparations Offered through Stokes' DEA manufacturer license: Buprenorphine 0.5 mg/ml Injection, 10 ml & 50 ml vial Buprenorphine 0.5 mg/ml AQ Bitter-Masking Suspension, 120 ml bottle Buprenorphine 1 mg/ml Transdermal, 1 ml syringe Butorphanol 10 mg/ml Injection, 50 ml vial Diazepam 5 mg/ml Injection, 30 ml vial Diazepam 10 mg/ml Injection, 30 ml vial Tramadol 10 mg Mini-Med Tablets, 100 count bottle Tramadol 20 mg Multi-Med Tablets, 100 count bottle Tramadol 20 mg/ml AQ Bitter-Masking Suspension, 120 ml bottle Stokes will continue providing customized compounded patient specific medications through our pharmacy DEA license for other controlled drugs not on this list. Our pharmacy license allows us to compound patient specific controlled and non-controlled medication for individual patients in any State. Protect your practice. If you are having controlled medications compounded for your office make sure your compounding pharmacy has a DEA manufacturer license. Go to dealookup.com/pharmaceuticalmanufacturers.asp. We are registered under Stokes Healthcare. our license number is RS DEA Security Continuous Facility Monitoring

29 Why Stokes? For over forty years, veterinarians and pet owners have turned to Stokes Pharmacy as a trusted provider of compounded medications. Here s why: Quality We employ rigorous standards and processes well surpassing both current and proposed standards to ensure only quality preparations reach our patients. Every formulation is evaluated to ensure consistency. Experience Since 1975, we have provided the highest quality compounded medicines for animals. Expertise We employ only highly skilled pharmacists, chemists and technicians who possess credentials based on our own high standards, often exceeding regulatory requirements. Safety Safety for our customers and our team will always be our number one priority. Service We have built our reputation on and are committed to exceptional service. Control Drugs for Office Use Why Stokes?

30 ACVO and Stokes Pharmacy National Service Animal Eye Exam Event Proud Namesake Sponsor since 2014 Each year, in the month of May, participating veterinary ophthalmologists and staff donate their time and services to provide screening eye examinations to Service Animals at no cost. It is anticipated that through these efforts Service Animal health can be improved and potential disease averted. For information on how to participate: ACVOeyeexam.org Precision Compounding - Nationwide Commerce Parkway, Suite 600 Mount Laurel, NJ p: f: Stokes Pharmacy 2016 Disclaimer: All information provided is valid at time of printing in October 2016; drug availability subject to change. Non food chain animals only. Medications compounded at the request of the prescriber.