Veterinary. Kevin Oberlander, RPh Deborah Clark, RPh Chris Simmons, RPh International Seminar Houston, TX November 10 12, PDF Free Download

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 2016. All Rights Reserved. 3

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 2016. All Rights Reserved. 6

Additional Relationships Animal / pet supply stores Humane Societies Animal shelters Animal rescue Groomers Rx customers make it known that you compound for animals / pets 2016. All Rights Reserved. 11

Disclosure Deborah 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. 2016. All Rights Reserved. 16

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. 2016. All Rights Reserved. 17

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. 2016. All Rights Reserved. 19

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. 2016. All Rights Reserved. 24

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. 2016. All Rights Reserved. 25

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? 2016. All Rights Reserved. 28

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? 2016. All Rights Reserved. 30

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. 2016. All Rights Reserved. 33

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 2016. All Rights Reserved. 34

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. 2016. All Rights Reserved. 35

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 2016. All Rights Reserved. 36

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?? 2016. All Rights Reserved. 37

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? 2016. All Rights Reserved. 38

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? 2016. All Rights Reserved. 39

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 2016. All Rights Reserved. 40

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 2016. All Rights Reserved. 49

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 2016. All Rights Reserved. 57

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 2016. All Rights Reserved. 58

Veterinary. Kevin Oberlander, RPh Deborah Clark, RPh Chris Simmons, RPh International Seminar Houston, TX November 10 12, 2016