Pharmacy Needs In a Disaster: Veterinary Patients

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Pharmacy Needs In a DisasterVeterinary Patients

• Margo Karriker, PharmD
• Pharmacist, VMAT 3
• University of California, Veterinary Medical
  Center
• San Diego
• NDMS Conference
• Reno, NV
• April 2006

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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

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Types of Disasters
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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

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Pharmacy Basics in a Disaster

• Medications for patient population
• Supplies to support administration of medications
• Proper storage/security
• Logistical support for re-supply

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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

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Drugs we need unique to VMAT

• Euthanasia solution
• Veterinary-labeled anti-inflammatory drugs
• Antidotes and reversal agents
• Large volume fluids

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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)

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Anti-inflammatory Drugs

• Carprofen (Rimadyl, Pfizer)
• Meloxicam (Metacam, Merial)
• Flunixin (Banamine, Schering-Plough)
• Phenylbutazone (generic, various)

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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)

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Fluids

• Lactated Ringers
• 5000ml bags
• Sodium Chloride 0.9
• 3000ml bags
• Ex. Equine fluid rate 1-2L per hour or more

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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)

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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)

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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

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Getting what we needImprovising when necessary

• Some drugs may allow for substitution
• Some drugs/patients do not
• Having items available that allow for flexibility

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Team interactionTreating 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

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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 thats optimal
  and ready to go

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Questions?