Presentation on theme: "Veterinary Pharmacy During Disaster CDR Shayne Blackmon, PharmD Federal Detention Center – Honolulu, HI LT Selena Ready, PharmD Winslow Indian Health Care."— Presentation transcript:
Veterinary Pharmacy During Disaster CDR Shayne Blackmon, PharmD Federal Detention Center – Honolulu, HI LT Selena Ready, PharmD Winslow Indian Health Care Center – Winslow, AZ
Introduction Over half of American families are pet-owners. Oftentimes, pet-owners will refuse to leave their pets during a disaster. It is estimated that 100,000 animals, pets and livestock are separated from their owners and/or lost during a major natural disaster.
Animal Care and Handling: Stressed or Injured Animals
U.S. Pets Evacuation and Transportation Standards Act (PETS) In the fall of 2006, Congress passed H.R. 3858, the Pets Evacuation and Transportation Standards Act of 2006 (PETS Act). On Friday, October 6, 2006, President Bush signed the PETS Act into law. What does the PETS Act do? When is the PETS Act in operation? How does the PETS Act work operationally?
Objectives After this presentation, the audience should be able to: Have a basic understanding of the supportive care necessary for animal patients during a disaster setting Understand how to assist with the triage and physical assessment of an animal patient Have a basic knowledge of common veterinary drugs and disease states used in a disaster Have a basic knowledge of how to administer drugs to an animal patient Be able to identify additional sources of information regarding veterinary emergency preparedness
Animal Care and Handling: During Disaster Recent Scenarios ▫Extreme Weather Mongolia ▫Flooding Tennessee ▫Earthquakes Haiti Chile
Triage and Physical Assessment Personal Protection ▫Wear gloves when handling sick or wounded animals. ▫Consider use of goggles or face protection if splashes from contaminated surfaces may occur Do not allow rescued animals to “kiss” you or lick your face. ▫Whenever possible, caretakers should have completed a 3-dose prophylactic vaccination series for rabies.
Triage and Physical Assessment Basic Triage and Physical Assessment ▫ABCs ▫Broken Appendages ▫Sources of Hemorrhage ▫Levels of Consciousness
Common Veterinary Drugs Used During Disaster Animal identification Date of treatment Name of product administered Name of the individual administering the product Name of the supervising veterinarian Records of individual animal treatments should be kept and include:
Common Veterinary Drugs Used During Disaster Vaccinations Flea and Tick Treatments Diarrheal Disease Disinfectants and Antiseptics Pain Management Behavioral Meds Euthanasia
Common Veterinary Drugs Used During Disaster Core Vaccinations Dogs ▫Rabies Personnel should be aware that rabies vaccines may take as long as 28 days to become effective. ▫ Distemper, Hepatitis, and Parvovirus ▫ Kennel Cough Vaccination (intranasal) Against Bordatella bronchisepta and parainfluenza
Common Veterinary Drugs Used During Disaster Cats ▫Viral Rhinotracheitis, Panleukopenia and Calicivirus ▫Feline leukemia Leptospirosis risk ▫Higher in flood-ravaged areas ▫Zoonotic ▫Adverse reactions may be higher than for some other vaccines
Common Veterinary Drugs Used During Disaster Diarrheal Disease ▫Separate from healthy animals ▫ Nosocomial agents of concern that may be transmitted by feces include parvovirus, panleukopenia, Giardi, and intestinal parasites. ▫ Zoonotic agents of concern for small animals include Campylobacter and Salmonella, which are highly infectious and have been associated with outbreaks in shelters and veterinary clinics.
Common Veterinary Drugs Used During Disaster External and Internal Parasite Treatment ▫Ectoparaciticides and Anthelmintics ▫Flea, tick, and worm coverage Spot-on, injectible, and oral formulations
Common Veterinary Drugs Used During Disaster Antiseptics and Disinfectants ▫Rubbing Alcohol ▫Chlorhexidine ▫Iodine Tincture ▫Povidone-Iodine ▫Hydrogen Peroxide 3%
Common Veterinary Drugs Used During Disaster Pain Management Opioid Analgesics Dosage DogsCats Buprenorphine0.01-0.02 mg/kg, SC, BID 0.005-0.01 mg/kg, SC or IM, BID Butorphanol tartrate0.2-0.4 mg/kg, IM or SC; 0.55 mg/kg, PO, every 4 hr 0.1-0.2 mg/kg, IV; 0.2- 0.4 mg/kg, IM or SC, every 4 h Meperidine hydrochloride 2-10 mg/kg, IM or SC, every 2 hr Morphine sulfate0.22-0.88 mg/kg, IM or SC, every 4-6 hr as needed 0.1 mg/kg, IM or SC, as needed
Common Veterinary Drugs Used During Disaster Opioid Analgesics Dosage Dogs Cats Nalbuphine0.5-2.0 mg/kg, SC, every 4-8 hr 1.5-3.0 mg/kg, IV, every 3 hr Oxymorphone hydrochloride 0.22 mg/kg, IV, IM, or SC, SID 0.1-0.2 mg/kg, IV, IM, or SC, SID Pentazocine lactate2-3 mg/kg, IM, every 4 hr; 15 mg/kg, PO, TID 2.2-3.3 mg/kg, IV, IM, or SC
Common Veterinary Drugs Used During Disaster Anti-inflammatory Agents DrugDosage Asprin Dogs: 10-40 mg/kg, PO, BID - TID. Horses : 10 mg/kg SID. Cats : (anti-platelet effects in thromboembolic disease)10 mg/kg, PO, q48 hrs, to allow for prolonged metabolism. AcetaminophenDogs : 10-15 mg/kg, PO, TID. Toxic to cats! PhenylbutazoneDog/Bovine/Equine: 1-5 mg/kg PO, IV SID-BID. Flunixin Meglumine Cats/Dogs/Bovine: 1.1 mg/kg IV, IM, PO SID. Highly effective NSAID. Potential for hepatotoxicity, gastrointestinal ulceration. May dilute with Vit. B12 inj. to reduce pain on IM or SQ injection. Carboprofen (Rimadyl) Dogs/Cats: 4mg/kg PO SID NSAID with a wide safety margin in dogs. Limited potential for GI ulceration, hepato or nephrotoxicity compared to other NSAIDs.
Common Veterinary Drugs Used During Disaster DrugDosage KetoprofenDog/Bovine: 2.2 mg/kg IV, IM Derocoxib (Deramaxx)Dog: Osteoarthritis - 1-2 mg/kg, PO, SID Firocoxib (Previcox)Dog: Osteoarthritis - 5 mg/kg, PO, SID Other NSAID info – DO NOT USEDogs – Indomethacin, naproxen, ibuprofen, piroxicam highly toxic to GI tract
Common Veterinary Drugs Used During Disaster Behavioral Medications DrugDosage Alprazolam 0.01-0.1 mg/kg, PO, as needed for phobic or panic attacks‡; start with 1-2 mg for a 25 kg dog Amitriptyline1-2 mg/kg, PO, bid to start Buspirone 1 mg/kg, PO, sid-tid (mild anxiety); 2.5-10 mg/dog, PO, sid-tid (mild anxiety); 10-15 mg/dog, PO, bid-tid (severe anxiety) Carbemazepine 4-8 mg/kg, PO, bid; 0.5-1.25 mg/kg, PO, tid; 4-10 mg/kg/day, divided tid Chlordiazepoxide2.2-6.6 mg/kg, PO, as needed Clomipramine#1-2 mg/kg, PO, bid; increase to 3 mg/kg, bid if necessary Alprazolam 0.01-0.1 mg/kg, PO, as needed for phobic or panic attacks‡; start with 1-2 mg for a 25 kg dog
DrugDosage Clonazepam 0.125-1.0 mg/kg, PO, bid; range 0.01-1.0 mg/kg, PO, as needed for phobic or panic attacks Clorazepate 0.5-2.2 mg/kg, PO, at least 1 hr before provocative stimulus; repeat every 4-6 hr as needed; 11.25-22.5 mg/large dog; ~11.25 mg/medium dog; ~5.6 mg/small dog Diazepam 0.5-2.2 mg/kg, PO, at least 1 hr before provocative stimulus; repeat every 4-6 hr as needed Doxepin3-5 mg/kg, PO, bid-tid Fluoxetine1 mg/kg, PO, sid-bid Fluvoxamine1 mg/kg, PO, sid-bid ** Imipramine 2.2-4.4 mg/kg, PO,sid-bid ; 1-2 or 2-4 mg/kg, PO, sid-bid (start low) Nortriptyline1-2 mg/kg, PO, bid Oxazepam0.2-1.0 mg/kg, PO,sid-bid Paroxetine1 mg/kg, PO, sid Protriptyline5-10 mg/dog, PO,sid-bid (narcolepsy) Selegiline0.5-1.0 mg/kg, PO, sid Sertraline1 mg/kg, PO, sid
Common Veterinary Drugs Used During Disaster Euthanasia In regard to animals -the act of killing an animal in a humane manner. The primary objectives of animal euthanasia are: ▫relieving pain and suffering of the animal(s) to be euthanized ▫minimizing the pain, anxiety, distress, and fear the animal experiences before consciousness is lost ▫inducing a painless and distress-free death
Common Veterinary Drugs Used During Disaster Cats and Dogs ▫Barbiturates, inhalant anesthetics, CO 2, CO, potassium chloride in conjunction with general anesthesia Birds ▫Barbiturates, inhalant anesthetics, CO 2, CO, gunshot (free-ranging only), N 2, argon, cervical dislocation, decapitation, thoracic compression (small, free- ranging only) Horses ▫Barbiturates, potassium chloride in conjunction with general anesthesia, penetrating captive bolt
Vet Medication Administration Techniques Wrapping in a blanket or towel is a great restraint technique Marshmellows, peanut butter, or cream cheese Pill gun Oral Syringe
Veterinary Pharmacy Resources Handbook of Veterinary Drugs – for PDAs, Smartphones, iPhones The Merck Veterinary Manual VMAT information
USCG/PHS mission to Barrow, AK, and surrounding villages Rabies prophylaxis and vet care provided 5 North Slope Borough village trips 113 vet clinical appts. seen Approx. 300 rabies vaccinations and 150 distemper/parvovirus vaccines given 26 surgeries performed
Operation Pacific Angel 13 th AF joint op. with the Phil. armed forces, national police, civilians, and non-gov orgs Two mobile veterinary services teams served 41 local villages Provided vet. care to 3360 animals/ incl. de- worming and vitamin vacc. to more than 3300 cattle, goats, and caribou
Operation Pacific Angel Primary meds used ▫Ketamine (Ketalar, Ketaject) 100mg/ml general anesthetic; high conc. for cattle, swine, etc. ▫Zinc gluconate (Neutersol) – chemical castration ▫Albendazole, atovaquone, ivermectin, quinacrine - antiparasitics
Pacific Partnership 2008 PP08 Team in Timor-Leste USPHS, U.S. Marines, Navy, Army, Air Force, Navy civilian mariners Armed forces of Australia, Canada, India, Indonesia, Portugal, & Republic of Korea USPHS CDR John Gibbon with Indian Army colleagues
PAPUA NEW GUINEA 4-17 Aug PHILIPPINES 29 May-17 Jun VIETNAM 19-29 Jun TIMOR LESTE 12-25 Jul MICRONESIA 22 Aug-1 Sep 5 4 3 2 1 PACIFIC PARTNERSHIP 2008 USNS Mercy
PHS, Navy, & Army joint op. with military and govt. officials of Haiti & Dominican Republic On-site trng. of college students & local vets. Provided host nation vets. disease-specific presentations on 40 animal dz of importance 43 general audience presentations – zoon. dz Provided vet. care to 1849 animals/12 species Performed 6366 procedures USNS Comfort
Continuing Promise 2009 Primary meds used ▫Pyrantel (Strongid T, Nemex) – deworming for dogs/cats ▫Rabies, Distemper/Parvo vaccines Exotic Newcastle Disease (PMV-1) vaccine (poultry) ▫Fipronil (Frontline) – fleas and ticks ▫Ivermectin – orally for internal and external parasites (poultry), horses; inj. form for goats/swine/rabbits ▫Hog Cholera (Classical Swine Fever) vaccines
Continuing Promise 2009 Primary meds used (cont.) ▫Vaccination for Clostridium C and D, & Tetanus ▫Vitamin ADE, B12, and iron inj. – goats and swine ▫Anesthetic premedication and anesthesia ▫Tetanus toxoid – horses ▫Leptospirosis vacc. – cattle ▫Moxidectin (Cydectin) – top. for int/ext parasites cattle ▫Brucella abortus vaccine – heifers 3-8 months
Lessons Learned: Be flexible – systems will be overwhelmed; human/animal pts. Disaster/humanitarian missions Demand for services ↑↑↑ People love their pets Train, train, train – Ft AP Hill 09, RDF 2010, Humanitarian missions Vets, pharmacists get involved earlier in the planning process – pre-deployment site survey teams, etc Advanced look at zoonotic dzs in the region (rabies, brucellosis, tuberculosis, tularemia, etc.) Helps avoid supply shortages/expired meds – common problem (AC09, CP09, etc.) Engage host nation representatives as to their needs/wishes for the mission
Lessons Learned: Establish partnerships – DOD, state MRCs (locals - lay of the land) U.S. Army Vet Corps PACOM – Dev. inventory templates for regions throughout the Pacific Plan early – many pharmaceutical needs are unique to veterinary medicine and cannot be easily obtained thru normal military supply channels Ex. High conc. Ketamine (100mg/ml) – pigs, buffalo Pack light Bring tools Plumb’s Veterinary Drug Handbook http://www.cdc.gov/nczved/ http://www.cdc.gov/nczved/ http://www.aavpt.org/