Veterinary Pharmacy During Disaster CDR Shayne Blackmon, PharmD Federal Detention Center – Honolulu, HI LT Selena Ready, PharmD Winslow Indian Health Care.
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Veterinary Pharmacy During Disaster
CDR Shayne Blackmon, PharmDFederal Detention Center – Honolulu, HI
LT Selena Ready, PharmDWinslow 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.
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?
ObjectivesAfter 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 AnalgesicsDosageDogs Cats
Buprenorphine 0.01-0.02 mg/kg, SC,BID
0.005-0.01 mg/kg, SC or IM, BID
Butorphanol tartrate 0.2-0.4 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
2-10 mg/kg, IM or SC, every 2 hr
Morphine sulfate 0.22-0.88 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 AnalgesicsDosageDogs Cats
Nalbuphine 0.5-2.0 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 lactate 2-3 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
Drug Dosage
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.
Acetaminophen Dogs : 10-15 mg/kg, PO, TID. Toxic to cats!
Phenylbutazone Dog/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 SIDNSAID 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
Drug Dosage
Ketoprofen Dog/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 USE Dogs – Indomethacin, naproxen, ibuprofen, piroxicam highly toxic to GI tract
Common Veterinary Drugs Used During Disaster
•Behavioral MedicationsDrug Dosage
Alprazolam0.01-0.1 mg/kg, PO, as needed for phobic or panic attacks‡; start with 1-2 mg for a 25 kg dog
Amitriptyline 1-2 mg/kg, PO, bid to start
Buspirone1 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
Chlordiazepoxide 2.2-6.6 mg/kg, PO, as needed
Clomipramine# 1-2 mg/kg, PO, bid; increase to 3 mg/kg, bid if necessary
Alprazolam0.01-0.1 mg/kg, PO, as needed for phobic or panic attacks‡; start with 1-2 mg for a 25 kg dog
Drug Dosage
Clonazepam0.125-1.0 mg/kg, PO, bid; range 0.01-1.0 mg/kg, PO, as needed for phobic or panic attacks
Clorazepate0.5-2.2 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
Diazepam0.5-2.2 mg/kg, PO, at least 1 hr before provocative stimulus; repeat every 4-6 hr as needed
Doxepin 3-5 mg/kg, PO, bid-tid
Fluoxetine 1 mg/kg, PO, sid-bid
Fluvoxamine 1 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)
Nortriptyline 1-2 mg/kg, PO, bid
Oxazepam 0.2-1.0 mg/kg, PO,sid-bid
Paroxetine 1 mg/kg, PO, sid
Protriptyline 5-10 mg/dog, PO,sid-bid (narcolepsy)
Selegiline 0.5-1.0 mg/kg, PO, sid
Sertraline 1 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, CO2, CO,
potassium chloride in conjunction with general anesthesia
• Birds▫Barbiturates, inhalant anesthetics, CO2, CO,
gunshot (free-ranging only), N2, 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
References: • http://www.avma.org/disaster/emerg_prep_resp_guide.pdf• http://veterinarynews.dvm360.com• http://news.nationalgeographic.com/news/2005/09/photog
alleries/hurricane_katrina_pets/index.html• http://www.avma.org/disaster/petsact_faq.asp• http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm
/bc/160201.htm• http://animalsindisasters.typepad.com/wspa/animals-in-dis
asters/• http://www.petalk.com/drug-dosages.html#Code
Arctic Crossroads 2009
•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
Arctic Crossroads 2009
• 9 euthanasia procedures/3 after hr. emergenc.• Pharmacist assistance provided by PHS CAPT
Paulson, USCG• Primary meds used
▫ Isoflurane – gas anesthesia▫Tiletamine/zolazepam (Telazol) – inj. anesth/tranq▫Pentobarbital/phenytoin - euthanasia i.v. soln.▫Praziquantel/pyrantel (Drontal Plus) – int. parasites
Operation Pacific Angel
•13th 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 2008PP08 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 GUINEA4-17 Aug
PHILIPPINES29 May-17 Jun
VIETNAM19-29 Jun
TIMOR LESTE12-25 Jul
MICRONESIA22 Aug-1 Sep
5
43
2
1
PACIFIC PARTNERSHIP 2008
USNS Mercy
Continuing Promise 2009
•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
Handbookhttp://www.cdc.gov/nczved/http://www.aavpt.org/
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