Veterinary pharmacy
Differences in diagnosis, treatment, prescribing and supply of medicines between animals and humans
Legislation and legal definitions that apply when dealing with medicines for animals
Prescribing and the supply cascade
Advice-giving for animal medicines
Introduction
Veterinary medicines are not dealt with by every pharmacist on a day-to-day basis and some pharmacists may never supply a veterinary medicine during their whole career.
Some pharmacists however, choose to work more exclusively with animals and may undertake further training (e.g. a postgraduate diploma in veterinary pharmacy). Such pharmacists will often work in more rural areas and with food-producing animals (see Ch. 14).
Animals, disease and medicines
It is unsafe to assume that the way a drug works in one animal species will be the same as the way it works in a human. This is also the case between different species of animals, and so in order to have a complete set of drugs available for every species of animal, very large sums of money would need to be invested in research and development. This does not happen and so anyone involved in treating animals may have to potentially prescribe medicines that have not been tested on that particular animal species. The other big difference between treating humans and animals is that humans are often in a position to describe symptoms, progression of symptoms and any contributing factors. When treating animals, a veterinary surgeon has to rely on physical examination and the owner’s observation of the animal, thus making diagnosis more difficult.
It is also important to recognize that some animals are food-producing, either because some produce food, e.g. eggs, milk, or are eaten as meat. If they have been taking medicines in the period of time before they or their products enter the human food chain, then it is likely that humans could be consuming quantities of the medicine. These medicines may not have been tested in humans and so may cause adverse drugs reactions or interactions with other prescribed medications within the human. Pharmacists involved in supplying veterinary medicines need to be aware of these issues, as they influence the medicines supplied, records made and advice given.
Definitions
There are three additional definitions used when working with medicines and animals:
1. Classification of a veterinary medicine
o. For treating or preventing disease in animals, or for making a medical diagnosis, or to restore, correct or modify physiological functions
2. Classification of an ‘animal’
o. ‘Animal’ means all animals other than man and includes birds, reptiles, fish, molluscs, crustacea and bees
3. Suitably qualified person (SQP)
o. This may include veterinary nurses, agricultural merchants, internet retailers and pet-shop staff. The list of SQPs is maintained by the Animal Medicines Training Regulatory Authority (AMTRA) and an individual can enter the list if they have undertaken an accredited training programme, have met the registration criteria and keep up-to-date. Registration allows the individual to supply certain legal classes of veterinary medicines.
Veterinary medicines directorate (VMD)
The VMD is the regulatory body for veterinary medicines. The vision of the VMD is the responsible, safe and effective use of veterinary medicinal products and in working towards this vision, the VMD aims to protect public health, animal health, the environment and promote animal welfare by assuring the safety, quality and efficacy of veterinary medicines.
Legal classifications
Each year, the VMD issues a new set of Veterinary Medicines Regulations (VMR), which are legally binding in the UK. These regulations displaced the Medicines Act in Great Britain and Northern Ireland. Other countries have similar regulations and there are also some European regulations.
There are four main legal classes of medicine and within these categories, there are also further classifications for controlled drugs (CDs).
POM-V (prescription only medicine – veterinarian)
May be sold or supplied by a pharmacist or a veterinary surgeon against a prescription which must be issued by a veterinary surgeon.
The prescription can be oral, i.e. not written down, unless it is being supplied elsewhere.
POM-VPS (prescription only medicine – veterinarian, pharmacist or SQP)
Must be both prescribed and supplied by a veterinary surgeon, pharmacist or SQP. The medicine must be supplied from registered premises.
The owner may request a written prescription if they do not want the prescriber to supply the medicine.
A clinical assessment of the animal is not required when prescribing this category of veterinary medicine.
NFA-VPS (non-food animal medicine – veterinarian, pharmacist, SQP)
Medicines in the NFA-VPS category are for companion animals (excluding horses). They must be supplied by a veterinary surgeon, pharmacist or SQP from registered premises.
A clinical assessment of the animal is not required for supply of this category of veterinary medicine.
AVM-GSL (authorized veterinary medicine – general sales list)
Medicines in the AVM-GSL category may be legally supplied by any retailer, to anyone, without restriction.
However, veterinary surgeons should take account of their professional duties in deciding when to supply all medicines, regardless of classification.
Prescribing and supply cascade
In-line with human medicines legislation, veterinary medicines regulations start from the principle that veterinary medicines must be authorized to protect the animal, user and the environment from untested or poor quality products. However, it is recognized that in some circumstances the benefits of supplying an unauthorized medicine will outweigh the risks and so veterinary surgeons have been given an exemption from the general rule under certain circumstances and this is known as the cascade.
The cascade tries to provide the balance between the need to use authorized products when available and the need for prescriber freedom when they are not. It is a way of increasing the range of products available to compensate for the lack of licensed products available for every condition in every animal species.
Any decision to supply a product under the cascade must take into account the following:
The veterinary surgeon remains responsible for the treatment of the animal under their care and so should use clear clinical evidence to support their decision-making process
If using a human medicine, the dose may seem appropriate but the formulation may mean it is not
Safety information about human medicines cannot be assumed to be relevant to their use in animals
Generic human medicines cannot be prescribed when a licensed veterinary product is available.
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