Veterinary Pharmacy During Disaster

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Veterinary Pharmacy During Disaster

• CDR Shayne Blackmon, PharmD
• Federal Detention Center Honolulu, HI
• LT Selena Ready, PharmD
• Winslow Indian Health Care Center Winslow, AZ

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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.

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Animal Care and Handling Stressed or Injured
Animals
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Animal Care and Handling Stressed or Injured
Animals
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Animal Care and Handling Stressed or Injured
Animals
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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?

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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

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Animal Care and Handling During Disaster

• Recent Scenarios
• Extreme Weather
• Mongolia
• Flooding
• Tennessee
• Earthquakes
• Haiti
• Chile

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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.

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Triage and Physical Assessment

• Basic Triage and Physical Assessment
• ABCs
• Broken Appendages
• Sources of Hemorrhage
• Levels of Consciousness

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Common Veterinary Drugs Used During Disaster
Records of individual animal treatments should be
kept and include

• Name of the individual administering the product
• Name of the supervising veterinarian

• Animal identification
• Date of treatment
• Name of product administered

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Common Veterinary Drugs Used During Disaster

• Vaccinations
• Flea and Tick Treatments
• Diarrheal Disease
• Disinfectants and Antiseptics
• Pain Management
• Behavioral Meds
• Euthanasia

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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

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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

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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.

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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

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Common Veterinary Drugs Used During Disaster

• Antiseptics and Disinfectants
• Rubbing Alcohol
• Chlorhexidine
• Iodine Tincture
• Povidone-Iodine
• Hydrogen Peroxide 3

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Common Veterinary Drugs Used During Disaster

• Pain Management

Opioid Analgesics Dosage Dogs 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
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Common Veterinary Drugs Used During Disaster
Opioid Analgesics Dosage Dogs 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
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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.
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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
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Common Veterinary Drugs Used During Disaster

• Behavioral Medications

Drug Dosage
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
Amitriptyline 1-2 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
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
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
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Drug Dosage
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
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
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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

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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

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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

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Veterinary Pharmacy Resources

• Handbook of Veterinary Drugs for PDAs,
  Smartphones, iPhones
• The Merck Veterinary Manual
• VMAT information

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References

• http//www.avma.org/disaster/emerg_prep_resp_guide
  .pdf
• http//veterinarynews.dvm360.com
• http//news.nationalgeographic.com/news/2005/09/ph
  otogalleries/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-disasters/
• http//www.petalk.com/drug-dosages.htmlCode

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USPHS LCDR Lauren Davidson
Arctic Crossroads 2009
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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

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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

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• Operation Pacific Angel 2010

Phase 1 - Philippines
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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

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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

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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
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USNS Mercy
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• USPHS LCDR Bryan Buss

Continuing Promise 2009
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Continuing Promise 2009
USNS Comfort

• 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

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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

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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

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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

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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
• Plumbs Veterinary Drug Handbook
• http//www.cdc.gov/nczved/
• http//www.aavpt.org/

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Questions?