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1 1 Introduction to Veterinary Pharmacy Gigi Davidson Clinical Pharmacy Services, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA Key Points ●● Several organizations exist that support vet- ●● Veterinary drug law is significantly differ- erinary pharmacy practice, including a train- ent from human drug law. For example, ing and credentialing process that culminates there is not currently a legal avenue for in the designation of Diplomate, International pharmacists to recommend human over‐ College of Veterinary Pharmacy (ICVP). the‐counter (OTC) drug products for veteri- ●● Veterinary pharmacists are uniquely trained nary patients. specialists that provide competent care and ●● Veterinary pharmacy residency training drug products to nonhuman species and programs have grown substantially since can be resources for community pharma- 1989. cists dispensing drugs to animals. ●● Core competencies for veterinary phar- ●● Veterinary pharmacotherapy is rapidly macy education must be standardized and entering the mainstream of pharmacy prac- uniformly implemented across pharmacy tice, despite the fact that most pharmacists school curricula. are not adequately trained in the field. 1.1 Introduction medicinal agents for animals were almost exclusively performed by veterinarians. In the Although the practice of providing medicinal late twentieth century, the practice of clinical therapy to animals dates back to the pharmacy for human medicine was estab Mesopotamian healer Urlugaledinna in 3000 lished, and veterinary professionals began to bce (Royal College COPYRIGHTEDof Veterinary Surgeons recognize MATERIAL the unique therapeutic contribu 2017), it took society nearly 5000 years to real tions made by clinically trained Doctors of ize that pharmacists were well‐placed medical Pharmacy. Veterinary pharmacy, which is professionals that could provide safe and practiced by pharmacists, is unique from the effective pharmacotherapy and monitoring to field of veterinary pharmacology, which is animal patients as well as to humans. In 1761, practiced by veterinarians, because it encom the first college of veterinary medicine was passes a three‐pronged approach that utilizes established in Lyon, France (Larkin 2010); and medicinal chemistry, pharmacology, and from that time until the mid‐twentieth century, species‐specific pharmacotherapeutics to eval the preparation, dispensing, and monitoring of uate the best action plan for a specific patient. Pharmacotherapeutics for Veterinary Dispensing, First Edition. Edited by Katrina L. Mealey. © 2019 John Wiley & Sons, Inc. Published 2019 by John Wiley & Sons, Inc. Chapter No.: 1 Title Name: <TITLENAME> 0004238187.INDD 0004238187.INDDComp. 1 by: RKarthikeyan Date: 25 Jan 2019 Time: 03:05:19 PM Stage: Printer WorkFlow:CSW Page Number:1/25/2019 1 3:05:19 PM 2 1 Introduction to Veterinary Pharmacy “I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow: • I will consider the welfare of humanity and relief of suffering my primary concerns. • I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients. • I will respect and protect all personal and health information entrusted to me. • I will accept the lifelong obligation to improve my professional knowledge and competence. • I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical, and legal conduct. • I will embrace and advocate changes that improve patient care. • I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists. I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.” Figure 1.1 The pharmacist’s oath. Beginning with a handful of pharmacists inter pharmacy, a US Food and Drug Administration ested in veterinary medicine, veterinary phar (FDA) guidance document released in 2015 macy has now evolved into a globally impactful estimated that 75 000 pharmacies fill 6 350 000 specialty area of pharmacy practice and resi compounded prescriptions for animal dency training programs and encompasses a patients annually (FDA 2015). It is important broad spectrum of practice settings, including to note that this estimate was only for com- veterinary teaching hospitals, veterinary medi pounded veterinary prescriptions and did not cal practices, community pharmacies, gov account for the number of all prescriptions ernmental agencies, and the pharmaceutical dispensed from pharmacies to animals. industry. Because most pharmacists have not received While most pharmacists are not trained as adequate training in comparative pharmacol veterinary pharmacy specialists, most com ogy and veterinary pharmacotherapeutics, munity pharmacists will encounter prescrip one would have to question whether pharma tions for nonhuman patients in their practice. cists are fulfilling the oath’s obligations when A survey of more than 13 000 licensed phar it comes to dispensing drugs to veterinary macists in North Carolina revealed that 77% patients. of respondents filled prescriptions for animal Drugs that achieve desired therapeutic patients in their practice (Sorah et al. 2015). A effects in humans do not always produce the similar survey of pharmacists in Oregon also same effects in nonhuman patients, and vice revealed that 77% of respondents filled pre versa. Using the wrong drug or the wrong scriptions for veterinary patients (Mingura dose of medications in animals can result in 2017). Pharmacists are the only healthcare therapeutic failure or serious adverse events. professionals expected by society – and legally In addition, statutes, regulations, rules, and permitted by regulatory authorities – to pro guidance for drug use in animals are signi vide pharmaceutical care and drug products ficantly different from those for humans, for all species. Yet despite this unique position, particularly with respect to animal species only 4% of pharmacy students who graduated whose tissues or milk may be consumed by in 2015 reported receiving any training in vet humans. Consequently, there is a critical erinary pharmacotherapy (Arnish et al. 2015). need for community pharmacists to under In fact, the pharmacy oath (Figure 1.1) does stand basic comparative pharmacology not distinguish between human patients principles, laws surrounding drug use in food and veterinary patients. Despite the lack animal species, and pharmacotherapy of of standardized education in veterinary common veterinary diseases in order to serve 0004238187.INDD 2 1/25/2019 3:05:20 PM 1.2 Veterinary Pharmacy Professional Organizations 3 the needs of the pet‐owning public. There is Kernan remains an active and vital contribu an additional need for a designated veteri tor to veterinary pharmacy practice. Several nary pharmacy specialty to meet the unique other veterinary schools followed suit in hir needs of providing legally compliant phar ing pharmacists in the late 1970s and early maceutical products, compounds, coun 1980s, and today all but one of the veterinary seling, and monitoring of veterinary patients schools in the USA and Canada employ at on an in‐patient basis, as well as serving as a least one pharmacist in a faculty, administra resource for community pharmacists outside tive, or professional staff position. In 1982, of the veterinary practice setting. a group of veterinary pharmacists, includ ing Kernan, met in Lincoln, Nebraska, to 1.1.1 History establish the Society of Veterinary Hospital Pharmacists (SVHP), the first professional Historically, the role of pharmacists in veteri organization representing veterinary phar nary medicine was limited to incidental macists. The organization has steadily grown compounding of medications and dispensing and now hosts more than 165 veterinary human‐approved prescription drugs for pets pharmacist members practicing throughout within the community pharmacy practice. the world. In 1989, the Auburn University Veterinary pharmacy, as an exclusive prac College of Veterinary Medicine and College tice, originated in colleges of veterinary med of Pharmacy collaborated to create the first icine in North America. In 1965, Laurence veterinary pharmacy residency program, and Reed Enos, PharmD, became the first veteri selected Dr. Bobbi Anglin as the first veteri nary pharmacist when he was hired by nary pharmacy resident (Dr. Sue Duran, per the University of California (UC) Davis sonal communication, Auburn University School of Veterinary Medicine (Laurence College of Veterinary Medicine, March 19, Reed Enos, personal communication, May 9, 2017). Since then, UC Davis, North Carolina 2011; Jeanne Enos, personal communication, State University, Purdue University, and the June 13, 2016). Clinical pharmacy was just University of Wisconsin have all established beginning in human medicine at that time, veterinary pharmacy residency training pro and Dr. Enos was hired to serve a clinical role grams, producing many residency‐trained providing pharmaceutical care for veterinary veterinary pharmacists. Compared to their patients and to provide education in pharma humble beginnings in 1965, today’s veteri cotherapeutic principles to veterinary stu nary pharmacists provide a significant and dents. He held administrative, teaching, and positive impact on animal healthcare. service roles within both the School of Veterinary Medicine and the

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