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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 veterinary pharmacy practice, including a training and credentialing process that culminates in the designation of Diplomate, International College of Veterinary Pharmacy ().
• Veterinary pharmacists are uniquely trained specialists that provide competent care and drug products to nonhuman species and can be resources for community pharmacists dispensing drugs to animals.
• Veterinary pharmacotherapy is rapidly entering the mainstream of pharmacy practice, despite the fact that most pharmacists are not adequately trained in the field.
• Veterinary drug law is significantly different from human drug law. For example, there is not currently a legal avenue for pharmacists to recommend human over‐the‐counter (OTC) drug products for veterinary patients.
• Veterinary pharmacy residency training programs have grown substantially since 1989.
• Core competencies for veterinary pharmacy education must be standardized and uniformly implemented across pharmacy school curricula.

1.1 Introduction

Although the practice of providing medicinal therapy to animals dates back to the Mesopotamian healer Urlugaledinna in 3000 BCE (Royal College of Veterinary Surgeons 2017), it took society nearly 5000 years to realize that pharmacists were well‐placed medical professionals that could provide safe and effective pharmacotherapy and monitoring to animal patients as well as to humans. In 1761, the first college of veterinary medicine was established in Lyon, France (Larkin 2010); and from that time until the mid‐twentieth century, the preparation, dispensing, and monitoring of medicinal agents for animals were almost exclusively performed by veterinarians. In the late twentieth century, the practice of clinical pharmacy for human medicine was established, and veterinary professionals began to recognize the unique therapeutic contributions made by clinically trained Doctors of Pharmacy. Veterinary pharmacy, which is practiced by pharmacists, is unique from the field of veterinary pharmacology, which is practiced by veterinarians, because it encompasses a three‐pronged approach that utilizes medicinal chemistry, pharmacology, and species‐specific pharmacotherapeutics to evaluate the best action plan for a specific patient. Beginning with a handful of pharmacists interested in veterinary medicine, veterinary pharmacy has now evolved into a globally impactful specialty area of pharmacy practice and residency training programs and encompasses a broad spectrum of practice settings, including veterinary teaching hospitals, veterinary medical practices, community pharmacies, governmental agencies, and the pharmaceutical industry.

While most pharmacists are not trained as veterinary pharmacy specialists, most community pharmacists will encounter prescriptions for nonhuman patients in their practice. A survey of more than 13 000 licensed pharmacists in North Carolina revealed that 77% of respondents filled prescriptions for animal patients in their practice (Sorah et al. 2015). A similar survey of pharmacists in Oregon also revealed that 77% of respondents filled prescriptions for veterinary patients (Mingura 2017). Pharmacists are the only healthcare professionals expected by society – and legally permitted by regulatory authorities – to provide pharmaceutical care and drug products for all species. Yet despite this unique position, only 4% of pharmacy students who graduated in 2015 reported receiving any training in veterinary pharmacotherapy (Arnish et al. 2015). In fact, the pharmacy oath (Figure 1.1) does not distinguish between human patients and veterinary patients. Despite the lack of standardized education in veterinary pharmacy, a US Food and Drug Administration (FDA) guidance document released in 2015 estimated that 75 000 pharmacies fill 6 350 000 compounded prescriptions for animal patients annually (FDA 2015). It is important to note that this estimate was only for compounded veterinary prescriptions and did not account for the number of all prescriptions dispensed from pharmacies to animals. Because most pharmacists have not received adequate training in comparative pharmacology and veterinary pharmacotherapeutics, one would have to question whether pharmacists are fulfilling the oath's obligations when it comes to dispensing drugs to veterinary patients.

Figure 1.1 The pharmacist's oath.

Drugs that achieve desired therapeutic effects in humans do not always produce the same effects in nonhuman patients, and vice versa. Using the wrong drug or the wrong dose of medications in animals can result in therapeutic failure or serious adverse events. In addition, statutes, regulations, rules, and guidance for drug use in animals are significantly different from those for humans, particularly with respect to animal species whose tissues or milk may be consumed by humans. Consequently, there is a critical need for community pharmacists to understand basic comparative pharmacology principles, laws surrounding drug use in food animal species, and pharmacotherapy of common veterinary diseases in order to serve the needs of the pet‐owning public. There is an additional need for a designated veterinary pharmacy specialty to meet the unique needs of providing legally compliant pharmaceutical products, compounds, counseling, and monitoring of veterinary patients on an in‐patient basis, as well as serving as a resource for community pharmacists outside of the veterinary practice setting.

1.1.1 History

Historically, the role of pharmacists in veterinary medicine was limited to incidental compounding of medications and dispensing human‐approved prescription drugs for pets within the community pharmacy practice. Veterinary pharmacy, as an exclusive practice, originated in colleges of veterinary medicine in North America. In 1965, Laurence Reed Enos, PharmD, became the first veterinary pharmacist when he was hired by the University of California (UC) Davis School of Veterinary Medicine (Laurence Reed Enos, personal communication, May 9, 2011; Jeanne Enos, personal communication, June 13, 2016). Clinical pharmacy was just beginning in human medicine at that time, and Dr. Enos was hired to serve a clinical role providing pharmaceutical care for veterinary patients and to provide education in pharmacotherapeutic principles to veterinary students. He held administrative, teaching, and service roles within both the School of Veterinary Medicine and the College of Pharmacy during his 37 years of practice there. His philosophy was to develop a strong clinical program in veterinary pharmacy that emphasized teaching, research, and therapeutics. In 1968, Faye Kernan, BSP, MTS, became Canada's first veterinary pharmacist, hired by the Western College of Veterinary Medicine at the University of Saskatchewan (Faye Kernan, personal communication, May 9, 2011). Like her US counterpart at UC Davis, Ms. Kernan established a model for veterinary pharmacy practice and earned tremendous respect from her veterinarian and pharmacist peers. Fifty years later, Kernan remains an active and vital contributor to veterinary pharmacy practice. Several other veterinary schools followed suit in hiring pharmacists in the late 1970s and early 1980s, and today all but one of the veterinary schools in the USA and Canada employ at least one pharmacist in a faculty, administrative, or professional staff position. In 1982, a group of veterinary pharmacists, including Kernan, met in Lincoln, Nebraska, to establish the Society of Veterinary Hospital Pharmacists (), the first professional organization representing veterinary pharmacists. The organization has steadily grown and now hosts more than 165 veterinary pharmacist members practicing throughout the world. In 1989, the Auburn University College of Veterinary Medicine and College of Pharmacy collaborated to create the first veterinary pharmacy residency program, and selected Dr. Bobbi Anglin as the first veterinary pharmacy resident (Dr. Sue Duran, personal communication, Auburn University College of Veterinary Medicine, March 19, 2017). Since then, UC Davis, North Carolina State University, Purdue University, and the University of Wisconsin have all established veterinary pharmacy residency training programs, producing many residency‐trained veterinary pharmacists. Compared to their humble beginnings in 1965, today’s veterinary pharmacists provide a significant and positive impact on animal healthcare.

1.2 Veterinary Pharmacy Professional Organizations

1.2.1 Society of Veterinary Hospital Pharmacists

The SVHP is an organization of pharmacists who work exclusively in the veterinary field, primarily at veterinary teaching hospitals in colleges of veterinary medicine (see www.svhp.org). Membership is international; the USA, Canada, the Netherlands, Denmark, South Africa, Australia, Spain, Austria, and New Zealand are currently represented. The SVHP membership meets annually to participate in the Accreditation Council for Pharmacy Education () and...