Essay: Principles Determining the Prescription and Supply of Veterinary Medicine

Worms are one of the most common problems veterinarians are likely to encounter in dogs. They comprise a significant portion of the disease burden in dogs in the United Kingdom, Europe and the world at large. Although dogs of any age are likely to carry them, worms are a particular health burden in puppies, dogs whose lifestyles predispose them to inevitable exposure, dogs with concomitant health problems causing significant immunity deficiencies and dogs living in squalid or substandard conditions (ESCCAP, 2017). There are a variety of worm species that are likely to affect dogs. While the greatest concern of most dog owners is intestinal worms, there are several potentially lethal non-intestinal worm types like the heartworm and lungworm (Traversa, 2010). In dealing with the problem of worms in dogs, therefore, it is important to be able to proactively deal with them through ways like a regular deworming schedule and also be able accurately diagnose and correctly treat them (Yeadon, 2010). The value of diagnosis and treatment, however, can be greatly enhanced through the identification and appreciation of the risk factors most commonly associated with worm infestation. Studies have identified being less than 2 years old, male gender and residence in either urban locality or a low-income neighborhood or both as some of the most important risk factors in the development of endoparasites. Veterinaries should therefore regard dogs with these risk factors with a high index of suspicion and subject them to routine diagnostic tests (Gates and Nolan, 2009).

Apply legal principles affecting prescription and supply of veterinary medicines. (including SQP)When it comes to the treatment of worms in dogs, it is important first of all that the dog is seen by a qualified animal health specialist, in this case, a suitably qualified person (SQP). According to the Veterinary Medicines Regulations (VMR), a suitably qualified person refers to a legal class of suitably professionally trained individuals who are entitled to prescribe and/or supply certain special classes of veterinary drugs (AMTRA, 2017). The classes of veterinary medication available to the SQPs to prescribe include the following: Prescription Only Medicines - Veterinary, Pharmacy SQP (POM-VPS), Non-Food Animal-Veterinary, Pharmacist, SQP medication (NFA-VPS) and Authorized Veterinary Medicine-General Sale List(AVM-GSL). The SQP is, however, not authorized to prescribe and/or supply POM-Vs which are the preserve of veterinarians (Wilder, 2006).

The SQP is charged with the responsibility to ensure that the statutory requirements relating to the prescription and/or supply of the medication they are entitled to handle are respected. The SQP qualification in the United Kingdom is a level four qualification - a level above that of the veterinarian nurse (Ackerman, 2013). The qualification requires that an individual have competencies that enable them to apply knowledge across a broad spectrum of complex technical and professional activities and allows them a substantial level of personal responsibility and autonomy. It is necessary, however, that nurses in small animal facilities have the SQP qualification to be able to prescribe the suitable medication for animals. This is particularly relevant for dogs seeing as most of the medication prescribed to dogs, especially antihelminthics, belong either to the POM-VPS or the NFA-VPS, classes which SQPs are allowed to control over. Veterinary nurses are however not automatically accredited as SQPs upon completion of the nursing course. The SQP qualification falls under the regulation of the Animal Medicines Training Regulatory Authority (AMTRA) (AMTRA, 2017). For a veterinary nurse to become an SQP, they would be allowed to take a few extra units and sit a level four examination.

Critically evaluate the choice of deworming product in this animal, relating this to the history and information required prior to dispensing medication, referring to relevant legislation where appropriate.

In the case of the 4-month-old Border Collie puppy, the medicines stocked by the practice are Panacur Oral Paste and Milbemax Tablets for dogs. Panacur Oral paste is in the NFA class of veterinary medicine and can therefore only be prescribed by either a veterinary, pharmacist or SQP (Nind and Mosedale, 2016). Milbemax tablets, on the other hand, are prescription only medicine-veterinary and, therefore, can only prescribed and/or supplied by a veterinary. The veterinary nurse on duty is a registered SQP and is therefore entitled to prescribe Panacur Oral Paste. However, the prescription and dispensation of medication are also dependent on additional factors including their suitability of the medication as determined by the presenting history of the puppy and the legislative requirements governing the practice.

The choice of the drug to be used in the treatment of a dog is dependent on a few factors; the most important being the suitability of the drug. The suitability of the drug is confirmed by making a correct diagnosis of the condition of the dog based on the history presented. In the case of worms, one needs to first confirm the infestation by looking out for some common signs and symptoms of some of the common worm infestation of dogs, particularly puppies, in the country. Some of the common worms known to affect dogs include the roundworm, tapeworm, heartworm, and whipworms (Lewis, 2009). Most of the worms are transmitted through ingestion of eggs, and a good number of them do not cause overt manifestations in adult dogs. A significant worm burden in young puppies, however, has been known to cause marked morbidity and even mortality. It is, therefore crucial that the diagnosis is made correctly and the appropriate medication administered. Some of the common manifestations of worm infestation on the health of the puppy include-: diarrhoea, weight loss, anaemia, subcutaneous manifestations, anorexia and respiratory manifestations including coughing and exercise intolerance (ESSCAP, 2017). Some worms can cause fatal anaemia in Border Collie puppies.

Symptomatic animals should undergo physical tests and lab examinations aimed at identifying the specific type of worm causing the symptoms. Some of the common diagnostic procedures utilised for worms include stool examinations to detect either larvae, eggs or adult worms in stool and microfilariae and/or antibody detection in the blood of symptomatic animals (Ferrasin and Venco, 2016). Stool for worm examination should be collected freshly as opposed to collecting it in the kernel or around the house or compound. It is important to remember that diagnosis has both quantitative and qualitative value, both of which have a significant bearing on the course of treatment of the dog or puppy (Traversa, 2012). The diagnostic procedure also helps enumerate or provide an estimate for the worm burden in the dog, therefore, guiding the necessary intervention measures available to the veterinarian or SQP.

After successful identification of the worm species present in the body of the dog, the SQP is then required to critically evaluate the choice of deworming medication to be used from among the available medications. This process takes into account first the condition of the dog including its age, weight, and identity of the offending agent and also the properties of the drug. The drug properties refer to both its pharmacokinetics and pharmacodynamics (Cunningham et al., 2009). The pharmacokinetics of the drug take into account the reactions that the drug undergoes and are crucial in determining the route of administration and the packaging mechanism to be utilised in delivering the drug. Pharmacokinetics also takes into consideration useful therapeutic parameters including the bioavailability of the drug and its mode of elimination which are also crucial in guiding the therapeutic regime chosen. Pharmacodynamics on the other hand crucially gives information on the spectrum of the drug including the species of worms it covers and also anticipates possible adverse events to be encountered upon the administration of the drug chosen (Cunningham et al., 2009). In this case, the SQP would be required to use the properties of the drugs available, Panacur Oral Paste and Milbemax Tablets, to come up with the correct choice for this particular case

MilbemaxMilbemax tablets are a broad spectrum anthelminthic comprising milbemycin oxime and praziquantel. It is indicated in small dogs and puppies for the treatment of mixed cestode and nematode infestations. It covers Dipylidium caninum, Taenia spp., Echinococcus spp., Mesocestoides spp, Toxocara Canis, Toxascaris leonina, Ancylostoma caninum, Trichuris vulpis (Noah, 2017). It has also found use in the prevention of heartworm disease where it has been prescribed for concomitant helminths (Guerrero et al., 2009). The recommended dosages of the drug are 5mg of praziquantel and 0.5mg of milbemycin oxime administered orally as a single dose. The drug is best administered during or after feeding. The dosing is dependent on the weight of the dog, and it is contraindicated for dogs weighing less than 0.5kilograms (Jung, et al., 2009).

Weight Milbemax tablets for puppies Milbemax tablets for big dogs

>0.5kg-1kg Half a tablet >1kg-5kg On tablet >5kg-10kg Two tablets One tablet

>5kg-25kg One tablet

>25-50kg Two tablets

>50-75kg Three tablets

Table of practical dosage recommendations for the drug (Defra, 2016)Studies support the use of Milbemycin in small doses in Collies breeds for heartworm prevention (Guerrero, et al., 2009). They, however, also show that the margin of safety of the doses used in the treatment of helminth infestation in some Collies and related breeds is significantly lower than that in other breeds. Collies and related breeds have a mutation in their MDR-1 gene that causes a change in the configuration of their blood-brain barrier and makes it much more permeable to macrocyclic lactones like Milbemycin oxime (Tappin et al., 2012). These lactones cause significant adverse effects in the event slightly higher than usual doses are used. There is therefore great need to make the dosing as accurate as possible. The propensity of Milbemax to cause adverse effects in Collie breeds including Border Collies necessitates the use of other available suitably efficacious anthelminthic medication before prescribing them.

Panacur Oral Paste

Panacur 18.75% Oral Paste is a broad spectrum anthelminthic whose active component Fenbendazole is found in a concentration of 18.75%. Panacur is used in the treatment of immature and mature forms of helminths in cats and dogs. The drug also has an ovicidal effect against the nematode eggs. The drug has activity against both respiratory and intestinal nematodes. The drug is particularly useful in the treatment of puppies with gastrointestinal nematodes and also has been demonstrated to be efficacious in the treatment of protozoa. Other helminths covered by the drug include Ancylostoma spp, Ascarid spp, Trichuris spp and Taenia spp (NOAH, 2017). An advantage of the Panacur Oral paste over Milbemax is in the spectrum of helminths it covers. The drug is suitable for use against most common worm infestations in the country except for the heartworm. Therefore, in the absence symptomatology suggesting heartworm infection and the absence of risk of contracting the infection, the SQP should choose this drug over Milbemax for the Border Collie puppy.

Explain how the selected product should be packaged and labelled for dispe...