June 18th, 2011
Medication administration: Doing it right
We often get prescriptions from our physicians or our veterinarian with directions for use. However, a big problem with both human and veterinary medicine is medication compliance. What is compliance?
It is the use of the medication as it was directed. This refers to using the right amount of the medication at the right time intervals. This article will focus on veterinary medication compliance, but some of the same questions can be asked of your physician when getting prescriptions filled.
Why is your pet being prescribed the drug?
One of the major reasons that medications are prescribed is to treat a disease or prevent disease by giving that medication. The biggest concern with compliance is correct prevention or treatment of that disease. One medication that if given correctly prevents disease by 99.9% is heartworm preventative. However, heartworm disease is very common in most states due to lack of compliance with medication. You may even want to ask what would happen if you did not use the medication and find out the cost of treatment if the disease is not prevented.
Before you buy or accept a medication, you should understand as best you are able, why your pet is on that specific medication. Get the veterinarian or a technical person in the office to explain to you why you are using this medication and how it relates to your pet’s condition. This may help you be motivated to make sure that your pet receives the medication as prescribed.
Dose the right amount and in the right way.
Carefully read the label and make sure that you understand the amount of the medication to give in number of pills or amount of fluid. If you need a measured amount for liquids, ask for a syringe for dosing oral liquid medications if the veterinarian does not give you one.
Before you take the prescription, make sure you understand the type of dosing: by mouth, in the eye or ear, or on the skin. Most oral medications (by mouth) will be given with food. This helps to prevent may of the side effects that may be seen. Vomiting is one of the most common.
Why do I need to give the medication every 8, 12 or 24 hours instead of when it is more convenient to give it when I normally feed my pet?
The most common problems with treating a disease is making sure that the dose of medication is given at the right time. Without the right dosing schedule, most medications will not work appropriately. This means that the medication may not treat the disease or that it may actually cause the pet to get ill if not dosed properly. If you cannot dose the medication as the veterinarian has prescribed, you should ask if another medication can be used.
Unfortunately, the best and most economical medication will be often prescribed for your pet at the time of diagnosis or the visit. It is better receive a slightly less effective medication or one that is more expensive than a medication that you will not be able to dose properly and consistently. This may result in a prescription for a more expensive medication. However, the cost of the medication (even if it is 2 or 3 times the cost of the original) is less than 2 or 3 additional office visits with diagnostic testing because of relapse due lack of compliance; i.e. not dosing the medication as directed.
When medications are not given as they are directed, treatment failure or lack of control of symptoms are common. If you cannot give the medication, hospitalization may also be another option to get things started and decrease the risk of relapse. If dosing is necessary very frequently (6 to 10 times a day), with a dangerous medication to humans or intravenously (I.V.), most veterinarians will hospitalize the patient to provide the best care. You can always ask about this option for the start of treatment if you cannot treat your pet easily at home.
My mantra with medication: the best medication is the one the patient will take!
Now that the medication and treatment has been set, what else can happen?
My cat or dog will not take pills or cannot take a liquid formulation.
If you know that your cat or dog cannot take a certain formulation or that sides effects were bad after a previous medication, then tell the veterinarian or a staff member during the visit. Often many drugs come in pill, capsule and/or liquid forms. If these are not available at the veterinary office, the veterinarian can call in a prescription for the pet at a pharmacy in the area where you can pick up the medication in a form that your pet can take. Although this is inconvenient to have to drive to the pharmacy, you normally have to do this for your own prescriptions.
Secondly, if a pet has had a previous reaction (vomiting, diarrhea or an allergic reaction) to a medication, that reaction may reoccur if the pet is put back on the medication. Tell the staff or veterinarian about the symptoms that have occurred before. If you are very concerned request a different medication.
My pet is having side effects such as vomiting and cannot take the rest of the medication. We are midway through a prescription. What do I do?
If you find out part of the way through a course of antibiotics or other medication that you cannot treat your pet, call your veterinarian immediately and tell him/her. The veterinarian can likely prescribe an alternate medication that will help you treat the condition. If the symptoms do not improve, another medical condition may be causing the problem.
One thing I have noted is that clients often stop treatment when a side effect occurs. This is not a problem. The major problem is that they never call the veterinarian office to let us know. If you just stop treatment, the condition may reoccur or a more difficult treatment regimen may be necessary in the future. Let your veterinarian know as soon as possible when a problem arises. I have seen pets require hospitalization when the medication was stopped for a few days. This will cost a lot more than a new prescription or a quick office visit to chart the recovery process. If you notice illness, you should go ahead and schedule the appointment because the longer you wait the more expensive the treatment tends to be.
What is the big deal about stopping the treatment a few days early? My pet took half or more of the medication.
The problem with stopping the treatment early is dependent upon what the initial problem was.
If it is a small skin laceration, there is usually less risk than with an eye or ear infection that needs topical medication. With systemic medications (given by mouth), follow up visits are very important.
One common side effect of antibiotic treatment ended early is development of resistance to the antibiotic. This is a huge problem in medicine in general. Therefore, if an antibiotic is prescribed, give it until it is gone or until the follow up visit to make sure that the condition is improving. If a recurrence is seen, call back immediately, as an extension on the antibiotic or a switch of medication may be necessary.
If this is chronic condition, such as heart disease, stopping the treatment may result in the relapse of symptoms or fast progression of the disease. With chronic conditions, this is often a problem and can cause the full disease process to result more quickly. Many medications are used to both prevent and treat development of symptoms and slow the disease progression. Without the medications, the disease process will often occur much more quickly.
Why do I need a follow up visit?
Finally, there is often a follow up visit scheduled around the time that the medication runs out for simple treatments or after a few weeks for chronic problems to check on progress. This visit is important to make sure that things are going well with your pet. Other reasons for follow up visits are to monitor the medication levels or to check enzyme levels in the blood.
For chronic problems, this is a key visit as it is used to correct anything before the disease process has time to get out of hand from your initial visit. This follow up is essential for the following conditions that we see commonly: urinary tract infections, ear or eye infections, thyroid disease, whole body skin infections, and medications given for seizure disorders.
Finally some miscellaneous concerns on called in prescriptions and costs.
Unfortunately, veterinary costs are often based on disposable income and many problems seem to crop up when we can least afford them.
Use your best judgment, but here are my suggestions.
1. Be upfront about money.
I can tell you that I am not always happy with the limits, but I can better choose how to proceed and stay within the constraints placed upon the care. This also lets me decide what tests have to be run today and what can wait until later. It is better to know that I have only $200 to work with upfront than to spend $200 on diagnostics and the owner cannot purchase any medications that are needed.
2. If you cannot afford all of the medications at one time, tell the veterinarian and only get the most important one(s).
I believe that clients should be as educated about what is going on with their pets as possible. If your veterinarian educates you about medications and why, it is often easier to determine what to purchase and he/she should be upfront about this.
3. If prescriptions are called into a pharmacy, pick them up.
Sometimes medications are not available in the veterinary hospital. If the doctor bothers to prescribe the medication, you should try to get all of the medications. However, you should understand which medications are the most important because the one that was called in may be more important than any that you can purchase from the clinic.
4. If the pharmacy prescriptions are cheaper, have them called into the pharmacy.
If money is tight and we can call in a generic prescription to a pharmacy, assuming they carry the right size, most clinics are okay doing this. However, veterinarians do worry that you may not pick up the medication if you do not get it at the clinic.
S. Mason, DVM