Pepper Ponies Up

No other equine ponies up like Pepper, the 32-year-old Shetland pony belonging to Janet Varhus, DVM, and family. Upon adoption many years ago, Pepper’s outlook was short and bleak.

 

But with great veterinary care via Doc Varhus and Animal Care Center of Poncha Springs, Colorado– along with a heaping dose of stubbornness — Pepper is still kicking up a fuss and using reverse psychology on Varhus and family like an obstinate teenager. In addition to the stem-cell therapy that has resolved this pony’s laminitis, Pepper takes compounded pergolide seasonally, tailor made by Monument Pharmacy.

 

Pepper also gives back to the community, sharing a little love with older adults in the Poncha Springs area. So this pony is not always tapping its inner stubborn mule (just most of the time). Go, Pepper, go! You’re a treasure.

 

pepper-getting-a-treatment

Pepper getting a treatment (pic via @animalcareponcha Facebook page)

 

 

pepper-giving-free-love

Pepper giving free love (pic via @animalcareponcha Facebook page)

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Health Issues & Medications for Guinea Pigs

GP

 

According to AVMA’s 2012 U.S. Pet Ownership & Demographic Sourcebook, guinea pigs are the second most popular small mammal pet; approximately 847,400 US households reported having at least one (hamsters were #1 with 877,000 households).  Guinea pigs, or ‘cavies’ as they are also known, are popular pets because of their friendly and unique personalities, they are long-lived (by rodent standards), and they are fairly easy to care for, making them excellent pets for older children.

 

Guinea pigs were originally domesticated as far back as 5000 BC by the Incas in the South American Andes; they were most likely used as food, but they also to this day hold a hallowed place in indigenous folklore and rituals.  Their docility and adorable portly form were most likely due to generations of breeding for the table; European sailors returned to England in the 1600s with a few specimens where they became popular pets with aristocrats. In the early 1900s, British immigrants brought them to the US.1

 

Cavia Porcellus’ wild relatives live in the cool mountains on grassy plains in abandoned burrows or tunnels formed by vegetation in family groups of up to 10 animals consisting of several females, one male, and offspring.  They eat a diet of wild grass and other vegetation, and are most active during dawn and dusk.2 As a result of their ancestry, modern guinea pigs have specific dietary and habitat requirements to stay healthy and happy.  Illness or injury due to malnutrition or unclean habitat is the most common causes of guinea pigs presenting for a veterinary visit.

 

Nutrition
Feeding guinea pigs a proper diet is extremely important.  Owners should provide continuous access to hay as it is imperative for their digestion and dental health.  Guinea pigs’ incisors grow continuously; their teeth can easily overgrow without access to hard fiber to wear down the teeth.3 Commercial pellet food specific for guinea pigs should be the primary food source, with the addition of fresh produce for enrichment.

 

A major dietary consideration is adequate intake of vitamin C.  Guinea pigs are not capable of manufacturing vitamin C on their own, so supplementation is required.  Good dietary sources (“treats”) of Vitamin C for guinea pigs include red or green peppers, tomatoes, spinach, and asparagus. 4   Most commercial foods are supplemented, but exposure to air, humidity, heat, and light quickly cause oxidation and loss.3,4   Monument Pharmacy can easily special order Oxbow brand vitamin C supplements made specifically for guinea pigs, and conveniently ship them directly to the pet owner.  A standard daily maintenance dose of vitamin C for guinea pigs is 10mg/kg (30mg/kg if pregnant). 4

 

If an owner brings in a guinea pig showing signs of diarrhea, alopecia, or joint pain, or the animal appears thin or unkempt, vitamin C deficiency should be considered. Petechia on mucous membranes are not always visible, though hematuria may be present.4

 

Additional nutritional problems in guinea pigs include metastatic calcification, which usually presents in animals over 1 year of age as muscle stiffness and failure to thrive.  Mineral deposition is caused by low-magnesium and high-phosphorus diet, and high calcium and/or high vitamin D intake.  The availability of commercially made, high-quality, guinea-pig specific diets has reduced the incidence seen in laboratory colonies.  Muscular dystrophy of skeletal muscle or myocardium is associated with a vitamin E/selenium deficiency, and unfortunately is often asymptomatic.  Owner education on proper nutrition and selection of a high-quality diet is important to ensure guinea pig health. 4

 

Habitat
Guinea pig cages should have a hard floor and be at a minimum two by three feet (many cages at pets stores marketed for guinea pigs are not big enough!). Wire mesh walls ensure proper ventilation.  Cavies also require a box or shelter to hide in.  Paper pulp is preferred for bedding as it is absorbent, dust-free, and widely available.  Bedding should be changed every few days to prevent accumulation of wastes, and the cage itself should be cleaned out weekly with diluted soap and water.  Water bottles should be washed daily to minimize bacterial growth.  As their wild ancestors are from the high mountains, cavies prefer cooler temperatures and can overheat easily in hot, humid weather.  Guinea pigs tend to be social animals and thrive in groups of two or more (usually multiple females, or a neutered male and females), and live on average 5-7 years. 3,4

 

In habitats with wire or abrasive floors and poor sanitation, chronic dermatitis (especially of the forepaws) may occur.  Straw and awns (husks) in the bedding can cause foot punctures, exacerbating symptoms and risk of infection.  Symptoms include swelling and hair loss of the feet, with ulcers and scabs on the plantar surface. Staph aureaus is the usual pathogen. Topical or parenteral antibiotic therapy may be warranted, but is not always successful. 4

 

Special considerations
Guinea pigs are generally healthy pets, but can be prone to upper respiratory infections.  They should not be housed with rabbits, cats or dogs due to risk of physical harm and transmission of disease.  If a guinea pig presents with oral abrasions, unilateral swellings in the neck, sneezing, dyspnea, wheezy breathing, nasal discharge, coughing, or conjunctivitis, infection is likely.  Streptococcus equi, Streptococcus pneumoniae, B bronchiseptica (usually observed secondary to exposure to rabbits), and Chlamydia caviae are frequently encountered pathogens. 4

 

Salmonella infections were historically common in guinea pig colonies due to contaminated feed, but is rarely encountered now due to improved husbandry standards and quality feeds.  Diarrhea is rarely present, and clinical signs include fever, lethargy, anorexia, rough fur, and conjunctivitis.4

 

Guinea pigs are also affected by parasites including lice and sarcoptid mites, which cause Mange; signs of infestation include intense pruitus, and alopecia.  Parenteral ivermectin is frequently recommended for treatment along with a dermal treatment. 4,5

 

Dermatophytosis (tinea or ringworm) is common in guinea pigs, and usually presents as broken hairs with circular, scaly alopecia starting at the tip of the nose, spreading to the forehead and pinnal areas.  High temperature and humidity may contribute to a more severe infection, and treatment is recommended to minimize spread to other animals and humans. Curing the infection in the pet while simultaneously decontaminating the environment is highly recommended. Environmental control should be performed every 14 days with chlorine bleach dilutions, and systemic therapy of itraconazole or terbinafine with or without topical treatment for 4-8 weeks. Often, infections require 2 to 3 months of therapy. 4,5

 

Guinea pigs are LETHALLY sensitive to antibiotic therapy.  Oral and topical therapeutic agents reported to cause enterotoxemia include penicillin, ampicillin, bacitracin, erythromycin, spiramycin, streptomycin, lincomycin, clindamycin, vancomycin, and tetracyclineTrimethoprim-sulfamethoxazole, chloramphenicol, and enrofloxacin are considered safe to use in guinea pigs.  Narrow-spectrum antibiotics with activity against gram-positive bacteria should be avoided; they are lethal as they destroy gram-positive flora, which allows overgrowth of gram-negative flora and leads to bacteremia/septicemia.

 

When well cared for and properly fed, guinea pigs are generally very healthy animals.  They are robust and long-lived by rodent standards and require little care, thus making great pets for children.  Their unique personalities and vocalizations make them cherished animal companions.  In the unusual event of illness, Monument Pharmacy is here and ready to compound many prescription medications for cavies in a customized dose and a variety of palatable oral suspensions.  Currently available agents include:

 

  • Azithromycin
  • Chloramphenicol palmitate
  • Ciprofloxacin
  • Doxycycline
  • Enrofloxacin
  • Trimethoprim-sulfamethoxazole
  • Itraconazole
  • Ivermectin
  • Metronidazole
  • Terbinafine
  • Oxbow Vitamin C Supplement (commercial)

 

References

  1. Morales, Edmundo. The Guinea Pig: Healing, Food, and Ritual in the Andes. University of Arizona Press, 1995.
  2. Wagner, Joseph E.; Manning, Patrick J.The Biology of the Guinea Pig. Academic Press, 1976.
  3. Alexander, Lyssa DVM. Tips for Keeping Guinea Pigs Happy and Healthy. The Ann Arbor News: 14 January, 2011. accessed online http://www.annarbor.com/pets/ask-the-veterinarian-guinea-pig-guide/
  4. Kahn, Cynthia, et al. The Merck Veterinary Manual (10th Edition). Whitehouse Station, NJ:  Merck & Co, Inc., 2010
  5. Plumb, Donald C. Plumb’s Veterinary Drug Handbook, 10th Ed. Stockholm, WI: Pharmavet, Inc., 2008

 

 

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Holiday Pet Hazards

Dog Candy

The ASPCA Animal Poison Control Center (APCC) in Urbana, Illinois handles over 167,000 cases of pets exposed to possibly poisonous substances every year.1 As we approach the holiday season, it is important to remember many of the seasonal traditions we enjoy offer a deadly temptation to pets. Many households will have guests who may not be familiar with items that can pose dangers to pets. Holiday baking will increase the opportunity for counter-surfing canines or felines to sneak a potentially harmful treat. Decorative plants, flowers, and ornaments, while beautiful by human standards, may offer a deadly fascination to a pet. Sidewalk de-icer can be particularly troublesome to dogs who will walk over it and then lick it off their paws. Owners must be aware of common household items that come out during the holidays that can be toxic to animal companions, and what do to in case of an exposure!

 

If cousin Eddie is staying for the holidays, make sure he knows not to leave his heart medication out! Human prescription and OTC medications are the most commonly reported pet poisoning. As these are some of the most commonly prescribed medications for human patients, it is not surprising that cardiac medications, antidepressants, and pain medications (opioids and NSAIDS) are the top culprits in pet poisonings. Many exposures occur when a dose falls on the floor and the family dog or cat, thinking it is a treat, rushes to gobble it up off the floor. Other commonly ingested medications include acetaminophen, ibuprofen and naproxen, and herbal and nutraceutical products (fish oil, joint supplements). Many of these products are tasty to pets, and some can be life threatening if ingested.

 

Unfortunately, the recent change in legal status of marijuana in many states has caused the number of poisoned pets to skyrocket. If a client is travelling to or expecting visitors from a state where marijuana is legal, ensure all drug products are kept strictly out of reach of pets (and children as well!). One veterinarian in Colorado reports treating at least 2 cases weekly where a pet has ingested medical marijuana in a “edible” form. Ingestion of Cannabis sativa by companion animals can result in CNS depression, tachycardia, hypothermia, and ataxia, as well as vomiting, diarrhea, drooling, increased heart rate, and even seizures and coma. Emetics are of limited effectiveness due to the antiemetic effect of THC. The reported lethal dose for dogs is over 3g per kg of body weight.2

 

During this time of year, many households also have extra sweet treats in the home. Chocolate is the most common toxic treat that is reported to the ASPCA. Although dogs are most often the culprits, cats are at risk as well. Methylxanthines (theobromine) and caffeine in the chocolate are rapidly absorbed from the GI tract and metabolized in the liver. They undergo enteroheptaic recycling, thus staying in the body fur up to 72 hours in severe cases. Clinical signs usually occur within 6 to 12 hours of ingestion and begin with polydipsia, vomitting, diarrhea, and restlessness. As the toxicosis progresses, hyperactivity, ataxia, tremors, hyperthermia, arrhythmias, and seizures can occur. In general the darker the chocolate, the higher the methylxanthine and caffeine content. One ounce of milk chocolate per pound of body weight is a potentially lethal dose in dogs. If an animal is presented within 1 hour of ingestion, decontamination is recommended. Induction of emesis using apomorphne or hydrogen peroxide should be considered. 2

 

For people utilizing low-calorie and sugar-free sweets and beverages, owners need to be sure the food does not contain xylitol, an artificial sweetener, prior to sharing the treat with canines. In most mammals, xylitol has not significant effect on insulin levels. In canines, however, it stimulates a rapid release of insulin that causes extreme hypoglycemia. Induction of emesis should only be attempted in the clinic setting in asymptomatic animals.2

 

There are many other foods that are toxic to animal companions. While this list is by no means comprehensive, these items are frequently encountered in the kitchen!2

  • Allium sp. (onions, garlic): organosulfoxide compounds in allium species cause hemolytic anemia in dogs and cats. s.       Clinical signs develop after several days (but may appear after one day if a large quantity was consumed) including depression, hemoglobinuria, icterus, tachypnea, tachycardia, exercise intolerance, cold sensitivity, inappetence, abdominal pain, or diarrhea4
  • Grapes, raisins: ingestion results in anuric renal failure in some dogs, cats, and ferrets (unknown mechanism)
  • raw, yeast-risen bread dough: yeast in bread dough ferments readily in the stomach, causing gastric distension. Ethanol, a byproduct of yeast fermentation, is rapidly absorbed, causing inebriation and metabolic acidosis
  • Macadamia nuts: ingestion associated with nonfatal syndrome (unknown mechanism) of vomiting, ataxia, hyperthermia, and depression. Dogs are the only species in which this has been reported. Symptoms usually resolve without treatment within 48 hours.
  • Fatty foods: when large amounts of fat are ingested, vomiting and diarrhea often occur. Pancreatitis often follows, especially in certain breeds such as miniature schnauzers, Shetland sheepdogs, and Yorkshire terriers

 

Besides food, many holiday traditions include decorative plants. In 2012, over 7000 cases of pet poisonings due to ingestion of household plants were reported to the ASPCA Poison Control Center. This is one category where felines were the most common patient (rather than canines). A list of common plants used for decoration or as holiday gifts is below

  • Crysanthemum
  • Cyclamen
  • Holly
  • Hyacinth & Amaryllis
  • Kalanchoe
  • Mistletoe
  • Poinsettia
  • Tulip/Narcissus (bulbs only!)
  • Yew

 

Although evergreen trees are not usually considered dangerous if nibbled on by companion animals, many felines (and even a few canines) have a fatal fascination with the shiny ribbon, tinsel, ornaments, and electric cords that are on the Christmas tree! In addition to the danger of knocking over the entire decorated tree, if these items are ingested they often end up having to be surgically removed from the digestive tract.

 

Other seasonal dangers around the house include antifreeze (ethylene glycol), ice-melting chemicals, and rodenticides. Owners need to be reminded to keep their antifreeze out of reach of pets and children, and clean up any spills immediately. It has an appealing, sweet taste to canines; as little as 1.4ml/kg in cats or 4.4ml/kg in dogs is lethal. Ethylene glycol causes severe metabolic acidosis and renal damage, with peak blood concentrations occurring within 3 short hours of ingestion. Another product encountered in colder weather is ice-melt. This product, intended for application to walkways or driveways, contains sodium chloride, potassium chloride, magnesium chloride, or calcium chloride. Calcium salts are the most hazardous for pets as they can cause severe GI as well as dermal irritation. Urea-based ice melt products are generally labeled as “safe” for use around pets as exposure usually leads to mild GI irritation. All types of ice melts have the potential to be hazardous, with exposure or ingestions resulting in GI irritation and local dermal irritation. It is important that owners are educated on the potential risks of exposure and proper storage and use of these items. During winter weather rodents are more frequently encountered inside homes, which increases utilization of rodenticides. The most commonly available rodenticides to the lay public are anticoagulants that inhibit the enzyme vitamin k epoxide reductase, essentially deactivating the blood’s ability to clot. Usually exposure occurs when a pet ingests the poison directly, or pet food is contaminated due to improper storage of the poison. Treatment with Vitamin K1 is antidotal, with treatment generally necessary for 3 to 4 weeks based on prothrombin time. 2,3

 

With all the excitement and activity during the holiday season, it is important for pet owners to consider the health and safety of their animal companions when choosing decorative plants and treats to have in the home. It is also important for owners to ensure their guests are aware of their personal items and medications to keep them out of reach of the furry household members. In the unfortunate event of a poisoning, Monument Pharmacy does compound apomorphine in tablets for ophthalmic administration.

 

For prescribers and their patients, quality means accuracy, consistency, professionalism and service. At Monument Pharmacy, our licensed pharmacists and certified technicians prepare all of our compounded products with the utmost attention to detail regarding purity, potency, and consistency. All ingredients are sourced from FDA-licensed suppliers and compounded prescriptions are prepared according to exacting federal and Colorado state standards.

 

Most orders for compounded medications received prior to 3pm Mountain can be shipped out the same business day. When you call toll-free 1-800-595-7565 (local 719-481-2209), you will always reach one of our friendly customer care specialists in person, right here in Monument, Colorado. We have competitive pricing and will beat others’ compound prices by 10%. Just let us know what you’re quoted or paying elsewhere. As an added value, we are able to ship many prescriptions via USPS first-class mail at no charge. Our goal is for your service to be second to none; in fact, you’re satisfaction is guaranteed! You can count on us to exceed your expectations. Feel free to contact us for details.

 

 

REFERENCES

  1. 10 Most Common Pet Toxins of 2014. ASPCA 15 April 2015. Web. Accessed 20 October 2015.
  2. Kahn, Cynthia, et al. The Merck Veterinary Manual (10th Edition). Whitehouse Station, NJ: Merck & Co, Inc. 2010
  3. Plumb, Donald C. Plumb’s Veterinary Drug Handbook, 10th Ed. Stockholm, WI: Pharmavet, Inc., 2008
  4. Burrows GE, Tyrl RJ. Liliaceae Juss.Toxic plants of North America. Ames: Iowa State Press, 2001;751-805.
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Geriatric Pet Health Issues & Medications, Part 2

As pets age they are more susceptible to certain conditions that can decrease longevity and diminish the quality of life.  Careful owner observation and regular office exams are critical to detect conditions of aging while they are more easily manageable. If caught early in disease progression, there is a good chance nutritional and pharmaceutical intervention can significantly decrease morbidity.  In our previous post, the effects of aging on the musculoskeletal, cardiovascular, renal, and urinary systems were discussed. To append, this month the increased incidence of ophthalmic issues, endocrine dysfunction, and cancer3 in the geriatric canine and feline will be discussed, as well as available treatments.

 

 Older Cat

Ophthalmic Issues

Many senior cats and dogs develop cataracts as a result of UV exposure (which is greater in high altitude states!), the presence of underlying illnesses such as diabetes10, exposure to radiation (cancer treatment), and possibly even chronic exposure to certain medications like ketoconazole (according to a 1996 study by Paul Da Costa).  Unfortunately there is very little that can be done to treat cataracts; depending on the severity, surgical invervention may be warranted.

Keratoconjunctivitis sicca (KCS) and pannus also increase in frequency for elderly pets, especially in certain canine breeds.3  Dry Eye is frequently treated successfully using anti-inflammatory eye drops.5  In felines, Feline Herpes Virus is a common cause of conjunctivitis and should be ruled out, especially if the patient is a younger feline with concurrent upper respiratory symptoms. The following compounded preparations are commonly requested from Monument Pharmacy to aid in the treatment of companion animal ophthalmic issues: 4,5

 

  • Cyclosporine- ophthalmic drop in corn, olive, or MCT oil; ophthalmic ointment
  • Idoxuridine- ophthalmic ointment
  • Tacrolimus- ophthalmic drop in corn, olive, or MCT oil; ophthalmic ointment
  • Prednisolone- ophthalmic ointment
  • Tetracycline- ophthalmic ointment

 

Endocrine dysfunction

The incidence of endocrine dysfunction in aging pets is skyrocketing, especially hyperthyroidism in felines. It is estimated that over 10% of felines over the age of 10 will develop this condition.  The reason for this sudden increase is unknown, but may be due to environmental and dietary exposure to hormone-disrupting chemicals.  Polybrominated diphenyl ethers (PBDEs) are flame retardants used on many household items and frequently a component of household dust; they are known thyroid hormone disruptors. Soy is also a known thyroid hormone disruptor and is frequently found in pet foods to increase protein content.  Bisphohenol-A (BPA) is used to coat the insides of cans (‘wet’ diets) and is also a known hormone disruptor. Also, too little or too much iodine in the diet can disrupt thyroid function (iodine is a very poorly regulated nutrient in the pet food industry).  Treatment options include surgery, radioactive iodide (I-131), or methimazole (Rx).  Monument pharmacy frequently compounds methimazole for feline patients in the following forms:

 

  • Methimazole- capsule, suspension, transdermal gel

 

Canines are more likely to suffer from hypothyroidism. Most frequently this results from natural atrophy or immune-mediated destruction of the gland. Iodine deficiency or congenital problems are also play a role.  Symptoms a pet may present with include thickening of the skin, hair loss (usually starting on the tail), excessive oily coat -or- dry/brittle coats, weight gain, and lethargy or listlessness.  When performing bloodwork, keep in mind certain breeds (sighthounds/Greyhounds) have lower T4 than the “normal” for most other breeds!  Also, certain drugs such as phenobarbital, potassium bromide, corticosteroids, NSAIDs, propranolol, clomipramine, and sulfa antibiotics can depress T4 secretions, causing false positives for hypothyroid lab results. Treatment most commonly utilizes prescription synthetic levothyroxine or prescription natural thyroid (T3/T4).  Our most commonly requested hypothyroid treatments for canines include the following forms:

 

 

  • Levothyroxine- capsule, suspension, transdermal gel, commercial tablet
  • T3/T4- available as commercial product NatureThroid® (RLC labs)

 

Most commonly found in canines, Cushing’s Disease, or pituitary-dependent hyperadrenocorticism, accounts for ~85% of hyperadrenocorticism cases in middle-aged and older canines. Cushing’s is caused by an adenoma or hyperplasia of the ACTH-producing cells in the pituitary gland.   The remaining 15% of cases are due to adrenal tumors (more common in large breeds).  The most common clinical signs in dogs and cats are polydipsia, polyuria, polyphagia, heat intolerance, lethargy, abdominal enlargement or “potbelly” due to hepatomegaly, panting, obesity, muscle weakness, alopecia, bruising, and recurrent urinary tract infections.  Cats may present with secondary respiratory infections and increased skin fragility.5 Cushing’s is a lifelong condition affecting canines and can often be managed with medications. Regular monitoring is necessary as disease progression necessitates dosing adjustment over time.

 

In addition to surgery or radiation therapy, there are two FDA-approved treatments for hyperadrenocorticism. Trilostane (Vetoryl®) is approved to treat both pituitary- and adrenal-dependent hyperadrenocorticism in dogs. Keep in mind trilostane is contraindicated if there is hepatic or renal disease, and interacts with some cardiac medications.  Selegiline (Anipryl®) is approved to treat only uncomplicated, pituitary-dependent Cushing’s disease in canines.  Some specialty centers are also using mitotane (Lysodren®) to treat Cushing’s in dogs; this drug permanently destroys the layers of the adrenal gland that produce cortisol and requires careful monitoring due to risk of severe side effects.

 

  • Mitotane- capsule, suspension, commercial tablet
  • Selegiline- capsule, suspension, transdermal gel
  • Trilostane (from brand name Vetoryl®)- capsule, suspension

 

 

Cancer
Cancer is the uncontrolled growth of abnormal cells of the body. It can be benign or malignant, localized or metastasized.  According to the American Kennel Club’s Canine Health Foundation, the most common canine cancers include hemangiosarcoma, lymphoma, mammary cancer, mast cell tumors, melanoma, osteosarcoma, prostate cancer, and transitional cell carcinoma. Breeds such as Golden Retrievers, Great Danes, Boxers, Boston Terriers, Bernese Mountain Dogs, Rottweilers, and Saint Bernards are considered “high risk” as they have a higher incidence than other purebred and mixed-breed animals.  According to the Veterinary Cancer Center, cats are less likely to develop cancer than dogs, but it is more likely to be aggressive. The most common types of feline cancer include leukemia/lymphoma (often from the FeLV virus), vaccine-associated fibrosarcoma, mammary cell tumor, mast cell tumor, oral squamous cell, and intestinal adenocarcinoma. There is less breed-specific data is available. However, cats with white ears and heads in particular are prone to skin tumors, and Siamese, Persians, and Bengals are considered “high risk” (Eric Barchas DVM, Catster 22 April 2008).

Depending on the diagnosis, disease progression, and the owner’s wishes, treatment choices include surgery, radiation therapy, chemotherapy, or a combination. There are many chemotherapeutic agents available, many of which can be very harmful to not only the patient, but the owner and household family members as well (due to secondary exposure).  When considering home-treatment protocols, It is of utmost importance to consider the owner’s ability to administer the medication without exposing him/herself (and other family members!) to the chemotherapeutic agent and educating the owner on minimizing environmental exposure (handling of waste, etc).  To protect our employees, Monument Pharmacy offers limited chemotherapeutic agents and many palliative treatments for cancer and related issues (pain, gastrointestinal issues, incontinence, antihistamines, glucocorticoids, etc).

 

  • Chlorambucil- capsule, suspension
  • Cyclophosphamide- suspenion, capsule
  • Mitotane- capsule, suspension, commercial tablet
  • Buprenorphine*- suspension (oil and aqueous), transdermal gel
  • Cetirizine- capsule, suspension, transdermal gel
  • Cisapride- capsule, suspension, transdermal gel
  • Chlorpheniramine- capsule, suspension, transdermal gel
  • Diethylstilbesterol (DES)- capsule, suspension, tablet
  • Diphenhydramine- capsule, suspension
  • Fludrocortisone- capsule, suspension, commercial tablet
  • Hydroxyzine- capsule, suspension
  • Metoclopramide- capsule, suspension, transdermal gel
  • Phenylpropanolamine- capsule, suspension
  • Prednisolone- capsule, suspension, transdermal gel, commercial tablet
  • Prednisone- capsule, suspension, transdermal gel, commercial tablet
  • Piroxicam- capsule, suspension
  • Tramadol*- capsule, suspension, commercial tablet, transdermal gel

 

*Prescriptions for Controlled substances require additional patient-specific information which varies by state. Please consult with a pharmacist for details.

 

“While age itself is not a disease, the aging process induces complex and interrelated metabolic changes that complicate health care.  Management decisions should not be based solely on the age of the patient, as many conditions that affect older pets can be controlled, if not cured.”6

 

For prescribers and their patients, quality means accuracy, consistency, professionalism and service.  At Monument Pharmacy, our licensed pharmacists and certified technicians prepare all of our compounded products with the utmost attention to detail regarding purity, potency, and consistency.  All ingredients are sourced from FDA-licensed suppliers, and compounded prescriptions are prepared according to exacting federal and Colorado state standards.

 

Most Rx orders for compounded medications received prior to 3pm Mountain can be shipped out the same business day. When you call, you will always reach one of our friendly customer care specialists in person, right here in Monument, Colorado.  We will beat others’ compound prices by 10%. Just let us know what you’re quoted or paying elsewhere. As an added value, we are able to ship many prescriptions via USPS first-class mail at no charge!  Our goal is for your service to be second to none.  Feel free to contact us fordetails at 1-800-595-7565.

 

References

  1. Goldston, Richart T, Hoskins, Johnny. Geriatrics & Gerontology of the Dog and Cat. Philadelphia: W.B. Saunders Co, 1995
  2. Senior Pet Care. AVMA. February 2009. Accessed July 2015.
    https://www.avma.org/public/PetCare/Pages/Caring-for-an-Older-Pet-FAQs.aspx
  3. AAHA Senior Care Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 2005;41:81-91.
  4. Plumb, Donald C. Plumb’s Veterinary Drug Handbook, 10th Ed. Stockholm, WI: Pharmavet, Inc., 2008
  5. Kahn, Cynthia; et al.  The Merck Veterinary Manual (10th Edition). Whitehouse Station, NJ:  Merck & Co, Inc. 2010
  6. Senior Care Guidelines (American Academy of Feline Practitioners). Journal of Feline Medicine and Surgery 2009;11:763-778 (accessed at http://jfm.sagepub.com/content/11/9/763.full.pdf)
  7. Becker, M. Caring for older pets and their families. Firstline; August/September 1998; 28-30.
  8. Epstein, M; Kuehn, NF; Landsberg, G; et al. AAHA Senior care guidelines for dogs and cats. Journal of the American Animal Hospital Association 2005; 41(2):81-91.
  9. Fortney, WD (ed). Veterinary Clinics of North America Small Animal Practice: Geriatrics. W.B Saunders Co, Philadelphia, PA; 2005.
  10. Summers, Alleice.  Common Diseases of Companion Animals (3rd Ed).  Philadelphia, PA: Elsevier, 2014

 

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Geriatric Pet Health Issues & Medications, Part 1

As pets age they are more susceptible to certain conditions that can decrease longevity and diminish the quality of life.  Careful owner observation and regular office exams are important to catch many of these conditions early. Proper nutrition and pharmaceutical intervention can significantly decrease the morbidity associated with certain diseases and conditions of aging in the canine and feline.

 

Trigger: Monument Pharmacy CEO Rob Frisbie's dearly departed dog

 

 

There is no hard and fast rule for declaring when a pet is considered “senior,” but according to the AAHA Senior Care Guidelines, a pet is considered “senior” when it is within the last 25% of its life expectancy.1 The tables below from AVMA are helpful in determining an individual pet’s age in “human years.”2

 

Cat ‘s age

Equivalent in human years

7

45

10

58

15

75

20

98

 

Dog’s age

Equivalent in human years (*dog size lbs)

7

Small  (0-20 lbs); Medium (21-50 lbs): 44-47
Large(51-90 lbs);  Very large (>90 lbs): 50-56

10

Small – Medium: 56-60
Large – Very large: 66-78

15

Small – Medium: 76-83
Large – Very large: 93-115

20

Small – Medium: 96-105
Large: 120
The oldest recorded age of a cat is 34 years. The oldest recorded age of a dog is 29 years.

 

“While age itself is not a disease, the aging process induces complex and interrelated metabolic changes that complicate health care.”  Management decisions should not be based solely on the age of the patient, as many conditions that affect older pets can be controlled or cured.6  Senior pets are at increased risk for arthritis, renal and urinary tract issues, cardiovascular complications, ophthalmic conditions, endocrine disorders, and cancer. 3 Early detection and treatment of these conditions can help extend the longevity and quality of life for many companion animals.

 

Musculoskeletal System

Just like humans, pets are at increased risk of osteoarthritis as they age. 2 Oftentimes a very active pet presents to the clinic with lameness, limping, or significant decrease in activity. A thorough orthopedic exam may be indicated as hip dysplasia and knee ligament injuries are also more common in elderly pets.  Arthritis is caused by constant wear and tear on joints, and some breeds are more prone than others.  There are many treatments for pets suffering from arthritis pain ranging from special diets, supplements, prescription medications, and surgery. Owners must use great care in choosing supplements as many designed for humans are not appropriate for use in cats and dogs due to inappropriate strength, excipients, or even dosage form.  Prescription pain medications4 and supplements available for compounding by Monument Pharmacy include:

 

  • Amantadine- suspension, capsule
  • Buprenorphine*- suspension, transdermal gel
  • Butorphanol*- suspension, commercial tablet
  • Carprofen (Rimadyl®)- suspension, capsule, commercial tablet
  • Gabapentin- suspension, capsule
  • Methocarbamol- suspension, capsule
  • Tramadol*- suspension, capsule, transdermal gel, commercial tablet
    (Due to tramadol’s extremely bitter taste, transdermal gel is the preferred route of administration.)

*Prescriptions for Controlled substances require additional patient-specific information which varies by state. Please consult with a pharmacist for details.

NOTE: When used for analgesia, current research suggests that amantadine and gabapentin are adjunctive agents and not intended for use in monotherapy.

 

Cardiovascular Disease
Cardiovascular disease (including heart failure and hypertension) can be idiopathic or may occur secondarily to a comorbid condition — or even be caused by medication in the aging pet.  Cats especially are prone to anxiety-induced hypertension when at the clinic (similar to “white coat syndrome” in humans). Conditions that can cause hypertension include renal disease, hyperthyroidism, hyperaldosteronism, and phaeocromocytoma. Even certain medications can induce hypertension including steroids, sodium chloride, and NSAIDs.  Hypertension rarely has any symptoms and is usually discovered upon exam.  When treating hypertension, there are some species differences5 to note.  For example, calcium-channel blockers (amlodipine) are usually dosed once daily in dogs and cats.  However, angiotension-converting enzyme (ACE) inhibitors (benazepril, enalapril), and angiotension-receptor blocker (ARB) (telmisartan) are dosed once daily in cats but twice daily in canines.  Similarly, while ACE inhibitors (or ARBs) and calcium-channel blockers may be administered together, a calcium-channel blocker is usually recommended as initial therapy in cats and an ACE inhibitor (or ARB) in dogs.

 

Prescription medications available for compounding by Monument Pharmacy include:

 

  • Amlodipine- suspension, capsule, transdermal gel
  • Atenolol- suspension, capsule, transdermal gel
  • Benazepril- suspension, capsule, transdermal gel
  • Clopidogrel- suspension, capsule
  • Diltiazem- suspension, capsule, transdermal gel
  • Enalapril- suspension, capsule, transdermal gel
  • Furosemide- suspension, capsule, transdermal gel
  • Pimobendan- suspension, capsule
  • Sildenafil- suspension, capsule

 

Renal and Urinary Tract

Senior dogs and cats are at increased risk of renal disease and/or failure, urinary tract infection, and urinary incontinence.3 Common symptoms of chronic kidney (CKD) disease in the older pet may include anorexia, polydipsia, polyuria and/or oliguria, and emesis.  The progressive nature of renal disease produces a vicious cycle of progressive renal destruction; it is vital to manage associated issues to slow progression.  Secondary hypertension (see CARDIOVASCULAR section for available treatments), proteinuria, electrolyte abnormalities, and bacterial urinary tract infections are also likely develop as renal disease progresses. Prescription “renal” diets or supplements can significantly improve proteinuria.  With appropriate therapy, animals can survive for long periods with only a small fraction of functional renal tissue, perhaps 5%–8%.5

Compounded medications from a reputable veterinary compounding pharmacy will most likely be required due to dosage modification for pets with reduced renal function. The following medications are available in patient-specific compounded formulas to assist in your treatments:

 

  • Aluminum hydroxide- suspension, capsule, or powder
  • Amoxicillin- suspension (14-day expiration ONLY), capsule
  • Calcium acetate- suspension, capsule
  • Clindamycin- suspension, capsule
  • Enrofloxacin- suspension, capsule, transdermal gel
  • Nitrofurantoin- suspension, capsule
  • Omeprazole- capsule
  • Potassium citrate- suspension, capsule
  • Potassium gluconate- suspension (14-day expiration ONLY), capsule, powder
  • Sodium bicarbonate- capsule
  • Diethylstilbestrol (DES)- capsule, tablet, suspension
  • Phenylpropanolamine- suspension, capsule, commercial chewable tablet

 

Geriatrics is a very complex topic. Please see part 2 of this blog post for further reading on conditions affecting senior canine and felines including ophthalmic issues, endocrine disorders, and cancer.

 

For prescribers and their patients, quality means accuracy, consistency, professionalism and service.  At Monument Pharmacy, our licensed pharmacists and certified technicians prepare all of our compounded products with the utmost attention to detail regarding purity, potency, and consistency.  All ingredients are sourced from FDA-licensed suppliers, and compounded prescriptions are prepared according to exacting federal and Colorado state standards.

 

Most Rx orders for compounded medications received prior to 3pm Mountain can be shipped out the same business day. When you call, you will always reach one of our friendly customer care specialists in person, right here in Monument, Colorado.  We will beat others’ compound prices by 10%. Just let us know what you’re quoted or paying elsewhere. As an added value, we are able to ship many prescriptions via USPS first-class mail at no charge!  Our goal is for your service to be second to none.  Feel free to contact us for details at 1-800-595-7565.

 

References

  1. Goldston, Richart T, Hoskins, Johnny. Geriatrics & Gerontology of the Dog and Cat. Philadelphia: W.B. Saunders Co, 1995
  2. Senior Pet Care. AVMA. February 2009. Accessed July 2015.
    https://www.avma.org/public/PetCare/Pages/Caring-for-an-Older-Pet-FAQs.aspx
  3. AAHA Senior Care Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 2005;41:81-91.
  4. Plumb, Donald C. Plumb’s Veterinary Drug Handbook, 10th Ed. Stockholm, WI: Pharmavet, Inc., 2008
  5. Kahn, Cynthia, et al.  The Merck Veterinary Manual (10th Edition). Whitehouse Station, NJ:  Merck & Co, Inc. 2010
  6. Senior Care Guidelines (American Academy of Feline Practitioners). Journal of Feline Medicine and Surgery 2009;11:763-778 (accessed at http://jfm.sagepub.com/content/11/9/763.full.pdf)
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Doggie Anxiety & Veterinary Compounding

Dog Anxiety

Summertime is highly anticipated by many families, but companion canines may see things differently. Prolonged family absences, thunderstorms, fireworks, and altered daily routines can wreak havoc on a family pet’s behavioral healthAnxiety is the second-most reported canine behavioral disorder after aggression1. It is exhibited by a variety of symptoms ranging from mild to severe, none of which are compatible with a harmonious household!   Treatment including extensive training and exercise may be enough to relieve symptoms for some, but for those who have severe anxiety the benefits of pharmacotherapy might be substantial.

 

Summer means vacations for many families, which often means the family dog will be boarded or have a house sitter. This sudden and drastic change in the family pack leaves many dogs very stressed and anxious2, especially if they are unfamiliar with the boarding environment or caretaker in their home.  Other common summertime canine anxiety triggers include loud noises such as thunderstorms and fireworks. The unpredictable and irregular nature of thunderstorms makes desensitization training very challenging.

 

Anxiety can be expressed in many ways depending on the canine and the home environment. Each patient is unique!  Most commonly, mild anxiety will result in increased vocalization (whining, barking, crying), housesoiling, and restlessness (pacing, following owner closely)3. As the anxiety level increases, symptoms can escalate to escape attempts (which can cause injury and significant property damage), aggression, destructive behavior, or to sheer panic. There are many documented examples of dogs with separation anxiety destroying furniture (especially pillows and sofa cushions), carpets and rugs, walls, and even doors while their owners are away at work.  There are even examples where dogs have broken glass windows during thunderstorms in their panic trying to escape.

 

To truly cure anxiety, the most efficacious treatment is to get to the root of the problem. Desensitization and counter-conditioning training are very effective.  Unless an owner is home with the dog for the majority of the day, however, the time commitment required by these methods is not practical.  If the client is unable to provide training due to work/family schedules but expresses interest, it may be advisable to have them consult with a specialized canine trainer. There are many independent and nationwide dog training centers that offer anxiety training.

 

Adjunctive pharmacotherapy might be very efficacious for canine anxiety, but underlying medical issues need to be ruled out prior to initiating medications with a complete physical exam, history, and lab work.  It is important to inform clients that the use of medication alone will not permanently change the dog’s behavior! Medication serves to “reestablish a more stable emotional state and improve trainability.3” The owner must provide training to permanently resolve anxiety-related behavior issues.

 

There are many supplements and pheromone products marketed for use in canine anxiety but unbiased, quality clinical evidence is sparse regarding their efficacy.  A few studies have shown tryptophan to be effective for mild anxiety4. Pheromone use is very appealing to many owners due to its “natural” and “holistic” reputation, but in a systematic review of 14 studies done from 1998 – 2008, only one of the studies showed sufficient evidence that dog-appeasing pheromone reduced anxiety.5

 

As for prescription pharmaceuticals, there are many veterinary and human prescription medications available for canine anxiety.  Clients need to be reminded that many of these agents can take several weeks to reach full effectiveness! 6 Clomipramine and fluoxetine are available in commercial products for veterinary use, so they are frequently chosen first for treatment.  Recent evidence suggests for some pets where a single agent is not effective, combination therapy with multiple agents (clomipramine and alprazolam7) may be more efficacious.  When using combination therapy, please consult with a pharmacist to ensure the combination does not have any drug interactions that could harm the patient.

 

Preparations of many human behavioral medications are not appropriate for use by pets, but customized dosage forms and strengths can be compounded by prescription based on individual patient need. The staff at Monument Pharmacy are experts on veterinary compounding and can offer the following behavior modification3,6 medications for your pet by Rx. (Please note all medications are compounded by prescription unless otherwise indicated.)

  • Benzodiazepines:
    • Alprazolam*- available as a transdermal gel, suspension, or tablet
    • Clonazepam*- available as a suspension or capsule
    • Clorazepate*- available as a suspension or capsule
    • Diazepam* – available as a suspension or capsule
    • Tricyclic Antidepressants
      • Amitriptyline- available as a transdermal gel, suspension, capsule, or tablet
      • Clomipramine – available as a transdermal gel, suspension, or capsule
      • SSRIs
        • Fluoxetine –  available as a transdermal gel, suspension, capsule, or tablet
        • Paroxetine –  available as a transdermal gel, suspension, or capsule
        • Acepromazine- available as a transdermal gel, suspension, or capsule
        • Buspirone- available as a transdermal gel, suspension, or capsule
        • Diphenhydramine- available as a transdermal gel, suspension, or capsule
        • Phenylpropanolamine-  available as a suspension or capsule
        • Propranolol –  available as a suspension or capsule
        • Selegiline – available as a suspension or capsule
        • Sertraline – available as a suspension or capsule
        • Trazodone8– available as a suspension or capsule
        • Tryptophan- available as a commercial chewable tablet [ProQuiet(R)]

*Please note that controlled substance prescriptions require additional patient-specific information which varies by state. Please consult with a pharmacist for details!

 

As a side note, some clinical evidence suggests diazepam may not be a first line choice for canine anxiety relief.  Adverse effects such as sedation, ataxia, agitation, and aggression, as well as lack of perceived efficacy caused clients to discontinue use as the medication interfered with the behavior modification process.

 

For prescribers and their patients, quality means accuracy, consistency, professionalism and service.  At Monument Pharmacy, our licensed pharmacists and certified technicians prepare each patient-specific compounded prescription with the utmost attention to detail regarding purity, potency, and consistency.  All ingredients are sourced from FDA-licensed suppliers, and compounded prescriptions are prepared according to exacting federal and State of Colorado standards.

Most orders received prior to 3pm Mountain time Monday through Friday can be shipped out the same business day. With each call, you will reach one of our friendly customer care specialists in person, right here in Monument, Colorado.  We have competitive pricing and will beat competitors’ compound prices by 10%. As an added value, we are able to ship many prescriptions via USPS first-class mail at no charge!  Our goal is for your service to be second to none. Feel free to contact us for details.

 

 

References:

  1. Barbara Sherman, et al. Effects of Reconcile (fluoxetine) Chewable Tablets Plus Behavior Management for Canine Separation Anxiety.” Veterinary Therapeutics Vol 8 No. 21, Spring 2007.
  2. Onthank, Chris. Separation Anxiety: Treating the Cause and Not the Symptoms.
  3. Kahn, Cynthia, et al.  The Merck Veterinary Manual (10th Edition). Whitehouse Station, NJ:  Merck & Co, Inc., 2010
  4. Da Graca Pereira G, Fragoso S, E. P. Effect of dietary intake of L-Tryptophan supplementation on working dogs demonstrating stress related behaviours. BSAVA 2010
  5. Diane Frank, et al. Systmatic review of the use of pheromones for treatment of undesirable behavior in cats and dogs.  J Am Vet Med Assoc 2010;236:1308-1316. June 15 2010
  6. Plumb, Donald C. Plumb’s Veterinary Drug Handbook, 10th Ed. Stockholm, WI: Pharmavet, Inc., 2008
  7. Sharon L Crowell-Davis, et al. Use of clomipramine, alprazolam, and behavior modification for treatment of storm phobia in dogs. J Am Vet Med Assoc 2003;222:744-748. March 15, 2003
  8. Margaret E Gruen, Barbara L Sherman. Use of trazodone as an adjunctive agent in the treatment of canine anxiety disorders: 56 cases (1995-2007). J Am Vet Med Assoc 2008;233:1902-1907. December 15, 2008.
  9. Meghan E. Herron, et al. Retrospective evaluation of the effects of diazepam in dogs with anxiety-related behavior problems. J Am Vet Med Assoc 2008; 233: 1420-1424. November 1, 2008
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Health Issues & Medications for Hybridized Cats

Hybridized felines resulting from purposeful breeding of domestic with wild species are exponentially increasing in popularity as “designer” or “lifestyle” pets.  They are bred for specific and stunning physical characteristics (usually to resemble their wild ancestor).  Hybrids are very controversial because the initial breeding can be fatal to the domestic feline, there are high kitten mortality rates, and male sterility can arise due to genetic and gestational incompatibilities. Also many offspring inherit behavior characteristics that are unacceptable to the average pet owner or severe health conditions as a result of hybridization.

 

Mongo the Bengal

Mongo the Bengal

 

 

 

To make matters even more complex, laws governing ownership of hybrid animals vary according to state and city, so it is important to check with your municipality prior to obtaining a pet. (For example, Bengals and most hybrids are illegal to own in Denver1, but not Colorado!) While legal and ethical considerations  need to be addressed prior to purchasing or adopting a pet, more than likely an owner is coming to a veterinary professional because they have already purchased a hybrid and have discovered their new “Lap Leopard” is not behaving  as promised or is having gastrointestinal issues.  The best course of action to improve behavior issues and certain health conditions could be judicious owner education, behavior modification, and if indicated, pharmaceutical intervention.

 

There are many hybrid breeds that originated with a wild cat being bred with a domestic cat.  Some of the most popular include the Bengal, the Savannah, and the Chausie.  The Bengal originated as a cross between the Asian Leopard Cat and a domestic.  Bengals are large and very muscular. They have soft, dense fur that is either brown or white and spotted, marbled or even striped (the “Toyger” being a Bengal/domestic cross with vertical stripes).  Behaviorally, Bengals are extremely intelligent, curious, and active.  They can open drawers and cupboards, be clicker trained, love to climb, and have been known to enjoy playing in water. They demand a lot of interaction and can be VERY vocal and territorial.  Their large and loud range of growls, chirps, and meows takes uninformed Bengal owners by surprise. Unfortunately regardless of gender, Bengals tend to mark their territory and are often cat-aggressive. Genetically, the breed can be prone to inflammatory bowel disease (IBD). 2

 

Savannah cats originated as a cross between the African Serval and a domestic cat. Savannahs tend to have a tall and slim build, making them look larger than their actual weight (although males can weigh up to 25 pounds).  Similar to Bengals, they have spotted coats and are very active, intelligent cats; they can be clicker trained and are often described as dog-like in their loyalty to their owners and trainability.  Savannahs vocalize in chirps (like their Serval ancestors) and meows, and are known for their incredible jumping ability; they can jump up to 8 feet up!  Because of their wild ancestry, Savannah cats also have the habit of territory marking and can be aggressive if not properly socialized as kittens.   Many Savannah enthusiasts claim that the breed has specific requirements for anesthesia and vaccine dosing due to their wild genetics, but this has not been found to be accurate.3

 

The Chausie is a product of a Jungle Cat (felis chaus) and a domestic cat.  Chausies are medium sized, usually weighing 10-15 pounds. They have long legs and a lean build. Chausies are born in a variety of colors, but breed standards allow solid black, black grizzled tabby, and black (aka brown) ticked tabby. Their behavior is gregarious, curious, and fun-loving. But they do not like to be alone and do best with a feline or even canine companion. They form deep bonds with their owners and, because of this, often do not respond well to being re-homed as adults.  They are unique in that, because of their Jungle Cat ancestor, some have shorter intestinal tracts than normal cats.4 Because of this, they frequently have protein allergies to commercial cat foods, may have difficulty processing plant-derived foods, and can develop IBD.5

 

Whatever breed of feline you have, if behavior issues such as aggression or spraying are present and behavior modification has not been successful, Monument Pharmacy may be able to offer some assistance in medicating a difficult cat by prescription. We are able to compound the following Rx medications — frequently requested  for behavior issues and IBD — into capsules, palatable suspensions, or easy-to-administer transdermal formulations to assist with compliance for the most difficult feline patients. 6,7 Although a standard for canine IBD, sulfasalazine is not routinely used in felines due to salicylate toxicity.

 

  • Amitriptyline
  • Buspirone
  • Clomipramine
  • Fluoxetine
  • Paroxetine
  • Trazodone
  • Cisapride
  • Budesonide
  • Enrofloxacin
  • Metoclopramide
  • Metronidazole
  • Tylosin (not available transdermally)

 

For prescribers and their patients, quality means accuracy, consistency, professionalism, and service.  At Monument Pharmacy, our licensed pharmacists and certified technicians prepare all of our compounds with the utmost attention to detail regarding purity, potency, and consistency.  All ingredients are sourced from FDA-licensed suppliers, and compounded prescriptions are prepared according to exacting federal and Colorado state standards.

 

Most orders for compounded medications received prior to 3pm Mountain time can be shipped out the same business day. When you call, you will always reach one of our friendly customer care specialists in person, right here in Monument, Colorado.  We have competitive pricing and will beat others’ compound prices by 10%. As an added value, we are able to ship most prescriptions via USPS first-class mail at no charge!  Our goal is for your service to be second to none; in fact, your satisfaction is guaranteed! You can count on us to exceed your expectations.  Feel free to contact us for details toll free at 1-800-595-7565.

 

 

REFERENCES

  1. City of Denver Municipal Code 1950, § 760.9-2; Ord. No. 270-92, § 1, 5-11-92; Ord. No. 1110-96, § 1, 12-16-96; Ord. No. 62-03, §§ 5, 6, 2-2-04; Ord. No. 622-08, § 1, 11-17-08. Accessed 9 June 2015. bit.ly/1epJ0yx
  2. Bengal Cat Animal World, Information Resource: Exotic Pets & Animals. Retrieved on 20 May 2015. bit.ly/1f8JGt1
  3. Moresco A, Larsen RS, Lassiter AJ. Evaluation of the effects of naloxone on recovery time and quality after ketamine-medetomidine-butorphanol anesthesia in servals (Leptailurus serval). Journal of Zoo and Wildlife Medicine, 2009 Jun, 40(2):289-95.
  4. Chausie—Breed Standard and Photos (On-line). Chausie Breed Committee, TICA. Retrieved 31 May 2015. bit.ly/1epKf0E
  5. Bird C. “The Chausie: The Cat That Came Up From the Reeds.” TICA Trend. Harlingen, TX: The International Cat Association, Inc., Dec. 2009/Jan. 2010, Vol. 31 No. 1.
  6. Plumb, Donald C. Plumb’s Veterinary Drug Handbook, 10th Ed. Stockholm, WI: Pharmavet, Inc., 2008.
  7. Kahn, Cynthia, et al.  The Merck Veterinary Manual (10th Edition). Whitehouse Station, NJ:  Merck & Co, Inc., 2010.
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Health Issues & Medications for Tortoises

While not “cuddly,” tortoises are increasing in popularity as companion animals. Russian, Desert, Leopard, and Sulcata Tortoises are common reptile species kept as companions. All tortoises are endangered due to habitat loss for reptiles and illegal pet trade, and many pets are actually wild animals “rescued” by good Samaritans after being injured by cars or dogs. Wild-caught animals tend to be more stressed and thus more susceptible to disease than their captivity-bred counterparts, and will more than likely require a veterinary intervention at some point in their captive lives. They are also highly likely to carry salmonella, which make them poor pet choices for households with infants, young children, and immunocompromised family members. When a tortoise with a runny nose presents in your veterinary practice, will you know what unique metabolic and biologic factors need to be considered when choosing a pharmaceutical treatment?

 

 

VW, a Sulcata Tortoise

VW, a Sulcata Tortoise

 

 

Illness in companion desert tortoises often results from infection, stress due to improper physical environment, or malnutrition. Some common symptoms of upper respiratory infection may include a combination of mucopurulent nasal discharge, puffy eyelids or recessed eyes, labored breathing, loose stool, anorexia or change in weight, listlessness, or a softening of the shell.1 Tortoises will often move their head and forelimbs into their shell to facilitate breathing. A chronically ill tortoise may even develop white scar tissue around the nares. Sick tortoises often refuse to eat and become emaciated.

 

 

Injectable or oral are the preferred routes for medication administration. For oral administration, medication can be injected into fruit, but in-water placement is not recommended due to the unpredictable nature of chelonian drinking2. The antibiotic of choice depends on the pathogen, and the dosage and delivery form will depend on the species, size and temperament of the animal. GI transit times vary among different species (as long as 21 days in large tortoises!), as does drug metabolism and excretion. For appropriate dosing, a specialty chelonian reference or exotic veterinary specialist should be consulted.

 

 

Monument Pharmacy is able to compound several medications by prescription into highly concentrated, palatable oral suspensions or small capsules. Tortoise-friendly flavors for suspensions include strawberry, banana, grape, cherry, orange, peanut butter, strawberry, watermelon, and tutti-frutti. It is important to keep in mind that African tortoises in particular (i.e., Sulcata) are very sensitive to sugar in the diet as it can disrupt the natural flora; it is recommended to use artificially sweetened flavors when needed. The following list3,5 of ORAL compounded medications for tortoises available by prescription from Monument Pharmacy.

 

 

• Acyclovir: flavored water- or oil-based suspension, frequently requested for early stage herpesvirus
• Cisapride: flavored water- or oil-based suspension, frequently requested for GI motility modification
• Clarithromycin: flavored oil-based suspension, frequently requested for mycoplasma infection
• Clindamycin: flavored oil-based suspension, frequently requested for respiratory infection
• Chloramphenicol: flavored oil-based suspension or ophthalmic ointment
• Doxycycline: flavored oil-based suspension, frequently requested for mycoplasma6 and respiratory infections
• Enrofloxacin (species-dependent dosing!4,5): flavored water- or oil-based suspension, frequently requested for upper respiratory infection
• Fluconazole: flavored oil-based suspension, frequently requested for GI mycoses
• Griseofulvin: flavored oil-based suspension, frequently requested for GI mycoses
• Levothyroxine: flavored oil-based suspension, frequently requested for hypothyroidism
• Ketoconazole: flavored oil-based suspension, frequently requested for GI mycoses
• Metoclopramide: flavored oil-based suspension, frequently requested for stimulation of gastric emptying
• Tylosin: flavored oil-based suspension, frequently requested for upper respiratory infection

 

 

Also, the following commercially-manufactured injectable medications are available by prescription on a special order basis. Please call for product availability and pricing.

 

 

• Amikacin
• Ampicillin
• Ceftiofur
• Enrofloxacin

 

 

As a clinical note, ivermectin can be fatal in tortoises and metronidazole can cause vestibular syndrome and sterile gut syndrome5. Aminoglycosides such as tobramycin can be used with caution, but concurrent fluid therapy is highly recommended due to nephrotoxicity. The use of these agents should be avoided. All antibiotics will have considerably longer half lives than in mammals due to slow renal elimination.

 

For prescribers and their patients, quality means accuracy, consistency, professionalism and service. At Monument Pharmacy, our licensed pharmacists and certified technicians prepare all of our compounded prescription medications with the utmost attention to detail regarding purity, potency, and consistency. All ingredients are sourced from FDA-licensed suppliers and compounded prescriptions are prepared according to exacting federal and State of Colorado standards.

 

 

Most prescription orders for compounded medications received prior to 3pm Mountain time Monday-Friday (holidays excepted) can be shipped out the same business day. When you call, you will always reach one of our friendly customer care specialists in person, right here in Monument, Colorado. We have competitive pricing and will beat others’ compounding prices by 10%. As an added value, we are able to ship many prescriptions via USPS first-class mail at no charge! Our goal is for your service to be second to none; in fact, your satisfaction is guaranteed! You can count on us to exceed your expectations. Feel free to contact Monument Pharmacy for details at 1-800-595-7565.

 

 

REFERENCES

 

 

1. Jacobson, Elliot, DVM. The Desert Tortoise and Upper Respiratory Tract Disease.
2. Chitty, J, Raftery, A. Essentials of Tortoise Medicine and Surgery. West Sussex UK: Wiley Blackwell, 2013.
3. Kahn, Cynthia, et al. The Merck Veterinary Manual (10th Edition). Whitehouse Station, NJ: Merck & Co, Inc., 2010
4. Mitchell, Mark. “Therapeutic Review: Enrofloxacin.” Journal of Exotic Pet Medicine, Vol 15, No 1 (January), 2006: pp 66-69
5. Plumb, Donald C. Plumb’s Veterinary Drug Handbook, 10th Ed. Stockholm, WI: Pharmavet, Inc., 2008
6. Eghianruwa, Kingsley. Essential Drug Data for Rational Therapy in Veterinary Practice. Bloomington, IN: AuthorHouse, 2014.

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Health Issues & Medications For Ferrets, Rabbits, & Rats

With the increasing popularity of small pets such as ferrets, rabbits, and rats, it is vitally important to have a current, working knowledge of common pathologies and unique biological factors that must be considered when treating these patients with pharmaceuticals.

Ferrets

Ferrets

Ferrets are susceptible to a variety of diseases throughout their lives.  A common acute care issue that will result in an office visit by many ferret parents is diarrhea.  Diarrhea in ferrets may be caused by a variety of gastrointestinal issues (colitis, viruses, bacteria, and parasites).  Ferrets are also highly susceptible to adrenal gland tumors, insulinoma, and lymphosarcoma. Unfortunately, these cancers frequently occur together in the same animal.1

There are many prescription medications that can be used to treat diarrhea in ferrets. The drug of choice will depend on a variety of factors, including the age of the patient and the cause of the GI disturbance. Below is a list of antiinfectives (not just for diarrhea) that are available for compounding from Monument Pharmacy.  Some medications such as metrodnidazole are very bitter and difficult to administer.  To increase compliance, consider a ferret-friendly flavored oral suspension such as banana, peanut butter, or marshmallow.  For dosing, Colorado State University Veterinary Hospital recommends if ferret dosing guidelines are unavailable on a particular pharmaceutical, follow feline dosing guidelines.

  • Ampicillin: available in capsules and suspension
  • Amoxicillin- available in capsule and suspension
  • Cefadroxil: availabe in commercial fruit-flavored suspension (NOT compounded)
  • Ciprofloxacin: available in capsule and suspension
  • Clarithromycin: availabe in suspension
  • Doxycycline: availabe in capsules and suspension
  • Enrofloxacin: available in capsules, suspension, transdermal. Should not be used in growing animals as it may interfere with bone development. 2
  • Gentamicin: should NEVER be used in ferrets as it causes fatal nephropathy3
  • Ivermection: available in suspension
  • Ketoconazole: available in capsules and suspension
  • Metronidazole: available in capsules, suspension, transdermal
  • Sulfa/Trimethoprim: availabe in suspension
  • Tetracycline: available in capsules and suspension. Should not be used in pregnant Jills or Kits under 11 weeks due to interference with bone and tooth growth3



Other frequently requested compounds for gastrointestinal distress include chloramphenicol (for colitis4), sucralfate, metoclopramide, cimetidine, and famotidine.

Cancer treatments that are available in compounded forms are listed below

  • Anastrozole: 0.23mg capsule only (for insulinoma5)
  • Diazoxide: available in capsules and suspension (for insulinoma4)
  • Flutamide: available in suspension (for adrenal tumor4)
  • Mitotane: available in capsules or suspension (for adrenal tumors5). Contraindicated if insulinoma is present.
  • Prednisolone: available in capsules and suspension (for insulinoma4)

Other medications that are frequently requested for small animals include chlorpheniramine, dexamethosone, melatonin, enalapril, atenolol, furosemide, digoxin, and azathioprine.

Rabbits

Rabbit

Pet rabbits are generally healthy, but may present for an office visit with an upper respiratory infection (aka “snuffles”). Rabbits are also prone to internal and external parasites.  Common culprits are coccidia, pinworms, ear and fur mites, and fleas.  A banana flavored suspension is a popular choice.  When treating rabbits, NEVER use penicillins, clindamycin, erythromycin, or lincomycin as they can cause fatal dysbiosis. 4

Rats

Rats

The most common health complaints for rats and other rodents include respiratory infection, intestinal parasites, and mammary tumors. 4  Frequently encountered intestinal parasites include pinworms and tapeworms.  Aggressive treatment may be desired as rats carry many infections that can be transmitted to humans including leptospirosis, streptococcus pneumoniae (can cause respiratory and meningeal disease in humans), and salmonella.  Rats are very individualized in their flavor preferences, but the most common flavor requests for suspensions are fruit flavors or peanut butter.

For prescribers and their patients, quality means accuracy, consistency, professionalism and service.  At Monument Pharmacy, our licensed pharmacists and certified technicians prepare all of our compounded products with the utmost attention to detail regarding purity, potency, and consistency.  All ingredients are sourced from FDA-licensed suppliers and compounded prescriptions are prepared according to exacting Federal and Colorado State standards.

Most orders received prior to 3pm can be shipped out the same business day. When you call, you will always reach one of our friendly customer care specialists in person, right here in Monument, Colorado.  We have competitive pricing and will price match competitors; as an added value, we are able to ship many prescriptions via USPS first-class mail at no charge!  Our goal is for your service to be second to none; in fact, you’re satisfaction is guaranteed! You can count on us to exceed your expectations.  Feel free to contact us for details.

References

1. Kahn, Cynthia, et al.  The Merck Veterinary Manual (10th Edition). Whitehouse Station, NJ:  Merck & Co, Inc., 2010

2.  Mitchell, Mark. “Therapeutic Review: Enrofloxacin.”  Journal of Exotic Pet Medicine, Vol 15, No 1 (January), 2006: pp 66-69

3.  Fox, James G., Marini, Robert P. Biology and Disease of the Ferret, Third Edition. UK: John Wiley & Sons, Inc. 2014

4. Mitchell, Mark A., Tully, Thomas N. Manual of Exotic Pet Practice. St Louis, MO: Elsevier Saunders, 2009

5. Plumb, Donald C. Plumb’s Veterinary Drug Handbook, 10th Ed. Stockholm, WI: Pharmavet, Inc., 2008

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Monument Pharmacy Compounding Services

For prescribers and their patients, quality means accuracy, consistency, professionalism, and service. Our licensed pharmacists and certified technicians prepare all of our compounded prescriptions with the utmost attention to detail regarding purity, potency, and consistency. Our compounds are prepared according to exacting federal and Colorado state standards. Monument Pharmacy utilizes only FDA-approved-and-licensed ingredient suppliers for our active and inactive ingredients.

Commercially available products will meet the needs of many patients. But when palatability, route of administration, strength, allergies, or unavailability creates a barrier to treatment, we have the knowledge and experience to solve compliance conundrums by tailoring therapies to individual patient needs.

Palatability

Monument Pharmacy can enhance the flavor, texture, scent, or color of many oral medications. Sometimes a patient refuses to take a med because it tastes bitter or metallic – or just plain icky. We have a wide array of palatable flavor options for pets, including tuna for cats, beef, chicken, liver, various fruits, and even marshmallow. We can also tweak medication palatability for finicky humans.

Route of administration

Have you tried to pill a frustrated feline lately? Trying to force the medication is traumatic for both the cat and pet parent. This is where a veterinary compounding pharmacy can help! Perhaps a palatable oral suspension with tuna or chicken flavor would go down more easily. Alternatively, one can avoid the oral route altogether and choose a transdermal gel rubbed inside the pet’s ear. Transdermal gels are our preferred feline drug delivery method, but there are many options available depending on the compound, including but not limited to oral suspensions, capsules, palatable powders, transdermal gels, ophthalmics, and injectables. Fine-tuning or changing the route of administration often improves compliance by making dosing easier and/or more convenient, has the potential to avoid side effect(s), and/or provides local versus systemic action.

Customized strength

Commercially available strengths of pharmaceuticals do not fit all patients. For example, a tiny bird, rodent, or dog might need a much smaller dose than is available on the market. Likewise a horse, gorilla, or elephant might need a much larger strength than is commercially available. Personalized dosing is especially critical for drugs with narrow therapeutic indices, in veterinary cancer treatment, and in patients that require non-commercially available dosages due to biometric factors, alternative dosing for different indications of use, or abnormal sensitivity to a drug.

Removal of allergens/irritants

Monument Pharmacy can often reformulate medications to eliminate allergens and/or irritants if there is a documented medical allergy or condition (i.e. celiac disease, corn allergy, xylitol sensitivity, etc).

Unavailable yet FDA-approved pharmaceutical

If a medication is needed but is on temporary back-order and is NOT currently available at local distributors, or if it has been discontinued by the commercial manufacturer, Monument Pharmacy may be able to compound said agent on an individual prescription basis. As long as the active ingredient is still FDA approved and obtainable from approved sources, we should be able compound it temporarily until availability resumes.

When you contact us at 1-(800) 595-7565, you will always reach one of our friendly customer care specialists in person, right here in Monument, Colorado. We have competitive pricing and will beat others’ compound prices by 10%. As an added value, we are able to ship many prescriptions via USPS first-class mail at no charge! Feel free to contact us for details and exceptions. Our goal is for your service to be second to none; in fact, you’re satisfaction is guaranteed! You can count on us to exceed your expectations. Most orders received prior to 3pm Mountain time can be shipped out the same business day. That’s the Monument Pharmacy way!

Compounding Services

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