Compounding and Nutraceuticals

Question 1

marijuana

Answer 1

all parts of the plant, not including hemp; DEA Schedule I

Question 2

cannabinoids

Answer 2

THC and CBD, in flowers/resin/leaves; DEA Schedule I

Question 3

What are our concerns with recommending CBD in veterinary patients?

Answer 3

-It is still illegal on a federal level, potentially putting our license at risk
-Not a lot of extensive research, especially concerning drug interactions
-Knowledge of efficacy/safety is minimal

Question 4

Is CBD psychoactive?

Answer 4

no

Question 5

What is the mechanism for CBD?

Answer 5

no one knows, misunderstood

Question 6

Potential Uses of CBD

Answer 6

epilepsy, pain, inflammation, psychosis, cancer, anxiety, nausea

Question 7

Are there any FDA approved CBD products?

Answer 7

yes - Epidiolex (Cannabidiol) for humans

Question 8

Effect of CBD on Diazepam

Answer 8

CBD increases the half-life of diazepam!

Question 9

Nutraceutical

Answer 9

any substance that is food or part of a food that provides medicinal or health benefits, which can include the prevention and treatment of disease

Question 10

USP

Answer 10

United States Pharmacopeia

Question 11

Ways to Assess Quality of Nutraceuticals

Answer 11

look up the product on the NASC (National Animal Supplement Council), location of manufacturing, verification seals, active vs. inactive ingredients, dosing, drug interactions, etc

Question 12

Do we use nutraceuticals in veterinary practice?

Answer 12

yes - many vets actually recommend/sell some

Question 13

Examples of Commonly Used Veterinary Nutraceuticals

Answer 13

SAMe, Denamarin, Cosequin, glucosamines, etc

Question 14

Compounding

Answer 14

the preparing, mixing, assembling, altering, packaging, and labeling of a drug (etc) in accordance with a prescription

Question 15

Examples of Compounding

Answer 15

-mixing drugs in one syringe
-making oral suspension from tablets
-adding flavoring
-making transdermal drug from other sources
-mixing OTIC solutions

Question 16

Are compounded medications made based on the pharmacist or the veterinarian?

Answer 16

veterinarian - important to have a good relationship with the client and the pharmacy, but you are the most important middle man

Question 17

Acceptable Reasons to Use Compounding

Answer 17

-patient requires different strength than commercially available
-patient requires a different dosage form than what’s available
-avoid potentially toxic inactive ingredients (patients with specific allergies, etc)

Question 18

Can you use compounded meds with a drug that has a narrow therapeutic index?

Answer 18

You really shouldn’t, that be a bad idea

Question 19

AVMA Limits to Compounding

Answer 19

1. No other drug delivery method is practical
2. Safety, efficacy, and stability have been demonstrated in this drug
3. Drug in question has a quantifiable response in order to measure its effects

Question 20

Poor Excuses to Compound

Answer 20

-the commercially available drug is too expensive
-one pharmacy doesn’t carry the strength you want
-backorders

Question 21

Risks of Compounding

Answer 21

not quite as closely regulated by the FDA, individual safety studies on each compounding pharmacies aren’t done, may not meet USP standards

Question 22

Expiration Date

Answer 22

assigned by manufacturer to commercially prepared product

Question 23

Beyond Use Date (BUD)

Answer 23

based on sterility and potency studies (not necessarily stability) on compounded products

Question 24

Examples of Compounding Forms

Answer 24

suspensions, solutions, capsules, OTIC, nebulizer, topical, opthalmics, injectables