Small Animal Clinical Pharmacology - CYF MEDICAL DISTRIBUTION

CHAPTER 1 PRINCIPLES OF CLINICAL PHARMACOLOGY
● Premature termination because of apparent control
of the disease or the presence of adverse effects.
Factors influencing the thoroughness of compliance
include the following.
● Disease being treated
– Seriousness and chronicity
– Natural history and susceptibility to treatment
– Rapidity of relapse once medication is
stopped
● Client
– Degree of commitment to the wellbeing of the
companion animal
– Language skills and ability to understand the
importance of compliance
– Complexity of daily schedule
– Respect for and trust in the veterinarian
● Patient (dog or cat)
– Acceptance or rejection of medications; brachycephalic
breeds and cats may pose particular challenges
to oral medication. Palatable dosage forms
may improve compliance
● Veterinarian
– Strength of relationship with client
– Ability to communicate with, motivate and
provide encouragement of client
● Medication
– Physical form (taste, odor, size) and ease of
administration
– Frequency of administration
– Propensity for side effects
– Influence on the disease being treated, whether
specific, supportive, symptomatic or palliative
– Rapidity of onset of improvement
Compliance can be positively influenced by the following
factors.
● Clinician/client communication. Clinicians should
tailor their style of communication to the client and
ensure full understanding of the disease being treated,
the prognosis, the expected response to treatment
and the nature of any expected side effects, as well
as the circumstances that warrant reassessment.
Interactive development of a mutually agreeable
therapeutic plan with achievable expectations is most
likely to succeed. The clinician should provide an
environment in which the client feels comfortable
about raising any concerns or objections.
● Written instructions. Provide precise, simple but
thorough and legible instructions, which may include
a treatment calendar.
● Medication. Select a medication with physical characteristics
suitable to the skills of the client and
acceptable to the patient. Demonstration of administration
technique and observation of the competence
of the client in administration will allow
appropriate training or adjustment of the plan to be
instituted.
● Dosage regimen. Frequency of dosage and duration
of therapy should be as simple as efficacy, safety and
cost considerations permit. The most sophisticated
treatment regimen is destined to fail if it cannot be
translated into a plan that can be implemented by
the client.
● Follow-up. At the appropriate time, it can be important
to contact the client and assess whether the
therapeutic plan is operating as expected.
Undesirable consequences of poor compliance include:
● inadequate response to treatment, depriving the
patient and client of potential benefits
● recurrence or relapse of the poorly treated
condition
● increased costs caused by continuing need for
reassessment and further treatment
● creation of doubt in the mind of the client and the
clinician about the effectiveness of the drug
● possible use of an elevated dose rate that increases
the likelihood of an adverse effect if compliance is
restored
● underdosing which, in addition to being ineffective,
may be a strong selection force for antibiotic,
arthropod or helminth resistance.
Whenever there is unexpected lack of efficacy or an
adverse response, the investigation should include an
examination of the likelihood of deficient compliance.
A number of studies have shown that owner compliance
cannot be readily predicted by the prescribing
veterinarian.
Medical and medication errors
It has been estimated that the human toll due to medical
management errors exceeds the combined number of
deaths and injuries from motor vehicle and air crashes,
suicides, falls, poisoning and drowning. While there are
a number of important differences between medical and
veterinary practice, it should be expected that errors are
not uncommon in the veterinary arena. Though half the
errors in two large medical studies were related to surgical
procedures, complications arising from drug administration
were the next largest category.
The psychology of human error has been a fruitful
field for psychologists, who have described a combination
of active failures and latent conditions frequently
associated with breaches in safeguards leading to adverse
events.
Active failures can be divided into mistakes, slips and
lapses. Mistakes can result from cognitive errors (e.g.
failing to verify the existence of a sign of disease) or
rule-based errors, incorrectly applying a good rule (oral
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