Medication Misuse

Dr. Kimberly Brokaw, DVM

(2/2014) Clients frequently ask me if they can have various prescription medications "just in case". In talking with friends of mine who are human doctors, they said that they rarely receive that kind of request. They usually only prescribe "just in case" medications in situations of foreign travel where they feel a specific disease is likely, such as travelers diarrhea during prolonged travel in areas such as rural Mexico where clean drinking water may be difficult to acquire. I admit that when I go camping with the horses I bring a large assortment of medications for the horses, "just in case." However, I know that I am going to use them correctly. I do not ask my personal physician to give me antibiotics just in case I drink dirty water and get giardia or for some other situation.

In veterinary medicine, I get the request for "just in case" medications frequently. When I first started in practice it really didn't seem like a bad idea. Yes, having a couple doses of Banamine in case your horse colics, or a bottle of sulfa antibiotics in case of an infection may seem like a good idea. People think they can save money if they have a simple colic and give a dose of Banamine. They may not have to pay for an emergency vet exam. In situations as just described, that is likely true, so I frequently would give a tube of Banamine for owners to have on hand. As I handed the medication to the owners, I would tell them they had to call me before they gave the medication but that I was happy to provide them with a tube. However, I have found myself becoming less inclined to give people "just in case" medications.

One of the problems with giving people medications to have on hand is that one is assuming they will use it correctly. In human care, I understand there is a concept of the 6 rights of medication administration. Medication administration should always involve giving the right medication, to the right person, in the right dose, by the correct route of administration, at the right time. The administration of the medication should also be documented in the right way. Nurses are trained to follow the 6 rights whenever they give medication. Unfortunately, horse owners are not often trained in the rights of medication administration.

I am always frustrated when I go to a barn to treat a horse and upon saying that the horse should start an antibiotic, the owner pulls out a container from a couple months ago where the directions clearly state on the label "give until finished" or they grab a bottle of antibiotics that expired a couple of years ago and ask if they can use that. Another frustration is when owners give the pain and fever reducer medication, Banamine, without calling first. I understand that their horse is colicking and they feel panicked and want to give Banamine right away., If you don't call, at least stop, think, and take the horse's temperature before or immediately after giving the dose of Banamine. Fever often looks like colic in a horse. Banamine reduces fever. Frequently owners give Banamine thinking their horse is colicking. The horse then seems better until the Banamine wears off, and again they have a "colicky" horse. If the fever is caused by an unrecognized infection, valuable time was lost when an appropriate antibiotic should have been started along with the Banamine.

One of my favorite misuse of medication stories involved a lawyer and a biomedical engineer. These two intelligent individuals, after discussion amongst themselves, still used a medication improperly. They own horses and dogs and had various bottles of partially used medications. They should know something about the Rights of Medication Administration. Earlier in the year one of their horses scratched its eye so they had a partial tube of antibiotic eye ointment in the medicine cabinet. They also have a dog that is prone to frequent ear infections and had a partially used tube of antibiotic ear ointment. The containers both clearly said that one was for eyes and the other for ears. The wife is usually the one to medicate the pets as she is a human nurse. However, she had gone to sleep early in preparation for a weekend shift. Her daughter (the PhD trained engineer) and son-in-law (another engineer) were in town for the weekend and were watching a movie marathon with her husband (the lawyer). In the midst of the movie marathon they noticed that the dog was scratching her ears a lot. While the dog was scratching she was crying as her ear had rapidly become sore. The lawyer knew that the dog had a history of having multiple ear infections. So along with the engineer, he went to the medicine drawer and looked frantically through it for something to treat the dogs ear. Rather than reading the label, they grabbed a tube of medicine and squirted it in the dog's ear. Right number one is that the medication should go to the right person or animal. They did not read the label to see if the dog's name was on the label. Another of the "Rights" involves using the proper method of administration for the medication. Ophthalmic/eye ointment should go in eyes. Otic/ear ointment should go in ears. This was also ignored. In their haste (or panic) to treat the crying dog, it did not occur to them that they might be making an error.

The next morning they told the nurse that the dog's ear had flared up so they started treating it and showed her the tube of medicine that they used. That's when I got the phone call. The nurse didn't think that putting eye medicine in the ear was a problem but wanted to make sure and ask if there was anything else she should do. She also wanted to know if she could come pick up an additional tube of eye medication to have on hand. Luckily the eye medication is safe for the ears, although more expensive, and greasier so not the ideal choice. She assured me that she would take over treating the dog and would use the correct medication and yet again asked if she could pick-up a tube of eye medication. As one could imagine, I was a bit hesitant to give her another tube.

So when you ask your vet if you can have some medication "just in case" my pet gets sick, and the vet hesitates. It's not because the veterinarian doesn't want to help you out. Rather she has probably had other clients misuse the medication and has become more cautious about giving out medication to have on hand. Sometimes, the "clients" who have misused the medications are even well educated, family members of the veterinarian.

Read other articles by Dr. Kim Brokaw