MEDIC: An Approach to Student Responsibility in Drug Usage

Gordon L.Coppoc, D.V.M., Ph.D., Purdue University, School of Veterinary Medicine

1. What is your therapeutic goal? What specific pathologic process do you wish to alter by using a drug from this class and this drug in particular. Is it essential that you use this or any other drug?
    
   
2. By what routes can the drug be given for the indication in question and which are you going to use? On what basis did you make this decision? What are, for example, the relative advantages or disadvantages of i.v. versus p.o. administration in this case?
    
   
3. What dose form are you going to use? Is it a tablet? Capsule? Bolus? Is it rapidly absorbed? A repository form? How much active ingredient per tablet or per ml of preparation? Is the size appropriate for this animal?
    
   
4. What dose, in units/kg or mg/kg is generally recommended and how much are you using in this particular animal? How did you arrive at this dose? Are there items considered under "precautions" that should modify the dose in this animal?
    
   
5. What is the dose interval? Is this going to be frequent enough to prevent the drug from dropping below effective concentrations? Will it be to frequent and precipitate accumulation and toxicity?
    
   
6. What is the probable duration of therapy, e.g., a single dose vs. three times a day for three weeks?
    
   
7. For food animals, what is the withdrawal time? Is the drug approved for use in this food producing species?
    
   
8. How much does the drug cost per treatment and per expected duration of therapy? This should include administration expenses such as syringes, technician time and special dispensers as in a water supply. Does the cost of treatment exceed the value of the animal or the desire of the owner to pay? Is the cost appropriate to the seriousness of the affliction?
    
   
9. What special precautions must be observed to enhance its effectiveness or safety? Examples: What if the drug is eliminated by the kidney and renal function is compromised? What about putting a bland ointment in the eyes of a cat given ketamine? Would acidifying urine increase antibacterial efficacy in a urinary cystitis? Will the drug interact with other drugs in the regimen?
    
   
10. What are the contraindications to the use of this drug, i.e., under what conditions should it not be used?
     
    
11. What adverse reactions might one reasonably expect to see? How would you monitor the animal to detect potentially serious reactions before they are permanent or endanger the animal's life? What possibilities do you need to watch for?
     
    
12. What antidote or course of action will you take if you elicit one of the drug reactions outlined above? Do you have the requisite drugs and/or equipment on hand? Do you know where to find the answers to these questions for the drugs that you prescribe?
     
    
13. What plans do you have for evaluating the results of your therapy? By what parameter(s) will you judge whether the animal is responding to treatment? When can you reasonably expect to see the first response? How will you judge whether you have "cured" the animal? What follow-up procedures should be instituted?
     
    
14. What are the costs of your decision? (benefits, losses, risks, lost opportunities, others?)