Introduction to Veterinary

Pharmacy
Elizabeth Young, Pharm.D., FSVHP
Wasson Veterinary Pharmacy Resident
Purdue University Veterinary Teaching Hospital

All images from google.com or personal collection of Elizabeth Young

Syllabus & Schedule Review
 Objectives
• Discuss the education received by veterinarians
• Briefly describe the Veterinarian-Client-Patient Relationship (VCPR) and its
implications on pharmacy practice
• Review the requirements needed on a veterinary prescription
• Identify and be able to use multiple veterinary resources
• Recognize potential toxins to pets
• Medications
• Excipients (i.e. xylitol)
• Foods
• Plants
• Discuss the MDR-1/ABCB-1 gene in dogs and why that can lead to toxicities
A Veterinarians Education
 Veterinary Education

• 4 years of undergraduate studies

• 4 years of Veterinary Medicine Doctor of Veterinary Medicine (DVM)
• 3 years didactic or
• 1 year of clinical rotations Veterinary Medical Doctorate (VMD)
• Internship (1-2 years)
• Residency (2-3 years)
https://www.avma.org/public/YourVet/Pages/training.aspx
 Strait into
Practice
Bachelor’s Specialized
Vet School Residency
Degree Internship

Internship
Residency
 Advanced Degrees

• Advanced Degrees
• Duel-degree programs can be offered depending on the
school
• Masters of Science (MS)
• Doctor of Philosophy (PhD)
 Supplemental Credentials

• Supplemental Credentials
• Veterinary Botanical Medicine Association (VBMA)
• Certified Veterinary Herbalist (CVH)
• American Veterinary Chiropractic Association (AVCA)
• Animal Chiropractor = a Doctor of Chiropractic Medicine with an AVCA certification
• Veterinarian Certified in Animal Chiropractic = a DVM/VMD certified by AVCA
• Doctor of Naturopathy (ND)
• Certified Veterinary Acupuncturist (CVA)
 Board Certification

• Veterinarians may also become certified by one or more of

twenty specialty boards
• This is denoted by a D prior to board specialty (ex: DACVIM)
• D stands for Diplomate
• Compared to BCPS (Board Certified Pharmacotherapy Specialist)
Veterinary Prescriptions
 What is required of a Veterinarian to write a
prescription?
• The veterinarian must be licensed in the state that she/he is
practicing
• Exceptions can include: if the veterinarian is working at a veterinary
teaching hospital
• If prescribing a controlled substance, the veterinarian must have
a DEA license
• Again, exceptions exist if working at a veterinary teaching hospital
• A valid veterinarian-client-patient relationship (VCPR) must exist
before a licensed veterinarian dispenses or prescribes a
prescription product.
https://www.avma.org/KB/Resources/Reference/Pages/VCPR.aspx
The Veterinarian-Client-Patient-Relationship
Veterinarians must have a valid VCPR
prior to prescribing prescription drugs
for animal patients
Agreement:
Examination: Follow-up:
Veterinarian accepts
Vet must have recently Vet agrees to be
responsibility for
examined the animal or available for follow-up
treating the animal;
documented a visit to if a problem occurs
owner agrees to follow
the farm with treatment
vet’s instructions
 VCPR
• IC 25-38.1-1-14.5"Veterinarian-client-patient relationship"
• Sec. 14.5. "Veterinarian-client-patient relationship" means a relationship between a veterinarian
and client that meets the following conditions:
• (1) The veterinarian has assumed the responsibility for making clinical judgments regarding the health of
the animal and the need for medical treatment, and the client has agreed to follow the veterinarian's
instructions.
• (2) The veterinarian has sufficient knowledge of the animal to initiate a diagnosis of the medical condition
of the animal. The veterinarian has recently seen and is personally acquainted with the keeping and care
of the animal by either of the following:
• (A) An examination of the animal.
• (B) By recently seeing and being personally acquainted with the keeping and care of representative animals and
associated husbandry practices by making medically appropriate and timely visits to the premises where the
animal is kept.
• (3) The veterinarian is readily available or has arranged for emergency coverage for follow-up evaluation if
there is an adverse reaction or failure of the treatment regimen.
• (4) When appropriate, the veterinarian has arranged for continuing care with another licensed
veterinarian who has access to the animal's medical record.

http://iga.in.gov/legislative/laws/2017/ic/titles/025#25-38.1-1
 What can be prescribed for animals?

• The Short Answer:

• anything as long as there is a valid VCPR and the clinician has
the correct licenses
 What can be prescribed for animals?
• The Long Answer:
Legend drugs approved for humans
Scheduled drugs approved for
humans
Over-the-counter drugs for use in
humans
Legend drugs approved for animals
Scheduled drugs approved for
animals
Over-the-counter drugs for use in
animals
Requires Rx from a licensed veterinarian
Requires Rx from a licensed veterinarian with a valid DEA license
and state CSR
Requires Rx from a veterinarian
Pharmacists cannot make recommendations for animals under
any circumstance.
Requires Rx from a veterinarian
Requires Rx from a licensed veterinarian with a valid DEA license
and state CSR
Does not require Rx (can be purchased online and “OTC” at
veterinary practices)
 What is required on a veterinary prescription?
• According to Federal and Indiana law each prescription must contain the
following:
1. Name of the owner & patient 9. Directions for use
2. Address of the patient 10. Quantity to dispense
3. Species of the patient 11. Number of refills (if any) authorized
4. Prescriber’s name 12. Prescriber’s DEA number (if prescribing a
5. Prescriber’s address controlled substance)
6. Drug name 13. Date of issue
7. Drug strength 14. Signature of prescriber
8. Dosage form

• There are also recommended items that can be included on a

prescription
1. Weight of the patient 2. Dosage (mg/kg) 3. Length of therapy

Drug Enforcement Agency http://www.deadiversion.usdoj.gov/pubs/manuals/pract/section5.htm

Indiana Code 25-26-13-2 Definition of “Prescription”
Veterinary Information Resources
 Regulatory Resources

• FDA Center for Veterinary Medicine

• FDA CVM regulates the manufacture and distribution of food additives
and drugs that will be given to both companion and food animals.
• CVM Updates: provides practitioners and consumers with information
on what is happening at the FDA’s CVM
• https://www.fda.gov/animalveterinary/newsevents/cvmupdates/default.ht
m
• FDA Approved Animal Drug List (Green Book or Animal Drugs @ FDA):
valuable tool for determining whether a drug is actually approved in a
certain species or just used extralabel.

https://www.fda.gov/AboutFDA/CentersOffices/OfficeofFoods/CVM/default.htm
 Regulatory Resources

• US Department of Agriculture (USDA)

• Regulates the production of vaccines (immunobiologics) for use in veterinary species
• Which agency regulates vaccines in human medicine?
• The USDA does not have authority to grant ‘prescription only’ status. Thus, all animal
vaccines and biologics are considered OTC.

https://www.usda.gov/
 Regulatory Resources

• Environmental Protection Agency

(EPA)
• Ensures all topical pesticides do not
cause unreasonable risks when used
according to the label directions and
precautions.
• These products must be used
according to the manufacturer's label
(i.e. off-label use is strictly prohibited
by law)
https://www.epa.gov/pets/epas-regulation-flea-and-tick-products
Image from Google
 Veterinary Drug Information Resources

• Plumb’s Veterinary Drug Handbook/Plumb’s Veterinary

Drugs
• “Plumb’s” is available as the print Plumb’s Veterinary Drug
Handbook and the online version of Plumb’s Veterinary Drugs.
• Contains comprehensive drug monographs including a client
information section.

• www.plumbsveterinarydrugs.com
Veterinary Drug Information Resources

• Saunders Handbook of Veterinary Drugs: Small and

Large Animal
• “Saunders” or “Papich” is available in print and e-book
formats.
• Includes comprehensive drug monographs and a
number of clinically useful appendices
 Papich: Saunders Handbook of Veterinary Drugs:
Small and Large Animal.

• A companion website provides access to more than 150

customizable education handouts for pet owners.
• “The handouts contain a basic description of the medication
and what it is used for, possible adverse effects, what to watch
for, and a list of Dos and Do Nots, all on a single page!”
• http://www.papichdrugformulary.com/
Veterinary Drug Information Resources

• Exotic Animal Formulary

• The only drug formulary produced for the treatment
of exotic animals
• Includes information on birds, fish, amphibians,
reptiles, primates, wildlife, and small mammals
Veterinary Drug Information Resources

• Compendium of Veterinary Products

• Widespread collection of veterinary
product information
• Organized by product/trade names,
companies, product categories,
product uses, and ingredients
• The mobile app is currently available free
of charge
 Veterinary Information Resources

• Merck Veterinary Manual

• Part of the Merck Manuals series of medical information resources
• Online and hard copy versions available
• Trusted source for reviewing anatomic systems and the specific
conditions that are located in that system.
• There is a pharmacology section that categorizes drugs used in animals
by therapeutic class and provides comprehensive dosing and indication
tables.

• http://www.merckvetmanual.com/
 Veterinary Information Resources

• Veterinary Pharmacology
and Therapeutics
• Equivalent to Goodman &
Gilman’s The Pharmacological
Basis of Therapeutics
• Gold standard for basic
pharmacology.
 Veterinary Information Resources

• Veterinary Journals
Journal of Veterinary Pharmacology
and Therapeutics
Journal of the American Veterinary
Medical Association (JAVMA)
American Journal of Veterinary
Research (AJVR)
Journal of Veterinary Internal
Medicine (JVIM)
Research in Veterinary Science
Canadian Journal of Veterinary
Research
Veterinary Clinics of North
America
Today’s Veterinary Practice
The Canadian Veterinary Journal
 Veterinary Pharmacy Professional
Organizations
• Society of Veterinary Hospital Pharmacists (SVHP)
• Organization of pharmacists that work in the veterinary
field.
• Annual meeting to participate in ACPE-accredited
continuing education
• Share information through an email listserv

• www.svhp.org
 Veterinary Pharmacy Professional
Organizations

• American College of Veterinary Pharmacists (ACVP)

• Provides support for independent pharmacists and help develop a successful veterinary
compounding practice
• Encourages interaction and exchange of ideas among pharmacists and provides
networking opportunities and specialty services for members

• https://vetmeds.org/
 Think-Pair-Share
• 5 minutes to fill out your index card with:
a) Your name
b) What is wrong with the prescription
c) 2 Counseling points for the pet owner
• 5-10 minutes to discuss with your classmates and take a
break – use this time to also browse the reference books
that I brought
• Then we will come back together and discuss the
prescription
 Purdue University Veterinary Teaching Hospital
625 Harrison St. West Lafayette, IN 47907
765-494-7622

Name: Shaggy Rogers “Scooby-Doo” Date: 3/9/18

Address: 123 Cartoon Ave. TVland, IN 47907 .

Furosemide 50 mg tablets
#45
1 & ½ tabs PO q24h

Refillable ___ times

x Non-Refillable
_______________________________ _______Elizabeth Young_________
Dispense as Written May Substitute
_______________________________ _______ Elizabeth Young__________
Print Name Print Name
 Toxicities in the
Veterinary Patient
 Toxicity Resources
• ASPCA Animal Poison Control Center
• https://www.aspca.org/pet-care/animal-poison-control
• Free mobile app
• Breaks down by species and type of toxin (plant,
food, medication, household hazards)
• Some substances link to dose calculators
(i.e.chocolate)
• 1-888-426-4435
• There is a consultation fee of $65
• Available 24/7
 Toxicity Resources

• Gupta RC, ed. Veterinary Toxicology: Basic and

Clinical Principles. 2nd ed. Waltham, MA: Elsevier
Academic Press; 2012.
• Plumlee K, ed. Clinical Veterinary Toxicology. St.
Louis, MO: Mosby; 2003.
 Species-Specific Susceptibilities to Toxins

• Factors that affect the risk of toxicity vary greatly among species;
they include (but are not limited to) differences in absorption,
distribution, metabolism, and elimination; anatomical
characteristics such as the inability to vomit; age and size of the
animal; and seasonal and environmental influences.
 Pet poisonings

• According the the ASPCA’s Animal Poison Control Center ,

approximately 33.7% of pet poisonings in 2016 can be attributable to
human drugs.
• 17% of cases from human prescription medications
• 16.7% of cases from OTCs

https://www.aspca.org/news/announcing-top-pet-toxins-2016
 Why are 1/3 of pet poisonings from human
medications?
• Lack of knowledge on the part of the pet owner can result in inadvertent
poisonings
1. Accidental exposer to the medication
2. Intentional exposer
• Owners may attempt to treat animals with OTC products that are
intended for humans, not realizing that they can be toxic to their
animal.
 Factors that Influence Toxicity

• Species-specific adaptation
• Cats have evolved to be obligate carnivores  very little dietary
exposure to phytoalexins in plant materials
• Cats have not developed metabolic enzyme systems to detoxify planar
phenolic xenobiotics  serious toxicity can occur from exposure to the
plant itself or from it’s metabolites
 Factors that Influence Toxicity

• Anatomical factors
• Some species do not have the ability to vomit which is a critical
safety mechanism for expelling toxins from the upper GI tract.
• Horses, rabbits, rats, and mice (as well as other small rodents)
• Thus, when one of these animals ingests a toxin, induction of
emesis is not an option
 Factors that Influence Toxicity

• Seasonal Factors
• Mycotoxins and poisonous
plants are more abundant in
certain climates and during
certain seasons
• Holidays can lead to more
exposure to both toxic foods and
plants (lilies, daffodils,
mistletoe, holly, etc.)
 Canine Toxicology

• Opportunistic gorgers
• Evolved to take large, infrequent meals instead of numerous small
meals
• Leads to a higher risk of toxicity from ingestion of large amounts
of potential toxins
• Chocolate, medications, etc.
 Feline Toxicology

• Finicky picnickers
• Poisonings therefore, usually occur do to intentional administration by
the well-intended cat owner
• Meticulous groomers
• Ingestion of topically applied substances can result in unintended
toxicity
 Pharmacogenetics Factors

• A genetic polymorphism in the p-glycoprotein (P-gp) transporter protein,

results in failure of the P-gp pump at the blood-brain or other blood-
compartment barriers
• A four-base pair deletion mutation in the MDR-1/ABCB1 gene occurs at a
very high incidence in many herding breed dogs
• These animals can suffer severe, often fatal, central nervous system toxicity
from typical doses of drugs.
 High-Risk Breeds

Australian Shepherd Long-Haired Whippet

Border Collie McNab
Collie Mixed Breeds
English Shepherd Old English Sheepdog
German Shepherd Shetland Sheepdog
Herding Breed Crosses Silken Windhound

• “White feet, don’t treat”

• Many herding canine breeds have white feet
 Medications Known to Cause Adverse Effects in
Animals with a P-gp Mutation
• Cats
cats lack a competent ABCG2 blood-aqueous barrier, thus, enrofloxacin is able to
• Enrofloxacin  enter the retina, where it is photoactivated to toxic oxygen species that cause
blindness

• Dogs • Loperamide
• Acepromazine • Erythromycin
• Butorphanol • Macrocyclic lactones
• Chemotherapy agents • Ivermectin
• Doxorubicin • Milbemycin
• Paclitaxel • Moxidectin (when used at higher
• Vinblastine
doses than labeled for heartworm
prevention)
• Vincristine
• Selamectin
Medications that can cause toxicity
 Non-Steroidal Anti-Inflammatory Drugs
(NSAIDs)

• One of the most common forms of drug toxicity and among the
10 most common types of poisoning reported to the National
Animal Poison Control Center
• Many brands of ibuprofen have a sweet outer coating that
makes them especially appealing to pets
 NSAIDs

• COX-1 inhibitors or enolic acids can be extremely toxic to dogs when

ingested.
• GI ulceration (hematemesis, diarrhea, melena, weakness, pale mucous
membranes, abdominal pain, lethargy, and inappetence)
• Larger ingestions can lead to acute renal failure, liver failure, and
neurological signs (tremors or seizures)
• In cats: the limited capacity to conjugate with glucuronide leads to
accumulation  resulting in loss of protective prostaglandins in the gastric
tract and kidneys. Acute renal failure, GI ulceration/perforation may occur
within 12 hours of exposure or up to 3 to 5 days later.
 NSAIDs
• Ibuprofen
• Doses as low as 25mg/kg can lead to GI ulceration
• Doses as low as 175 mg/kg increase the risk of acute renal failure (in healthy dogs)
• Doses >400 mg/kg cause CNS effects (depression, seizures, and comas)
• Doses >600 mg/kg can lead to death
• Naproxen Cats only need half of
these doses to
• Doses of 5 mg/kg may result in GI irritation or ulceration experience toxicity
• Doses >10-20 mg/kg may result in acute renal failure

• These should never be used in cats or dogs because there are much safer
veterinary NSAIDs available.
 Acetaminophen toxicity

• Cats lack the ability to conjugate with glucuronide which means that the
metabolism pathway we see in humans does not occur in cats
• Because of slow formation of the glucuronide conjugate, the toxic N-acetyl-
p-benzoquinone imine (NAPQI) metabolite is produced by an alternate
metabolic pathway.
• Doses as low as 10 mg/kg have resulted in methemoglobinemia and death.
• Doses of 40 mg/kg have resulted in hepatotoxicity and death.
 Medications that can cause toxicity to Cats

Drug Mechanism Toxic Effects

Acetaminophen Alternate metabolic pathway to glucuronide conjugation Reduction of hemoglobin,
creating toxic NAPQI metabolite methemoglobinemia, failure of
oxygen transport, death
Alpha lipoic acid Unknown Hepatotoxicity, neurotoxicity,
death
Chloramphenicol Accumulation due to metabolic deficiencies in conjugation Myelosuppression
with glucuronide, hydroxylation, and demethylation
Diazepam Toxic metabolite formation due to deficient demethylation Fulminant hepatic necrosis and
and hydroxylation death
Enrofloxacin Failure of ABCG2 blood aqueous barrier, photoactivation to Retinal toxicity, blindness
reactive species
Local anesthetics Oxidative injury to hemoglobin Methemoglobinemia, hemolysis,
(benzocaine) failure of oxygen transport
Continued next slide
 Medications that can cause toxicity to Cats

Drug Mechanism Toxic Effects

NSAIDs and salicylates Accumulation of parent drug and toxic metabolites
resulting in loss of protective prostaglandins
Permethrins Deficient conjugation with glucuronide, accumulation of
permethrin and toxic metabolites
Phenazopyridine (azo dye) Oxidative injury to hemoglobin
Propylthiouracil Immune-mediated antinuclear antibody formation
Venlafaxine Non-selective serotonin reuptake blockade
Gastric ulceration, perforation,
renal papillary necrosis, death
Tremors and muscle fasciculation,
hyperesthesias, hyperthermia,
seizures, death
Heinz body anemia, hemolysis,
failure of oxygen transport
Lethargy, weakness, hemolytic
anemia, thrombocytopenia
Sedation, tremors, serotonin
syndrome, arrhythmias
 Human Prescription Products
• When ingested in large quantities the following are likely to be toxic:

- Albuterol - Diltiazem
- Amitriptyline - Isoniazid
- Amlodipine - Lamotrigine
- Amphetamines - Opioids
- Antipsychotics - SSRIs
- Baclofen - Warfarin
- Calcium chloride - Zinc
- Cyclobenzaprine - Nicotine replacement
- Digoxin
 Excipient Toxicity

• Medications approved for use in humans may be prescribed to animal

patients. However, product labeling should be carefully scrutinized to
ensure that there are no surfactants, preservatives, or other additives
present that are known to be toxic to animals
 Potential Excipient Toxicities in Dogs
Excipient Uses Toxic Effect
Aromatic amines Flavors and colors Substance dependent
Ethanol Solvent, preservative Ataxia, coma, respiratory paralysis
Ethoxyquin Prescervative Nephrotoxicity, hepatotoxicity,
thyrotoxicity, alopecia, allergic reactions
Polyethoxylated castor oil Surfactant Anaphylaxis, death
(Cremophor EL, Kolliphor EL)
Polysorbate 20 (Tween) Surfactant Anaphylaxis, death
Polysorbate 80 (Tween) Surfactant Anaphylaxis, death
Thimerosal Preservative Cutaneous reactions, anaphylaxis, death
Xylitol Sweetener Hypoglycemia, hepatocellular necrosis,
death
 Potential Excipient Toxicities in Dogs

• Surfactants
• Can trigger histamine release and complement activation  nonimmune anaphylactic
shock reactions, hypotension, and death
• Preservatives
• The LD50 of ethanol in dogs is 5.5 to 6.5 mL/kg with death occurring within 12 to 24 hours.
• Flavorings, Colorings, and Sweeteners
• Substances containing primary aromatic amine structures must undergo acetylation in
order to be eliminated, which dogs do not possess. This can thus be problematic.
• Xylitol is ubiquitous in human drugs and foods.
 Xylitol toxicity

• Doses as low as 100 mg/kg can be extremely toxic to dogs.

• Present with lethargy, weakness, ataxia, vomiting, seizures, coma, and death
• Dogs absorb xylitol from the gut (while humans do not)
• Once xylitol enters the bloodstream, it provokes insulin release that then causes
profound hypoglycemia, and hypokalemia. This can be fatal.
• > 30 to 40 minutes
• Exposure to higher doses can result in hepatotoxicity as well.
• > 1 to 72 hours
 Other products that can contain Xylitol

• Xylitol is an artificial sweetener so it’s found in many “sugar free” substances

• Chewing gum
It’s important to note that on labeling,
• Candies xylitol is often expressed as “sugar
• Breads alcohols (polyols)” and not specifically as
xylitol
• Peanut Butter
• Dental Products (toothpaste, mouth wash, whitening products)
 Potential Excipient Toxicities in Cats
Excipient Uses Toxic Effect

Azo dyes Coloring Methemoglobinemia

Benzoic acid derivatives Preservative Methemoglobinemia

Essential oils Flea repellent, Oral and lingual ulceration, lethargy,

aromatherapy depression, ataxia, tremors, seizures,
death
Ethanol Solvent, preservative Ataxia, coma, respiratory paralysis

Propylene glycol Solvent, moistening Heinz body hemolytic anemia, death

agent for semi-soft
foods
Foods that can cause toxicity
 Foods that are toxic to pets
Food
Caffeine, chocolate (methylxanthines)
Garlic, onions, leeks, chives
Grapes, raisins, currants
Hops*
Macadamia nuts*
Peanut butter (sweetened with xylitol)*
Sodium Chloride
*Applies only to dogs
Effect
Tachycardia, CNS stimulation, seizures, coma,
death
Depression, weakness, hemoglobinemia,
hemolysis, death
Vomiting, acute renal failure, death
Malignant hyperthermia, death
Lethargy ataxia, tremors, hyperthermia
Hypoglycemia, hepatotoxicity, death
Seizures, cerebral edema, death
 Methylxanthines

• Phosphodiesterase inhibitors
• Increase cyclic adenosine monophosphate which results in increased contraction and
neurologic and cardiovascular stimulation
• Example: Caffeine
• Chocolate contains 2 methylxanthines: caffeine and theobromine
• Toxicity is dose-related
 Allium Species
• Garlic, onions, leeks, and chives
• Contain organosulfoxide components that cause oxidative hemolysis
• The anemia and impaired oxygen transport caused by this are worsened by the
hypotensive and antithrombotic effects of ajoene  depression, lethargy, and
weakness
• Allicin and ajoene, found in garlic, are potent cardiac and smooth muscle
relaxants, vasodilators, and hypotensive agents
• Ajoene is also a potent antithrombotic agent
• As little as 15 to 30 g/kg of onion can result in important hematologic
changes in dogs
• In cats, consumption of as little as 5 g/kg of onions can result in important
changes
 Grapes, Raisins, and Currants

• Acute renal failure can occur following ingestion

• This includes grape skins and pressings crushed for juice or winemaking.
• Doses as low as 0.32 oz/kg for grapes and 0.65 oz/kg for raisins
have been reported to be toxic.
• Onset: 6-12 hours or as late as 2 days post ingestion
• Signs: nausea, vomiting, diarrhea, and anorexia, as well as acute
renal failure laboratory findings.
Sodium Chloride

• Large amounts of salts can lead to hypernatremia

and cerebral edema
• One of the most common reasons for sodium
chloride poisoning is due to owners giving salt in
an attempt to induce emesis after ingestion of
another toxin.
 Possible Treatments for Toxic Substances
• Inducing emesis (as a pharmacist you should never recommend this)
• Hydrogen peroxide, apomorphine
• Only useful for recent ingestion
• Can be harmful due to risk of aspiration
• Administering activated charcoal  Oral Adsorbent
• Administering GI protectants
• H2-blockers, sucralfate, misoprostol
• Induce diuresis with IV fluids
 References
• Kukanich B. “Over-the-Counter Human Medications.” Chapter 156, p. 599-602. Ettinger & Feldman’s Textbook of
Veterinary Internal Medicine.
• McConkey SE & Cribb A. The Mechanism of Acetaminophen-Induces Toxicity in Dogs and Cats. Proceeding of the
ACVP/ASVCP Concurrent Annual Meetings; Nov. 15-19, 2008.
• Dunayer E. Ibuprofen toxicosis in dogs, cats, and ferrets. Toxicology Brief. July 2004.
• Baggott MJ, Childs E, Hart AB, et al. Psychopharmacology of theobromine in healthy 19. volunteers. Psychopharmacology.
2013;228(1):109-18.
• Mayeux PR, Agrawal KC, Tou JS, et al. The pharmacological effects of allicin, a constituent of garlic oil. Agents Actions.
1988;25:182-90.
• Martin N, Bardisa L, Pantoja C, et al. Experimental cardiovascular depressant effects of garlic (Allium sativum) dialysate. J
Ethnopharmacol. 1992;37:145-9.
• Malik ZA, Siddiqui S. Hypotensive effect of freeze-dried garlic (Allium sativum) sap in dog. J Pak Med Assoc 1981;31:12-13.
• Apitz-Castro R, Badimon JJ, Badimon L. Effect of ajoene, the major antiplatelet compound from garlic, on platelet
thrombus formation. ThrombRes. 1992;68:145-55.
• Cope RB. Toxicology Brief: Allium species toxicity in dogs and cats. http://veterinarymedicine.dvm360.com/toxicology-
brief-allium-species-poisoning-dogs-andcats.Accessed August 1, 2016.
• Yamoto O, Maede Y. Susceptibility to onion-induced hemolysis in dogs with hereditary high erythrocyte reduced
glutathione and potassium concentrations. Am JVet Res. 1992;53:134-7.
• Mazzaferro EM. Acute renal failure associated with raisin or grape ingestion in 4 dogs. J Vet Emerg Crit Care.
2004;14(3):203-12.
• Duncan KL, Hare WR, Buck WB. Malignant hyperthermia-like reaction secondary to ingestion of hops in five dogs. J Am Vet
Med Assoc. 1997;210(1):51-3.
• Hansen SR, Buck WB, Meerdink G, et al. Weakness, tremors, and depression associated with macadamia nuts in dogs. Vet
Hum Toxicol. 2000;42(1):18-21.
• Hansen SR. Macadamia nut toxicosis in dogs. Veterinary Medicine. April 2002. http://aspcapro.org/sites/pro/files/x-
toxbrief_0402_0.pdf. Accessed August 1,2016.