September 06, 2018

What Do Pharmacists Know About Potential Pet Poisons?

A recent study highlighted limitations in pharmacists’ knowledge of toxic pharmaceutical ingredients and household substances.
By Natalie Stilwell, DVM, MS, PhD
Pharmacist Pet ToxinAn increasing number of veterinary clients are choosing to fill pet prescriptions through human pharmacies; however, veterinary pharmacology is not a required component of pharmacology training programs in the United States.

A recent article in Pharmacy Practice evaluated the baseline knowledge of licensed pharmacists with regard to common pet toxins.

Study Design
Investigators administered an online survey to all licensed pharmacists in the state of North Carolina during October and November 2015. Pharmacists were given a list of 25 substances and asked to evaluate the potential toxicity of each for either a cat or dog. Respondents rated items on a 5-point scale, ranging from 1 (“not a poison emergency”) to 5 (“very serious poison emergency”). The investigators considered ratings of 1 and 2 to be appropriate levels of concern for a nontoxin, while a rating of 3.5 and higher indicated appropriate concern for a true toxin.  

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Fifteen true toxins were included in the list: loratadine, macadamia nuts, Sago palm, allium (onions, garlic, chives), English ivy, tea tree oil, grapes, caffeine, artificial sweeteners (xylitol), acetaminophen, ethanol, nicotine, chocolate, moth balls, and DEET (insect repellent). Also included in the list were the following 10 nontoxins: green beans, bananas, pumpkin, acorn squash, tomatoes, paper, famotidine, leather, pony tail palms, and African violets.

Results
Of North Carolina’s 11,599 pharmacists, 413 women and 287 men completed the survey, providing a response rate of 6.3%. As male pharmacists and those over 60 years of age were underrepresented, researchers applied poststratification weights to account for age and sex variables. They also adjusted the sample size to 700.

Most pharmacists (86%) chose to evaluate the toxicity of substances in dogs, while the remainder considered potential toxicity of substances in cats. Respondents were able to classify 15 of 25 items (60%) correctly as toxic or nontoxic; only 50% of pharmaceutical substances were classified appropriately.

Most respondents did not recognize the following substances as toxic:
  • Macadamia nuts
  • Tea tree oil
  • Loratadine
  • Allium
  • English ivy
  • Xylitol
  • Grapes
  • Sago palm
  • Caffeine

However, most considered African violets to be potentially toxic.

Pharmacists gave significantly different ratings for dogs and cats for 6 potential toxins, including macadamia nuts, chocolate, famotidine, loratadine, grapes, and acetaminophen. Of these, acetaminophen is the only substance with clinically different toxicity levels in the 2 species. In general, female pharmacists and those over age 50 were more likely to express concern for potential toxins than were male respondents and those age 50 or younger. Responses were statistically similar among pharmacists working in hospital, community, and independent settings.

Take-home Message
Surveyed pharmacists appropriately identified just over half of common substances as toxic or nontoxic to pets. According to the authors, this study highlights the need for increased veterinary toxicology training and resources for pharmacists. However, they emphasized that pharmacists should only offer “basic triage information” and “refer pet owners to proper veterinary professionals” after suspected toxin exposure.

 
Dr. Stilwell received her DVM from Auburn University, followed by a MS in fisheries and aquatic sciences and a PhD in veterinary medical sciences from the University of Florida. She provides freelance medical writing and aquatic veterinary consulting services through her business, Seastar Communications and Consulting.
 

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