Medication Errors in Vet Med

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Pregabalin in Cats

The study focused on comparing the sedative effects of gabapentin and pregabalin in cats, particularly in the context of premedication before general anesthesia. These drugs, known as gabapentinoids, are commonly used for their sedative properties. Although gabapentin is widely used in veterinary practices for its anxiolytic effects in cats, there was a hypothesis that pregabalin might produce deeper sedation due to its more favorable pharmacokinetic properties. The study found no significant difference between pregabalin and gabapentin in terms of their sedative effects on cats when used alongside buprenorphine IM for premedication. Both drugs were administered orally, and their dosages were extrapolated from previous studies on dogs, aiming to achieve comparable analgesic properties. The sedation scores for both treatments were similar, suggesting that both drugs are equally potent for sedating cats. Another aspect investigated was the timing of the sedative effect. The peak concentrations for gabapentin typically occur well after 60 minutes, which was the time frame for the postsedation assessment. This could mean that the maximum sedative effect of gabapentin might not have been reached during the assessment. The study also considered the need for additional sedation with dexmedetomidine. The results indicated that both gabapentin and pregabalin, in combination with buprenorphine, were adequate for general handling and intravenous catheter (IVC) placement in most cats. However, the effect of dexmedetomidine on sedation scores and recovery times was noted, as it could potentially obscure the differences between treatment groups. The sample size for this study was similar to previous research that successfully detected sedation effects in cats. The conclusion was that there is no significant difference in the sedative effects between gabapentin and pregabalin in this specific population of cats. Thus, either drug can be effectively used for adjunct oral sedation in cats in a perianesthetic setting. 

Madan, R. D., Cenani, A., Montgomery, E., Azevedo, T., Vernau, K. M., & Brosnan, R. J. (2023). Pregabalin produces similar effects as gabapentin for preanesthetic sedation in cats. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.23.09.0493 

 Bottom line — No difference in sedation between gabapentin and pregabalin.

Cancer Reoccurrence Monitoring with Liquid Biopsy

The study explores using next-generation sequencing-based liquid biopsy for cancer monitoring in dogs post-surgery. This method detects cancer-related genetic changes in blood, offering a non-invasive approach to identify cancer recurrence. The study found that dogs with a detected cancer signal in their postoperative liquid biopsy had a higher chance of cancer recurrence within six months compared to those without a detected signal. The liquid biopsy was also able to identify molecular recurrence of cancer before clinical signs appeared in 55% of the cases. Despite these promising results, the study acknowledges limitations such as the diversity of cancer types studied, small sample sizes, and predetermined follow-up intervals that might not align with standard monitoring or tumor progression. The study highlights that liquid biopsy should complement, not replace, standard monitoring methods. Its accuracy across different cancer types and its ability to differentiate between recurrence of original cancer and new cancers are not fully established. The study concludes that more research is needed to determine the impact of liquid biopsy on clinical decision-making and outcomes. Future studies should focus on integrating liquid biopsy into standard monitoring practices for specific tumor types to better understand its diagnostic accuracy and effectiveness in clinical settings. 

McCleary-Wheeler, A. L., Fiaux, P. C., Flesner, B. K., Ruiz-Perez, C. A., McLennan, L. M., Tynan, J. A., Hicks, S. C., Rafalko, J. M., Grosu, D. S., Chibuk, J., O'Kell, A. L., Cohen, T. A., Chorny, I., Tsui, D. W., Kruglyak, K. M., & Flory, A. (2023). Next-generation sequencing-based liquid biopsy may be used for detection of residual disease and cancer recurrence monitoring in dogs. American Journal of Veterinary Research (https://doi.org/10.2460/ajvr.23.07.0163 

 Bottom line — It is a good compliment but doesn’t replace standard monitoring yet …

Medication Errors Over 2 Year Period

 This study investigated medication errors in a large animal veterinary teaching hospital over two years, aiming to describe their frequency and types. It was hypothesized that the error rates would be similar to those in human medicine. The study found 226 medication errors, equating to 36.8 errors per 1,000 patient visits, a rate comparable to human medicine but higher than previous veterinary reports. Most errors occurred during the prescription phase.Errors were classified according to a modified version of Kron’s 5 R’s of medication administration and categories from the National Coordinating Council for Medication Error Reporting and Prevention. The study’s findings aligned with trends in human medicine, particularly the prevalence of prescribing errors.The influence of veterinary training programs on error rates was examined, similar to the “July effect” observed in human medical training. The study highlighted the significant role of a decentralized pharmacist in identifying and preventing errors, leading to higher error reporting and fewer errors reaching patients.However, the study's retrospective nature and reliance on voluntary reporting suggest that the actual error rate could be higher. The lack of advanced error tracking technologies in veterinary medicine, as compared to human medicine, was also a concern.Overall, the study emphasizes the need for systematic changes, including improved error reporting, to reduce medication errors in veterinary settings. It suggests that incorporating decentralized pharmacists in veterinary hospitals could be beneficial, offering a framework for standardized error reporting and enhanced patient safety in veterinary medicine.

Hepworth-Warren, K. L., Maynard-Swift, E., Prange, T., Colwell, C., Stallings, O., Derks, K. G., Love, K., Hepworth, D. A., & Marks, S. L. (2023). Error reporting in a large animal veterinary teaching hospital identifies medication errors occur most often in the prescribing phase of therapy. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.23.10.0556 

Bottom line — Similar to human rate. Most happen in the ordering/prescribing phase.

Just putting things in perspective …

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