Shelter Medicine Controlled Drugs

Implementation Date: 10/2021

Date of Last Revision: 9/14/2022

Next Review Due: 9/13/2025

 

Reviewed by VTH Administrative Team: 10/2021

Reviewed by VTH Board: N/A

 

Reviewed by Legal Counsel: N/A

Reviewed by Biosecurity Subcommittee: N/A

Subject to modification by the VTH Director without approval.

*See below for TTDex Dosage Chart*

Policy

This document is designed to establish clear guidelines for the use and storage of controlled drugs within the Shelter Medicine service. This applies to Shelter Medicine faculty, Shelter Medicine interns and technicians and veterinary students. The Shelter Medicine Service uses multiple controlled drugs daily which includes, butorphanol, buprenorphine and Telazol. All logs must be maintained accurately and returned to the Medication Dispensary with the empty vials on a weekly basis. 

Procedure (if applicable)

1. The following procedure should be used to mix the butorphanol (Torbugesic), dexmedetomidine (Dexdomitor), and Telazol to create the TTDex mixture:
2. The sterile vial containing previously unconstituted Telazol will be used to store TTDex and will be labeled with TTDex xxxx, where xxxx is the controlled drug number given to the Telazol bottle by the Medication Dispensary.
3. The following will be added to the bottle of unconstituted Telazol powder (tiletamine-zolazepam 500 mg) to make the TTDex formulation
   1. Torbugesic/butorphanol (10 mg/ml): 2.5 ml
   2. Dexmedetomidine (0.5 mg/ml): 2.5 ml
4. The yellow sheets assigned to the Telazol vials are then filled out using the volume and mg amounts of TTDex used. Each line must include a patient identifier (name, number, etc.).
   1. a. At the top of each yellow sheet for which the Telazol was used to make TTDex, indicate that on the first line with the following: “Full vial used to make 5ml of TTDex. The below log shows the TTDex volumes administered.”
5. When mixing a vial of TTDex, complete a line on the butorphanol yellow sheet indicating the date. The patient will be TTDex xxxx.
6. Affix to each vial of TTDex a label indicating the following information. These labels are provided by the sheet from the Medication Dispensary.
   1. TTDex xxxx
   2. Name and quantity of each drug
   3. Date prepared
   4. Expiration date (30 days from the date prepared)
   5. Initials of person preparing the vial
      
      

Yellow controlled drug sheets:

1. Every bottle of controlled drugs should have a yellow sheet with a corresponding drug number.
2. The yellow sheet should stay in the same physical location as the corresponding drug bottle.
3. Whenever controlled drugs are used, the amount in both mg and ml should be logged on the yellow sheet, along with the remaining amount, the person drawing up and administering the sample and a witness.
   1.  If medications are given directly to individual animals, then the name of the individual patient should be logged on the yellow sheet.
   2. If medications are being used to make TTDex, then the total volume of TTDex administered should be logged on the Telazol yellow sheet as described in number 4 under Procedure above.
   3. Telazol yellow sheets do not need to indicate the person administering, clinician or witness as long as they are accompanied by surgery logs that contain these signatures for each dose.
      
      

Use and logging of TTDex:

1. A Surgery Day log sheet (see end of this document) is completed for each day that surgeries are performed.
2. The amount of TTDex used from each bottle for each patient is logged in the TTDex column next to the patient. At the end of the surgery day the total volume used from each bottle of TTDex are calculated and recorded at the bottom of the sheet.
3. The total hub loss of drug based on the number of sticks and acceptable hub loss (0.05ml/stick) is calculated by multiplying the total number of sticks x 0.05ml.
4. The surgery log is maintained as part of shelter med records and a copy is turned into the medication dispensary with the empty vials.
5. TTDex administration is also documented in the patient’s medical record with all other medications administered. This record is maintained in a Box folder and the Pharmacist in Charge (PIC) has access to this folder.
   
   

Ordering controlled drugs for ward stock:

1. The controlled drugs will be charged in SANDI under account 307149, Drugs and Supplies or account 417033, Pet Population Grant. The appropriate account will be indicated when ordering.
2. A Shelter Medicine ward stock order form indicating the quantity of each item needed will be sent to the pharmacy. If controlled drugs are ordered, a doctor must sign next to those lines indicating their approval.
3. Turn the form into the Medication Dispensary. Please allow 24 hours for controlled drugs to be prepared with all necessary log sheets.
4. When controlled drugs are picked up, the person obtaining them will sign the order form and sign the controlled substance pickup log.
   
   

Returning empty bottles to pharmacy:

1. To prevent too many empty bottles of controlled drugs from accumulating on the mobile unit, empty bottles should be returned, at a minimum, every week to the Medication Dispensary.
2. Confirm that every bottle of controlled drug has a yellow sheet with the corresponding controlled drug number, xxxx.
3. Confirm that the yellow sheets are filled out appropriately
4. Attach the yellow sheet to the corresponding empty bottle with a rubber band and return to pharmacy.
5. Provide all white surgery logs showing the use of all TTDex vials being returned. Number of sticks and acceptable hub loss (0.05 ml/stick) should be indicated at the bottom of the sheet. Confirm that all TTDex is accounted for by these logs.

Definitions (if applicable)

Veterinary Teaching Hospital (VTH): The collective clinical services of the Large Animal Clinic, Midwest Equine, the Small Animal Clinic, and the Veterinary Medicine South Clinic.

TTDex Dosage Chart:

Patient Weight kgs	Patient Weight Lbs	Low End Dose (0.01mL/kg) in mL for Moderate Sedation	High End Dose (0.035 mL/kg) in mL Surgical Anesthesia
0.9	2	0.01	0.03
1.4	3	0.01	0.05
1.8	4	0.02	0.06
2.3	5	0.02	0.08
2.7	6	0.03	0.10
3.2	7	0.03	0.11
3.6	8	0.04	0.13
4.1	9	0.04	0.14
4.5	10	0.05	0.16
5.0	11	0.05	0.18
5.5	12	0.05	0.19
5.9	13	0.06	0.21
6.4	14	0.06	0.22
6.8	15	0.07	0.24
7.3	16	0.07	0.25
7.7	17	0.08	0.27
8.2	18	0.08	0.29
8.6	19	0.09	0.30
9.1	20	0.09	0.32
9.5	21	0.10	0.33
10.0	22	0.10	0.35
10.5	23	0.10	0.37
10.9	24	0.11	0.38
11.4	25	0.11	0.40
11.8	26	0.12	0.41
12.3	27	0.12	0.43
12.7	28	0.13	0.45
13.2	29	0.13	0.46
13.6	30	0.14	0.48
14.1	31	0.14	0.49
14.5	32	0.15	0.51
15.0	33	0.15	0.53
15.5	34	0.15	0.54
15.9	35	0.16	0.56
16.4	36	0.16	0.57
16.8	37	0.17	0.59
17.3	38	0.17	0.60
17.7	39	0.18	0.62
18.2	40	0.18	0.64
18.6	41	0.19	0.65
19.1	42	0.19	0.67
19.5	43	0.20	0.68
20.0	44	0.20	0.70
20.5	45	0.20	0.72
20.9	46	0.21	0.73
21.4	47	0.21	0.75
21.8	48	0.22	0.76
22.3	49	0.22	0.78
22.7	50	0.23	0.80
23.2	51	0.23	0.81
23.6	52	0.24	0.83
24.1	53	0.24	0.84
24.5	54	0.25	0.86
25.0	55	0.25	0.88
25.5	56	0.25	0.89
25.9	57	0.26	0.91
26.4	58	0.26	0.92
26.8	59	0.27	0.94
27.3	60	0.27	0.95
27.7	61	0.28	0.97
28.2	62	0.28	0.99
28.6	63	0.29	1.00
29.1	64	0.29	1.02
29.5	65	0.30	1.03
30.0	66	0.30	1.05
30.5	67	0.30	1.07
30.9	68	0.31	1.08
31.4	69	0.31	1.10
31.8	70	0.32	1.11
32.3	71	0.32	1.13
32.7	72	0.33	1.15
33.2	73	0.33	1.16
33.6	74	0.34	1.18
34.1	75	0.34	1.19
34.5	76	0.35	1.21
35.0	77	0.35	1.23
35.5	78	0.35	1.24
35.9	79	0.36	1.26
36.4	80	0.36	1.27
36.8	81	0.37	1.29
37.3	82	0.37	1.30
37.7	83	0.38	1.32
38.2	84	0.38	1.34
38.6	85	0.39	1.35
39.1	86	0.39	1.37
39.5	87	0.40	1.38
40.0	88	0.40	1.40
40.5	89	0.40	1.42
40.9	90	0.41	1.43

Citations:

Atipamazole (Antisedan will be administered at 1/3 of the TTDex injection volume per recommendation of the ASPCA spay/neuter project. Example: TTDex dosage of 0.3mL would be reversed with 0.1mL of Antisedan.

Ko, J. C., & Berman, A. G. (2010). Anesthesia in Shelter Medicine. Topics in Companion Animal Medicine, 25(2), 92–97. https://doi.org/10.1053/j.tcam.2010.03.001