SOVG PATIENT Rx DRUG REFILL

AND THERAPEUTIC CARE GUIDELINES

The following information is to enable you to more easily schedule your pets recommended drug and/or lab testing in order to monitor their heath progress, as well as to remain within safety guidelines for continued Rx refills. We are providing this data to minimize your inconvenience in retesting before you are out of medication and a recheck is OVEDUE. These recommendations are partially medical common sense, as many diseases are dynamic and fluctuate in dose requirements over time AND partially legal, as the State of California requires a “hands-on doctor-patient relationship” AT LEAST ONCE A YEAR, or more often, as dictated by the nature of the condition and the prevailing standards set by the California Veterinary Community. Be aware these are the most common conditions seen and is not a complete list. The following applies to dogs unless noted otherwise for cats. If you have questions, please call us for more information.

Note: SOVG will be providing internet-based sales for both prescription and OTC supplies. Please check our website for this option. Please call ahead at least 24 hours prior to in-person pick up of

medications. Doctors may need to review your pets chart for accuracy and staff members will require time to refill and label Rx medications before the prescription can be released.

A CURRENT BODY WEIGHT is crucial for calculating a correct dose. If your pet has gained weight over time or lost weight due to severe disease, WE NEED FOR YOU TO LET US KNOW if there has been a change so that we can provide the most accurate dose.

Rx Medications and Refill Requirements۞ Condition: Bladder or Kidney Infection Drug: Antibiotic(s)

Rx Requirements: Urinalysis, Urine culture, possible kidney blood values, exam Initial Repeat Monitoring Interval: Urine culture (UMIC) 4-5 days AFTER Rx meds are completedFollow-up Monitoring Interval: 1 month additional urine culture if kidney disease 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): No Appt required: Generally not if stable or unless recommended by vet. Medication to be given before testing: No - Not for 4-5 days for antibiotics

Condition: Kidney Insufficiency or Failure Drug: Rx Diet, Omega-3 oils, Epakiten, +/- enalapril (Vasotec®)

Rx Requirements: Blood panel, urinalysis, urine culture, blood pressure, exam Initial Repeat Monitoring Interval: 2-3 weeks after dismissal Follow-up Monitoring Interval: generally every 3-4 months 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): No Appt required: As Recommended by Vet and patient is stable.

Medication to be given before testing: Yes Condition: Anemia due to Kidney Failure Drug: Epogen®

Rx Requirements: Blood panel, urinalysis, reticulocyte count, exam Initial Repeat Monitoring Interval: Weekly until PCV ≥ 30% Follow-up Monitoring Interval: 3-4 months 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): No Appt required: As Recommended by Vet and patient is stable. Medication to be given before testing: Yes -as per schedule.

Condition: Hypertension (High blood pressure) Drug: Amlopidine (Norvasc®), Benazepril (Lotensin®), Enalapril, Captopril, Atenolol (Tenormin®), Sotolol, etc.

Rx Requirements: Blood pressure, blood panel, exam, no antihistamines Initial Repeat Monitoring Interval: 4-6 days Follow-up Monitoring Interval: 2 weeks, then every 3-4 months 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): No Appt required: Yes, if stable or until BP is stable.

Medication to be given before testing: Yes

Condition: Diabetes mellitus Drug: Insulin and/or glipizide (Dogs and cats) Rx Requirements: Blood glucose (BG), glucose curve, blood panel, fructosamine, exam, urinalysis, urine culture (half of all diabetics have urinary infections), Rx diets.

Initial Repeat Monitoring Interval: 2-4 days between BG curves, 2 wks between fructosamine levels. Follow-up Monitoring Interval: every 3-4 months if stable and no excessive water intake. 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): No

Appt required: Yes, if patient is stable – unless otherwise directed by vet. Medication to be given before testing: Yes -and fed on schedule –VERY IMPORTANT!

Condition: Bladder/kidney stones Drug: Rx diet, antibiotics, etc

Rx Requirements: Urinalysis, urine culture, X-rays, blood panel, diet supplements, exam. Initial Repeat Monitoring Interval: 30 days +/- antibiotic Rx period for re-culture Follow-up Monitoring Interval: 60-120 days for stone disappearance by X-ray review, Every 6 months for repeat calcium oxalate patient for cultures and/or X-rays, esp. dogs 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): No

Appt required: Yes Medication to be given before testing: Yes

Condition: Seizures/Epilepsy Drug: Phenobarbital

Rx Requirements: Blood panel, urinalysis, possible bile acids test, possible MRI, exam. Initial Repeat Monitoring Interval: 2-4 weeks at 4-6 hrs after morning dose

Cats: recheck at 8 wks, then every 6 months Follow-up Monitoring Interval: 6months, then every 12 months if stable at 4-6 hrs after

morning dose. Perform asap if breakthrough seizures. 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): No Appt required: No - after initial recheck, stable and if seen in past 12 months. Medication to be given before testing: Yes

Condition: Seizures/Epilepsy Drug: Bromide (cats and dogs)

Rx Requirements: Blood panel, urinalysis, possible bile acids test, possible MRI, exam.

No NaBr for hypertension or cardiac patients. No KBr for Addison’ s patients or diabetics

Initial Repeat Monitoring Interval: 1 month, then 3 months later. Follow-up Monitoring Interval: 6months, then every 12 months if stable and taken 4-6 hrs after morning dose. Perform asap if breakthrough seizures. 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): Yes No Appt required: No - after initial recheck and if seen in past 12 months and stable. Medication to be given before testing: Yes

Condition: Heart Failure Drug: Digoxin (cats and dogs)

Rx Requirements: Chest X-ray, EKG, blood panel. Blood pressure, pulse oximeter, exam, possible chest Ultrasound Initial Repeat Monitoring Interval: 5-6 days for blood levels. Follow-up Monitoring Interval: every 6 months if stable +/- heart ultrasound/EKG 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): No

Appt required: No - after initial recheck and if seen in past 12 months and stable. Medication to be given before testing: Yes

Condition: Hypothyroidism Drug: L-Thyroxine (Soloxine®) (Phenobarbital lowers blood test results) Rx Requirements: Blood test (panel, UA, thyroid blood test = T4 and Free T4 levels by

ED, not RIA), blood pressure, exam. Initial Repeat Monitoring Interval: 4 weeks – 4-6 hrs after morning dose thyroid, CBC, kidney values and blood pressure. Follow-up Monitoring Interval: every 12 months with regular blood panel including post pill total T4 level, UA 4-6 hrs after morning dose. Sooner if weight gain or skin problems noted. 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): No Appt required: No - if seen in past 12 months and stable. Medication to be given before testing: Yes

Condition: Arthritis/ Joint disease Drug: NSAID/Prednisolone Aka Rimadyl®, Deramaxx®, Etodolac®, Meloxicam®, Piroxicam®, Tepoxalin®, Ketoprofen, Previcox®, etc. Rx Requirements: Blood panel, urinalysis, possible X-rays, exam.

Initial Repeat Monitoring Interval: 2-4 weeks Follow-up Monitoring Interval: 12 months if stable and no gastrointestinal upset. 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): No Appt required: No – if seen past 12 months and stable. Medication to be given before testing: Yes

Condition: Hyperthyroidism Drug: Tapazole® (methimazole)

(Cats) Rx Requirements: Blood panel, urinalysis, blood pressure, exam. Initial Repeat Monitoring Interval: 4 weeks, blood pressure, blood panel for kidney disease, CBC for adverse bone marrow reactions and thyroid levels. 2 months later to further evaluate blood counts and liver enzymes. Follow-up Monitoring Interval: 12 months if stable. Sooner with vomiting, kidney/liver disease, weight loss or excessive appetite. 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): No Appt required: No – if seen past 12 months and stable. Medication to be given before testing: Yes

Condition: Cushing’s Disease Drug: Trilostane (Vetoryl®),

Lysodren® (mitotane) Rx Requirements: Blood panel, urinalysis, Low Dose Dexamethasone Suppression test (8 hrs) +/- ACTH stimulation test (2 hrs) if LDDST ineffective, exam. Initial Repeat Monitoring Interval: 2 wks and 6 weeks, ACTH stimulation test (2 hrs) plus urine culture, blood panel. Follow-up Monitoring Interval: ACTH stimulation at 4 months if stable and no weight gain or excessive appetite/ water intake. 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): Yes Appt required: No – if seen past 12 months and stable. Medication to be given before testing: Yes

Condition: Addison’s disease Drug: Percorten® +/-

prednisolone Rx Requirements: Blood panel, urinalysis, ACTH stimulation test (2 hrs), exam. Initial Repeat Monitoring Interval: ACTH stimulation and electrolytes 4 weeks, Follow-up Monitoring Interval:1) Percorten® injection every 28-40 days and 2) then 8 wks, then every 4 months for ACTH stimulation if stable and no weight loss or excessive appetite. 12 Hr Fasting Required (CRITICAL FOR SOME TEST RESULTS): Yes Appt required: No – if seen past 12 months and stable. Medication to be given before testing: Yes - on schedule as per DVM instruction.