Step 5 of the prescribing cascade describes extemporaneous preparation. Who can perform this?

• A. A vet, a pharmacist or a person holding MANSA
• B. Only the vet
• C. Only the pharmacist
• D. The owner

Answer: (A)

Extemporaneous preparation means formulating a medicine for an individual animal when there is no licensed product that exactly fits the species, dose, or route needed. In the prescribing cascade, this allows treatment to go ahead by compounding a medicine under proper control and safety standards, with appropriate supervision and record-keeping.

A veterinarian can supervise and carry out the preparation within a practice, ensuring it matches the patient’s needs and the clinical rationale. A pharmacist brings expertise in compounding, quality control, and appropriate excipients, ensuring the product is prepared safely and accurately. A person holding MANSA is authorized to perform extemporaneous preparations under the cascade, reflecting a recognized regulatory authorization to compound for animals.

An owner isn’t appropriate to perform compounding due to risks around dosing accuracy, sterility, stability, and regulatory compliance. So the combination of a vet, a pharmacist, or a MANSA holder covers who can carry out this step.