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Microsoft word - mar 07 - rnantnu np prescription drug list - ready
REGISTERED NURSES ASSOCIATION OF THE NORTHWEST TERRITORIES AND NUNAVUT PRESCRIPTIVE AUTHORITY GUIDELINES FOR NWT PRIMARY HEALTH CARE NURSE PRACTITIONERS
These Guidelines form an addendum to the August 2005 RNANT/NU PracticeGuidelines for Primary Health Care Nurse Practitioners, approved by the Ministerof Health and Social Services (the Minister), and are approved by the Ministerunder subsection 5(2) of the Nursing Profession Act, S.N.W.T. 2003, c.15 (NPA). For reference, section 5 of the NPA reads,
5. (1) The Association may recommend to the Minister guidelines respecting the practice of nurse practitioners. (2) The Minister may approve the guidelines recommended by the Association.
These Guidelines, as approved by the Minister, provide the necessary authorityfor nurse practitioners, as defined in section 1 (Definitions) of the NPA, toprescribe those drugs included in the following Schedules A, B and C, andreplace the Nurse Practitioner Prescription Regulations, repealed with thecoming into force of the new Pharmacy Act, S.N.W.T. 2006, c.24, on April 2,2007.
For further clarification, according to subsection 20(1) of the new Pharmacy Act,which reads,
20. (1) Before dispensing a drug a pharmacist shall take reasonable steps to satisfy himself or herself that… (d) if the practitioner is a "nurse practitioner" as defined in section 1 of the Nursing Profession Act, he or she is entitled, under guidelines approved by the Minister under subsection 5(2) of that Act, to prescribe the drug.
a pharmacist should refer to Schedules A, B and C of these Guidelines in orderto determine if a nurse practitioner is entitled to prescribe the drug in questionbefore dispensing. RNANT/NU PRESCRIPTIVE AUTHORITY GUIDELINES for NWT PRIMARY HEALTH CARE NURSE PRACTITIONERS (PHCNP’s) Prescription Schedules A,B,C *Please Note : This is a COMPANION DOCUMENT to the NIHB DRUG BENEFIT LIST. *IT IS NOT TO BE USED ALONE Schedule A is a list of inclusions by pharmacologic-therapeutic classification AND exclusions and limitations itemized by sub-classification or drug name from the Jan 2007 NIHB Drug Formulary Schedule B excludes all NAPRA Schedule 1 drugs NOT mentioned in Schedule A, but contains a secondary list of inclusions that can be prescribed by NP’s. Schedule C is a list of inclusion of NAPRA Schedules 2, 3 and Unscheduled not previously mentioned in Schedule A to the NP Guidelines Definitions: “Inclusion”: an NP MAY prescribe the drug or drugs listed in a particular sub- classification. “Exclusion”: an NP MAY NOT prescribe the drug or drugs listed in a particular sub- “Limitation” restricts NP prescribing to a specified course length or clinical indication. “Maintenance”: an NP may prescribe the drug in the same dosage as originally ordered for the continuation of therapy provided the drug has been previously prescribed for the patient by a physician. As outlined in the Practice Guidelines, it is the responsibility of the NP to continue appropriate screening and monitoring when assuming care in collaborative practice. Note: The NP must write “Maintenance” on Script .
RNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
General NP Prescription Guidelines:
1) A PHCNP can prescribe all drugs listed in the NIHB Formulary unless there is an
exclusion or limitation noted in the schedule A.
2) A PHCNP must always prescribe within his/her scope of practice.
3) A Community NP (working in a Territorial Health Centre) may perform all duties of a
Community Health Nurse (CHN) as well as the legally defined additional functions of theNP. Note: A Community NP may select, dispense, compound and repackage medicationunder medical directives, policy and guidelines, as the Community Health Nurses may do,in addition to prescribing.
4) Combination drugs: unless clearly stated otherwise,
a) where both drugs are approved for initial, they are included ,b) where one drug is excluded and the other is included, the combination is drug is
c) where one drug is maintenance the other is an inclusion, the combination drug is
RNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
SCHEDULE A A PHCNP may prescribe all drugs in this schedule unless there is an exclusion or limitation. ANTIHISTAMINE DRUGS 04:00.00 ANTI-INFECTIVE DRUGS 08:00.00 Anthelmintics Cephalosporins Macrolides Penicillins Quinolones Sulfonamides Tetracyclines Miscellaneous Antibiotics 08:12:28
Inclusions: All except Maintenance: Linezolid Allylamines
Inclusions: All except Exclusions: Oral Ketoconazole Polyenes Antituberculosis Agents
Maintenance: AllNB: Rifampin can be prescribed for meningitis prophylaxisNB: Isoniazid can be prescribed for chemoprophylaxis
Adamantanes
RNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
Maintenance: AmantadineNB: May be prescribed for Influenza prophylaxis
Antiretrovirals
Maintenance: AllNote: prophylaxis after needle stick injury to be initiated per employer policy
Interferons Nucleosides and Nucleotides
Inclusions: All except Exclusions: Ganciclovir & Valganiclovir Amebicides
Maintenance:Note: See 08:30.92 for Metronidazole which is an inclusion
Antimalarials Inclusions: All except
Maintenance: Hydroxychloroquine, Primaquine and PyrimethaineNote: See Schedule B re: Laroium and Mallerone
Miscellaneous Antiprotozoals Inclusions: All except Maintenance: Atovaquone, Pentamidine Trimetrexate Urinary Anti-Infectives ANTINEOPLASTIC DRUGS 10:00.00
Maintenance: All except Exclusions: Mitotane, Procarbazine, Temozolomide, Thioguanine, Tretinoin and Vincristine AUTONOMIC DRUGS 12:00.00 Parasympathomimetics Antiparkinsonian Drugs
Inclusions: All except Maintenance: Ethopropazine, Procyclidine, Ropirole, Trihexyphenidyl Antimuscarinics/Antispasmodics Sympathomimetic Agents –
Inclusions: All except Maintenance: Salmeterol Alpha-Adrenergic Agonists
RNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
Beta-Adrenergic Agonists
Inclusions: All except Maintenance: Formoterol & Terbutaline, Salmeterol . Beta and Alpha-Adrenergic Agonists Sympatholytic Agents Skeletal Muscle Relaxants
Inclusions: All except Maintenance: Dantrolene, Tizanidine Miscellaneous Autonomic Drugs BLOOD FORMATION COAGULATION AND THROMBOSIS 20:00.00 Iron Preparations
Inclusions: AllMaintenance: All injectable iron
Anticoagulants
Exclusions: All except Maintenance: Dalteparin sodium, Enoxaparin sodium Platelet Aggregation Inhibitors
Maintenance: AllNote: Clopidogrel – see 92:00.00
Hematopoietic Agents Hemorrheologic Agents Hemostatics CARDIOVASCULAR DRUGS 24:00.00 Antiarrhythmic Drugs Cardiotonic Agents
RNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
Bile Acid Sequestrants Cholesterol Absorption Inhibitors Fibric Acid Derivatives HMG-CoA Reductase Inhibitors (Statins) Central Alpha-Agonists Direct Vasodilators
Exclusion: DiazoxideMaintenance: Hydralazine , Minoxidil oral
Nitrates and Nitrites
Maintenance: Isosorbide dinitrate, Nitroglycerine patch
Miscellaneous Vasodilating Agents Alpha-Adrenergic Blocking Agents Beta-Adrenergic Blocking Agents
Limitations: Atenolol and Metoprenol – included for hypertension onlyMaintenance : Acebutolol, Bisoprolol, Carvedilol, Labetalol, Nadalol, Oxprenolol,
Dihydropyridines Miscellaneous Calcium Channel Blocking Agents ACE Inhibitors Angiotension II Receptor Antagonists Aldosterone Receptor Antagonists CENTRAL NERVOUS SYSTEM AGENTS 28:00.00
RNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
Non-Steroidal Anti-Inflammatory Agents Opiate Agonists Opiate Partial Agonists Miscellaneous Analgesics & Antipyretics Inclusions: All Anticonvulsants-Barbiturates Anticonvulsants-Benzodiazepines Anticonvulsants-Hydantoins Anticonvulsants-Succinimides Miscellaneous Anticonvulsants
Limitations - limited to post-herpetic neuralgia and herpetic pain, trigeminal neuralgia
Antidepressants
Inclusions: Amitriptyline, BuproprionExclusions: MAOI’s – Phenelzine and TranylcypromineLimitations: -Trazodone - may not be prescribed in a dosage more than 50mg.
-SSRI’s and SNRI’s – Citalopram, Fluoxetine, Fluvoxamine, Mirtazepine,
Paroxetine, Sertraline and Venalafaxine are inclusions BUT limited to patients
over 18 years of age. NP can initiate first course, Reassessment by physician
Maintenance: All other drugs in this sub-category
Antipsychotic Agents Amphetamines Miscellaneous Anorexigenic Agents, Respiratory & Cerebral Stimulants Exclusions: All Anxiolytics, Sedatives and Hypnotics – Benzodiazepines
RNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
Miscellaneous Anxiolytics, Sedatives and Hypnotics Antimanic Agents Selective Serotonin Agonists Miscellaneous Central Nervous System Agents CONTRACEPTIVES (NON-ORAL) 32:00.00 DIAGNOSTIC AGENTS 36:00:00 ELECTROLYTIC, CALORIC, AND WATER BALANCE 40:00.00 Alkalinizing Agents Replacement Preparations Calcium-Removing Resins Ion-Removing Agents Caloric Agents DIURETICS 40:28.00 Loop Diuretics
Exclusion: Ethacrynic acidLimitations: Furosemide approved for use for mild to moderate heart failure, up to 7 day course,
Maintenance: Furosemide for long term use
Potassium-Sparing Diuretics Thiazide Diuretics
Limitations: Hydrochlorthiazide for management of hypertensionRNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
Thiazide Like Diuretics
Exclusion: ChlorthalidoneMaintenance: All others
Uricosuric Agents
Inclusions: All except Limitations: Probenecid –restricted: for adjunctive therapy with antibiotics ; maintenance only
Maintenance: SulfinpyrazoneNote: For Allopurinol see 92:00.00
RESPIRATORY AGENTS 48:00.00 Antitussives Leukotriene Modifiers
Inclusions: All . NP can initiate first course, Reassessment by physician within 3 months
Mast Cell Stabilizers EYE, EAR NOSE AND THROAT (EENT) PREPARATIONS 52:00.00 EENT - Antiallergic Agents EENT – Antibacterials EENT – Antivirals EENT – Corticosteroids
Inclusions: All for nasal, inhaled and otic useMaintenance: All for ophthalmic use
EENT – Nonsteroidal Anti -inflammatory agents EENT – Carbonic Anhydrase Inhibitors
Inclusions: for high-altitude travelMaintenance: All others
EENT- Miotics EENT – Mydriatics
Maintenance: AllRNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
EENT – Mouthwashes and Gargles EENT – Vasoconstrictors Miscellaneous EENT Drugs
Inclusions: Aluminum Acetate/Benzethonium Chloride Otic, all Methylcellulose-based
ophthalmic preparations, all Petrolatum-based ophthalmic ointments, all Polyvinylalcohol-based ophthalmic drops , all Sodium Chloride eye and nasal preparations,and all propylene glycol nasal preparations. GASTROINTESTINAL DRUGS 56:00.00 Antacids and Adsorbents Antidiarrhea Agents Cathartics and Laxatives Cholelitholytic Agents Digestants Antihistamines (Anti-nauseants) 5-HT3 Receptor Antagonists Miscellaneous Antiemetics
Inclusions: All exceptExclusions: NabiloneLimitations: Domperidone –inclusion for breastfeeding; otherwise Maintenance
Histamine H2-Antagonists Prostaglandins
- with Arthrotec;- for pre-endometrial biopsy, IUD insertion or other GYN procedure
Exclusions: All othersRNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
Protectants Proton-Pump Inhibitors Prokinetic Agents Anti-inflammatory Agents GOLD COMPOUNDS 60:00.00 HEAVY METAL ANTAGONISTS 64:00.00 HORMONES AND SYNTHETIC SUBSTITUTES 68:00.00 Adrenals
Inclusions: Beclomethasone, Budesonide, and Fluticasone for inhalationLimitations: Oral Prednisone-ADULT - acute therapy- up to 14 days to a maximum of 2
- for CROUP- one dose only- if more is needed, need to consult MD- for other conditions- 5 day course, maximum once in three months
Androgens
Exclusions: All except Maintenance: Danazol Contraceptives Estrogens Estrogen Agonists/Antagonists Alpha-Glucosidase Inhibitors Biguanides Insulins
RNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
Meglitinides Antidiabetic Agents – Sulfonylureas Thiazolidinediones Parathyroid Pituitary Progestins
Inclusions: All except Maintenance: Thyroid Antithyroid Agents SKIN AND MUCOUS MEMBRANE AGENTS (SMMA) 84:00.00 SMMA – Antibiotics SMMA – Antivirals SMMA – Scabicides and Pediculicides SMMA-Miscellaneous Local Anti-Infectives
RNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
SMMA – Anti-inflammatory Agents
Inclusions: All except Maintenance: -Potent and very potent topical anti-inflammatory corticosteroid agents
Note: Very Potent topical corticosteroids: Beclomethasone diproprionate, Clobetasol,
Potent topical corticosteroids: Amcinonide, Betamethasone valerate, Desoximetasone,
Diflucortolone, Fluocinolone, Fluocinonide, Halcinonideand Mometasone
SMMA-Cell Stimulants and Proliferants Basic Ointments and Protectants Keratolytic Agents Keratoplastic Agents Pigmenting Agents Miscellaneous Skin and Mucous Membrane Agents
Inclusions: Calcipotriol topical, Capsaicin, Collagenase, and Vitamin E topical Exclusion: Accutane Maintenance: All others SMOOTH MUSCLE RELAXANTS 86:00.00 Genitourinary Smooth Muscle Relaxants
Inclusions: Oxybutynin is a drug of inclusion, Maintenance: All others Respiratory Smooth Muscle Relaxants
Maintenance: All VITAMINS 88:00.00
Inclusions: All except Maintenance: Alfacalcidol, calcitriol and ergocalciferol maintenance UNCLASSIFIED THERAPEUTIC AGENTS 92:00.00
Inclusions: Alendronate, Allopurinol, Betahistine,Etidronate, Risendronate
Limitatuions: Colchicine may be prescribed for acute therapy up to 10 days to a maximum of 2
Exclusions: Adalimumab, Botulinum Toxin Type A ,Inliximab, Leucovorin,Pamidronate.
RNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
Maintenance: Alfuzosin, Azathioprine, Bromocriptine, Clopidogrel, Cyclosporin,
Cyproterone/ethinyl estradiol, Finasteride, Flunarizize, Leflunomide,Mycophenolate, Nafarelin, Nedocromil, Octrotide,Pentosan, Pergolide,Tetrabenazine. NATURAL HEALTH PRODUCTS 92:01.00 94:00.00 PHARMACEUTICAL AIDS 96:00.00
Inclusions: All except Exclusion: Methadone
RNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
SCHEDULE B. As Schedule A is based upon NIHB, and as NIHB does not list all drugs in NAPRA Schedule 1, this list will provide additional inclusion, maintenance and limitation drugs for NP Prescribing, in addition to Schedule A. Inclusions- Drugs or Devices:
All Health Canada approved hormonal contraceptive drugs and devices not mentioned in
Cyclobenzaprine 10mg Tabs (Flexeril) – Muscle RelaxantEtodolac PO - NSAID used in RAImiquimod (Aldara) - Genital WartsMoxifloxacin (Avelox) - AntibioticOlopatadine (Patanol – Anti-allergy eye dropOseltamivir (Tamiflu) – Oral AntiviralOrphenadrine (Norflex) - Muscle relaxant
Limitations :
Atovaquone/Proguanil combination (Malarone), andMefloquone (Larium) - Antimalarials –Note: Must write name of referring agency or person on prescription eg CDC,Travel clinic, MD
Cefriaxone Injectable (Rocephen) -Injectable antibiotic- to treat STI’s only. Maintenance:
Buspirone (Buspar) – Anti-anxietyGriseofulvin PO – Systemic antifungal
SCHEDULE C. Nurse Practitioners may prescribe any medications listed in NAPRA schedule 2, 3 and Unscheduled without exclusion and limitations.
This Schedule includes, but is not limited to:
All Oral Iron Preparations. All Insulins including newest agents Lispro and LevemirAll Vaccines given through the life span as per Immunization Schedule of the NWTCholera vaccine in Oral form (Dukoral)Minoxidil 2% lotion for hair replacementNitroglycerin sublingual immediate release dosage form eg SL tablets and spraysTioconazole PV - Vulvovaginal Candidiasis
RNANT/NU Prescriptive Authority Guidelines for NWT PHCNP’s
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