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those drugs included in the following Schedules A, B and C, andreplace the Nurse Practitioner Prescription Regulations, repealed with thecoming into force of the new Pharmacy Act, S.N.W.T. 2006, c.24, on April 2,2007.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

Source: http://www.fshssa.ca/sites/default/files/prescriptive_authority_guidelines_for_nwt_primary_health_care_np.pdf