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(1) The following protocols apply to each classification and following list of topical medications for which a prescription is required under state or federal law:

(a) bactericidal agents:

(i) action: interferes with functions of the cell wall membrane;

(ii) indication: topical treatment for dermal infections; and

(iii) contraindications: hypersensitivity to the specific substance, concurrent use of curariform muscle relaxants and other relaxants and other neurotoxic drugs. Consult the current Physicians Desk Reference (PDR) for further specifics.

(b) debriding agents:

(i) action: cleanse the surface of wounds of wound exudate, bacteria, and particulate contaminants;

(ii) indication: cleanse exudative wounds such as venous stasis ulcers, decubitus ulcers, infected traumatic and surgical wounds, and infected burns; and

(iii) contraindications: debriding enzymes, should be used with precaution against allergic reactions, particularly in patients hypersensitive to materials of bovine origin or to mercury compounds. Consult the current PDR for specifics.

(c) anesthetic agents:

(i) action: blocks both the initiation and conduction of nerve impulses by decreasing the neuron membranes permeability to sodium ions;

(ii) indication: relieve pain and inflammation associated with minor skin disorders and for acute inflammatory conditions; and

(iii) contraindications: sensitivity to the topical anesthetic, local infections at the site of application, and skin disorders, severe or extensive, especially if the skin is abraded or broken. Consult the current PDR for specifics.

(d) anti-inflammatory agents (see adrenocortico-steroids).

(e) antispasmodic agents:

(i) action: forms strong drug-receptor complex at postganglionic parasympathetic neuroeffector sites in smooth muscle, cardiac muscle and exocrine glands, thereby blocking action of acetylcholine;

(ii) indication: reduce the volume of perspiration by inhibiting sweat gland secretions; and

(iii) contraindications: some commercially available formulations may contain a sulfite that can cause allergic-type reactions in certain susceptible individuals. Consult the current PDR for specifics.

(f) adrenocortico-steroids:

(i) action: diffuses across cell membranes to complex with specific cytoplasmic receptors. The resulting complexes enter the nucleus, bind to DNA thereby irritating cytoplasmic synthesis of enzymes responsible for systemic effects of adrenocortico-steroid;

(ii) indication: anti-inflammatory (bursitis, tendonitis, myositis, arthritis), antipruritic and vasoconstrictor actions; and

(iii) contraindications: special care must be exercised when these agents are used in children, growing adolescents, and pregnant women. Intolerance to adrenocortico-steroids, infection present at the treatment site not controlled by antibiotics, prolonged use, large areas, and occlusive dressings. Consult the current PDR for specifics.

(2) The board considers anti-fungal agents to be within the class of bactericidal agents.

History: 37-11-107, 37-11-201, MCA; IMP, 37-11-106, 37-11-107, MCA; NEW, 1992 MAR p. 789, Eff. 4/17/92; TRANS, from Commerce, 2005 MAR p. 380; AMD, 2009 MAR p. 2153, Eff. 11/13/09.

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