(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.

(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.

(iv) SSD, SSD-AF--Silver sulfadiazine; (Sulfamylon) --Mafenide acetate cream; Gentamicin Sulfate--(Garamycin) ; Mycostatin - (Nystatin) --(cream, powder, ointment) ; (Lotrisone) --Clotrimazole and betamethasone dipropionate; Polymyxin B Sulfate--(Cortisporin, Neosporin) ; Nystatin--(Nystex) ; (Bactroban) --Mupirocin; Neomysin Sulfate--(Cortisporin cream, NeoDecadron topical cream, Neosporin cream, Neo-Synalar cream) ; Unna Boot--Dome Paste (zinc) .

(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.

(iii) contraindications: Dextranomer should not be used with topical antibiotics or debriding enzymes and should not be used in deep fistulas or any body cavity from which complete removal is not assured.  Fibrinolysin and Deoxyribonuclease Combined (Bovine) , a debriding enzyme, 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.

(iv) (Elase) --Fibrinolysin and desoxyribonuclease; (Elase-Chloromycetin) --Fibrinolysin and desoxyribonuclease with chloramphenicol; Debrisan--(Dextranomer) .

(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.

(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.

(iv) (Fluori Methane) --Dichlorodifluoromethane 15%, trichloromonofluoromethane 85%; Lidocaine Hydrochloride; (Xylocaine) --Lidocaine Hydrochloride; (Chempad) --L Lidocaine, Menthol, H Hydrocortisone, Menthol, LH Lidocaine Hydrocortisone, Menthol; (Medipad) --L Lidocaine, Menthol, H Hydrocortisone, Menthol, LH Lidocaine Hyrocortisone, Menthol; (Ethyl Cloride) --Chloroethane; Menthol 0.8%--(Dermoplast, Medicore Derma-HC, Methalgen Cream, Panalgesic Gold cream-liniment, PrameGel, Nephro-Derm Cream) ; Dibucaine 1%--(Nupercainal cream and ointment, only 0.5%) .

(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.

(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.

(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.

(iv) Hydrocortisone Cream 10%, 1%; (Decadron) --Dexamethasone sodium phosphate; (Aristocort) --triamcinolone acetonide; (Chempad) --L Lidocaine, Menthol, H Hydrocortisone, Menthol, LH Lidocaine Hydrocortisone, Menthol; (Medipad) --L Lidocaine, Menthol, H Hydrocortisone, Menthol, LH Lidocaine Hydrocortisone, Menthol; Dexamethasone--(Decaderm, Decadron) ; Betamethasone--(Alphatrex cream-ointment, Diprolene AF, Lotrisone cream, Maxivate cream-lotion-ointment, Psorion cream, Betatrex) .