Current through Register Vol. 18, September 20, 2024
(1)
Within the class of debriding agents, only the following subclasses are
approved for use by a clinician on a patient:
(a) papain-based ointments;
(b) papain with urea additives;
(c) anti-inflammatories;
(d) collangenases;
(e) endogenous platelet-derived growth
factors; and
(f)
fibrinolytics.
(2)
Clinicians may use papain-based ointments as directed by a licensed medical
practitioner with prescriptive authority.
(a)
Papain-based ointments act via a proteolytic enzyme that digests nonviable
proteins, but which is harmless to viable tissues.
(b) Papain-based ointments are indicated for
debriding necrotic tissue and liquefying slough in acute and chronic lesions,
trauma wounds, or infected lesions.
(c) Papain-based ointments are
contraindicated for patients with known sensitivities to papain or any other
ingredient of the medication.
(3) Clinicians may use papain with urea
additive agents as directed by a licensed medical practitioner with
prescriptive authority.
(a) Papain with urea
additive acts as a denaturant to proteins, helps expose papain's activators by
a solvent action, rendering them more susceptible to enzymatic
digestion.
(b) Papain with urea
additive indications are for treating acute and chronic lesions including but
not limited to:
(i) venous ulcers;
(ii) diabetic and decubitus ulcers;
(iii) burns;
(iv) postoperative wounds;
(v) pilonidal cyst wounds;
(vi) carbuncles; and
(vii) traumatic or infected wounds.
(c) Papain with urea
additive has no known contraindications.
(4) Clinicians may use anti-inflammatory
agents as directed by a licensed medical practitioner with prescriptive
authority.
(a) Anti-inflammatory agents act
to decrease histamine reactions to peri-wound areas, decreasing inflammation,
and encouraging remodeling.
(b)
Anti-inflammatory agents are indicated for relieving inflammation and pruritis
caused by dermatosis.
(c)
Anti-inflammatory agents are contraindicated for patients with known
sensitivity to any components of the preparation.
(5) Clinicians may use collagenase agents as
directed by a licensed medical practitioner with prescriptive authority.
(a) Collagenase agents act by digesting
collagens in necrotic tissues, without destroying healthy granulation, and by
encouraging epithelialization.
(b)
Collagenase agents are indicated debriding chronic dermal ulcers and severely
burned areas
(c) Collagenase agents
are contraindicated for patients with local or systemic hypersensitivity to
collangenases.
(6)
Clinicians may use endogenous platelet derived growth factor agents as directed
by a licensed medical practitioner with prescriptive authority.
(a) Endogenous platelet derived growth factor
agents act by promoting chemotactic recruitment and the proliferative stage of
healing. They enhance formation of granulation tissue.
(b) Endogenous platelet derived growth
factors are indicated for diabetic neuropathic ulcers that extend into
subcutaneous tissue with an adequate blood supply.
(c) Endogenous platelet-derived growth factor
agents are contraindicated for patients with known hypersensitivity, including
but not limited to parabens. Endogenous platelet-derived growth factor agents
are not for use with wounds that close by primary intention because they are a
nonsterile, low bioburden, preserved product.
(7) Clinicians may use fibrinolytics as
directed by a licensed medical practitioner with prescriptive authority.
(a) Fibrinolytics act by contributing to
collagen synthesis, where over-production of collagen can cause poor remodeling
of the wound.
(b) Fibrinolytics
are indicated in patients who exhibit painful, indurated wounds. Fibrinolytics
are also indicated in slow healing venous wounds. Fibrinolytics are only used
adjunctively in therapy.
(c)
Fibrinolytics are contraindicated in patients who are allergic or exhibit a
sensitivity to steroids. Fibrinolytics are also contraindicated when used alone
in the treatment of wounds.
AUTH:
37-24-201,
37-24-202,
MCA IMP:
37-24-108,
37-24-109,
MCA
