Pharmacy Insider » Pharmacy Tricks and Tips » Beyond the Counter: How Pharmacists are Expanding Their Role with Inhalers and Injections

Beyond the Counter: How Pharmacists are Expanding Their Role with Inhalers and Injections

Exciting news coming your way! Starting July 1, 2023, there’s a big, positive change on the horizon for Ontario’s healthcare system. Some new amendments have been approved to O. Reg 202/94 (General) of the Pharmacy Act, 1991 that are going to make a world of difference for patients and pharmacy professionals alike.

So, what’s all the buzz about? Well, Ontario’s Part A pharmacists, as well as registered pharmacy students and interns, are now authorized to administer substances listed in the regulations via injection and inhalation. And guess what? It’s not just for the purpose of demonstration and education anymore.

This scope expansion is a massive step forward! It means that pharmacists and pharmacy students, provided they’ve got the necessary injection training, will be able to assist their patients with the regular injection (think Ozempic® and Vitamin B12 shots) or inhalation of medicines. This is a game changer for patients suffering from conditions like osteoporosis, diabetes, and rheumatoid arthritis, who may struggle with self-injection due to a fear of needles or physical difficulties.

Not to mention, those who require inhaled medications for conditions such as asthma are also going to benefit enormously. This change is all about making healthcare more accessible and manageable for everyone involved. And that, my friend, is why we are buzzing with excitement! Stay healthy, and remember, your MisterPharmacist™ is now more equipped than ever to support you on your health journey.

Approval  MisterPharmacist


List of INHALERS approved by the new regulations:

1. **Anticholinergic Agents** (Aclidinium (Tudorza® Genuair), Glycopyrronium, Ipratropium (Seebri ® Breezhaler), Tiotropium (Spiriva®), Umeclidinium): These drugs work by blocking the action of acetylcholine, a neurotransmitter that can cause muscle contractions. In the case of respiratory conditions, these drugs can help relax the muscles around the bronchi (airways), reducing symptoms like wheezing and shortness of breath.

2. **Anti-infective Agents** (Aztreonam, Levofloxacin (Quinsair®), Tobramycin, Zanamivir (Relenza®): These medications are used to treat or prevent infections. For example, Levofloxacin is an antibiotic that can treat bacterial infections, while Zanamivir is an antiviral medication used for influenza.

3. **Autonomic Drugs, Miscellaneous** (Nicotine): This category includes drugs that affect the autonomic nervous system, which controls involuntary body functions. Nicotine, for example, stimulates the release of various neurotransmitters and can have a range of effects on the body.

4. **Eye, Ear, Nose and Throat (EENT) Preparations** (Beclomethasone, Budesonide, Ciclesonide, Fluticasone, Mometasone, Sodium Cromoglycate): These medications are typically used to treat conditions related to the eyes, ears, nose, or throat. They include corticosteroids (Beclomethasone, Budesonide, Ciclesonide, Fluticasone, Mometasone) which can reduce inflammation and Sodium Cromoglycate which is used to prevent allergic reactions.

5. **Miscellaneous Agents** (Sodium chloride, Sterile water for inhalation): These substances can be used in various ways. Sodium chloride can be used for hydration or to replace lost electrolytes. Sterile water for inhalation is typically used as a diluent for inhaled medications.

6. **Respiratory Tract Agents** (Acetylcysteine, Dornase alfa): These drugs are used to treat respiratory conditions. Acetylcysteine is a mucolytic agent that helps to break down mucus, making it easier to cough up. Dornase alfa is used in cystic fibrosis to reduce the thickness and stickiness of mucus in the lungs.

7. **Sympathomimetic (Adrenergic) Agents** (Formoterol, Indacaterol, Olodaterol, Salbutamol, Salmeterol, Terbutaline, Vilanterol): These drugs mimic the effects of the sympathetic nervous system, leading to bronchodilation. They are often used to treat conditions like asthma and COPD by relaxing the muscles around the bronchi, making it easier to breathe.


List of INJECTABLES approved by the new regulations:

Injectable MisterPharmacist approved
Analgesics & Antipyretics:
– Codeine
– Hydromorphone
– Morphine
– Nalbuphine

– Amikacin
– Ampicillin
– Cefazolin
– Cefepime
– Cefotaxime
– Cefoxitin
– Ceftazidime
– Ceftriaxone
– Clindamycin
– Cloxacillin
– Ertapenem
– Gentamicin
– Penicillin G

Anticholinergic Agents:
– Glycopyrrolate
– Hyoscine
– Scopolamine

– Dalteparin
– Danaparoid
– Enoxaparin
– Fondaparinux
– Heparin
– Nadroparin
– Tinazaparin

Antidiabetic Agents:
– Exenatide
– Dulaglutide
– Insulins
– Liraglutide
– Lixisenatide
– Semaglutide (OZEMPIC)

Antihemorrhagic Agents:
– Emicizumab

– Dimenhydrinate
– Diphenhydramine

Antimigraine Agents:
– Erenumab
– Sumatriptan

Antiparkinsonian Agents:
– Apomorphine
– Benztropine

– Enfuvirtide
– Interferons
– Peginterferon alfa-2a

Central Nervous System Agents, Miscellaneous:
– Inotersen

Complement Inhibitors:
– Icatibant
– Lanadelumab

Disease-modifying Antirheumatic Drugs:
– Abatacept
– Adalimumab
– Anakinra
– Etanercept
– Golimumab
– Methotrexate
– Sarilumab
– Tocilizumab
– Ustekinumab

– Asfotase Alfa

GI Drugs, Miscellaneous:
– Certolizumab Pegol
– Methylnaltrexone

Gonadotropins & Antigonadotropins:
– Follitropin-alpha
– Follitropin-beta
– Follitropin-delta
– Gonadotropin-chorionic
– Gonadotropin-chorionic alfa
– Goserelin
– Lutropin-alfa
– Menotropins
– Triptorelin acetate

Gonadotropin-releasing Hormone Antagonists:
– Cetrorelix
– Ganirelix

Heavy Metal Antagonists:
– Deferoxamine

Hematopoietic Agents:
– Darbepoetin alfa
– Epoetin alfa
– Filgrastim
– Pegfilgrastim
– Romiplostim

Immunomodulatory Agents:
– Denosumab
– Glatiramer
– Interferon-Beta-1A
– Interferon-Beta-1B
– Natalizumab

Immunosuppressive Agents:
– Belimumab
– Mepolizumab

Miscellaneous Agents:
– Sodium Chloride
– Sterile Water for Injection (Diluent)

– Calcitonin Salmon
– Teriparatide

– Desmopressin
– Vasop


– Medroxyprogesterone
– Progesterone

Prokinetic Agents:
– Metoclopramide

Proprotein Convertase Subtilisin Kexin Type 9 (Pcsk9) Inhibitors:
– Alirocumab
– Evolocumab

Psychotherapeutic Agents:
– Haloperidol
– Methotrimeprazine

Respiratory Tract Agents:
– Omalizumab

Skin & Mucous Membrane Agents:
– Brodalumab
– Dupilumab
– Guselkumab
– Ixekizumab
– Risankizumab
– Secukinumab

Somatostatin Agonists & Antagonists:
– Lanreotide
– Octreotide
– Pasireotide

Somatotropin Agonists & Antagonists:
– Pegvisomant
– Somatropin
– Tesamorelin

Sympatholytic (Adrenergic Blocking) Agents:
– Dihydroergotamine

Vitamins ( not to be administered IV)
– Ascorbic Acid aka VITAMIN C
– Cyanocobalamin aka VITAMIN B12
– Folic Acid
– Pyridoxine
– Thiamine
– Vitamin K

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