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CSC BMT Outpt Cyclophosphamide 2.5 grams-M2 For Mobilization Of Stem Cells VER 2-10-16 (HL 3348)

CSC BMT Outpt Cyclophosphamide 2.5 grams-M2 For Mobilization Of Stem Cells VER 2-10-16 (HL 3348) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, BMT


CSC BMT OP CYCLOPHOSPHAMIDE 2.5 GRAMS/M2 FOR MOBILIZATION OF STEM CELLS VER: 2-10-16 – Properties
Cycle 1 – 6/2/2016, Planned
Day 1, Cycle 1 – Planned for 6/2/2016
Treatment Plan Information
Reference Information (1)
BMT: Shepperd KM, et al. Exp Hematol 1990;18:442.
Reference Information (2)
BMT: Giralt S, et al. Biol Blood Marrow Transplant 2014;20(3):295-308.
Reference Information (3)
BMT: To LB, et al. Blood 1997; 89(7):2233-58.
Reference Information (4)
BMT: To LB, et al. Blood 2011;118(17):4530-40.
Treatment Plan Summary
DISEASE: All malignancies that will be treated with autologous SCT; THERAPY: cyclophosphamide 2.5
gm/m2 IV Day 1; CYCLE LENGTH: 1 day; COURSE: 1 cycle.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
URINALYSIS WITH MICROSCOPY
Expected-S Approximate, Expires-S+365, Routine
Nursing Procedure, Assessment and Monitoring
Vital Signs
SEE COMMENTS Starting when released Until Specified
Obtain vitals before and after cyclophosphamide infusion.
Monitoring Parameters (1)
Verify the patient is voiding prior to leaving the clinic
Patient Instructions(1)
Please give written instructions to page the BMT attending 608-265-7000 with any problems over the
weekend.
Patient Instructions(2)
RN instruct patient to drink 12 (8 ounce) glasses of water day of and for two days after treatment.
Hydration
sodium chloride 0.9% BOLUS
2,000 mL, Intravenous, ONCE, 1 dose Starting when released
Infuse over 2 - 4 hours before cyclophosphamide.
sodium chloride 0.9% BOLUS
1,000 mL, Intravenous, ONCE, 1 dose Starting when released
Infuse over 1 - 2 hours. May be given concurrently with cyclophosphamide
Pre-Medications
dexamethasone (DECADRON) tab 12 mg
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Zztestonc,PedsBeiber [2668824]
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2016CCKM@uwhealth.org
HL # 3348

12 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to cyclophosphamide.
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to cyclophosphamide.
aprepitant (EMEND) cap 125 mg
125 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to cyclophosphamide.
Treatment Medications
cyclophosphamide (CYTOXAN) 5,225 mg bag
5,225 mg (2.5 g/m2 × 2.09 m2 Treatment plan actual BSA), Intravenous, ONCE, 1 dose Starting when
released
Treatment Medications (delete all that do not apply)
furosemide (LASIX) 10 MG/ML injection
Intravenous, ONCE, 1 dose Starting when released
Give {BEFORE/AFTER:18845} cyclophosphamide. IV push rate 10 mg/minute
Conditional Orders
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, EVERY 6 HOURS PRN, For 24 hours Starting when released until S at 2359, For nasal
burning or discomfort during cyclophosphamide
Take Home Medications
ondansetron (ZOFRAN) 8 MG tab
Take 1 tab by mouth every 8 hours as needed for nausea/vomiting., 8 mg, Disp-30 tab, R-5, EVERY 8
HOURS PRN starting S, Local Printer
aprepitant (EMEND) 80 MG cap
Take 1 cap by mouth one time daily. Take on Day 2 and 3., 80 mg, Disp-2 cap, R-0, 1 X DAILY starting S
dexamethasone (DECADRON) 4 MG tab
Take 2 tabs by mouth one time daily. Take on Day 2, 3 and 4., 8 mg, Disp-6 tab, R-0, 1 X DAILY starting
S
prochlorperazine (COMPAZINE) 10 MG tab
Take 1 tab by mouth every 6 hours as needed for nausea/vomiting. Take between ondansetron doses,
10 mg, Disp-30 tab, R-0, EVERY 6 HOURS PRN starting S
levofloxacin (LEVAQUIN) 500 MG tab
Disp-8 tab, R-0, starting S, Local Printer
Days 3 through Day 10. Take 1 tab by mouth once daily.
Take Home Medications (delete all that do not apply)
TBO-filgrastim (GRANIX) 300 MCG/0.5ML soln prefilled syringe
Inject *** mcg subcutaneous in the AM and *** mcg in the PM. Begin on ***., R-0, starting S, Local
Printer
Dosing: <60kg=300mcg SC 2x/day, 60-78kg=300mcg SC AM/480mcg SC PM (order both strengths), >78 kg=480mcg
SC 2x/day. Give 10 day supply. RPh may substitute filgrastim at an equivalent dose and qty based on insurance
coverage.
TBO-filgrastim (GRANIX) 480 MCG/0.8ML soln prefilled syringe
Inject *** mcg subcutaneous in the AM and *** mcg in the PM. Begin on ***., R-0, starting S, Local
Printer
Dosing: <60kg=300mcg SC 2x/day, 60-78kg=300mcg SC AM/480mcg SC PM (order both strengths), >78 kg=480mcg
SC 2x/day. Give 10 day supply. RPh may substitute filgrastim at an equivalent dose and qty based on insurance
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Zztestonc,PedsBeiber [2668824]
6/2/2016 11:48:43 AM Page 2 of 3
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2016CCKM@uwhealth.org
HL # 3348

coverage
Follow-Up
VERIFY APPOINTMENTS
Verify follow up appointment(s) have been scheduled: LABS: Urinalysis with microscopy. Frequency to
be determined by Stem Cell Coordinator.
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Zztestonc,PedsBeiber [2668824]
6/2/2016 11:48:43 AM Page 3 of 3
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2016CCKM@uwhealth.org
HL # 3348