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/clinical/cckm-tools/content/beacon-protocols/gu/name-103397-en.cckm

201706166

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Beacon Protocols,GU

CSC GU Cabozantinib(28D:1-28) VER 12-1-16 (HL 5863)

CSC GU Cabozantinib(28D:1-28) VER 12-1-16 (HL 5863) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, GU


CSC GU CABOZANTINIB(28D1-28) VER 12-1-16 (HL 5863) – Properties
Pre-Cycle – 6/7/2017 through 6/13/2017 (7 days), Planned
Day 1, Pre-Cycle – Planned for 6/7/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Carcinoma (Advanced); THERAPY: cabozantinib 60 mg by mouth once daily continuously; CYCLE LENGTH:
28 days; COURSE: until disease progression.
Note to All Staff (1)
Adjust cabozantinib dose for the following drug interactions:
In patients concurrently taking a strong CYP3A4 inhibitor, reduce the daily dose by 20 mg (minimum dose 20 mg/day);
In patients concurrently taking a strong CYP3A4 inducer, increase the daily dose by 20 mg (maximum dose 80 mg/day).
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S Approximate, Expires-S+397, Routine
GLUCOSE
Expected-S Approximate, Expires-S+397, Routine
BUN
Expected-S Approximate, Expires-S+397, Routine
CREATININE
Expected-S Approximate, Expires-S+397, Routine
CALCIUM
Expected-S Approximate, Expires-S+397, Routine
ALBUMIN
Expected-S Approximate, Expires-S+397, Routine
PROTEIN, TOTAL
Expected-S Approximate, Expires-S+397, Routine
BILIRUBIN, TOTAL
Expected-S Approximate, Expires-S+397, Routine
AST/SGOT
Expected-S Approximate, Expires-S+397, Routine
ALT/SGPT
Expected-S Approximate, Expires-S+397, Routine
ALKALINE PHOSPHATASE
Expected-S Approximate, Expires-S+397, Routine
PHOSPHATE
Expected-S Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S Approximate, Expires-S+365, Routine
TSH
Expected-S Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
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Zztestonc,Jeff J [2507481]
6/14/2017 4:21:00 PM Page 1 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Expected-S Approximate, Expires-S+365, Normal, Routine
Pre-Labs (delete all that do not apply)
HCG, QUALITATIVE, URINE
Expected-S Approximate, Expires-S+365, Routine
Cycle 1 – 6/14/2017 through 7/11/2017 (28 days), Planned
Day 1, Cycle 1 – Planned for 6/14/2017
Treatment Plan Information
Reference Information (1)
RENAL CELL CARCINOMA: Choueiri TK, et al. N Engl J Med 2015;373(19):1814-23.
Reference Information (2)
Cabozantinib (Cabometyx™) [package insert]. Exelixis; 2016.
Treatment Plan Summary
DISEASE: Renal Cell Carcinoma (Advanced); THERAPY: cabozantinib 60 mg by mouth once daily continuously; CYCLE LENGTH:
28 days; COURSE: until disease progression.
Note to All Staff (1)
Adjust cabozantinib dose for the following drug interactions:
In patients concurrently taking a strong CYP3A4 inhibitor, reduce the daily dose by 20 mg (minimum dose 20 mg/day);
In patients concurrently taking a strong CYP3A4 inducer, increase the daily dose by 20 mg (maximum dose 80 mg/day).
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Sodium, Potassium, Magnesium, Calcium, Phosphate, AST, ALT,
Total Bilirubin, Alkaline Phosphatase, Urinalysis without Microscopy
Treatment Parameters
Hold treatment and notify authorizing prescriber for: ANC less than 1500/µL or Sodium less than 135 mmol/L or Potassium less than
3.5 mmol/L or Magnesium less than 1.7 mg/dL or Phosphate less than 2.5 mg/dL or Calcium less than 8.5 mg/dL or AST greater
than 3 x ULN or ALT greater than 3 x ULN or Alkaline Phosphatase greater than 2.5 x ULN or Total Bilirubin greater than 1.5 x ULN
or Urine Protein greater than or equal to 100 mg/dL
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome and to call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
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Zztestonc,Jeff J [2507481]
6/14/2017 4:21:00 PM Page 2 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): cabozantinib (dispensed Day 1 of Cycle 1 only
- subsequent refills will be ordered through the medication activity).
Take Home Medications
cabozantinib S-malate (CABOMETYX) 60 MG tab
Take 1 tab by mouth one time daily. Take with 8oz water. No food 2h before or 1h after dose., 60 mg, Disp-30 tab, R-0, 1 X DAILY
starting S, Local Printer
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN,
Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Phosphate, Magnesium, TSH,
Urinalysis without Microscopy.
Cycle 2 – 7/12/2017 through 8/8/2017 (28 days), Planned
Day 1, Cycle 2 – Planned for 7/12/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Carcinoma (Advanced); THERAPY: cabozantinib 60 mg by mouth once daily continuously; CYCLE LENGTH:
28 days; COURSE: until disease progression.
Note to All Staff (1)
Adjust cabozantinib dose for the following drug interactions:
In patients concurrently taking a strong CYP3A4 inhibitor, reduce the daily dose by 20 mg (minimum dose 20 mg/day);
In patients concurrently taking a strong CYP3A4 inducer, increase the daily dose by 20 mg (maximum dose 80 mg/day).
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+397, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+397, Routine
BUN
Expected-S+28 Approximate, Expires-S+397, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+397, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+397, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+397, Routine
PROTEIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
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Zztestonc,Jeff J [2507481]
6/14/2017 4:21:00 PM Page 3 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+397, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+397, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+397, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S+28 Approximate, Expires-S+365, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT, Alkaline Phosphatase, Total Bilirubin
Treatment Parameters
Hold treatment and notify authorizing prescriber for: AST greater than 3 x ULN or ALT greater than 3 x ULN or Alkaline Phosphatase
greater than 2.5 x ULN or Total Bilirubin greater than 1.5 x ULN
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome and to call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, cabozantinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN,
Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Phosphate, Magnesium, TSH,
Urinalysis without Microscopy.
Cycle 3 – 8/9/2017 through 9/5/2017 (28 days), Planned
Day 1, Cycle 3 – Planned for 8/9/2017
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Zztestonc,Jeff J [2507481]
6/14/2017 4:21:00 PM Page 4 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Carcinoma (Advanced); THERAPY: cabozantinib 60 mg by mouth once daily continuously; CYCLE LENGTH:
28 days; COURSE: until disease progression.
Note to All Staff (1)
Adjust cabozantinib dose for the following drug interactions:
In patients concurrently taking a strong CYP3A4 inhibitor, reduce the daily dose by 20 mg (minimum dose 20 mg/day);
In patients concurrently taking a strong CYP3A4 inducer, increase the daily dose by 20 mg (maximum dose 80 mg/day).
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+397, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+397, Routine
BUN
Expected-S+28 Approximate, Expires-S+397, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+397, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+397, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+397, Routine
PROTEIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+397, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+397, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+397, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S+28 Approximate, Expires-S+365, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
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Zztestonc,Jeff J [2507481]
6/14/2017 4:21:00 PM Page 5 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Expected-S+28 Approximate, Expires-S+365, Normal, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT, Alkaline Phosphatase, Total Bilirubin
Treatment Parameters
Hold treatment and notify authorizing prescriber for: AST greater than 3 x ULN or ALT greater than 3 x ULN or Alkaline Phosphatase
greater than 2.5 x ULN or Total Bilirubin greater than 1.5 x ULN
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome and to call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, cabozantinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN,
Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Phosphate, Magnesium, TSH,
Urinalysis without Microscopy.
Cycle 4 – 9/6/2017 through 10/3/2017 (28 days), Planned
Day 1, Cycle 4 – Planned for 9/6/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Carcinoma (Advanced); THERAPY: cabozantinib 60 mg by mouth once daily continuously; CYCLE LENGTH:
28 days; COURSE: until disease progression.
Note to All Staff (1)
Adjust cabozantinib dose for the following drug interactions:
In patients concurrently taking a strong CYP3A4 inhibitor, reduce the daily dose by 20 mg (minimum dose 20 mg/day);
In patients concurrently taking a strong CYP3A4 inducer, increase the daily dose by 20 mg (maximum dose 80 mg/day).
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
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Zztestonc,Jeff J [2507481]
6/14/2017 4:21:00 PM Page 6 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+397, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+397, Routine
BUN
Expected-S+28 Approximate, Expires-S+397, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+397, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+397, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+397, Routine
PROTEIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+397, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+397, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+397, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S+28 Approximate, Expires-S+365, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT, Alkaline Phosphatase, Total Bilirubin
Treatment Parameters
Hold treatment and notify authorizing prescriber for: AST greater than 3 x ULN or ALT greater than 3 x ULN or Alkaline Phosphatase
greater than 2.5 x ULN or Total Bilirubin greater than 1.5 x ULN
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome and to call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
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Zztestonc,Jeff J [2507481]
6/14/2017 4:21:00 PM Page 7 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, cabozantinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN,
Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Phosphate, Magnesium, TSH,
Urinalysis without Microscopy.
Cycle 5 – 10/4/2017 through 10/31/2017 (28 days), Planned
Day 1, Cycle 5 – Planned for 10/4/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Renal Cell Carcinoma (Advanced); THERAPY: cabozantinib 60 mg by mouth once daily continuously; CYCLE LENGTH:
28 days; COURSE: until disease progression.
Note to All Staff (1)
Adjust cabozantinib dose for the following drug interactions:
In patients concurrently taking a strong CYP3A4 inhibitor, reduce the daily dose by 20 mg (minimum dose 20 mg/day);
In patients concurrently taking a strong CYP3A4 inducer, increase the daily dose by 20 mg (maximum dose 80 mg/day).
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+397, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+397, Routine
BUN
Expected-S+28 Approximate, Expires-S+397, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+397, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+397, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+397, Routine
PROTEIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
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Zztestonc,Jeff J [2507481]
6/14/2017 4:21:00 PM Page 8 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+397, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+397, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+397, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S+28 Approximate, Expires-S+365, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT, Alkaline Phosphatase, Total Bilirubin
Treatment Parameters
Hold treatment and notify authorizing prescriber for: AST greater than 3 x ULN or ALT greater than 3 x ULN or Alkaline Phosphatase
greater than 2.5 x ULN or Total Bilirubin greater than 1.5 x ULN
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome and to call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, cabozantinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN,
Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Phosphate, Magnesium, TSH,
Urinalysis without Microscopy.
Cycle 6 – 11/1/2017 through 11/28/2017 (28 days), Planned
Day 1, Cycle 6 – Planned for 11/1/2017
Treatment Plan Information
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Zztestonc,Jeff J [2507481]
6/14/2017 4:21:00 PM Page 9 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Plan Summary
DISEASE: Renal Cell Carcinoma (Advanced); THERAPY: cabozantinib 60 mg by mouth once daily continuously;
CYCLE LENGTH: 28 days; COURSE: until disease progression.
Note to All Staff (1)
Adjust cabozantinib dose for the following drug interactions:
In patients concurrently taking a strong CYP3A4 inhibitor, reduce the daily dose by 20 mg (minimum dose 20 mg/day);
In patients concurrently taking a strong CYP3A4 inducer, increase the daily dose by 20 mg (maximum dose 80 mg/day).
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+397, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+397, Routine
BUN
Expected-S+28 Approximate, Expires-S+397, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+397, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+397, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+397, Routine
PROTEIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+397, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+397, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+397, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+397, Routine
PHOSPHATE
Expected-S+28 Approximate, Expires-S+365, Routine
MAGNESIUM
Expected-S+28 Approximate, Expires-S+365, Routine
TSH
Expected-S+28 Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
Treatment Conditions
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Zztestonc,Jeff J [2507481]
6/14/2017 4:21:00 PM Page 10 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Verify Labs
Verify pretreatment labs have been obtained: AST, ALT, Alkaline Phosphatase, Total Bilirubin
Treatment Parameters
Hold treatment and notify authorizing prescriber for: AST greater than 3 x ULN or ALT greater than 3 x ULN or Alkaline Phosphatase
greater than 2.5 x ULN or Total Bilirubin greater than 1.5 x ULN
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome and to call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, cabozantinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN,
Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Phosphate, Magnesium, TSH,
Urinalysis without Microscopy.
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Zztestonc,Jeff J [2507481]
6/14/2017 4:21:00 PM Page 11 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org