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201707191

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CSC GU Abiraterone(28D:1-28) Prednisone(28D:1-28) VER 7-6-17 (HL 4429)

CSC GU Abiraterone(28D:1-28) Prednisone(28D:1-28) VER 7-6-17 (HL 4429) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, GU


CSC GU ABIRATERONE(28D:1-28)/PREDNISONE(28D:1-28) VER: 7-6-17 – Properties
Pre-Cycle – 6/29/2017 through 7/5/2017 (7 days), Planned
Day 1, Pre-Cycle – Planned for 6/29/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate Cancer (Advanced); THERAPY: abiraterone 1000 mg by mouth once daily continuously, prednisone 5 mg by
mouth twice daily continuously (prednisone 5 mg by mouth once daily continuously for patients with metastatic hormone-sensitive
prostate cancer (mHSPC)); CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE: Need to maintain castrate state
Note to All Staff (1)
Dose Modification Guide- Dose level -1 = 750 mg; Dose level -2 = 500 mg
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S Approximate, Expires-S+365, Routine
CREATININE
Expected-S Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S Approximate, Expires-S+365, Routine
PSA TOTAL, DIAGNOSTIC
Expected-S Approximate, Expires-S+365, Routine
Cycle 1 – 7/6/2017 through 8/2/2017 (28 days), Planned
Day 1, Cycle 1 – Planned for 7/6/2017
Treatment Plan Information
Reference Information (1)
PROSTATE CANCER: James ND, et al. N Engl J Med 2017;doi: 10.1056/NEJMoa1702900. [Epub ahead of print]
Reference Information (2)
PROSTATE CANCER: Fizazi K, et al. N Engl J Med 2017;doi: 10.1056/NEJMoa1704174. [Epub ahead of print]
Reference Information (3)
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Zztestonc,Edward E [2435061]
7/6/2017 11:18:23 AM Page 1 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2017CCKM@uwhealth.org

PROSTATE CANCER: Ryan CJ, et al. Lancet Oncol 2015;16(2):152-60.
Reference Information (4)
PROSTATE CANCER: Ryan CJ, et al. N Engl J Med 2013;368(2):138-48.
Reference Information (5)
PROSTATE CANCER: Scher HI, et al. J Clin Oncol 2011; (suppl 7; abstr 4).
Treatment Plan Summary
DISEASE: Prostate Cancer (Advanced); THERAPY: abiraterone 1000 mg by mouth once daily continuously, prednisone 5 mg by
mouth twice daily continuously (prednisone 5 mg by mouth once daily continuously for patients with metastatic hormone-sensitive
prostate cancer (mHSPC)); CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE: Need to maintain castrate state
Note to All Staff (1)
Dose Modification Guide- Dose level -1 = 750 mg; Dose level -2 = 500 mg
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.
Nursing Procedure, Assessment and Monitoring
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
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): abiraterone (dispensed Day 1 of Cycle 1 only -
subsequent refills will be ordered through the medication activity) and prednisone (dispensed on Day 1 of each Cycle).
Take Home Medications
abiraterone acetate (ZYTIGA) 250 MG tab
Take 4 tabs by mouth one time daily. In fasted state (no food 2 hrs prior, or 1 hr post)., 1,000 mg, Disp-120 tab, R-0, 1 X DAILY
starting S, Local Printer
Take Home Medications (delete all that do not apply)
Note to All Staff (1)
Provider: select prednisone ONCE DAILY dosing for patients with metastatic hormone-sensitive prostate cancer (mHSPC).
prednisone (DELTASONE) 5 MG tab
Take 1 tab by mouth 2 times daily at mealtime., 5 mg, Disp-60 tab, R-0, 2 X DAILY (AT MEALTIME) starting S, Local Printer
prednisone (DELTASONE) 5 MG tab
Take 1 tab by mouth one time daily. Take with a meal., 5 mg, Disp-30 tab, R-0, 1 X DAILY starting S, Local Printer
Follow-Up
DAY 15 FOLLOW-UP
LABS: AST, ALT, and Total Bilirubin.
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Zztestonc,Edward E [2435061]
7/6/2017 11:18:23 AM Page 2 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org

DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC without DIFF, ANC (DIFF if
done locally), Electrolytes, Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH, Glucose, PSA.
Day 15 - Lab Only, Cycle 1 – Planned for 7/20/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate Cancer (Advanced); THERAPY: abiraterone 1000 mg by mouth once daily continuously, prednisone 5 mg by
mouth twice daily continuously (prednisone 5 mg by mouth once daily continuously for patients with metastatic hormone-sensitive
prostate cancer (mHSPC)); CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE: Need to maintain castrate state
Note to All Staff (1)
Dose Modification Guide- Dose level -1 = 750 mg; Dose level -2 = 500 mg
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
AST/SGOT
Expected-S+14 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+14 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+14 Approximate, Expires-S+365, Routine
Nursing Procedure, Assessment and Monitoring
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.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 2 – 8/3/2017 through 8/30/2017 (28 days), Planned
Day 1, Cycle 2 – Planned for 8/3/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate Cancer (Advanced); THERAPY: abiraterone 1000 mg by mouth once daily continuously, prednisone 5 mg by
mouth twice daily continuously (prednisone 5 mg by mouth once daily continuously for patients with metastatic hormone-sensitive
prostate cancer (mHSPC)); CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE: Need to maintain castrate state
Note to All Staff (1)
Dose Modification Guide- Dose level -1 = 750 mg; Dose level -2 = 500 mg
IV Access
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Zztestonc,Edward E [2435061]
7/6/2017 11:18:23 AM Page 3 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org

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 WITHOUT DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
PSA TOTAL, DIAGNOSTIC
Expected-S+28 Approximate, Expires-S+365, Routine
Nursing Procedure, Assessment and Monitoring
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, abiraterone will be ordered through the medication activity after the initial order.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): prednisone (dispensed on Day 1 of each
Cycle).
Take Home Medications (delete all that do not apply)
Note to All Staff (1)
Provider: select prednisone ONCE DAILY dosing for patients with metastatic hormone-sensitive prostate cancer (mHSPC).
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Zztestonc,Edward E [2435061]
7/6/2017 11:18:23 AM Page 4 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org

prednisone (DELTASONE) 5 MG tab
Take 1 tab by mouth 2 times daily at mealtime., 5 mg, Disp-60 tab, R-0, 2 X DAILY (AT MEALTIME) starting S, Local Printer
prednisone (DELTASONE) 5 MG tab
Take 1 tab by mouth one time daily. Take with a meal., 5 mg, Disp-30 tab, R-0, 1 X DAILY starting S, Local Printer
Follow-Up
DAY 15 FOLLOW-UP
LABS: AST, ALT, and Total Bilirubin.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC without DIFF, ANC (DIFF if done locally),
Electrolytes, Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH, Glucose, PSA.
Day 15 - Lab Only, Cycle 2 – Planned for 8/17/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate Cancer (Advanced); THERAPY: abiraterone 1000 mg by mouth once daily continuously, prednisone 5 mg by
mouth twice daily continuously (prednisone 5 mg by mouth once daily continuously for patients with metastatic hormone-sensitive
prostate cancer (mHSPC)); CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE: Need to maintain castrate state
Note to All Staff (1)
Dose Modification Guide- Dose level -1 = 750 mg; Dose level -2 = 500 mg
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
AST/SGOT
Expected-S+14 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+14 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+14 Approximate, Expires-S+365, Routine
Nursing Procedure, Assessment and Monitoring
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.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 3 – 8/31/2017 through 9/27/2017 (28 days), Planned
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Zztestonc,Edward E [2435061]
7/6/2017 11:18:23 AM Page 5 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org

Day 1, Cycle 3 – Planned for 8/31/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate Cancer (Advanced); THERAPY: abiraterone 1000 mg by mouth once daily continuously, prednisone 5 mg by
mouth twice daily continuously (prednisone 5 mg by mouth once daily continuously for patients with metastatic hormone-sensitive
prostate cancer (mHSPC)); CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE: Need to maintain castrate state
Note to All Staff (1)
Dose Modification Guide- Dose level -1 = 750 mg; Dose level -2 = 500 mg
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 WITHOUT DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
PSA TOTAL, DIAGNOSTIC
Expected-S+28 Approximate, Expires-S+365, Routine
Nursing Procedure, Assessment and Monitoring
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
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Zztestonc,Edward E [2435061]
7/6/2017 11:18:23 AM Page 6 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org

Oral Chemotherapy Order Management
For this regimen, abiraterone will be ordered through the medication activity after the initial order.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): prednisone (dispensed on Day 1 of each
Cycle).
Take Home Medications (delete all that do not apply)
Note to All Staff (1)
Provider: select prednisone ONCE DAILY dosing for patients with metastatic hormone-sensitive prostate cancer (mHSPC).
prednisone (DELTASONE) 5 MG tab
Take 1 tab by mouth 2 times daily at mealtime., 5 mg, Disp-60 tab, R-0, 2 X DAILY (AT MEALTIME) starting S, Local Printer
prednisone (DELTASONE) 5 MG tab
Take 1 tab by mouth one time daily. Take with a meal., 5 mg, Disp-30 tab, R-0, 1 X DAILY starting S, Local Printer
Follow-Up
DAY 15 FOLLOW-UP
LABS: AST, ALT, and Total Bilirubin.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC without DIFF, ANC (DIFF if done locally),
Electrolytes, Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH, Glucose, PSA.
Day 15 - Lab Only, Cycle 3 – Planned for 9/14/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate Cancer (Advanced); THERAPY: abiraterone 1000 mg by mouth once daily continuously, prednisone 5 mg by
mouth twice daily continuously (prednisone 5 mg by mouth once daily continuously for patients with metastatic hormone-sensitive
prostate cancer (mHSPC)); CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE: Need to maintain castrate state
Note to All Staff (1)
Dose Modification Guide- Dose level -1 = 750 mg; Dose level -2 = 500 mg
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
AST/SGOT
Expected-S+14 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+14 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+14 Approximate, Expires-S+365, Routine
Nursing Procedure, Assessment and Monitoring
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
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Zztestonc,Edward E [2435061]
7/6/2017 11:18:23 AM Page 7 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org

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.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 4 – 9/28/2017 through 10/25/2017 (28 days), Planned
Day 1, Cycle 4 – Planned for 9/28/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate Cancer (Advanced); THERAPY: abiraterone 1000 mg by mouth once daily continuously, prednisone 5 mg by
mouth twice daily continuously (prednisone 5 mg by mouth once daily continuously for patients with metastatic hormone-sensitive
prostate cancer (mHSPC)); CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE: Need to maintain castrate state
Note to All Staff (1)
Dose Modification Guide- Dose level -1 = 750 mg; Dose level -2 = 500 mg
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 WITHOUT DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
PSA TOTAL, DIAGNOSTIC
Expected-S+28 Approximate, Expires-S+365, Routine
Nursing Procedure, Assessment and Monitoring
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
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Zztestonc,Edward E [2435061]
7/6/2017 11:18:23 AM Page 8 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org

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, abiraterone will be ordered through the medication activity after the initial order.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): prednisone (dispensed on Day 1 of each
Cycle).
Take Home Medications (delete all that do not apply)
Note to All Staff (1)
Provider: select prednisone ONCE DAILY dosing for patients with metastatic hormone-sensitive prostate cancer (mHSPC).
prednisone (DELTASONE) 5 MG tab
Take 1 tab by mouth 2 times daily at mealtime., 5 mg, Disp-60 tab, R-0, 2 X DAILY (AT MEALTIME) starting S, Local Printer
prednisone (DELTASONE) 5 MG tab
Take 1 tab by mouth one time daily. Take with a meal., 5 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 without DIFF, ANC (DIFF if done locally),
Electrolytes, Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH, Glucose.
Cycle 5 – 10/26/2017 through 11/22/2017 (28 days), Planned
Day 1, Cycle 5 – Planned for 10/26/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate Cancer (Advanced); THERAPY: abiraterone 1000 mg by mouth once daily continuously, prednisone 5 mg by
mouth twice daily continuously (prednisone 5 mg by mouth once daily continuously for patients with metastatic hormone-sensitive
prostate cancer (mHSPC)); CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE: Need to maintain castrate state
Note to All Staff (1)
Dose Modification Guide- Dose level -1 = 750 mg; Dose level -2 = 500 mg
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 WITHOUT DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
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Zztestonc,Edward E [2435061]
7/6/2017 11:18:23 AM Page 9 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org

AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
PSA TOTAL, DIAGNOSTIC
Expected-S+28 Approximate, Expires-S+365, Routine
Nursing Procedure, Assessment and Monitoring
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, abiraterone will be ordered through the medication activity after the initial order.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): prednisone (dispensed on Day 1 of each
Cycle).
Take Home Medications (delete all that do not apply)
Note to All Staff (1)
Provider: select prednisone ONCE DAILY dosing for patients with metastatic hormone-sensitive prostate cancer (mHSPC).
prednisone (DELTASONE) 5 MG tab
Take 1 tab by mouth 2 times daily at mealtime., 5 mg, Disp-60 tab, R-0, 2 X DAILY (AT MEALTIME) starting S, Local Printer
prednisone (DELTASONE) 5 MG tab
Take 1 tab by mouth one time daily. Take with a meal., 5 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 without DIFF, ANC (DIFF if done locally),
Electrolytes, Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH, Glucose.
Cycle 6 – 11/23/2017 through 12/20/2017 (28 days), Planned
Day 1, Cycle 6 – Planned for 11/23/2017
Treatment Plan Information
Treatment Plan Summary
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Zztestonc,Edward E [2435061]
7/6/2017 11:18:23 AM Page 10 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org

DISEASE: Prostate Cancer (Advanced); THERAPY: abiraterone 1000 mg by mouth once daily continuously,
prednisone 5 mg by mouth twice daily continuously (prednisone 5 mg by mouth once daily continuously for patients
with metastatic hormone-sensitive prostate cancer (mHSPC)); CYCLE LENGTH: 28 days; COURSE: until disease
progression. NOTE: Need to maintain castrate state
Note to All Staff (1)
Dose Modification Guide- Dose level -1 = 750 mg; Dose level -2 = 500 mg
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 WITHOUT DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
PSA TOTAL, DIAGNOSTIC
Expected-S+28 Approximate, Expires-S+365, Routine
Nursing Procedure, Assessment and Monitoring
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, abiraterone will be ordered through the medication activity after the initial order.
See Take Home Medication(s)
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Zztestonc,Edward E [2435061]
7/6/2017 11:18:23 AM Page 11 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org

Refer to the take home medications section for the following treatment medication(s): prednisone (dispensed on
Day 1 of each Cycle).
Take Home Medications (delete all that do not apply)
Note to All Staff (1)
Provider: select prednisone ONCE DAILY dosing for patients with metastatic hormone-sensitive prostate cancer (mHSPC).
prednisone (DELTASONE) 5 MG tab
Take 1 tab by mouth 2 times daily at mealtime., 5 mg, Disp-60 tab, R-0, 2 X DAILY (AT MEALTIME) starting S, Local Printer
prednisone (DELTASONE) 5 MG tab
Take 1 tab by mouth one time daily. Take with a meal., 5 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 without DIFF, ANC (DIFF if done locally),
Electrolytes, Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH, Glucose.
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Zztestonc,Edward E [2435061]
7/6/2017 11:18:23 AM Page 12 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org