/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/beacon-protocols/,/clinical/cckm-tools/content/beacon-protocols/hem---myeloma/,

/clinical/cckm-tools/content/beacon-protocols/hem---myeloma/name-123238-en.cckm

201712341

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Beacon Protocols,Hem - Myeloma

CSC HEM INPT Cytarabine(28-42D:1-7)/Idarubicin(28-42D:1-3)/Midostaurin(28-42D:8-21) Ver 12-5-17 (HL 6613)

CSC HEM INPT Cytarabine(28-42D:1-7)/Idarubicin(28-42D:1-3)/Midostaurin(28-42D:8-21) Ver 12-5-17 (HL 6613) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Hem - Myeloma


CSC HEM INPT CYTARABINE(28-42D:1-7)/IDARUBICIN(28-42D:1-3)/MIDOSTAURIN(28-42D:8-21) VER: 12-5-
17 –  Properties
Cycle 1 –  12/5/2017 through 1/1/2018 (28 days), Planned
Days 1 through 8, Cycle 1 –  Planned for 12/5/2017
Treatment Plan Information
Reference Information (1)
ACUTE MYELOGENOUS LEUKEMIA: RYDAPT [package insert]. East Hanover, NJ: Novartis; 2017.
Reference Information (2)
ACUTE MYELOGENOUS LEUKEMIA: Stone RM, et al. N Engl J Med 2017;377(5):454-64.
Treatment Plan Summary
DISEASE: FLT3(+) Acute Myelogenous Leukemia; THERAPY: idarubicin 12 mg/m2/day IV Days 1, 2 and 3, cytarabine 100
mg/m2/day IV continuous infusion over 24 hours Days 1 through 7 for a total of 168 hours, midostaurin 50 mg by
mouth twice daily Days 8 through 21; CYCLE LENGTH: 28 to 42 days; COURSE: up to 2 cycles.
Note to All Staff (1)
Discontinue midostaurin if signs/symptoms of interstitial lung disease or pneumonitis without infectious etiology.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
ONCE Starting when released, Routine
ELECTROLYTES
ONCE Starting when released
BUN
ONCE Starting when released
CREATININE
ONCE Starting when released
GLUCOSE
ONCE Starting when released
BILIRUBIN, TOTAL
ONCE Starting when released
AST/SGOT
ONCE Starting when released
ALKALINE PHOSPHATASE
ONCE Starting when released
ALT/SGPT
ONCE Starting when released
Pre-Labs (delete all that do not apply)
HCG, QUALITATIVE, URINE
ONCE Starting when released
Treatment Conditions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Zztestonc,Fiona F [2462287]
12/5/2017 8:35:51 AM Page 1 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine, Total Bilirubin.
Treatment Parameters
Verify labs with MD prior to start on Day 1, and confirm that patient is cleared to receive chemotherapy.
Treatment Condition A
Verify ECG obtained at baseline and one week following the start of midostaurin.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to midostaurin can occur. For first and second dose, patient should be treated in a location to
optimize emergency care. See Emergency Medications.
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.
Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Day 1: Start.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Days 1, 2, and 3: Administer first dose prior to chemotherapy. May give IV if PO not tolerated.
ondansetron (ZOFRAN) 16 mg in sodium chloride 0.9 % 50 mL bag
16 mg, Intravenous, EVERY 24 HOURS PRN, For 96 hours Starting when released, nausea/vomiting
Days 1, 2, and 3: Administer first dose prior to chemotherapy. Give IV if PO not tolerated.
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Days 1, 2, and 3: Administer first dose prior to chemotherapy. May give IV if PO not tolerated.
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, EVERY 24 HOURS PRN, For 96 hours Starting when released, nausea/vomiting
Days 1, 2, and 3: Administer first dose prior to chemotherapy. Give IV if PO not tolerated.
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 24 HOURS, 4 doses Starting S+3 at 0000
Days 4, 5, 6, and 7: Administer prior to chemotherapy. May give IV if PO not tolerated.
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, For 120 hours Starting S+3 at 0000, nausea/vomiting, Administer over 3
Minutes
Day 4, 5, 6 and 7: Administer prior to chemotherapy. Give IV if PO not tolerated. Administer over 3 to 5 minutes.
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Zztestonc,Fiona F [2462287]
12/5/2017 8:35:51 AM Page 2 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

ondansetron (ZOFRAN) tab 4 mg
4 mg, Oral, EVERY 12 HOURS Starting S+7 at 0000
Days 8 through 21. Administer prior to midostaurin.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
idaruBICIN (IDAMYCIN) injection 12 mg/m2 (Treatment Plan)
12 mg/m2, Intravenous, 1 X DAILY, 3 doses Starting S As Scheduled, Administer over 10-15 Minutes
Day 1,2 and 3: IV push Into in running IV line.
cytarabine PF (CYTOSAR) 100 mg/m2 in sodium chloride 0.9 % 500 mL bag
100 mg/m2, Intravenous, EVERY 24 HOURS, 7 doses Starting when released
Day 1-7: Continuous infusion over 24 hours Day 1 through 7 for a total of 168 hours.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): midostaurin.
CUSTOM chemotherapy medication unit dose
Oral, EVERY 12 HOURS, 28 doses Starting S+7 at 0800
Days 8 through 21: midostaurin (RYDAPT) 25 mg capsule. Give 2 capsules (50 mg) by mouth twice daily with food.
Supportive Care Medications
allopurinol (ZYLOPRIM) tab 300 mg
300 mg, Oral, 1 X DAILY, 7 doses Starting when released
acyclovir (ZOVIRAX) tab 400 mg
400 mg, Oral, 2 X DAILY Starting when released
famotidine (PEPCID) tab 20 mg
20 mg, Oral, 2 X DAILY Starting S As Scheduled
micafungin (MYCAMINE) 50 mg in sodium chloride 0.9 % 100 mL bag
50 mg, Intravenous, EVERY 24 HOURS Starting S+3 at 0000, Administer over 60 Minutes
Starting Day 4. Continue until ANC recovers to greater than 500/uL post-nadir.
Conditional Orders
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
IV push slowly, max rate 5 mg/minute.
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Zztestonc,Fiona F [2462287]
12/5/2017 8:35:51 AM Page 3 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting, If
unable to tolerate PO., Administer over 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to
5 minutes
Take Home Medications
midostaurin (RYDAPT) 25 MG cap
Take 2 caps by mouth 2 times daily. Days 8 through 21. Take with food at approximately 12-hour intervals., 50 mg,
Disp-56 cap, R-0, 2 X DAILY starting S, E-Prescribe
This medication will not be e-prescribed. If patient is present, script will go to printer. Otherwise,
script will go to nursing or tech pool.   Invalid items: Pharmacy   Details...
Actions
Actions
Actions
Zztestonc,Fiona F [2462287]
12/5/2017 8:35:51 AM Page 4 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org