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CSC Lung Carboplatin(21D:1) Etoposide(21D:1,(ORAL)2,3) VER 10-3-16 (HL 353)

CSC Lung Carboplatin(21D:1) Etoposide(21D:1,(ORAL)2,3) VER 10-3-16 (HL 353) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Lung


CSC LUNG CARBOPLATIN(21D:1)/ETOPOSIDE(21D:1,(ORAL)2,3) VER: 3-5-15 – Properties
Cycle 1 – 3/9/2015 through 3/29/2015 (21 days), Planned
Day 1, Cycle 1 – Planned for 3/9/2015
Treatment Plan Information
Reference Information (1)
SMALL CELL LUNG CANCER: Bishop, JF, et al. J Clin Oncol, 1987;3:1474-8.
Treatment Plan Summary
DISEASE: Small Cell Lung Cancer (Adjuvant/Advanced); THERAPY: CARBOplatin (AUC = 5 or 6) IV
Day 1, etoposide 100 mg/m2 IV Day 1, etoposide 100 mg/m2 by mouth twice daily on Day 2 and 3; CYCLE LENGTH:
21 days; COURSE: 4 cycles.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
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
BUN
Expected-S Approximate, Expires-S+365, Routine
CREATININE
Expected-S Approximate, Expires-S+365, Routine
CALCIUM
Expected-S Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: WBC, ANC, Platelets,Creatinine.
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Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1000/µL or Platelets less than 100K/µL
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to CARBOplatin 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 10 UNIT/ML lock flush 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 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 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
CARBOplatin (PARAPLATIN) in dextrose 5 % 500 mL bag
Intravenous, ONCE, 1 dose Starting when released
Administer over 60 minutes. Hypersensitivity reaction to CARBOplatin can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
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etoposide (VEPESID) 207 mg in sodium chloride 0.9 % 500 mL NSS bag
207 mg (100 mg/m2 × 2.07 m2 Treatment plan actual BSA), Intravenous, ONCE, 1 dose Starting when
released
Administer over 30 to 60 minutes. Administer with non-PVC tubing.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): etoposide
Take Home Medications
etoposide (VEPESID) 50 MG cap
Take 4 caps by mouth 2 times daily. Take only on Day 2 and 3 of each cycle., R-0, 2 X DAILY starting
S, Local Printer
ANTIEMETICS: HIGH RISK
Antiemetic orders per protocol to be assessed by the pharmacist.
RN and RPh verify that antiemetic protocol drug selections do not duplicate or conflict with other medication orders.
dexamethasone (DECADRON) 4 MG tab
Take 2 tabs by mouth one time daily. Take for 2 days following chemotherapy., Disp-16 tab, R-5, 1 X
DAILY starting S, Local Printer
ondansetron (ZOFRAN) 8 MG tab
Take 1 tab by mouth every 8 hours as needed., Disp-30 tab, R-5, EVERY 8 HOURS PRN starting S,
Local Printer
Follow-Up
DAY 10 FOLLOW-UP
LABS:CBC, ANC (DIFF if done locally)
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to
be done locally), Electrolytes, BUN, Creatinine, Calcium, Alkaline Phosphatase, AST, Albumin and Total Bilirubin;
CHEMOTHERAPY ROOM APPOINTMENT: CARBOplatin and etoposide infusion for 150 minutes.
Lab Only - Day 10, Cycle 1 – Planned for 3/18/2015
Treatment Plan Information
Treatment Plan Summary
DISEASE: Small Cell Lung Cancer (Adjuvant/Advanced); THERAPY: CARBOplatin (AUC = 5 or 6) IV
Day 1, etoposide 100 mg/m2 by mouth Day 1, etoposide 100 mg/m2 by mouth twice daily on Day 2 and 3; CYCLE
LENGTH: 21 days; COURSE: 4 cycles.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+9 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+9 Approximate, Expires-S+365, Routine
Follow-Up
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Zztestonc,Jef f J [2507481]
3/9/2015 12:46:43 PM Page 3 of 12
Copyright © 2015 University of Wisconsin Hospital and Clinics Authority


VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 2 – 3/30/2015 through 4/19/2015 (21 days), Planned
Day 1, Cycle 2 – Planned for 3/30/2015
Treatment Plan Information
Reference Information (1)
SMALL CELL LUNG CANCER: Bishop, JF, et al. J Clin Oncol, 1987;3:1474-8.
Treatment Plan Summary
DISEASE: Small Cell Lung Cancer (Adjuvant/Advanced); THERAPY: CARBOplatin (AUC = 5 or 6) IV
Day 1, etoposide 100 mg/m2 IV Day 1, etoposide 100 mg/m2 by mouth twice daily on Day 2 and 3; CYCLE LENGTH: 21
days; COURSE: 4 cycles.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+21 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+21 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+21 Approximate, Expires-S+365, Routine
BUN
Expected-S+21 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+21 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+21 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+21 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+21 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+21 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+21 Approximate, Expires-S+365, Routine
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Zztestonc,Jef f J [2507481]
3/9/2015 12:46:43 PM Page 4 of 12
Copyright © 2015 University of Wisconsin Hospital and Clinics Authority


Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: WBC, ANC, Platelets,Creatinine.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1000/µL or Platelets less than 100K/µL
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to CARBOplatin 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 10 UNIT/ML lock flush 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 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 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
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3/9/2015 12:46:43 PM Page 5 of 12
Copyright © 2015 University of Wisconsin Hospital and Clinics Authority


CARBOplatin (PARAPLATIN) in dextrose 5 % 500 mL bag
Intravenous, ONCE, 1 dose Starting when released
Administer over 60 minutes. Hypersensitivity reaction to CARBOplatin can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
etoposide (VEPESID) 207 mg in sodium chloride 0.9 % 500 mL NSS bag
207 mg (100 mg/m2 × 2.07 m2 Treatment plan actual BSA), Intravenous, ONCE, 1 dose Starting when
released
Administer over 30 to 60 minutes. Administer with non-PVC tubing.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): etoposide
Take Home Medications
etoposide (VEPESID) 50 MG cap
Take 4 caps by mouth 2 times daily. Take only on Day 2 and 3 of each cycle., R-0, 2 X DAILY starting
S, Local Printer
Follow-Up
DAY 10 FOLLOW-UP
LABS:CBC, ANC (DIFF if done locally)
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to
be done locally), Electrolytes, BUN, Creatinine, Calcium, Alkaline Phosphatase, AST, Albumin and Total Bilirubin;
CHEMOTHERAPY ROOM APPOINTMENT: CARBOplatin and etoposide infusion for 150 minutes.
Lab Only - Day 10, Cycle 2 – Planned for 4/8/2015
Treatment Plan Information
Treatment Plan Summary
DISEASE: Small Cell Lung Cancer (Adjuvant/Advanced); THERAPY: CARBOplatin (AUC = 5 or 6) IV
Day 1, etoposide 100 mg/m2 IV Day 1, etoposide 100 mg/m2 by mouth twice daily on Day 2 and 3; CYCLE LENGTH: 21
days; COURSE: 4 cycles.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+9 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+9 Approximate, Expires-S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,Jef f J [2507481]
3/9/2015 12:46:43 PM Page 6 of 12
Copyright © 2015 University of Wisconsin Hospital and Clinics Authority


Cycle 3 – 4/20/2015 through 5/10/2015 (21 days), Planned
Day 1, Cycle 3 – Planned for 4/20/2015
Treatment Plan Information
Reference Information (1)
SMALL CELL LUNG CANCER: Bishop, JF, et al. J Clin Oncol, 1987;3:1474-8.
Treatment Plan Summary
DISEASE: Small Cell Lung Cancer (Adjuvant/Advanced); THERAPY: CARBOplatin (AUC = 5 or 6) IV
Day 1, etoposide 100 mg/m2 IV Day 1, etoposide 100 mg/m2 by mouth twice daily on Day 2 and 3; CYCLE LENGTH: 21
days; COURSE: 4 cycles.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+21 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+21 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+21 Approximate, Expires-S+365, Routine
BUN
Expected-S+21 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+21 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+21 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+21 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+21 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+21 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+21 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: WBC, ANC, Platelets,Creatinine.
Treatment Parameters
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Copyright © 2015 University of Wisconsin Hospital and Clinics Authority


Hold and notify authorizing prescriber for ANC less than 1000/µL or Platelets less than 100K/µL
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to CARBOplatin 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 10 UNIT/ML lock flush 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 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 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
CARBOplatin (PARAPLATIN) in dextrose 5 % 500 mL bag
Intravenous, ONCE, 1 dose Starting when released
Administer over 60 minutes. Hypersensitivity reaction to CARBOplatin can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
etoposide (VEPESID) 207 mg in sodium chloride 0.9 % 500 mL NSS bag
207 mg (100 mg/m2 × 2.07 m2 Treatment plan actual BSA), Intravenous, ONCE, 1 dose Starting when
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Copyright © 2015 University of Wisconsin Hospital and Clinics Authority


released
Administer over 30 to 60 minutes. Administer with non-PVC tubing.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): etoposide
Take Home Medications
etoposide (VEPESID) 50 MG cap
Take 4 caps by mouth 2 times daily. Take only on Day 2 and 3 of each cycle., R-0, 2 X DAILY starting
S, Local Printer
Follow-Up
DAY 10 FOLLOW-UP
LABS:CBC, ANC (DIFF if done locally)
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to
be done locally), Electrolytes, BUN, Creatinine, Calcium, Alkaline Phosphatase, AST, Albumin and Total Bilirubin;
CHEMOTHERAPY ROOM APPOINTMENT: CARBOplatin and etoposide infusion for 150 minutes.
Lab Only - Day 10, Cycle 3 – Planned for 4/29/2015
Treatment Plan Information
Treatment Plan Summary
DISEASE: Small Cell Lung Cancer (Adjuvant/Advanced); THERAPY: CARBOplatin (AUC = 5 or 6) IV
Day 1, etoposide 100 mg/m2 IV Day 1, etoposide 100 mg/m2 by mouth twice daily on Day 2 and 3; CYCLE LENGTH: 21
days; COURSE: 4 cycles.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+9 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+9 Approximate, Expires-S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 4 – 5/11/2015 through 5/31/2015 (21 days), Planned
Day 1, Cycle 4 – Planned for 5/11/2015
Treatment Plan Information
Reference Information (1)
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3/9/2015 12:46:43 PM Page 9 of 12
Copyright © 2015 University of Wisconsin Hospital and Clinics Authority


SMALL CELL LUNG CANCER: Bishop, JF, et al. J Clin Oncol, 1987;3:1474-8.
Treatment Plan Summary
DISEASE: Small Cell Lung Cancer (Adjuvant/Advanced); THERAPY: CARBOplatin (AUC = 5 or 6) IV
Day 1, etoposide 100 mg/m2 IV Day 1, etoposide 100 mg/m2 by mouth twice daily on Day 2 and 3; CYCLE LENGTH: 21
days; COURSE: 4 cycles.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+21 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+21 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+21 Approximate, Expires-S+365, Routine
BUN
Expected-S+21 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+21 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+21 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+21 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+21 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+21 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+21 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: WBC, ANC, Platelets,Creatinine.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1000/µL or Platelets less than 100K/µL
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to CARBOplatin can occur. For first and second dose, patient should be treated
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3/9/2015 12:46:43 PM Page 10 of 12
Copyright © 2015 University of Wisconsin Hospital and Clinics Authority


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 10 UNIT/ML lock flush 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 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 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
CARBOplatin (PARAPLATIN) in dextrose 5 % 500 mL bag
Intravenous, ONCE, 1 dose Starting when released
Administer over 60 minutes. Hypersensitivity reaction to CARBOplatin can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See emergency medications.
etoposide (VEPESID) 207 mg in sodium chloride 0.9 % 500 mL NSS bag
207 mg (100 mg/m2 × 2.07 m2 Treatment plan actual BSA), Intravenous, ONCE, 1 dose Starting when
released
Administer over 30 to 60 minutes. Administer with non-PVC tubing.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): etoposide
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Copyright © 2015 University of Wisconsin Hospital and Clinics Authority


Take Home Medications
etoposide (VEPESID) 50 MG cap
Take 4 caps by mouth 2 times daily. Take only on Day 2 and 3 of each cycle., R-0, 2 X DAILY starting
S, Local Printer
Follow-Up
DAY 10 FOLLOW-UP
LABS:CBC, ANC (DIFF if done locally)
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to
be done locally), Electrolytes, BUN, Creatinine, Calcium, Alkaline Phosphatase, AST, Albumin and Total Bilirubin;
CHEMOTHERAPY ROOM APPOINTMENT: CARBOplatin and etoposide infusion for 150 minutes.
Lab Only - Day 10, Cycle 4 – Planned for 5/20/2015
Treatment Plan Information
Treatment Plan Summary
DISEASE: Small Cell Lung Cancer (Adjuvant/Advanced); THERAPY: CARBOplatin (AUC = 5 or 6) IV
Day 1, etoposide 100 mg/m2 IV Day 1, etoposide 100 mg/m2 by mouth twice daily on Day 2 and 3; CYCLE LENGTH: 21
days; COURSE: 4 cycles.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+9 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+9 Approximate, Expires-S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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