/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/beacon-protocols/,/clinical/cckm-tools/content/beacon-protocols/sarcoma/,

/clinical/cckm-tools/content/beacon-protocols/sarcoma/name-117487-en.cckm

201706165

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100

UWHC,UWMF,

Tools,

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

CSC Sarcoma Pazopanib (28D1-28) VER 5-1-17 (HL 5107)

CSC Sarcoma Pazopanib (28D1-28) VER 5-1-17 (HL 5107) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Sarcoma


CSC SARCOMA PAZOPANIB (28D1-28) VER 5-1-17 (HL 5107) – Properties
Pre-Cycle – 6/6/2017 through 6/12/2017 (7 days), Planned
Day 1, Pre-Cycle – Planned for 6/6/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcomas (Advanced); THERAPY: pazopanib 800 mg by mouth daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression
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+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
TSH
Expected-S Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S Approximate, Expires-S+365, Normal, Routine
Take Home Medications
prochlorperazine (COMPAZINE) 10 MG tab
Take 1 tab by mouth every 6 hours as needed for nausea/vomiting., 10 mg, Disp-30 tab, R-5, EVERY 6 HOURS PRN starting S,
Local Printer
loperamide 2 MG cap
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Zztestonc,Jeff J [2507481]
6/13/2017 4:02:33 PM Page 1 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Take 2 tab by mouth with 1st loose stool followed by 1 tab every 2h or 2 tab every 4h until no diarrhea x12h. Max
dose=8 tab/day, Disp-30 cap, R-5, starting S, Local Printer
Counsel patient to purchase over the counter if not covered by insurance and provide instructions for use.
Cycle 1 – 6/13/2017 through 7/10/2017 (28 days), Planned
Day 1, Cycle 1 – Planned for 6/13/2017
Treatment Plan Information
Reference Information (1)
SOFT TISSUE SARCOMAS: Van der Graaf WT, et al. Lancet 2012;379:1879-86.
Treatment Plan Summary
DISEASE: Soft Tissue Sarcomas (Advanced); THERAPY: pazopanib 800 mg by mouth daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression
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 without DIFF, ANC (DIFF if done locally), Urinalysis without microscopy.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1500/µL or Platelets less than 75K/µL or Urine Protein greater than 100
mg/dL or Blood Pressure greater than 140/90 mmHg.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Instruct the patient to conduct home blood pressure monitoring at least weekly during Cycle 1, and then every 2 weeks for
subsequent cycles. Call if Systolic Blood Pressure is greater than 140 mmHg or Diastolic Blood Pressure is greater than 90 mmHg.
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 medication section for the following treatment medication(s): pazopanib (dispensed on Day 1 of Cycle 1 only
- subsequent refills will be ordered through the medication activity).
Take Home Medications
PAZOPanib HCl (VOTRIENT) 200 MG tab
Take 4 tabs by mouth one time daily. Take on empty stomach., 800 mg, Disp-120 tab, R-0, 1 X DAILY starting S, Local Printer
Follow-Up
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Zztestonc,Jeff J [2507481]
6/13/2017 4:02:33 PM Page 2 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC without DIFF, ANC (with
DIFF if done locally), Electrolytes, Glucose, BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST,
ALT, Alkaline Phosphatase, Urinalysis without microscopy; LABS (ODD cycles only): TSH.
Cycle 2 – 7/11/2017 through 8/7/2017 (28 days), Planned
Day 1, Cycle 2 – Planned for 7/11/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcomas (Advanced); THERAPY: pazopanib 800 mg by mouth daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression
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 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+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
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
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Zztestonc,Jeff J [2507481]
6/13/2017 4:02:33 PM Page 3 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC without DIFF, ANC (DIFF if done locally), Urinalysis without microscopy.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1500/µL or Platelets less than 75K/µL or Urine Protein greater than 100
mg/dL or Blood Pressure greater than 140/90 mmHg.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Instruct the patient to conduct home blood pressure monitoring at least weekly during Cycle 1, and then every 2 weeks for
subsequent cycles. Call if Systolic Blood Pressure is greater than 140 mmHg or Diastolic Blood Pressure is greater than 90 mmHg.
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, pazopanib 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 without DIFF, ANC (with DIFF if done locally),
Electrolytes, Glucose, BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Urinalysis
without microscopy; LABS (ODD cycles only): TSH.
Cycle 3 – 8/8/2017 through 9/4/2017 (28 days), Planned
Day 1, Cycle 3 – Planned for 8/8/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcomas (Advanced); THERAPY: pazopanib 800 mg by mouth daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression
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 WITHOUT DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+28 Approximate, Expires-S+365, Routine
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Zztestonc,Jeff J [2507481]
6/13/2017 4:02:33 PM Page 4 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

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
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
Pre-Labs (delete all that do not apply)
TSH
Expected-S+28 Approximate, Expires-S+397, Routine
EVERY ODD CYCLE
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC without DIFF, ANC (DIFF if done locally), Urinalysis without microscopy.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1500/µL or Platelets less than 75K/µL or Urine Protein greater than 100
mg/dL or Blood Pressure greater than 140/90 mmHg.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Instruct the patient to conduct home blood pressure monitoring at least weekly during Cycle 1, and then every 2 weeks for
subsequent cycles. Call if Systolic Blood Pressure is greater than 140 mmHg or Diastolic Blood Pressure is greater than 90 mmHg.
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]
6/13/2017 4:02:33 PM Page 5 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Medications
Oral Chemotherapy Order Management
For this regimen, pazopanib 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 without DIFF, ANC (with DIFF if done locally),
Electrolytes, Glucose, BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Urinalysis
without microscopy; LABS (ODD cycles only): TSH.
Cycle 4 – 9/5/2017 through 10/2/2017 (28 days), Planned
Day 1, Cycle 4 – Planned for 9/5/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcomas (Advanced); THERAPY: pazopanib 800 mg by mouth daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression
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 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+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
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Zztestonc,Jeff J [2507481]
6/13/2017 4:02:33 PM Page 6 of 10
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+397, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+397, Routine
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
Pre-Labs (delete all that do not apply)
TSH
Expected-S+28 Approximate, Expires-S+397, Routine
EVERY ODD CYCLE
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC without DIFF, ANC (DIFF if done locally), Urinalysis without microscopy.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1500/µL or Platelets less than 75K/µL or Urine Protein greater than 100
mg/dL or Blood Pressure greater than 140/90 mmHg.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Instruct the patient to conduct home blood pressure monitoring at least weekly during Cycle 1, and then every 2 weeks for
subsequent cycles. Call if Systolic Blood Pressure is greater than 140 mmHg or Diastolic Blood Pressure is greater than 90 mmHg.
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, pazopanib 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 without DIFF, ANC (with DIFF if done locally),
Electrolytes, Glucose, BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Urinalysis
without microscopy; LABS (ODD cycles only): TSH.
Cycle 5 – 10/3/2017 through 10/30/2017 (28 days), Planned
Day 1, Cycle 5 – Planned for 10/3/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcomas (Advanced); THERAPY: pazopanib 800 mg by mouth daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
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Zztestonc,Jeff J [2507481]
6/13/2017 4:02:33 PM Page 7 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@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+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
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
Pre-Labs (delete all that do not apply)
TSH
Expected-S+28 Approximate, Expires-S+397, Routine
EVERY ODD CYCLE
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC without DIFF, ANC (DIFF if done locally), Urinalysis without microscopy.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1500/µL or Platelets less than 75K/µL or Urine Protein greater than 100
mg/dL or Blood Pressure greater than 140/90 mmHg.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Instruct the patient to conduct home blood pressure monitoring at least weekly during Cycle 1, and then every 2 weeks for
subsequent cycles. Call if Systolic Blood Pressure is greater than 140 mmHg or Diastolic Blood Pressure is greater than 90 mmHg.
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Zztestonc,Jeff J [2507481]
6/13/2017 4:02:33 PM Page 8 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

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, pazopanib 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 without DIFF, ANC (with DIFF if done locally),
Electrolytes, Glucose, BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Urinalysis
without microscopy; LABS (ODD cycles only): TSH.
Cycle 6 – 10/31/2017 through 11/27/2017 (28 days), Planned
Day 1, Cycle 6 – Planned for 10/31/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Soft Tissue Sarcomas (Advanced); THERAPY: pazopanib 800 mg by mouth daily continuously; CYCLE LENGTH: 28
days; COURSE: until disease progression
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 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+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
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Zztestonc,Jeff J [2507481]
6/13/2017 4:02:33 PM Page 9 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

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
URINALYSIS, NO MICROSCOPY
Expected-S+28 Approximate, Expires-S+365, Normal, Routine
Pre-Labs (delete all that do not apply)
TSH
Expected-S+28 Approximate, Expires-S+397, Routine
EVERY ODD CYCLE
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC without DIFF, ANC (DIFF if done locally), Urinalysis without microscopy.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1500/µL or Platelets less than 75K/µL or Urine Protein greater than 100
mg/dL or Blood Pressure greater than 140/90 mmHg.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Instruct the patient to conduct home blood pressure monitoring at least weekly during Cycle 1, and then every 2 weeks for
subsequent cycles. Call if Systolic Blood Pressure is greater than 140 mmHg or Diastolic Blood Pressure is greater than 90 mmHg.
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, pazopanib 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 without DIFF, ANC (with DIFF if done locally),
Electrolytes, Glucose, BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Urinalysis
without microscopy; LABS (ODD cycles only): TSH.
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Zztestonc,Jeff J [2507481]
6/13/2017 4:02:33 PM Page 10 of 10
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org