/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/,

/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-123015-en.cckm

20180101

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Hospital-wide

IP - Cyclophosphamide Non-Oncology Infusion - Adult - Supplemental [5252]

IP - Cyclophosphamide Non-Oncology Infusion - Adult - Supplemental [5252] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Cyclophosphamide Non-Oncology Infusion - Adult - Supplemental [5252]
please verify recent CBC resultsProviders:
for Adult Patients OnlyIntended
Patient Care Orders
Verify Consent [143085]
UW Health Clinical Policy 6.1.1.- "Chemotherapy
Processes: Informed Consent, Ordering,
Verification, Administration, Documentation, and
Patient/Family Education
URL: https://uconnect.wisc.edu/policies/clinical/uw-
health-clinical/medications-and-
pharmacy/611.policy
Verify informed consent has been obtained
[NURCOM0022]
ONCE, Starting today For 1 Occurrences, Verify
consent form has been obtained
Non-Categorized Patient Care Orders [143861]
Fluid Intake [NURCOM0022] ONCE For 1 Occurrences, Instruct patient to drink 8 to
10 (8 ounce) glasses of water day prior to treatment,
day of treatment, and for 2 days after treatment.
Medications - Pre- Infusion
Flushes [223021]
sodium chloride 0.9% flush 10 mL injection
[785055]
Flush, PRN, flush/line care
Flush per VAD guidelines
heparin lock flush 10 UNIT/ML injection [75031] 1-150 units, Flush, PRN, flush/line care
Flush per VAD guidelines
heparin lock flush 100 units/mL 5 mL injection
[64978]
500 units, Flush, PRN, flush/line care
Implanted port use ONLY to be used when de-
accessing port. Flush per VAD guidelines
IV Fluids [142404]
sodium chloride 0.9% infusion [64367] at 250-500 mL/hr, Intravenous, ONCE For 1 Doses
Infuse 1000 mL throughout course of treatment
Anti-emetics [142405]
ondansetron (ZOFRAN) tab [45939] 16 mg, Oral, ONCE For 1 Doses
Administer 30 minutes prior to infusion
Steroids [142406]
dexamethasone (DECADRON) tab [36586] 10 mg, Oral, ONCE For 1 Doses
Administer 30 minutes prior to infusion
Non-Categorized Medications [142407]
mesna (MESNEX) bag [700066] 300 mg/m2, Intravenous, EVERY 4 HOURS For 3
Doses
Starting immediately prior to infusion, and 4 and 8
hours after the start of the cyclophosphamide infusion.
Medications - Infusion
Cyclophosphamide Infusion [142408]
cyclophosphamide (CYTOXAN) bag [700050] Intravenous, ONCE For 1 Doses
Medications - Post-Infusion
Pneumocystis Jiroveci Pneumonia Prophylaxis (Single Response) [142409]
Albuterol - Pentamidine [243229]
albuterol neb soln (3 mL) [800248] 1.25 mg, Nebulization, EVERY 30 DAYS
Give prior to pentamidine administration to prevent
bronchospasms. Order BOTH pentamidine and
albuterol for patients allergic to sulfa.
pentamidine (PENTAM) neb soln [780161] 300 mg, Nebulization, EVERY 30 DAYS
Order BOTH pentamidine and albuterol for patients
allergic to sulfa
Page 1 of 2
Printed by WILLIAMS, HEATHER R [HRS0] at 12/27/2017 3:31:42 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

sulfamethoxazole-trimethoprim (BACTRIM DS)
800-160 MG per tab [46804]
1 tab, Oral, EVERY MON, WED, FRI
atovaquone (MEPRON) susp [50620] 750 mg, Oral, 2 X DAILY (AT MEALTIME)
Anti-emetics [142410]
ondansetron (ZOFRAN) tab [45939] 8 mg, Oral, EVERY 8 HOURS PRN, nausea/vomiting,
nausea
Page 2 of 2
Printed by WILLIAMS, HEATHER R [HRS0] at 12/27/2017 3:31:42 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org