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GU Pazopanib (28D_DAILY) (3157 VER: 10-14-14)

GU Pazopanib (28D_DAILY) (3157 VER: 10-14-14) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


Final Approved VER: 05-26-16 (3157 VER: 10-14-14) Page 1 of 2
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Pazopanib
Disease Group: GU
Disease: Renal Cell Cancer (Advanced)

Therapy: pazopanib 800 mg by mouth once daily continuously

Cycle Length: 28 days Course: until disease progression or toxicity, at MD and patient discretion

Reference(s): Sternberg CN, et al. J Clin Oncol 2009;27(15S):abstr 5021

Allergies:  NKDA  Other ____________________________

Height _________cm Weight __________kg BSA ________m
2


Cycle _______ Starting with:  Day 1 (date) ___________

Pre labs:
• Day 1: Obtain CBC without DIFF, ANC, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Calcium,
Electrolytes, Albumin, Creatinine, Urinalysis (with microscopy), TSH
 Other:


Treatment Conditions:
• Verify Informed consent obtained Day 1 of each cycle.
• Verify the following labs have been obtained: WBC, ANC, Platelets, Urine Protein
• Hold and notify provider for: ANC ≤ 1000/µL or Platelets ≤ 75K/µL or Urine protein > 100 mg/dL or Blood
Pressure > 140/90 mmHg

Nursing Procedure, Assessment and Monitoring:
• Educate/reinforce with patient regarding oral chemotherapy and home safety.
• 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 grater than 150 mmHg or Diastolic Blood
Pressure is greater than 90 mmHg.

Hydration/Fluids: None

Premedications/Antiemetics: (May substitute formulary equivalent) - None

Treatment Medications:
• Pazopanib (Votrient) - See Take Home Medication section

Other Orders:







Final Approved VER: 05-26-16 (3157 VER: 10-14-14) Page 2 of 2
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Take Home Medications - (Prescribe Cycle 1, Day 1: Review for adequate supply during treatment)
• pazopanib (Votrient) 200 mg tablet, Disp. #120, Refills: __________
Take 4 tablets (800 mg) by mouth once daily on an empty stomach.

 Other:







Follow Up
• Clinic Visit: Day 1 every 28 days

• Labs:
 Other:





• Procedures/Imaging/Scans:







• Other Orders:







MD Signature_________________________________________ Pager______________
Date __________________Time___________________

Order Verification:
RN Signature: __________________________ Date: ___________ Time: __________ Pager #: ________
RPh Signature: _________________________ Date: ___________ Time: __________ Pager #: ________