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GU Docetaxel (21D:1) (717 VER: 04-20-16)

GU Docetaxel (21D:1) (717 VER: 04-20-16) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


VER: 08-16-16 (717 VER: 04-20-16) Page 1 of 3
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Docetaxel
Disease Group: Genitourinary
Disease: Prostate Cancer (Adjuvant/Advanced)

Therapy: DOCEtaxel 75 mg/m2 IV Day 1,
Optional: prednisone 5 mg by mouth two time daily (except when taking dexamethasone)

Cycle Length: 21 days Course: 6 cycles or until disease progression

NOTE: Dose varies from reference.

Reference(s): Tannock IF, et al. N Engl J Med 2004;351:1502-12

Allergies:  NKDA  Other ____________________________

Height _________cm Weight __________kg BSA ________m
2


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

Pre labs:
• Obtain CBC without DIFF, ANC, Glucose, Creatinine, Alkaline Phosphatase, Total Bilirubin, ALT, PSA (Total,
Diagnostic)
 Other:


Treatment Conditions:
• Verify Informed consent obtained Day 1 of each cycle.
• Verify the following labs have been obtained: WBC, ANC, Platelets, Creatinine
• Hold and notify provider for: ANC ≤ 1000/µL or Platelets ≤ 75K/µL or Creatinine > ULN
• Verify that patient has taken home dexamethasone and document.

Nursing Procedure, Assessment and Monitoring:
• Vital signs to be monitored every 15 minutes for the first and second dose of DOCEtaxel administration and
then every 30 minutes for any subsequent doses.
• Flush/Line Care per Institution standards

Hydration/Fluids: sodium chloride 0.9% IV to establish line and for flushing

Premedications/Antiemetics: (May substitute formulary equivalent)
Give prior to DOCEtaxel:
• dexamethasone (Decadron) 20 mg IV once PRN. For use only in patients who did not take dexamethasone at
home.
 Other:




VER: 08-16-16 (717 VER: 04-20-16) Page 2 of 3
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Treatment Medications for Day 1: (in order of administration)
Dose modifications from previous day/cycle?  No  Yes – list which drugs and indicate dose reduction below:



• DOCEtaxel (Taxotere) __________mg (75 mg/m2) IV once over 60 minutes in non-PVC bag and non-PVC
tubing.
Hypersensitivity risk. For first and second dose, patient should be treated in a location to optimize
emergency care.

• See Take Home Medications for the following treatment medication: prednisone



Other Orders for Day 1:





Take Home Medications - (Prescribe Cycle 1, Day 1: Review for adequate supply during treatment)
• dexamethasone (Decadron) 4 mg tablet, Disp. #24, Refills: 5
Take 2 tablets (8 mg) by mouth 12 hours, 3 hours and 1 hour prior to treatment for DOCEtaxel.

• ondansetron (Zofran) 8 mg tablet, Disp. #30, Refills: 5
Take 1 tablet (8 mg) by mouth every 8 hours as needed for nausea/vomiting.

• prednisone (Deltasone) 5 mg tablet, Disp. #60, Refills: 5
Take 1 tablet (5 mg) by mouth two times daily. Do not take when taking dexamethasone.

 Other:





VER: 08-16-16 (717 VER: 04-20-16) Page 3 of 3
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Follow Up
• Chemotherapy: Day 1 every 21 days

• Labs:
 Day 10 – Obtain CBC, ANC (DIFF if done locally)
 Other:






• Procedures/Imaging/Scans:















• Other Orders:









MD Signature_________________________________________ Pager______________
Date __________________Time___________________

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