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Breast Paclitaxel (14D1) following ddAC (674 Ver 02-18-15) Part 2 of 2

Breast Paclitaxel (14D1) following ddAC (674 Ver 02-18-15) Part 2 of 2 - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


VER: 08-24-16 (674 VER: 02-18-15) Page 1 of 3
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Paclitaxel
Disease Group: Breast
Disease: Breast Cancer (Adjuvant)

Therapy: PACLItaxel 175 mg/m2 IV Day 1,
GROWTH FACTOR REQUIRED

Cycle Length: 14 days Course: 4 cycles

Note: This regimen is for use following dose-dense doxorubicin and cyclophosphamide (ddAC).

Reference(s): Citron ML, et al. J Clin Oncol 2003;21:1431-39

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, AST, Total Bilirubin
 Other:



Treatment Conditions:
• Verify Informed consent obtained Day 1 of each cycle.
• Verify the following labs have been obtained: CBC, ANC, Total Bilirubin, AST
• Hold and notify provider for: ANC ≤ 1000/µL or Platelets ≤ 100K/µL or AST > 5 X ULN or Total Bilirubin > 1.25
X 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 hour and then every 30 minutes until infusion
complete for the first and second dose of PACLItaxel administration. Monitor vital signs every 30 minutes for
all subsequent doses if previous doses tolerated.
• 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 PACLItaxel:
• diphenhydramine (Benadryl) 50 mg IV once
• ranitidine (Zantac) 50 mg IV once
• dexamethasone (Decadron) 20 mg IV once PRN. For use only in patients who did not take dexamethasone at
home.




VER: 08-24-16 (674 VER: 02-18-15) 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:


• PACLItaxel (Taxol) __________mg (175 mg/m2) in non-PVC Bag IV once through non-PVC tubing and
standard in-line filter. Administer over 180 minutes. Hypersensitivity risk. For first and second dose, patient
should be treated in a location to optimize emergency care.



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: 0
Take 5 tablets (20 mg) by mouth 12 & 6 hours prior to 1
st
PACLItaxel dose, 3 tablets (12 mg) by mouth 12 & 6
hours prior to 2
nd
PACLItaxel dose and 2 tablets (8 mg) by mouth 12 & 6 hours prior to remaining PACLItaxel
doses.

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


Select One: (May substitute formulary equivalent)
 filgrastim (Neupogen) 300 mcg/0.5 mL syringe. Disp. 10 syringes, Refills: 5
Inject one syringe (300 mcg) under skin one time daily in evening beginning Day ____ and continue until ANC
is greater than __________ after nadir.

 filgrastim (Neupogen) 480 mcg/0.8 mL syringe. Disp. 10 syringes, Refills: 5
Inject one syringe (480 mcg) under skin one time daily in evening beginning Day ____ and continue until ANC
is greater than __________ after nadir.


 Other:










VER: 08-24-16 (674 VER: 02-18-15) Page 3 of 3
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Follow Up
• Chemotherapy: Day 1 every 14 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 #: ________