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Lung Carboplatin(21D:1)Paclitaxel Protein Bound Particles(21D:1)(4917 VER: 6-12-17)

Lung Carboplatin(21D:1)Paclitaxel Protein Bound Particles(21D:1)(4917 VER: 6-12-17) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


VER: 1-31-18 (4917 VER: 6-12-17) Page 1 of 3
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Carboplatin/Paclitaxel Protein Bound Particles
Disease Group: Lung
Disease: Non-Small Cell Lung Cancer (Advanced)

Therapy: PACLItaxel protein bound particles 100 mg/m2 IV Day 1, 8 and 15,
CARBOplatin (AUC=6) IV Day 1

Cycle Length: 21 days Course: 4 to 6 cycles

Reference(s): Socinski MA, et al. J Clin Oncol 2012;30(17):2055-62

Allergies:  NKDA  Other ____________________________

Height _________cm Weight __________kg BSA ________m
2


Cycle _______ Starting with:  Day 1 (date) ___________  Day 8 (date) ___________
 Day 15 (date) ___________

Pre labs:
• Day 1: Obtain CBC without DIFF, ANC, Electrolytes, Glucose, BUN, Creatinine, Calcium, Albumin, Total
Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase
 Other:

• Day 8 and15: Obtain CBC without DIFF, ANC
 Other:


Treatment Conditions:
• Verify Informed consent obtained Day 1 of each cycle.
• Verify the following labs have been obtained: Day 1, 8 and 15: CBC, ANC
• Hold and notify provider for: Day 1, 8 and 15: ANC < 1500/µL or Platelets < 100K/µL

Nursing Procedure, Assessment and Monitoring:
• 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)
Day 1: Give prior to chemotherapy (*indicates preferred antiemetic regimen):
 *ondansetron (Zofran) 16 mg by mouth once. PO preferred – may give 8 mg IV if unable to tolerate PO.
 *dexamethasone (Decadron) 10 mg by mouth once. PO preferred – may give 10 mg IV if unable to tolerate
PO.
 fosaprepitant (Emend) 150 mg IV once.
 aprepitant (Emend) 125 mg by mouth once.
 palonosetron (Aloxi) 0.25 mg IV once.
 Other:

Day 8 and 15: Give prior to chemotherapy (*indicates preferred antiemetic regimen):
 *ondansetron (Zofran) 8 mg by mouth once. PO preferred – may give 8 mg IV if unable to tolerate PO.
 Other:

VER: 1-31-18 (4917 VER: 6-12-17) Page 2 of 3
Copyright © 2018 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 protein-bound (Abraxane) __________mg (100 mg/m2) IV once over 30 minutes

• CARBOplatin (Paraplatin) _____________mg (AUC = 6) IV once over 30 minutes
Hypersensitivity risk. For first and second dose, patient should be treated in a location to optimize emergency
care.
(GFR + 25) X AUC = CARBOplatin dose (mg).

NOTE: The GFR used in this equation should not exceed 125 mL/min

Calculated Creatinine Clearance =

(140 – ___Patient age) x (patient weight in _____kg) = ________
72 x serum creatinine

(for females, multiply this result by 0.85) = ________

This value will substitute for GFR to determine CARBOplatin dose

(GFR + 25) X AUC = CARBOplatin dose (mg)

(_____ + 25) X ____ = CARBOplatin _____________ mg



Treatment Medications for Day 8: (in order of administration)
Dose modifications from previous day/cycle?  No  Yes – list which drugs and indicate dose reduction below:


• PACLItaxel protein-bound (Abraxane) __________mg (100 mg/m2) IV once over 30 minutes


Treatment Medications for Day 15: (in order of administration)
Dose modifications from previous day/cycle?  No  Yes – list which drugs and indicate dose reduction below:


• PACLItaxel protein-bound (Abraxane) __________mg (100 mg/m2) IV once over 30 minutes


Other Orders for Day 1, 8 and/or 15:



VER: 1-31-18 (4917 VER: 6-12-17) Page 3 of 3
Copyright © 2018 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)
• ondansetron (Zofran) 8 mg tablet, Disp. #30, Refills: 5
Take 1 tablet (8 mg) by mouth twice daily for 2 days after CARBOplatin then 1 tab (8 mg) every 8 hours as
needed for nausea/vomiting.

• prochlorperazine (Compazine) 10 mg tablet, Disp. #30, Refills: 5
Take 1 tablet (10 mg) by mouth every 6 hours as needed for nausea/vomiting.

 Other:




Follow Up
• Chemotherapy: Day 1, 8 and 15 every 21 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 #: ________