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Lung Cisplatin(21D1)/Docetaxel(21D1) (62 VER: 03-05-15)

Lung Cisplatin(21D1)/Docetaxel(21D1) (62 VER: 03-05-15) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


Final Approved VER: 12-2-15 (62 VER: 03-05-15) Page 1 of 3
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Cisplatin/Docetaxel
Disease Group: Lung
Disease: Non-Small Cell Lung Cancer (Adjuvant/Advanced)

Therapy: DOCEtaxel 75 mg/m2 IV Day 1
CISplatin 75 mg/m2 IV Day 1

Cycle Length: 21 days Course: 4 to 6 cycles

Reference(s): Belani CP, et al. Clin Lung Cancer 1999;1(2):144-50.

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, Electrolytes, BUN, Creatinine, Calcium, Albumin, Total Bilirubin, AST,
Alkaline Phosphatase, Magnesium
 Other:



Treatment Conditions:
• Verify Informed consent obtained Day 1 of each cycle.
• Day 1: Verify the following labs have been obtained: WBC, ANC, Platelets, Creatinine
• Hold and notify provider for:
 Day 1: ANC < 1000/µL or Platelets < 100K/µL
• Verify that patient has taken home dexamethasone premedication and document.

Nursing Procedure, Assessment and Monitoring:
• Monitor vital signs during docetaxel administration every 15 minutes for the first hour and then every 30
minutes for all subsequent doses if previous doses tolerated.
• Measure IV intake and urine output.
• Flush/Line Care per Institution standards

Hydration/Fluids: sodium chloride 0.9% IV administer 1000 mL throughout chemotherapy
 Additional additives required – these may be added to any appropriate fluid throughout treatment
 Magnesium ______ grams
 Potassium chloride ______ mEq



Final Approved VER: 12-2-15 (62 VER: 03-05-15) Page 2 of 3
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Premedications/Antiemetics
Give prior to chemotherapy (*indicates preferred antiemetic regimen):
 *ondansetron (Zofran) 24 mg by mouth once. PO preferred – may give 12 mg IV if unable to tolerate PO.
 *dexamethasone (Decadron) 20 mg IV once PRN. For use in patients who did not take dexamethasone at
home.
 fosaprepitant (Emend) 150 mg IV once.
 *aprepitant (Emend) 125 mg by mouth once.
 palonosetron (Aloxi) 0.25 mg IV once.
 Other:

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 through non-PVC
tubing.
Hypersensitivity risk. For first and second dose, patient should be treated in a location to optimize
emergency care. RN to stay at patient’s bedside for a minimum of 15 minutes for first dose. RN to do the
same for the second dose if adverse reaction during first dose.

• CISplatin (Platinol) ____________ mg (75 mg/m2) IV once over 30 to 60 minutes.

Conditional Orders Day 1:
• furosemide (Lasix) 20 mg IV once PRN. IV push rate 10 mg/minute. Administer if IV intake is greater than
2000 mL and urine output is less than 500 mL.

Other Orders for Day 1:







Final Approved VER: 12-2-15 (62 VER: 03-05-15) Page 3 of 3
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)
• dexamethasone (Decadron) 4 mg tablet, Disp. #50, Refills: 1
Starting the morning before chemotherapy, take 2 tablets (8 mg) by mouth twice daily for 3 days, then 2 tablets
(8 mg) once daily for 2 days.

• ondansetron (Zofran) 8 mg tablet, Disp. #30, Refills: 5
Take 1 tablet (8 mg) by mouth 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.

 aprepitant (Emend) 80 mg capsule, Disp. #2, Refills: 5
Take 1 capsule by mouth once daily for two days following chemotherapy.
(Prescribe only if patient received aprepitant as a premedication)

 Other:



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 #: ________