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HEM Bleomycin-Dacarbazine-Doxorubicin-Vinblastine(28D1,15) (1031 VER: 02-02-16)

HEM Bleomycin-Dacarbazine-Doxorubicin-Vinblastine(28D1,15) (1031 VER: 02-02-16) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


Final Approved VER: 03-16-16 (1031 VER: 02-02-16) Page 1 of 4
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Bleomycin, Dacarbazine, Doxorubicin, Vinblastine (ABVD)
Disease Group: Hematology
Disease: Hodgkin Lymphoma

Therapy: doxorubicin 25 mg/m2 IV Day 1 and 15,
vinBLAStine 6 mg/m2 IV Day 1 and 15,
bleomycin 10 units/m2 IV Day 1 and 15,
dacarbazine 375 mg/m2 IV Day 1 and 15

Cycle Length: 28 days Course: 4 to 8 cycles

Note to All Staff: Avoid filgrastim because of potential synergistic risk with bleomycin toxicity. OK to use
filgrastim if neutropenic as long as no signs of active infection and patient is monitored closely for
signs/symptoms of bleomycin pulmonary toxicity.

Reference(s): Bonadonna G, et al. Cancer 1975;36:252-9, Santoro A, et al. J Clin Oncol 1987;5:27-37.

Allergies:  NKDA  Other ____________________________

Height _________cm Weight __________kg BSA ________m
2


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

Pre labs:
• Cycle 1:
 Day 1: Obtain CBC with DIFF, Total Bilirubin, Creatinine, Potassium, Uric Acid, LDH
 Day 15: Obtain CBC with DIFF
 Other:


• Cycles ≥ 2:
 Day 1: Obtain CBC with DIFF, Total Bilirubin, Creatinine
 Day 15: Obtain CBC with DIFF
 Other:


Treatment Conditions:
• Verify Informed consent obtained Day 1 of each cycle.
• Verify the following labs have been obtained:
 Day 1: CBC with DIFF, Creatinine, Total Bilirubin
 Day 15: CBC with DIFF
• Hold and notify provider for:
 Day 1: Platelets ≤ 75K/µL or Total Bilirubin > ULN or Creatinine Clearance l< 50 mL/min
 Day 15: Platelets ≤ 75K/µL
• Notify provider (but do not hold) for:
 Day 1 and 15: ANC ≤ 1000/µL

Nursing Procedure, Assessment and Monitoring:
• Flush/Line Care per Institution standards


Final Approved VER: 03-16-16 (1031 VER: 02-02-16) Page 2 of 4
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Hydration/Fluids: sodium chloride 0.9% IV administer 1000 mL throughout chemotherapy

Premedications/Antiemetics: (May substitute formulary equivalent)
Give prior to bleomycin:
• acetaminophen (Tylenol) 650 mg by mouth once.
• diphenhydramine (Benadryl) 50 mg by mouth once

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) 12 mg by mouth once. PO preferred – may give 10 mg IV if unable to tolerate
PO.
 *aprepitant (Emend) 125 mg by mouth once.
 fosaprepitant (Emend) 150 mg IV 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:


• doxorubicin (Adriamycin) __________mg (25 mg/m2) IV once. Administer as side arm push 3 to 5 mL/minute
into running IV.

• vinBLAStine (Velban) ____________ mg (6 mg/m2) IV once over 5 minutes.

• bleomycin (Blenoxane) __________ units (10 units/m2) IV once over 15 minutes. Hypersensitivity risk. For first
and second dose, patient should be treated in a location to optimize emergency care. Patient should be
monitored for 30 minutes post first dose.

• dacarbazine (DTIC-DOME) ____________ mg (375 mg/m2) IV once over 60 minutes. Additional Sodium
Chloride 0.9% may be y-set into IV site to decrease site irritation. Protect from light.

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:


• doxorubicin (Adriamycin) __________mg (25 mg/m2) IV once. Administer as side arm push 3 to 5 mL/minute
into running IV.

• vinBLAStine (Velban) ____________ mg (6 mg/m2) IV once over 5 minutes.

• bleomycin (Blenoxane) __________ units (10 units/m2) IV once over 15 minutes. Hypersensitivity risk. For first
and second dose, patient should be treated in a location to optimize emergency care. Patient should be
monitored for 30 minutes post first dose.

• dacarbazine (DTIC-DOME) ____________ mg (375 mg/m2) IV once over 60 minutes. Additional Sodium
Chloride 0.9% may be y-set into IV site to decrease site irritation. Protect from light.


Final Approved VER: 03-16-16 (1031 VER: 02-02-16) Page 3 of 4
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Other Orders for Day 1 and/or 15:








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 once daily for 3 days following chemotherapy.

• 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.

• ranitidine (Zantac) 150 mg tablet, Disp. #60, Refills: 5
Take 1 tablet (150 mg) by mouth two times daily.

• acyclovir (Zovirax) 400 mg tablet, Disp. #60, Refills: 5
Take 1 tablet (400 mg) by mouth two times daily.

• allopurinol (Zyloprim) 300 mg tablet, Disp. #7, Refills: 0
Take 1 tablet (300 mg) by mouth once daily for Day 1 through 7.

• sulfamethoxazole-trimethoprim (Bactrim DS) 800-160 mg per tablet, Disp. #16, Refills: 5
Take 1 tablet (800-160 mg) by mouth two times daily on Saturday and Sunday.

 aprepitant (Emend) 80 mg capsule, Disp. #4, Refills: 5
Take 1 capsule by mouth once daily for two days following chemotherapy.
(Prescribe only if patient received aprepitant as a premedication)

 Other:





Final Approved VER: 03-16-16 (1031 VER: 02-02-16) Page 4 of 4
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Follow Up
• Chemotherapy: Day 1 and 15 every 28 days

• Labs:
 Day 4 and 7 (Cycle 1 only): Potassium, Uric Acid, LDH, Creatinine
 Day 15 – 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 #: ________