/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/ppo/,

/clinical/cckm-tools/content/ppo/name-99107-en.cckm

201608217

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Preprinted Paper Orders

GI Lanreotide(84D:1,29,57) (5452 VER: 9-17-15)

GI Lanreotide(84D:1,29,57) (5452 VER: 9-17-15) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


Final Approved VER: 9-24-15 (5452 VER: 9-17-15) Page 1 of 2
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Lanreotide
Disease Group: Gastrointestinal
Disease: Gastroenteropancreatic Neuroendocrine Tumors (Advanced)

Therapy: lanreotide autogel 120 mg subcutaneous Day 1, 29 and 57

Cycle Length: 84 days Course: until disease progression

Reference(s): Caplin ME, et al. N Engl J Med 2014;371(3):224-33

Allergies:  NKDA  Other ____________________________

Height _________cm Weight __________kg BSA ________m
2


Cycle _______ Starting with:  Day 1 (date) _________  Day 29 (date) _________  Day 57 (date) _________

Pre labs: None
 Other:


Treatment Conditions: Verify Informed consent obtained Day 1 of each cycle.

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

Hydration/Fluids: None

Premedications/Antiemetics: None

Treatment Medications for Day 1:
• lanreotide (Somatuline) 120 mg subcutaneous once
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site
between the right and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection
then remove and allow to come to room temperature. Protect from light.

Treatment Medications for Day 29:
• lanreotide (Somatuline) 120 mg subcutaneous once
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site
between the right and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection
then remove and allow to come to room temperature. Protect from light.

Treatment Medications for Day 57:
• lanreotide (Somatuline) 120 mg subcutaneous once
Administer subcutaneous in the superior external quadrant of the buttock. Alternate the injection site
between the right and left sides from one injection to the next. Refrigerate until 30 minutes prior to injection
then remove and allow to come to room temperature. Protect from light.

Other Orders for Day 1, 29 and/or 57:



Final Approved VER: 9-24-15 (5452 VER: 9-17-15) Page 2 of 2
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)
 Other:




Follow Up
• Chemotherapy: Day 1, 29 and 57 every 84 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 #: ________