Zzbeacon,Zayna [MR ]

Transcription

1 AALL1131 INTERIM MAINTENANCE, HR-ALL, ARM B, HD MTX Properties Cycle 1 9/27/2012 through 11/28/2012 (63 days), Planned Day 1, Cycle 1 Planned for 9/27/2012 Release CBC and differential Release Release Comprehensive metabolic panel Release Bilirubin, direct (GH L Q YH) Release CSF cell count with differential (L YH) Release Nursing Orders Nurse Verification I verify the treatment plan. Release Release sodium chloride 0.9 % infusion 25 ml/hr, Intravenous, CONTINUOUS PRN, Other, as needed to keep vein open., Starting Release Release Hydration Release sodium bicarbonate 30 meq in D5 1/4 NS 1,000 ml infusion at 125 ml/hr, Intravenous, CONTINUOUS, 1,030 ml, Starting when released Release Hydrate prior to high dose methotrexate for at least 6 hour and until urine specific gravity is < or = and ph is > or = 7.0 and < or = 8.0. Release midazolam (VERSED) injection 1.79 mg Release 0.05 mg/kg 35.8 kg (Treatment plan actual weight) = 1.79 mg, Intravenous, PRN, for sedation for procedure., Starting, For 3 doses fentanyl PF (SUBLIMAZE) injection 36 mcg 1 mcg/kg 35.8 kg (Treatment plan actual weight) = 36 mcg, IV Push, PRN, for sedation for procedure., Starting, For 3 doses Release naloxone (NARCAN) injection 0.36 mg 10 mcg/kg 35.8 kg (Treatment plan actual weight) = 0.36 mg, IV Push, PRN, Opioid Reversal, Starting, For 10 doses May repeat every 2-3 minutes. Release flumazenil (ROMAZICON) injection mg Release 0.01 mg/kg 35.8 kg (Treatment plan actual weight) = mg, Intravenous, PRN, for benzodiazepine reversal., Starting, For 5 doses Ordered dose of 0.01 mg/kg PRN exceeds the recommended single dose limit of 0.2 mg. lidocaine (LMX) 4 % cream Release 9/27/2012 3:18:21 PM Page 1 of 9

2 Topical, PRN, for procedure sites., Starting Release methotrexate, hydrocortisone sodium succinate (Solu-CORTEF), cytarabine Release (CYTOSAR) in sodium chloride 0.9 % PF INTRATHECAL chemo injection Intrathecal, ONCE, Starting at treatment start time, For 1 dose Prepared in preservative-free 0.9% sodium chloride. Administration is by MD or other licensed oncology provider. mercaptopurine (PURINETHOL) tablet 50 mg 25 mg/m m2 (Treatment plan actual BSA) = 50 mg, Oral, DAILY, Starting, For 56 days Release 25 mg/m2 (29 mg = 0.58 tablet) cannot be administered using available products. The nearest available dose is 50 mg (43.1 mg/m2). vincristine (ONCOVIN) 1.7 mg in sodium chloride 0.9 % 25 ml chemo Release infusion 1.5 mg/m m2 (Treatment plan actual BSA) = 1.7 mg, Intravenous, for 5 Minutes, ONCE, Starting 6 hours after treatment start time, For 1 dose Vesicant-monitor infusion site frequently. Fatal if given intrathecally. methotrexate 580 mg in D5 1/4 NS 75.4 ml Release 500 mg/m m2 (Treatment plan actual BSA) = 580 mg, Intravenous, for 30 Start after pre-hydration. methotrexate 2,610 mg, sodium bicarbonate meq in D5 1/4 NS 1,702.3 Release ml Intravenous, at ml/hr, ONCE, Starting 6.5 hours after treatment start time, For 1 dose Bag #1 of #2. methotrexate 2,610 mg, sodium bicarbonate meq in D5 1/4 NS 1,702.3 Release ml Intravenous, at ml/hr, ONCE, Starting hours after treatment start time, For 1 dose Bag #2 of #2. Release Methotrexate level (BH GH L YH) Release PRN Starting Until Specified Draw MTX level and serum creatinine at 24, 36, 42, & 48 hours; NOTE: 36 hour MTX level is only drawn if the 24 hour level is > 150 micromolar and/or creatinine > 125% baseline, repeat level if MTX contamination is possible. If the value is "real" refer to the changes in hydration, etc described in the protocol and repeat the level with a serum Cr at hour 36. Then refer to the table in protocol section Creatinine, serum (BH GH L YH) Release PRN Starting Until Specified Draw MTX level and serum creatinine; NOTE: 36 hour level is only drawn if needed (see protocol) Supportive Care Release leucovorin 20 mg injection 15 mg/m m2 (Treatment plan actual BSA) = 20 mg, Intravenous, for 3 Minutes Release EVERY 6 HOURS PRN, for elevated methotrexate levels, Starting, For 3 doses If the 42 and 48 hour MTX levels are < or =1 and >0.4 micromolar, respectively, give leucovorin at 15 mg/m2 IV/PO at 42, 48 and 54 hours post the start of methotrexate loading dose. 9/27/2012 3:18:21 PM Page 2 of 9

3 15 mg/m2 (17.4 mg) cannot be administered using available products. The nearest available dose is 20 mg (17.2 mg/m2). sodium bicarbonate 8.4 % injection 29 meq Release 25 meq/m m2 (Treatment plan actual BSA) = 29 meq, IV Push, Once, PRN may repeat X1, Infuse over 15 minutes, if needed to maintain study parameters for ph., Starting Post-Medications heparin 100 unit/ml lock flush 250 Units 2.5 ml = 250 Units, Intra-Catheter, PRN, Catheter Care, for Portacath., Starting Release Release heparin PF 10 units/ml lock flush 25 Units 2.5 ml = 25 Units, Intra-Catheter, PRN, for broviac/picc catheter use., Starting Release sodium chloride 0.9 % flush 10 ml 10 ml, IV Push, PRN, Administer pre- and post-treatments and blood draw/administration., Starting Release Day 3, Cycle 1 Planned for 9/29/2012 mercaptopurine (PURINETHOL) 50 mg tablet Take 1 tablet by mouth daily. Give at least 1 hour after evening meal. To be taken without milk or citrus products. Normal, R-0 Adjust dose using half tablets and different doses on alternating days in order to attain a weekly cumulative dose as close to 175 mg/m2/week as possible. See Appendix I for details. Do not escalate or modify dose based on blood counts during this course. 25 mg/m2 (29 mg = 0.58 tablet) cannot be prescribed using the selected product. The nearest available dose is 50 mg (43.1 mg/m2). This medication will not be e-prescribed. Details Day 15, Cycle 1 Planned for 10/11/2012 CBC and differential Comprehensive metabolic panel Bilirubin, direct (GH L Q YH) Nursing Orders Nurse Verification I verify the treatment plan. 9/27/2012 3:18:21 PM Page 3 of 9

4 sodium chloride 0.9 % infusion 25 ml/hr, Intravenous, CONTINUOUS PRN, Other, as needed to keep vein open., Starting Hydration sodium bicarbonate 30 meq in D5 1/4 NS 1,000 ml infusion at 125 ml/hr, Intravenous, CONTINUOUS, 1,030 ml, Starting Hydrate prior to high dose methotrexate for at least 6 hour and until urine specific gravity is < or = and ph is > or = 7.0 and < or = 8.0. vincristine (ONCOVIN) 1.7 mg in sodium chloride 0.9 % 25 ml 1.5 mg/m m2 (Treatment plan actual BSA) = 1.7 mg, Intravenous, for 5 Vesicant-monitor infusion site frequently. Fatal if given intrathecally. methotrexate 580 mg in D5 1/4 NS 75.4 ml 500 mg/m m2 (Treatment plan actual BSA) = 580 mg, Intravenous, for 30 Start after pre-hydration. methotrexate 2,610 mg, sodium bicarbonate meq in D5 1/4 NS 1,702.3 ml Intravenous, at ml/hr, ONCE, Starting 6.5 hours after treatment start time, For 1 dose Bag #1 of #2. methotrexate 2,610 mg, sodium bicarbonate meq in D5 1/4 NS 1,702.3 ml Intravenous, at ml/hr, ONCE, Starting hours after treatment start time, For 1 dose Bag #2 of #2. Methotrexate level (BH GH L YH) PRN Starting Until Specified Draw MTX level and serum creatinine at 24, 36, 42, & 48 hours; NOTE: 36 hour MTX level is only drawn if the 24 hour level is > 150 micromolar and/or creatinine > 125% baseline, repeat level if MTX contamination is possible. If the value is "real" refer to the changes in hydration, etc described in the protocol and repeat the level with a serum Cr at hour 36. Then refer to the table in protocol section Creatinine, serum (BH GH L YH) PRN Starting Until Specified Draw MTX level and serum creatinine; NOTE: 36 hour level is only drawn if needed (see protocol) Supportive Care leucovorin 20 mg injection 15 mg/m m2 (Treatment plan actual BSA) = 20 mg, Intravenous, for 3 Minutes EVERY 6 HOURS PRN, for elevated methotrexate levels, Starting, For 3 doses If the 42 and 48 hour MTX levels are < or =1 and >0.4 micromolar, respectively, give leucovorin at 15 mg/m2 IV/PO at 42, 48 and 54 hours post the start of methotrexate loading dose. 15 mg/m2 (17.4 mg) cannot be administered using available products. The nearest available dose is 20 mg (17.2 mg/m2). 9/27/2012 3:18:21 PM Page 4 of 9

5 sodium bicarbonate 8.4 % injection 29 meq 25 meq/m m2 (Treatment plan actual BSA) = 29 meq, IV Push, Once, PRN may repeat X1, Infuse over 15 minutes, if needed to maintain study parameters for ph., Starting Post-Medications heparin 100 unit/ml lock flush 250 Units 2.5 ml = 250 Units, Intra-Catheter, PRN, Catheter Care, for Portacath., Starting heparin PF 10 units/ml lock flush 25 Units 2.5 ml = 25 Units, Intra-Catheter, PRN, for broviac/picc catheter use., Starting sodium chloride 0.9 % flush 10 ml 10 ml, IV Push, PRN, Administer pre- and post-treatments and blood draw/administration., Starting Day 29, Cycle 1 Planned for 10/25/2012 CBC and differential Comprehensive metabolic panel Bilirubin, direct (GH L Q YH) CSF cell count with differential (L YH) Nursing Orders Nurse Verification I verify the treatment plan. sodium chloride 0.9 % infusion 25 ml/hr, Intravenous, CONTINUOUS PRN, Other, as needed to keep vein open., Starting Hydration sodium bicarbonate 30 meq in D5 1/4 NS 1,000 ml infusion at 125 ml/hr, Intravenous, CONTINUOUS, 1,030 ml, Starting Hydrate prior to high dose methotrexate for at least 6 hour and until urine specific gravity is < or = and ph is > or = 7.0 and < or = 8.0. midazolam (VERSED) injection 1.79 mg 0.05 mg/kg 35.8 kg (Treatment plan actual weight) = 1.79 mg, Intravenous, PRN, for sedation for procedure., Starting, For 3 doses 9/27/2012 3:18:21 PM Page 5 of 9

6 fentanyl PF (SUBLIMAZE) injection 36 mcg 1 mcg/kg 35.8 kg (Treatment plan actual weight) = 36 mcg, IV Push, PRN, for sedation for procedure., Starting, For 3 doses naloxone (NARCAN) injection 0.36 mg 10 mcg/kg 35.8 kg (Treatment plan actual weight) = 0.36 mg, IV Push, PRN, Opioid Reversal, Starting, For 10 doses May repeat every 2-3 minutes. flumazenil (ROMAZICON) injection mg 0.01 mg/kg 35.8 kg (Treatment plan actual weight) = mg, Intravenous, PRN, for benzodiazepine reversal., Starting, For 5 doses Ordered dose of 0.01 mg/kg PRN exceeds the recommended single dose limit of 0.2 mg. lidocaine (LMX) 4 % cream Topical, PRN, for procedure sites., Starting methotrexate, hydrocortisone sodium succinate (Solu-CORTEF), cytarabine (CYTOSAR) in sodium chloride 0.9 % PF INTRATHECAL chemo injection Intrathecal, ONCE, Starting at treatment start time, For 1 dose Prepared in preservative-free 0.9% sodium chloride. Administration is by MD or other licensed oncology provider. vincristine (ONCOVIN) 1.7 mg in sodium chloride 0.9 % 25 ml 1.5 mg/m m2 (Treatment plan actual BSA) = 1.7 mg, Intravenous, for 5 Vesicant-monitor infusion site frequently. Fatal if given intrathecally. methotrexate 580 mg in D5 1/4 NS 75.4 ml 500 mg/m m2 (Treatment plan actual BSA) = 580 mg, Intravenous, for 30 Start after pre-hydration. methotrexate 2,610 mg, sodium bicarbonate meq in D5 1/4 NS 1,702.3 ml Intravenous, at ml/hr, ONCE, Starting 6.5 hours after treatment start time, For 1 dose Bag #1 of #2. methotrexate 2,610 mg, sodium bicarbonate meq in D5 1/4 NS 1,702.3 ml Intravenous, at ml/hr, ONCE, Starting hours after treatment start time, For 1 dose Bag #2 of #2. Methotrexate level (BH GH L YH) PRN Starting Until Specified Draw MTX level and serum creatinine at 24, 36, 42, & 48 hours; NOTE: 36 hour MTX level is only drawn if the 24 hour level is > 150 micromolar and/or creatinine > 125% baseline, repeat level if MTX contamination is possible. If the value is "real" refer to the changes in hydration, etc described in the protocol and repeat the level with a serum Cr at hour 36. Then refer to the table in protocol section Creatinine, serum (BH GH L YH) PRN Starting Until Specified Draw MTX level and serum creatinine; NOTE: 36 hour level is only drawn if needed (see protocol) 9/27/2012 3:18:21 PM Page 6 of 9

7 Supportive Care leucovorin 20 mg injection 15 mg/m m2 (Treatment plan actual BSA) = 20 mg, Intravenous, for 3 Minutes EVERY 6 HOURS PRN, for elevated methotrexate levels, Starting, For 3 doses If the 42 and 48 hour MTX levels are < or =1 and >0.4 micromolar, respectively, give leucovorin at 15 mg/m2 IV/PO at 42, 48 and 54 hours post the start of methotrexate loading dose. 15 mg/m2 (17.4 mg) cannot be administered using available products. The nearest available dose is 20 mg (17.2 mg/m2). sodium bicarbonate 8.4 % injection 29 meq 25 meq/m m2 (Treatment plan actual BSA) = 29 meq, IV Push, Once, PRN may repeat X1, Infuse over 15 minutes, if needed to maintain study parameters for ph., Starting Post-Medications heparin 100 unit/ml lock flush 250 Units 2.5 ml = 250 Units, Intra-Catheter, PRN, Catheter Care, for Portacath., Starting heparin PF 10 units/ml lock flush 25 Units 2.5 ml = 25 Units, Intra-Catheter, PRN, for broviac/picc catheter use., Starting sodium chloride 0.9 % flush 10 ml 10 ml, IV Push, PRN, Administer pre- and post-treatments and blood draw/administration., Starting Day 43, Cycle 1 Planned for 11/8/2012 CBC and differential Comprehensive metabolic panel Bilirubin, direct (GH L Q YH) Nursing Orders Nurse Verification I verify the treatment plan. sodium chloride 0.9 % infusion 25 ml/hr, Intravenous, CONTINUOUS PRN, Other, as needed to keep vein open., Starting Hydration sodium bicarbonate 30 meq in D5 1/4 NS 1,000 ml infusion at 125 ml/hr, Intravenous, CONTINUOUS, 1,030 ml, Starting 9/27/2012 3:18:21 PM Page 7 of 9

8 Hydrate prior to high dose methotrexate for at least 6 hour and until urine specific gravity is < or = and ph is > or = 7.0 and < or = 8.0. vincristine (ONCOVIN) 1.7 mg in sodium chloride 0.9 % 25 ml 1.5 mg/m m2 (Treatment plan actual BSA) = 1.7 mg, Intravenous, for 5 Vesicant-monitor infusion site frequently. Fatal if given intrathecally. methotrexate 580 mg in D5 1/4 NS 75.4 ml 500 mg/m m2 (Treatment plan actual BSA) = 580 mg, Intravenous, for 30 Start after pre-hydration. methotrexate 2,610 mg, sodium bicarbonate meq in D5 1/4 NS 1,702.3 ml Intravenous, at ml/hr, ONCE, Starting 6.5 hours after treatment start time, For 1 dose Bag #1 of #2. methotrexate 2,610 mg, sodium bicarbonate meq in D5 1/4 NS 1,702.3 ml Intravenous, at ml/hr, ONCE, Starting hours after treatment start time, For 1 dose Bag #2 of #2. Methotrexate level (BH GH L YH) PRN Starting Until Specified Draw MTX level and serum creatinine at 24, 36, 42, & 48 hours; NOTE: 36 hour MTX level is only drawn if the 24 hour level is > 150 micromolar and/or creatinine > 125% baseline, repeat level if MTX contamination is possible. If the value is "real" refer to the changes in hydration, etc described in the protocol and repeat the level with a serum Cr at hour 36. Then refer to the table in protocol section Creatinine, serum (BH GH L YH) PRN Starting Until Specified Draw MTX level and serum creatinine; NOTE: 36 hour level is only drawn if needed (see protocol) Supportive Care leucovorin 20 mg injection 15 mg/m m2 (Treatment plan actual BSA) = 20 mg, Intravenous, for 3 Minutes EVERY 6 HOURS PRN, for elevated methotrexate levels, Starting, For 3 doses If the 42 and 48 hour MTX levels are < or =1 and >0.4 micromolar, respectively, give leucovorin at 15 mg/m2 IV/PO at 42, 48 and 54 hours post the start of methotrexate loading dose. 15 mg/m2 (17.4 mg) cannot be administered using available products. The nearest available dose is 20 mg (17.2 mg/m2). sodium bicarbonate 8.4 % injection 29 meq 25 meq/m m2 (Treatment plan actual BSA) = 29 meq, IV Push, Once, PRN may repeat X1, Infuse over 15 minutes, if needed to maintain study parameters for ph., Starting Post-Medications heparin 100 unit/ml lock flush 250 Units 2.5 ml = 250 Units, Intra-Catheter, PRN, Catheter Care, for Portacath., Starting 9/27/2012 3:18:21 PM Page 8 of 9

9 heparin PF 10 units/ml lock flush 25 Units 2.5 ml = 25 Units, Intra-Catheter, PRN, for broviac/picc catheter use., Starting sodium chloride 0.9 % flush 10 ml 10 ml, IV Push, PRN, Administer pre- and post-treatments and blood draw/administration., Starting 9/27/2012 3:18:21 PM Page 9 of 9