Hazardous Medication List

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Homer Morrison
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1 Hazardous Medication List REDUCING OCCUPATIONAL EXPOSURE TO HAZARDOUS MEDICATION FOR ALL STAFF

2 Table of Contents Hazardous Medication List Key Points... 1 Hazardous Medication List... 2 Special Handling Considerations for Specified Hazardous Medication... 5 Precautionary Period for KNOWN Hazard Medication... 6 i

3 Hazardous Medication List Key Points Indicates the medication is a CYTOTOXIC agent. The following products are NOT listed on the Hazardous Medication List, but may require special handling precautions: Salts, PEGylated and liposomal medication - only the parent compound is listed (e.g. doxorubicin) Combination products containing a hazardous medication (e.g. spironolactone-hydrochlorothiazide) Investigational / Clinical Trial medication as toxicological data is often incomplete or unavailable Chemicals and / or raw powders; follow the Safety Data Sheet (SDS) for safe handling precautions Radiopharmaceuticals; Nuclear Medicine has policies and procedures for the handling of these products The Hazardous Medication List will be reviewed and updated on a periodic basis as new medication or information becomes available. Refer to Insite for the most current version. 1

4 A Hazardous Medication List abacavir alitretinoin apomorphine abatacept altretamine arsenic trioxide abiraterone ambrisentan axitinib acitretin amsacrine azacitidine afatinib anagrelide azathioprine alefacept anastrozole B BCG bicalutamide bosutinib belinostat bleomycin brentuximab vedotin bendamustine bortezomib buserelin bexarotene bosentan busulfan C cabazitaxel chlorambucil clonazepam cabergoline chloramphenicol colchicine cabozantinib choriogonadotropin crizotinib capecitabine alpha cyclophosphamide carbamazepine cidofovir cyclosporine CARBOplatin CISplatin cyproterone carfilzomib cladribine cytarabine carmustine clofarabine cetrorelix acetate clomiphene D dabrafenib deferiprone DOXOrubicin dacarbazine degarelix dronedarone dactinomycin dexrazoxane dutasteride danazol diethylstilbesterol dasatinib dinoprostone DAUNOrubicin divalproex sodium decitabine DOCEtaxel E entecavir erlotinib estrogen / enzalutamide eslicarbazepine progesterone combinations epirubicin estradiol ergonovine estramustine estropipate (ergometrine) / estrogen - esterfied etoposide methylergonovine everolimus estrogen - conjugated eribulin exemestane 2

5 Hazardous Medication List F finasteride fludarabine fosphenytoin fingolimod fluorouracil (5FU) fulvestrant floxuridine fluoxymesterone fluconazole flutamide G ganciclovir gemcitabine gonadotropin, ganirelix acetate chorionic gemtuzumab gefitinib ozogamicin goserelin H histrelin hydroxyurea I ibrutinib ifosfamide ISOtretinoin icatibant imatinib ixabepilone IDArubicin irinotecan ixazomib J / K L lapatinib leuprolide lomitapide leflunomide lenalidomide letrozole M liraglutide recombinant lomustine macitentan methimazole mitomycin medroxyproges methotrexate mitotane -TERone methyltestos- mitoxantrone megestrol TERone mycophenolate melphalan mifepristone mofetil menotropins mipomersen mycophenolic acid mercaptopurine misoprostol N nafarelin nevirapine nilutamide nelarabine nilotinib O omacetaxin oxaliplatin OXcarbazepine ospemifene oxandrolone oxytocin 3

6 Hazardous Medication List P PACLitaxel pemetrexed plerixafor PACLitaxel-(nab) pentamidine pomalidomide palifermin pentetate calcium ponatinib paliperidone pentostatin porfimer pamidronate pertuzumab pralatrexate panobinostat phenoxybenzamine procarbazine PARoxetine phenytoin progesterone pasireotide piritrexim isethionate pazopanib propylthiouracil peginesatide pipobroman Q R progestins raloxifene regorafenib risperidone raltitrexed ribavirin romidepsin rasagiline riociguat ruxolitinib S sirolimus spironolactone SUNItinib SORAfenib streptozocin T tacrolimus testosterone trametinib tamoxifen thalidomide telavancin thioguanine trastuzumab emtansine (Kadcyla) temazepam thiotepa tretinoin temozolomide tofacitinib temsirolimus topiramate trifluridine / tipiracil (combination only) teniposide topotecan triptorelin U ulipristal uracil mustard V valganciclovir vemurafenib vinorelbine valproate / valproic acid vigabatrin vismodegib vinblastine voriconazole valrubicin vincristine vorinostat vandetanib W X Y warfarin Z zidovudine ziv-aflibercept zonisamide ziprasidone zoledronic acid 4

7 Special Handling Considerations for Specified Hazardous Medication BCG vaccine (bacillus calmette Guerin) BCG, although classified as a vaccine, is used in the treatment of certain cancers. BCG should be prepared with aseptic techniques. To avoid cross-contamination, parenteral drugs should not be prepared in areas where BCG has been prepared. A separate area for the preparation of BCG suspension is recommended. All equipment, supplies, and receptacles in contact with BCG should be handled and disposed of as biohazardous. If preparation cannot be performed in a containment device, then respiratory protection, gloves, and a gown should be worn to avoid inhalation or contact with BCG organisms. Follow special handling guidelines. Pentamidine For inhalation (administered by respiratory therapist). Follow special handling guidelines. Monoclonal Antibodies (mabs) While many monoclonal antibodies are classified by American Hospital Formulary Service (AHFS) as 10:00 antineoplastic medication, they are not typically classified as hazardous medication by NIOSH. These medications should be handled using aseptic technique. Monoclonal antibodies included on the Hazardous Medication List require handling precautions as per the PPE Guide. 5

8 Precautionary Period for KNOWN Hazard Medication Precautionary Period for KNOWN Hazard Medication Requiring PPE for Longer than 48 hours* Hazardous Medication Detected in Urine Detected in Stool or Bile carmustine At least 4 days -- CISplatin At least 5 days -- DOCEtaxel 6% excretion Up to 7 days DOXOrubicin 5% excretion for up to 5 days Up to 7 days etoposide At least 5 days -- gemcitabine At least 7 days -- imatinib mesylate 13% excretion for up to 7 days Up to 7 days methotrexate (oral) Up to 5 days Up to 5 days mitoxantrone Up to 5 days Up to 5 days temsirolimus 4.6% excretion for up to 14 days teniposide Up to 5 days -- 78% excretion for up to 14 days vincristine Minimal excretion Up to 3 days vinorelbine Minimal excretion At least 3 days *All KNOWN hazard medication on the AHS Hazardous Medication List require 48 hours handling precautions except those listed above. For further questions contact AHS Drug Information. Note: Based on information from the American Society of Health-System Pharmacists, 2009, Thomson Reuters Micromedex 2.0, Source: Oncology Nursing Society Safe Handling of Hazardous Drugs, 2 nd Edition, 2011, p

9 Developed by: AHS Hazardous Medication Evaluation Committee (HazMEC) and the AHS Hazardous Medication Evaluation Panel, AHS Pharmacy Services Medication Quality and Safety Team (MQST), AHS Health Professions, Strategy and Practice (HPSP), AHS Pharmacy Services Technical Practice Leads, AHS Human Factors, AHS Workplace Health and Safety (WHS), and COV Medication Management & Safety Team. Acknowledgements to: AHS Cancer Control, Eastern Health - Newfoundland, British Columbia Cancer Agency (BCCA), and Winnipeg Regional Health Authority (WRHA) for their work on hazardous medications. If you have questions, please contact a WHS Advisor in your zone. Document History Document Version Revision Date Original Document (V1.0) Dec 2017 Revision #1 Next Revision Due 7

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Objective: To provide a standard procedure for the recycling of unused medication and the disposal of medicines across all BCPFT Hospital sites.

WARDS/DEPARTMENTS By: 0 01/09/019 1 of 3 Objective: To provide a standard procedure for the recycling of unused medication and the disposal of medicines across all BCPFT Hospital sites. Scope: All Black