Docstoc

VINCRISTINE DACTINOMYCIN CYCLOPHOSPHAMIDE

Document Sample
VINCRISTINE DACTINOMYCIN CYCLOPHOSPHAMIDE Powered By Docstoc
					SA-VAC               08/29/2008 CCO   Eligibility Form Required  Green STR   CLINICAL MONITORING:
VINCRISTINE-DACTINOMYCIN-CYCLOPHOSPHAMIDE                                     - Clinical assessment of stomatitis; oral examination upon patient complaint
                                                                              of a sore mouth.
Chemotherapy
                                                                              - Urinalysis (RBCs) & cystitis toxicity ratings- ONLY in response to patient
Rhabdomyosarcoma                                                              complaint.
DACTINOMYCIN                                                                  Sensory
0.4mg/m2          IV      Weekly x 6            Round to nearest 0.1mg        1. Asymptomatic; loss of deep tendon reflexes or paresthesia (including
- Slow push through sidearm of free flowing IV.                               tingling) but not interfering with function 2. Sensory alteration or paresthesia
VINCRISTINE                                                                   (including tingling), interfering with function, but not interfering with ADL 3.
1.5mg/m2           IV     Weekly x 6, then every Round to nearest 0.1mg       Sensory alteration or paresthesia interfering with ADL 4. Disabling 5. Death
                          2 weeks x 3                                         Constipation
- Mix in 50mL bag Normal Saline; infuse over 10 minutes.                      1. Occasional or intermittent symptoms; occasional use of stool softeners,
- Maximum dose = 2mg                                                          laxatives, dietary modification, or enema
                                                                              2. Persistent symptoms with regular use of laxatives or enemas indicated 3.
CYCLOPHOSPHAMIDE
                                                                              Symptoms interfering with ADL; obstipation with manual evacuation indicated
300mg/m2           IV     Weekly x 6, then every Round to nearest 10mg
                                                                              4. Life-threatening consequences (e.g., obstruction, toxic megacolon) 5.
                          2 weeks x 3
                                                                              Death
- Mix in 250mL bag Normal Saline; Infuse over 20 minutes.
                                                                              RATED AT EACH VISIT
                     REPEAT 12 WEEK CYCLE X 4
                                                                              ANTIEMETIC PRE-CHEMO REGIMEN:
PATIENT VISITS and APPOINTMENT TYPE:
                                                                              Level C       - Day 1 (each week)
 Day 1 (Weekly)         45min                    Type B
                                                                              - Ondansetron 8mg PO/IV or Granisetron 1mg PO/IV
TESTS:                                                                        - Dexamethasone 20mg PO/IV
Baseline Tests - WBC HB PLT ANC Cr Urea 24Hr CrCl T.Bili                      ANTIEMETIC TAKE-HOME REGIMEN:
                 Albumin AST ALT AlkPhosphatase                               Level B/C      - Day 1 ( each week)
Weekly         - WBC HB PLT ANC                                               - Ondansetron 8mg PO BID for 2-3 days, or
Every 6 weeks - WBC HB PLT ANC Cr Urea 24Hr CrCl T.Bili                         Granisetron 1mg PO 12 hours post chemotherapy, then 2mg PO OD for 2-3
                 Albumin AST ALT AlkPhosphatase                               days
                                                                              - Dexamethasone 8mg PO BID for 2-3 days
Notes:                                                                        - Prochlorperazine 10mg PO q4-6h prn
- Oral hydration is strongly encouraged; poorly hydrated patients may need
more IV hydration to prevent renal toxicity.                                  TOXICITIES:
                                                                              Hematologic
                                                                              1. If ANC < 1.5 x 109/L, or if PLT < 100 x 109/L, HOLD dose for 1 week.
                                                                              Hepatic Dysfunction
                                                                              1. If T.Bili = 25-50umol/L, or AST = 60-180 IU/L, REDUCE Vincristine to 50%
                                                                              dose.
                                                                              2. If T.Bili = 51-85umol/L, or AST > 180 IU/L, REDUCE Cyclophosphamide to
                                                                              75% dose and Vincristine to 25% dose.
                                                                              3. If T.Bili > 85umol/L, OMIT all drugs.
                                                                              Neurologic
                                                                              1. If Neurotoxicity > Grade 2, HOLD Vincristine dose for 1 week or until
                                                                              resolved.
                                                                              2. If severe paresthesia or foot drop, REDUCE Vincristine to 50% dose.

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:4
posted:3/22/2012
language:Latin
pages:1