Colon Ca - UCLA-Olive View Internal Medicine Residency



Pre-docetaxel:

q 3 wkly:  8 mg po bid x 3 days (day before, day of, and day after)

along with 10 mg IV along with therapy

q wk:  8 mg po night before, IV 10 mg with, and 8 mg po morning after

Pre-paclitaxel

1st dose:  20 mg po 12 hrs and 6 hrs before (qhs and morning of)  then

20 mg IV with dose, along with H2 blocker and benadryl

subsequent doses of taxol 20 mg iv with therapy (along with pepcid and

benadryl), whether q 3 wk or weekly

weekly dose can safely taper decadron if no HSR

Infusion Data

ado-trastuzumab/Kadcyla

IVPB / 1st dose 90 min, subsequent 30 min

0.22 micron filter

low emetigenic potential

cardiac monitoring

alemtuzumab / Campath

IVPB or subcut / 2 hrs / NS / 100 mL

min emetigenic potential

with escalating doses, keep 2 hr infusion time

ppx: PCP, anti-viral

amifostine / Ethyol

IVPB / 5 min / NS / 50 mL

mod emetigenic potential

give rapidly to reduce hypotension (see OV guideline for administration)

arsenic trioxide / Trisenox

IVPB / 1-2 hrs, increase to 4 hr to lessen infusion rxn/ D5W or NS 100-250 mL

mod emetigenic potential

weekly ECG, twice weekly electrolytes

azacitidine / Vidaza

IVPB / 10-40 min

subcut / >4 mL 2 syringes inject separate sites

mod emetigenic potential

bendamustine / Treanda

IVPB / 30-60 min

mod emetigenic potential

bevacizumab / Avastin

IVPB / 90 minutes / NS / 100 mL

min emetigenic potential

first dose 90 min; subsequent doses 60 min

check RUA, BP each dose

bleomycin / Blenoxane

push / 10 minutes / D5W or NS / 5 mL

min emetigenic potential

1st time - test dose of 1-2U intradermally

monitor cumulative dose

pre-med hydrocortisone 25mg

bortezomib / Velcade

subcut or IV/ decreased risk neuropathy if given subcut

min emetigenic potential

brentuximab bedotin / Adcetris

IVPB / 30 min

low emetigenic potential

carboplatin / Paraplatin

IVPB / 30-60 min / D5W / 250 mL

calculate as AUC

mod emetigenic potential

shorter infusion for lower doses

carfilzomib/Kyprolis

IVPB / 2-5 min

hydrate pre/post 250-500 mL NS

low emetigenic potential

cetuximab / Erbitux

IVPB / loading 2 hr, maintenance 1 hr

low emetigenic potential

supplied as 2 mg/mL soln; administer w/o dilution, max rate 5 mL/ min; 0.22 micron filter

monitor phos

cisplatin / Platinol

IVPB / NS

mod-high emetigenic potential depending on dose

administer @ 1 mg/min

mix with mannitol, hydrate pre/post 1L NS

cladribine / 2-CdA / Leustatin

IVPB or subcut / NS

add calculated dose to 500 mL NS and infuse over 24 hrs; repeat as per protocol

min emetigenic potential

clofarabine / Clolar

IVPB / 60-120 min

mod emetigenic potential

ppx hydrocortisone 100mg/m2 D1-3 for cap leak/SIRS

cyclophosphamide / Cytoxan

IVPB / per protocol / D5W or NS /

mix at 20 mg/mL or total volume 500 mL

mod-high emetigenic potential

provide fluid to flush through bladder

high dose monitor RUA

cytarabine / ara-C

IVPB or subcut / D5W or NS / 500 mL

low emetigenic potential for < 1 g/m2

mod emetigenic potential for higher doses

high dose – predforte ophth drops

dacarbazine / DTIC-Dome

IVPB / 30-60 min / D5W or NS / 500 mL

maximum concentration 25 mg/ml

high emetigenic potential; vesicant

post infusion: flush with SoluCortef and Heparin

dactinomycin-D / Actinomycin-D

push / 15 min / D5W or NS / 50-100 mL

max concentration 10 mcg/ mL

mod emetigenic potential; vesicant

post infusion: flush with SoluCortef and Heparin

daunorubicin

push / 2-5 min / D5W or NS / 5 mg/mL

mod emetigenic potential; vesicant

into side port of running IV

monitor cumulative dose; cardiac monitoring

daunorubicin liposomal / Daunoxome

IVPB / 1-2 hrs / D5W / 1 mg/mL

< 90 mg over 60 min; > 90 mg over 90 min;

first exposure give 20% of dose over 1 hr then rest over 2 hrs

cardiac monitoring

denileukin diftitox / Ontak

IVPB / 15 min / NS / 15 mcg/ml

keep > 0.015 mg/ mL final concentration

dexrazoxane / Zinecard

IVPB / 15-30 min / D5W or NS / < 5 mg/mL

mix in smallest volume possible; infuse before doxorubicin as cardioprotective

min emetigenic potential

docetaxel / Taxotere

IVPB / D5W or NS / 250 mL

low emetigenic potential

1 hr infusion for weekly or q3wk infusion

steroid pre-medication

doxorubicin / Adriamycin

push / 2-5 min / D5W or NS / 5 mg/mL

specify total dose in mg and pharmacy will determine volume

into side port of running IV

mod emetigenic potential; vesicant

monitor cumulative dose; cardiac monitoring

doxorubicin liposomal / Doxil

IVPB / 60-90 min / D5W / 250 mL

< 90 mg over 60 min; > 90 mg over 90 min;

first exposure give 20% of dose over 1 hr then rest over 2 hrs

low emetigenic potential

cardiac monitoring

epirubicin / Ellence

push / 2-5 midaunorubicinn / comes premixed solution

push into side port of running IV

mod emetigenic potential; vesicant

monitor cumulative dose; cardiac monitoring

eribulin / Halaven

IVPB / 2-5 min / NS

low emetigenic potential

etoposide / Toposar

IVPB / 1-2 hours / D5W or NS / 500 mL

1 mg/mL remains soluble only 2 hrs; 0.4 mg/mL for 24 hrs

low emetigenic potential

PO dosing double IV dose

fludarabine / Fludara

IVPB / 30 min / D5W or NS / 100 mL

10 mg/mL max concentration

min emetigenic potential

fluorouracil / Adrucil

IVPB / 15 min / D5W or NS

low emetigenic potential

gemcitabine / Gemzar

IVPB / 30 min / NS / 250 mL

low emetigenic potential

gemtuzumab ozogamicin / Mylotarg

IVPB / 2 hrs / NS / 100 mL

low emetigenic potential

1.2 micron terminal filter

idarubicin / Idamycin

push / over 15 min / D5W / 50 mL

mod emetigenic potential

into side port of running IV; vesicant

monitor cumulative dose; cardiac monitoring

ixabepilone / Ixempra

IVPB / 3 hours

low emetigenic potential; filter with a 0.2-1.2 micron inline filter

HSR – H1 and H2 antagonist

ifosfomide / Ifed

IVPB / 30 min / D5W or NS / 500 mL

maximal concentration 25 mg/mL

mod emetigenic potential

given with mesna

monitor RUA

interferon a2b / Intron-A

IVPB, IM, subcut/ 20 min / NS / 100 mL

min emetigenic potential

10 million unit/100 mL is minimum concentration for IV administration; use smaller volumes if necessary

Irinotecan / Camptosar

Doses give q3 wk: IVPB / 90 minutes / D5W or NS / 500 mL

Doses give q1 wk: IVPB / 60 minutes / D5W or NS / 250 mL

mod emetigenic potential

early cholinergic side effects; 1 mg/mL maximal concentration - prn atropine

Ipilumimab / Yervoy

IVPB / 90 min / low protein-binding in-line filter

flush D5W or NS at end of infusion

min emetigenic potential

mechlorethamine / Mustagren

push / over 15 min / D5W / 50 mL

high emetigenic potential; vesicant

post infusion: flush with SoluCortef and heparin

methotrexate

IVPB, IM, subcut/ protocol specific / D5W or NS / max 2 mg/mL

low-min emetigenic potential

leucovorin rescue for higher doses; r/o effusion before administering

mitomycin C

push / 15 min / NS / 50 mL

into side port of running IV

low emetigenic potential; vesicant

post infusion flush solucortef and heparin

mitoxantrone

push / 5-15 min / D5W or NS / 50 mL

low emetigenic potential

cardiac monitoring

oxaliplatin / Eloxatin

IVPB / 2 hrs / D5W / 250-500 mL

mod emetigenic potential

avoid cold exposure

paclitaxel / Taxol

IVPB / 1-3 hrs / D5W or NS / < 1 mg/mL

low emetigenic potential

rate of infusion depends on dose and schedule; in-line filter of not greater than 0.22 microns

HSR – steroid pre-med

paclitaxel microparticles / Abraxane

IVPB / 30 min / NS / 5 mg/mL

low emetigenic potential

pharmacy mixes drug to 5 mg/mL concentration and delivers volume based on mg of drug ordered

no steroid or benadryl needed

pamidronate / Aredia

IVPB / 2-4 hrs / D5W or NS / 250-500 mL

min emetigenic potential

pegasparagase / Oncaspar

IM or IV / Q14 days

min emetigenic potential

weekly coags, fibrinogen, TG, LFT

pemetrexed / Almita

IVPB / 10 minutes / NS / 100 mL

low emetigenic potential

start b12/folate before 1st dose

pertuzumab / Perjeta

IVPB / NS

min emetigenic potential

loading dose over 60 min; subsequent doses over 30-60 min

>6 wks from last dose, readminister loading dose

cardiac monitoring

rituximab / Rituxan

IVPB / per protocol / D5W or NS / 500 mL

min emetigenic potential

50 mg/hr increase q 30 min to 400 mg/hr for first tx; double rates for all subsequent infusions

decadron prior to first dose

streptozocin

IVPB / 15 min / D5W or NS / 50 mL

high emetigenic potential

maximal concentration 20 mg/mL

temsirolimus / Torisel

IVPB / 30-60 min / NS / inline filter

min emetigenic potential

HSR –H1 antagonist

teniposide

IVPB / 30-60 min / D5W or NS / 250 mL

1 mg/mL remains soluble only 2 hrs; 0.4 mg/mL for 24 hrs

topotecan / Hycamtin

IVPB / 30 min / D5W or NS / 100 mL

low emetigenic potential

trastuzumab / Herceptin

IVPB / 30-90 min / NS / 250 mL

min emetigenic potential

loading dose over 90 min; subsequent doses over 30 min

missed dose > 3 week require reloading

cardiac monitoring

vinblastine / Velban

push / 3-5 min / NS / 1 mg/mL

into side port of running IV

min emetigenic potential; vesicant

vincristine / Oncovin

push / 3-5 min / NS / 1 mg/mL

into side port of running IV

min emetigenic potential; vesicant

vinorelbine / Navelbine

push / 5-15 min / D5W or NS / 50 mL

into side port of running IV; post flush IV with 100 mL

min emetigenic potential; vesicant

zoledronic acid / Zometa

IVPB / 15 min / D5W or NS / 100 mL

min emetigenic potential

longer infusions for mild azotemia; never < 15 min

check renal function prior

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