Unique Plan Description: ONC High-Dose Cytarabine (HiDAC) AML Consolidation
Plan Selection Display: ONC High-Dose Cytarabine (HiDAC) AML Consolidation
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2022-09-08 13:37:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-18 12:18:00
Available at all facilities: Yes

ONC High-Dose Cytarabine (HiDAC) AML Consolidation
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
		T;N, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
		T+1;0400, Routine, Q24H, spec type = Blood
	Pregnancy Test Urine
		T;N, Stat, Stat, spec type = Urine
IV Solutions
	Sodium Chloride 0.9%
		250 mL, IV, T;N+30, 1 Dose(s)/Time(s), 25 ml/hr
			Comment: DAY 1: use as primary/flush with cytarabine
		250 mL, IV, T+2;N+30, 1 Dose(s)/Time(s), 25 ml/hr
			Comment: DAY 1: use as primary/flush with cytarabine
		250 mL, IV, T+4;N+30, 1 Dose(s)/Time(s), 25 ml/hr
			Comment: DAY 1: use as primary/flush with cytarabine
Medications
	dexAMETHasone 0.1% ophthalmic solution
		1 gtt, Solution, Eye, Both, QID
	prochlorperazine
		10 mg, Tab, By Mouth, Q6H, PRN nausea and/or vomiting
		10 mg, Injection, IV Push, Q6H, PRN nausea and/or vomiting
Premeds
	palonosetron/dexamethasone/NS 50mL
		0.25 mg, IVPB, Once, infuse over 15 min(s), T;N+90
			Comment: Day 1; 30 minutes prior to first chemo dose
		12 mg, EVERY BAG
		50 mL, EVERY BAG
	palonosetron
		0.25 mg, INT, IVPB, EVERY OTHER DAY, infuse over 15 min(s), T+2;0830
			Comment: Day 3, 30 minutes prior to AM cytarabine dose
		0.25 mg, INT, IVPB, EVERY OTHER DAY, infuse over 15 min(s), T+4;0830
			Comment: Day 5, 30 minutes prior to AM cytarabine dose
	dexAMETHasone
		8 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: give on days 2-5
	fosaprepitant
		150 mg, INT, IVPB, Once, T:N+30
			Comment: give 30 minutes prior to first chemo dose
Chemotherapy Agent
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	cytarabine/NS 500 mL
		1,500 mg/m2, IVPB, BID, T;N+120, 2 Dose(s)/Time(s), Infuse Over 3 hr
			Comment: Vesicant. DAY 1: Give over 3 hours; two doses
		50 mL, EVERY BAG
		500 mL, EVERY BAG
		1,500 mg/m2, IVPB, BID, T+2;0900, 2 Dose(s)/Time(s), Infuse Over 3 hr
			Comment: Vesicant. DAY 3: Give over 3 hours; two doses
		50 mL, EVERY BAG
		500 mL, EVERY BAG
		1,500 mg/m2, IVPB, BID, T+4;0900, 2 Dose(s)/Time(s), Infuse Over 3 hr
			Comment: Vesicant. DAY 5: Give over 3 hours; two doses
		50 mL, EVERY BAG
		500 mL, EVERY BAG
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		50 mL, EVERY BAG
		500 mL, EVERY BAG
		2,000 mg/m2, IVPB, BID, T;N+120, 2 Dose(s)/Time(s), Infuse Over 3 hr
			Comment: Vesicant. DAY 1: Give over 3 hours; two doses
		50 mL, EVERY BAG
		500 mL, EVERY BAG
		2,000 mg/m2, IVPB, BID, T+2;0900, 2 Dose(s)/Time(s), Infuse Over 3 hr
			Comment: Vesicant. DAY 3: Give over 3 hours; two doses
		50 mL, EVERY BAG
		500 mL, EVERY BAG
		2,000 mg/m2, IVPB, BID, T+4;0900, 2 Dose(s)/Time(s), Infuse Over 3 hr
			Comment: Vesicant. DAY 5: Give over 3 hours; two doses
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		50 mL, EVERY BAG
		500 mL, EVERY BAG
		3,000 mg/m2, IVPB, BID, T;N+120, 2 Dose(s)/Time(s), Infuse Over 3 hr
			Comment: Vesicant. DAY 1: Give over 3 hours; two doses
		50 mL, EVERY BAG
		500 mL, EVERY BAG
		3,000 mg/m2, IVPB, BID, T+2;0900, 2 Dose(s)/Time(s), Infuse Over 3 hr
			Comment: Vesicant. DAY 3: Give over 3 hours; two doses
		50 mL, EVERY BAG
		500 mL, EVERY BAG
		3,000 mg/m2, IVPB, BID, T+4;0900, 2 Dose(s)/Time(s), Infuse Over 3 hr
			Comment: Vesicant. DAY 5: Give over 3 hours; two doses
Patient Care

	Obtain Consent/Permit for:
		T;N, or verify Consent for Chemotherapy
	Hazardous Drug Precautions
		T;N
	IV-Maintain
		T;N
			Comment: ensure 2 means of vascular access
	Oral Care
		BID
	Neurologic Assessment (CP)
		Q4H
			Comment: with start of cytarabine administration
	Notify MD
		Any abnormal baseline vital signs or Symptoms of moderate to severe reaction or severe hypersensitivity.
	Initiate MD Plan for:
		T;N, Allergy Reaction protocol if patient experiences reaction to treatment.
	Notify MD
		T;N, Contact Provider for further orders if allergic reaction protocol initiated.

CHEMO Reaction Protocol
Vital Signs
	Vital Signs
		Assess vital signs every 2 to 5 minutes until the patient is stable. Place patient into a recumbent position with elevation of the lower extremities if hypotensive
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		Reassess vital signs every 15 minutes x 2, then q30min x 2, or more frequently as needed, I&O, etc until stable
Activity
	Position Patient
		T;N
			Comment: If hypotensive, keep patient supine with legs elevated or bed in Trendelenburg.
IV Solutions
	Sodium Chloride 0.9% IVPB
		500 mL, Solution-Injection, IVPB, DAILY, PRN see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
		1,000 mL, Solution-Injection, IVPB, DAILY, PRN see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
Medications
	Benadryl
		50 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy
		25 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy
	Decadron (MH/WH)
		20 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 1st choice steroid
	SOLU-Medrol
		125 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 2nd choice steroid
	Solu-CORTEF
		100 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 3rd choice steroid
	EPINEPHrine
		0.5 mg, Injection, SUBCUTANEOUS, DAILY, PRN see comment
			Comment: for hypersensitivity reaction not resolved by diphenhydramine and/or anaphylactic				reactions to chemotherapy, may repeat every 10 minutes for up to 3 doses
		0.5 mg, Injection, IM-Intramuscular, DAILY, PRN see comment
			Comment: for hypersensitivity reaction not resolved by diphenhydramine and/or anaphylactic				reactions to chemotherapy, may repeat every 10 minutes for up to 3 doses
	meperidine
		25 mg, Syringe, IV Push, Once, PRN for see comment
			Comment: For chills and rigors
Patient Care
	Notify MD
		T;N, Contact the oncologist if any of the reaction protocol medications are administered to the patient.

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