Unique Plan Description: ONC Hyper CVAD Cycle A
Plan Selection Display: ONC Hyper CVAD Cycle A
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2023-12-11 11:26:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-18 12:18:42
Available at all facilities: Yes

ONC Hyper CVAD Cycle A
Laboratory
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Pregnancy Test Urine
		Stat, Stat, spec type = Urine
Diagnostic Tests
	MUGA Rest
		Routine, Pre-Chemo Evaluation/Cardiac
			Comment: Pre Chemo Evaluation/Cardiac prior to chemotherapy
	Echo w Doppler resting
		Routine, Indication: Chemotherapy/follow-up exam
			Comment: Prior to Chemotherapy
IV Solutions
	Sodium Chloride 0.9% IV Flush
		250 mL, IVPB, DAILY, PRN see comment, 25 ml/hr
			Comment: Use as primary/flush with vincristine/doxorubicin
	Dextrose 5% in water Chemo flush
		250 mL, IVPB, DAILY, PRN see comment, 25 ml/hr
Chemotherapy Agent
	cyclophosphamide/D5W 500mL
		300 mg/m2, IVPB, Q12H, T;N+90, 6 Dose(s)/Time(s), Infuse Over 3 hr
			Comment: Days 1,2,3
		50 mL, EVERY BAG
		500 mL, EVERY BAG
	vinCRIStine/NS 50 mL
		2 mg, IVPB, Once, T+4;N, Infuse Over 15 min(s)
			Comment: Day 4Vesicant. MAX DOSE 2mg
		5 mL, EVERY BAG
		50 mL, EVERY BAG
		2 mg, IVPB, Once, T+11;N, Infuse Over 15 min(s)
			Comment: Day 11Vesicant. MAX DOSE 2mg
		5 mL, EVERY BAG
		50 mL, EVERY BAG
	DOXOrubicin/NS 100 mL
		50 mg/m2, IVPB, Once, Routine, infuse over 24 hr, T+4;N
			Comment: Day 4Vesicant
		10 mL, EVERY BAG
		100 mL, EVERY BAG
	methotrexate
		12 mg, Injection, IntraThecal, Once, T+2;N
			Comment: In IR; Day 2, Intrathecal, schedule for IR time.
	cytarabine
		100 mg, Injection, IntraThecal, Once, T+7;N
			Comment: In IR; Day7
Medications

	mesna/NS 500 mL
		600 mg/m2, IVPB, DAILY, T;N+90, 4 Day(s), Infuse Over 24 hr
			Comment: start 15 minutes before first dose of cyclophosphamide and complete 12 hours after last dose of cyclophosphamide is started.
		50 mL, EVERY BAG
		500 mL, EVERY BAG
	filgrastim
		5 mcg/kg, Solution, SUBCUTANEOUS, DAILY, T+5;N
			Comment: to start after completion of myelosuppressive chemotherapy (round to 300 mcg or  480 mcg syringe)
Premeds
	dexamethasone IVPB
		40 mg, INT, IVPB, DAILY, T;N+60, duration: 4 Dose(s)/Time(s)
			Comment: Days 1,2,3,4
	dexAMETHasone
		40 mg, Tab, By Mouth, DAILY, T+10;N, duration: 4 Dose(s)/Time(s)
			Comment: Days 11,12,13,14
	ondansetron
		0.15 mg/kg, INT, IVPB, Q12H
			Comment: Give 30 minutes prior to cyclophosphamide.
	prochlorperazine
		10 mg, Injection, IV Push, Q6H, PRN nausea and/or vomiting
		10 mg, Tab, By Mouth, Q6H, PRN nausea and/or vomiting
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, strict oral care
	Neurologic Assessment (CP)
		Q4H
	Notify MD
		Any abnormal baseline vital signs or Symptoms of moderate to severe reaction or severe hypersensitivity.
	Initiate MD Plan for:
		T;N, CHEMO Allergy Reaction protocol if patient experiences reaction to treatment.
	Notify MD
		T;N, Contact Provider for further orders if allergic reaction protocol initiated.
Consults/Follow-up
	Pharmacy Consult
		Pharmacist allowed to round doses to nearest measurable volume (0.1 mL) and/or vial size if dose change is not greater than 5% of original calculated dose .

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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NOTE - This component is a note
Rx - This component is a prescription
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