Conversely, injection forms, though being painful and needing help of medical personnel for application, help to quickly achieve necessary concentration of preparation in blood buy antibiotics online Antibiotic is usually chosen in an empiric way (at random). But when choosing one is obligatory guided by definite rules.

Jcc.hhsc.ca

25/01/2013CCO Eligibility Form Required ¨ Grey STR
CLINICAL MONITORING:
CISPLATIN-ETOPOSIDE Chemotherapy
- Oral examination upon patient complaint of a sore mouth.
CISPLATIN
1. Asymptomatic; loss of deep tendon reflexes or paresthesia (including tingling) but not interfering with function 2. Sensory alteration or paresthesia (including tingling), interfering with function, but not interfering with ADL 3. - Mix in 500mL bag Normal Saline; Infuse over 60 minutes.
Sensory alteration or paresthesia interfering with ADL 4. Disabling 5. Death ETOPOSIDE
1. Asymptomatic, detected on exam/testing only 2. Symptomatic, not - Dose < or =200mg, mix in 500mL Normal Saline; Infuse over 30-60
minutes.
3. Symptomatic, interfering with ADL 4. Life-threatening; disabling 5. - Dose > 200mg, mix in 1000mL Normal Saline; Infuse over 1 to 2 hours.
- Adjust rate if blood pressure drops.
ANTIEMETIC PRE-CHEMO REGIMEN:
- Give Etoposide BEFORE Cisplatin, to hydrate patient.
REPEAT EVERY 21 DAYS For a Total of 4 Cycles - Ondansetron 8mg PO/IV or Granisetron 1mg PO/IV PATIENT VISITS and APPOINTMENT TYPE:
ANTIEMETIC TAKE-HOME REGIMEN:
Level B/C
HYDRATION:
- Ondansetron 8mg PO BID for 2-3 days, or Granisetron 1mg PO 12 hours post chemotherapy, then 2mg PO OD for 2-3 days - Infuse 1000mL Normal Saline with 20mEq Potassium Chloride IV over 1
hour on Days 1-2.
Concurrent:
TOXICITIES:
- Physician may order 250mL of 20% Mannitol solution (50G Mannitol) IV. Hematologic
Infuse through sidearm concurrent with Cisplatin (may give Furosemide 1. If ANC < 1.5 x 109/L, or if PLT < 75 x 109/L, HOLD dose for 1 week.
Renal Failure
1. If CrCl = 0.5-1.0mL/sec, or SrCr = 136-185umol/L, REDUCE Cisplatin to - Infuse 500mL Normal Saline with 10mEq Potassium Chloride IV (2G
50% dose, and Etoposide to 75% dose.
Magnesium Sulfate may also be ordered) over 1 hour after Cisplatin on Days 2. If CrCl < 0.5mL/sec, or SrCr > 185umol/L, OMIT Cisplatin dose.
3. If CrCl < 0.2mL/sec, REDUCE Etoposide to 50% dose.
Hepatic Dysfunction
Baseline Tests - WBC HB PLT ANC K Na Chloride Mg Glucose
1. If T.Bili = 26-51umol/L, or AST = 60-180 IU/L, REDUCE Etoposide to 25%
- WBC HB PLT ANC Cr Urea
2. If T.Bili = 52-85umol/L, REDUCE Etoposide to 50% dose.
Test Notes:
3. If T.Bili > 85umol/L, or AST > 180 IU/L, OMIT Etoposide dose.
- Baseline & routine renal function tests, especially if there are other FORMULAE:
Male: [140-age(yrs)] x TBW(Kg) / [50 x SCr(umol/L)] Female: [140-age(yrs)] x TBW(Kg) / [50 x SCr(umol/L)] x 0.85 Baseline Tests - WBC HB PLT ANC K Na Chloride Mg Glucose
- WBC HB PLT ANC Cr Urea
Baseline Tests - WBC HB PLT ANC K Na Chloride Mg Glucose
- WBC HB PLT ANC Cr Urea

Source: http://jcc.hhsc.ca/workfiles/PHARMACY/CN-CISP-ETOP.pdf

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