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Luajpp Pppo

This document outlines the treatment protocol LUAJPP for a patient, including dosage and administration details for pemetrexed and CISplatin, as well as necessary premedications and hydration requirements. It emphasizes the importance of verifying treatment information against BC Cancer protocols and includes instructions for monitoring blood work and follow-up appointments. The document also specifies the need for vitamin B12 injections and other tests, along with a doctor's signature for authorization.

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Eunice Finch
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© © All Rights Reserved
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64 views1 page

Luajpp Pppo

This document outlines the treatment protocol LUAJPP for a patient, including dosage and administration details for pemetrexed and CISplatin, as well as necessary premedications and hydration requirements. It emphasizes the importance of verifying treatment information against BC Cancer protocols and includes instructions for monitoring blood work and follow-up appointments. The document also specifies the need for vitamin B12 injections and other tests, along with a doctor's signature for authorization.

Uploaded by

Eunice Finch
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Information on this form is a guide only.

User will be solely


responsible for verifying its currency and accuracy with the
corresponding BC Cancer treatment protocols located at
www.bccancer.bc.ca/terms-of-use and according to
acceptable standards of care.

PROTOCOL CODE: LUAJPP


Page 1 of 1

DOCTOR’S ORDERS Ht____________cm Wt___________kg BSA____________m2


REMINDER: Please ensure drug allergies and previous bleomycin are documented on the Allergy & Alert Form
DATE: To be given: Cycle #:
Date of Previous Cycle:
Delay treatment _______ week(s)
CBC & Diff day of treatment
May proceed with doses as written if within 96 hours ANC greater than or equal to 1.5 x 109/L, Platelets greater than
or equal to 100 x 109/L, Creatinine Clearance greater than or equal to 45 mL/minute (for pemetrexed), or
greater than or equal to 60 mL/minute (for CISplatin)
Dose modification for: Hematology Other Toxicity: ____________________________
Proceed with treatment based on blood work from ________________________
PREMEDICATIONS: Patient to take own supply. RN/Pharmacist to confirm ___________________________.
dexamethasone 8 mg or 12 mg (select one) PO 30 to 60 minutes prior to treatment
and select ONE of the following:
aprepitant 125 mg PO 30 to 60 minutes prior to treatment
ondansetron 8 mg PO 30 to 60 minutes prior to treatment
netupitant-palonosetron 300 mg-0.5 mg PO 30 to 60 minutes prior to treatment
ondansetron 8 mg PO 30 to 60 minutes prior to treatment
Ensure patient is taking folic acid and has had vitamin B12 injection starting at least 7 days prior to first cycle, and to
continue while on treatment, until 21 days after last pemetrexed dose.
HYDRATION:
1000 mL NS over 1 hour prior to CISplatin
TREATMENT:

pemetrexed 500 mg/m2 x BSA = ___________ mg


Dose Modification: ________% = ________ mg/m2 x BSA = ___________ mg
IV in 100 mL NS over 10 minutes (may be given during prehydration)

CISplatin 75 mg/m2 x BSA = __________ mg


Dose Modification: ________% = ________ mg/m2 x BSA = ___________ mg
IV in 500 mL NS, with potassium chloride 20 mEq, magnesium sulfate 1 g and mannitol 30 g over 1 hour

RETURN APPOINTMENT ORDERS


Return in three weeks for Doctor and Cycle _________
Last Cycle. Return in ______ week(s).
CBC & Diff, creatinine, alkaline phosphatase, total bilirubin, ALT, LDH prior to
each cycle

Vitamin B12 injection required every 9 weeks. Patient to obtain supply.


This patient to receive injection in clinic. Next injection due by ______________.
Other tests:
Consults:
See general orders sheet for additional requests.
DOCTOR’S SIGNATURE: SIGNATURE:

UC:
BC Cancer Provincial Preprinted Order LUAJPP
Created: 1 Jan 2022 Revised: 1 Mar 2025 (Tests updated)

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