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Chemotherapy Drug Sequencing...

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on 11 December 2013

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Transcript of Chemotherapy Drug Sequencing...

What circumstances warrant hanging a drug out of sequence from how it's listed in the MD's order?
Why filter drugs?
Filters are used to prevent microbubles, any micro bacterial contaminants and particulates from infusing into the pt. Infusion of these may result in phlebitis, emboli, or other serious adverse effects. *ONS
First rule of thumb:
Drugs that should only hang with D5
Doxil, Oxaliplatin, IVIG and Kadcyla
Drugs that should only hang with NS
Vectibix (often given with Oxaliplatin)

Chemotherapy Drug Sequencing...

and other drug facts

Taxanes before Platins
decreases severity of neutropenia
Vesicants before irritants
ie.. Push Adria before any other drug in DTIC
Why does drug sequencing matter?
Hang drugs in the order in which they were written.
The sequencing in which certain chemo drugs are given may enhance efficacy and/or minimize toxicity."
However, nursing knowledge and proven drug facts supersede this rule

Julie Nelan, RN, OCN
December 11, 2013

Taxol before Adria or Doxil
to reduce dose limiting neutropenia and mucositis
Rituxan first in RCHOP
Rituxan prepares the cells for the remaining drugs.
Avastin before Oxaliplatin or Irinotecan
Leucovorin should always immediately precede 5-FU
Avastin - when hung with D5 the drug becomes denatured and all you have is a bag of $2,000 sugar water and a happy cancer cell.
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