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PRMCE Chemotherapy Volume Administration Guidelines

|Drug |Administration Volume |Infusion Time |Stability |IV Administration/ |
|Usual Adult Dose | | | |Comments |
|Alemtuzumab (Campath) |NS 100ml (if given IV) |2 hours |8 hours |Do not shake. Premed with diphenhydramine 50mg + |
|3mg/day to 30mg 3x/week | | | |acetaminophen 650mg |
|May be given subcut or IV | | | | |
|Arsenic Trioxide |250ml NS |1-2 hours |24 hours room temp |Infuse over 4 hours if vasomotor reactions |
|0.15mg/kg | | |48 hours refrigerated |Are observed. |
|Azacitidine (Vidaza) |25mg/ml (reconstitute 100mg vial with 4ml |Subcutaneous injection |1 hour room temp |Divide doses more than 4ml into 2 separate syringes |
|75-100mg/m2 Subcut. |sterile water) | |8 hours refrigerated | |
|Bortezomib (Velcade) |1mg/ml (reconstitute 3.5mg vial with 3.5ml |IV push over 3-5 seconds |8 hours room temp | |
|1.3mg/m2 |NS) | | | |
|Bevacizumab |NS 100ml |90min 1st infusion |8 hours |Incompatible with D5W |
|(Avastin) | |60min 2nd infusion if tolerated | | |
|5mg/kg | |30min 3rd infusion if tolerated | | |
|Bleomycin |1) IV Push (preferred) in 10 ml NS |10-20 minutes |24 hours (REF) |Piggyback/Large Volume – IV Push preferred |
|10-20 units/m2 |2) 50 ml NS | | |Anaphylaxis potential – test dose w/1st dose |
| |Or 1000 ml NS continuous infusion |24 hours GLASS ONLY |24 hours |Large Volume |
|Carboplatin |50 ml D5W |Over 30 minutes |24 hours |Piggyback – when ordered w/VP-16 (same day |
|360mg/m2 or Calvert dosing | | | |administration) mix both drugs in same bag. |
|Carmustine (BCNU) |250 ml D5W Excel Bag |1-2 hours |6 hours |Use polyethylene-lined (lipid) tubing |
|150-200mg/m2 | | | |Piggyback – Irritant |
|Cetuximab |2mg/ml from vial; Do Not Dilute. |2 hours (loading dose) |8 hours (R.T.) |Do not shake. Use 0.22micron in-line filter. |
|(Erbitux®) |Put entire dose into empty bag for infusion. |1 hour (maintenance dose) |12 hours (REF) |Premed with diphenhydramine. |
|400mg/m2 load then | |(maximum 5 ml./min) | | |
|250mg/m2/week | | | | |
|Cisplatin |Put in 500-1000ml NS unless otherwise |Over 2 hours unless otherwise |24 hours – DO NOT REFRIGERATE |Usually piggyback. Must be at least 0.5 NS. When |
|20-100mg/m2 |specified. Use 250ml for 30 minute infusion.|specified. | |ordered w/VP-16 (same day administration) mix both |
| | | | |drugs in same NS bag. |
|Cladribine (2-CDA) |500 ml NS only |24 hours |32 hours (call nurse before mixing) |Continuous infusion |
|0.09mg/kg/day | | | | |
|Cyclophosphamide (Cytoxan) |< 2 gm: 100 ml D5W |15-30 min |24 hours |Piggyback |
|100-1500mg/m2 |( 2 gm: 250 ml D5W |60 minutes | | |
| | |3 hours (Hyper-CVAD reg.) | | |
|Cytarabine (ARA C) |100 mg/5 ml |Over 1 to 3 minutes |48 hours |Doses >500mg generally NOT cont. infusion. |
|100-200mg/m2 IV |500 mg/10ml |___________________________ |DO NOT REFRIGERATE |Verify rate with MD if not sure. |
| |______________________________ |Cont. infusion over 24 hours | |Note: Patients on cytarabine must be on ophthalmic |
|___________________________ |500ml NS for cont. infusion | | |steroid drops |
|( 2 gm/ m2 = high dose | | | | |
| | | | | |
|___________________________ | | | | |
|IT: 5-75mg/ m2 or 30-100mg | | | | |
| |(500 mg/dose 250 ml NS or D5W |As specified (1-3 hours) |48 hours |Intermittent infusion over 1-3 hours |
| |(Use soln. with no preservatives for initial | | |Hydration IV is needed as well to prevent renal damage|
| |reconstitution) | | | |
| |Intrathecal: Dilute 100mg vial w/2ml NS PF, | | |IT: must be preservative free |
| |qs dose to 2ml w/NS PF. | | |: must be administered by MD |
|Dacarbazine (DTIC) |Dilute 10mg/ml in sterile water |Over 30 – 60 min. |24 hours (R.T.) |Irritant: Infuse slowly over 30-60 min.; or |
|150mg – 375mg/m2 |IV infusion: in 250 – 1,000 ml NS or D5W |Or: 24 – infusion in combination with |3 days (REF) |24-hour infusion with other meds |
| | |other medications |PROTECT FROM LIGHT | |
|Dactinomycin (Actinomycin D) ~500mcg |10-15 ml NS (preservative free) Reconstitute|Over 2 to 3 minutes |48 hours |Push – Vesicant |
| |per pkg insert and add to 10-15 ml NS | |DO NOT FILTER THROUGH CELLULOSE ESTER | |
| |preservative free) | |FILTER | |
|Daunorubicin (Daunomycin) 30-60 |10-15 ml NS (preservative free) |Over 2 to 3 minutes |48 hours |Push – Vesicant |
|mg/m2 | | | | |
|Decitabine (Dacogen) |100ml NS (use COLD bag) |Over 3 hours |15 min room temp |Keep 100ml NS bags in refrigerator so fluid is cold |
|15mg/m2 |(keep conc. 0.1-1mg/ml) | |7 hours in cold IV fluid |when drug added. Call RN before mixing (mix only |
| | | | |immediately before due) |

|Docetaxel (Taxotere) |D5W or NS EXCEL bag |60 minutes |48 hours |Infusing over >1 hour may increase side effects. |
|60mg-100mg/m2 |Up to 200mg in 250ml | | |EXCEL bag & polyethylene-lined(lipid) tubing |
| |>200mg in 500ml | | |required. Ensure premeds are given. |
|Doxorubicin (Adriamycin) |2mg/ml NS (preservative free) |Over 10-15 minutes |24 hours (R.T.) |Push (unless specifically ordered as continuous) |
|30-75mg/m2 | | |48 hours (REF) |VESICANT |
| |100 – 1000 ml NS or D5W |12-24 hours |24 hours |Continuous infusion – central line only. |
| | | | |May add vincristine or vinblastine if so ordered. |
| | | | |VESICANT. |
| | | | |No protection from fluorescent light is needed; esp. |
| | | | |for low concentrated cont. infusion solutions (conc. |
| | | | |less than 0.5 mg/ml) |
|Doxorubicin Liposomal (Doxil ( 20mg/m2 |250 ml D5W |30 minutes |24 hours |Do not filter – Irritant |
|Etoposide (VP – 16) |D5W or NS 250 ml for doses ( 150 mg |60 minutes | 150 mg | |0.6mg/ml or more = 8 hours | |
|Fludarabine 25 mg/m2 |100 ml D5W |Over 30 minutes |8 hours |Piggyback |
|Fluorouracil (5FU) |500 mg/10 ml |1 to 15 minutes |30 days |Push |
|200-1000mg/m2 | | | | |
| |Per MD orders – put in 1000 ml D5W 24-hour |As specified |48 hours |Continuous infusion |
| |infusion | | | |
|Fluorouracil (5FU)/Leucovorin |5FU IV Push |1 to 2 minutes |30 days |Give 5FU 1 hour after Leucovorin infusion started |
|370-425mg/m2 | | | |(give 5FU in middle of Leucovorin infusion) |
| |Leucovorin in 250 ml D5W (usual dose 500 |2 hours |24 hours | |
| |mg/m2) | | | |
|Gemcitabine (Gemzar®) |50 ml NS (max conc. 40 mg/ml) |30 minutes |24 hours (Do not refrigerate) |Piggyback |
|1 gm/ m2 | | | | |
|Gemtuzumab ozogamicin |100ml NS |2 hours |8 hours |Mix in hood with light OFF. Infuse through 1.2 micron |
|(Mylotarg) 9mg/m2 |Protect bag from light | | |low protein-binding filter. Premed w/Tylenol & |
| | | | |Benadryl. |
|Herceptin (trastuzumab) |250 ml NS – Chemo precautions not necessary. |90 minutes (first infusion) |24 hours (refrigerate) |Reconstitute 440mg vial with 20ml BWFI. Label and |
|4mg/kg x1, then 2mg/kg q week | |30 minutes (subsequent) | |save remainder for up to 28 days in refrigerator for |
| | | | |subsequent doses. |
|Idarubicin 12mg//m2 |5mg/5 ml NS (preservative free) |Over 10 to 15 minutes |72 hours (R.T.) |Slow push – Vesicant |
| | | |7 days (REF) | |
| |10mg/10 ml NS (preservative free) | | | |
|Ifosfamide 1.2 – 2.5 gm/m2 |250 ml D5W |Over 60 minutes |48 hours |May mix in same bag with Mesna if so ordered. May be |
| | | | |ordered as continuous infusion. |
|Drug |Administration Volume |Infusion Time |Stability |IV Administration/ |
|Usual Adult Dose | | | |Comments |
|Irinotecan (Camptosar, CPT-11) |250-500 ml D5W |90 minutes |24 hours (R.T.) |See package insert guidelines for giving atropine for |
|125-350mg/m2 | | |48hrs refrig.& protected from light |cholinergic side effects. |
| | | | |Irritant |
| (Mesna)* |50 ml D5W* Maximum concentration 20 mg/ml D5W|Over 20 minutes |24 hours |NOT COMPATIBLE WITH CISPLATIN |
|*ADJUNCTIVE AGENT | | | |Adjunctive agent only NOT a chemo drug |
|L-Asparaginase |IM recommended route. | | |Anaphylaxis potential – test dose with first dose |
| |Dilute 10,000 unites/2ml NS | | | |
|Methotrexate 5-80 mg/m2 |10-100mg/IV push |Over 1 to 2 minutes |14 days |Push |
|IT: 12 mg | | |(REF preservative free) |IT: must be administered by MD |
|High dose = >400mg/m2 | | | | |
| |>100 to 500mg/100 ml D5W |Over 60 minutes |24 hours |Piggyback |
| |High dose: (500 mg/100-1000 ml D5W (Determine|Over 4 hours |24 hours (preservative free) |Piggyback/large volume |
| |infusion volume by amount of drug used.) | | | |
|Mithramycin (plicamycin) 25mcg/kg |1000 ml D5W |Slowly over 4-6 hours |24 hours |Piggyback – Vesicant |
| | |CHELATES WITH DIVALENT CATIONS, i.e. |Do not filter through 0.22 mm filter | |
| | |Trace elements | | |
|Mitomycin 2-20mg/m2 |5 mg/10 ml NS (preservative free) |Over 5-10 minutes |48 hours |Push Vesicant |
|Mitoxantrone 12mg/m2 |50 ml D5W (or NS) |15-30 minutes |48 hours |Piggyback into freely running IV (vesicant potential) |
|Oxaliplatin 85mg/m2 |D5W 250ml |2 hours |6 hours room temp |Incompatible w/NS or any |
| | | |24 hours refrigerated |Chloride-containing solution |
|Rituximab 375mg/m2 |NS – keep concentration 1-4mg/ml |Variable – see package insert |48 hours room temperature |Piggyback. Watch for reactions. |
| | | |24 hours refrigerated | |
|Taxol (Paclitaxel) |D5W or NS EXCEL bag |Total dose over 3 or 24 hours |48 hours |EXCEL bag only. Nurses must use polyethylene-lined |
|135-250mg/m2 |Up to 300mg in 250ml | | |(lipid)tubing and a 0.22 micron filter. Anaphylaxis |
| |>300mg in 500ml | | |potential – premed per standing orders. |
|Abraxane (Paclitaxel Protein-bound |5mg/ml (reconstitute each 100ml vial with |30 minutes |8 hours room temp |Do not shake. Follow package insert directions |
|particles) |20ml NS; add required dose into empty bag) | | |carefully to avoid foam generation. NO inline filter.|
|260mg/m2 | | | | |
|Topotecan 1.5mg/m2 |50 ml D5W (or NS) |30 minutes |48 hours (in 50 ml) RT or refrigerator, |Only stable 24 hours ambient light. Save partial vial|
| | | |protected from light. 7 days (in vial), |for next dose – very expensive. |
| | | |protect from light, in refrigerator. | |
|Vinblastine (Velban) |10 mg/ml bacteriostatic saline with Benzyl |Over 1 minute (into running IV) |24 hours |Push – Vesicant |
|3.7 – 18.5mg/m2 |Alcohol | | | |
| |1000 ml D5W, NS as specified |Over 24 hours |48 hours |Large volume (Central Line Only) |
| | | | |Vesicant |
|Vincristine (Oncovin) |Add vincristine dose to 23ml NS in syringe. |Over 1-2 minutes |7 days |Push – Vesicant |
|2mg maximum dose |Send in warning bag labeled “fatal if given | |Do Not filter through 0.22 micron filter |MUST send with warning against intrathecal |
| |intrathecally”. | | |administration. |
| | | | |When ordered with Adriamycin as a 24 hr infusion, mix |
| | | | |both drugs in same bag. |
| | | | |(central line only) |
|Vinorelbine 30 mg/m2 |(Keep concentration 1.5-3 mg/ml in NS in |6 to 10 minutes |24 hours |Syringe – IV push |
| |syringe) | | |Vesicant |

KEY: IV Push: Infusion of drug and diluent by means of syringe injection into a free running compatible IV line. Piggyback: Infusion of drug and diluent in volumes of less than 500 ml Large Volume: Infusion of drug and diluent in volumes from 500 ml to 1000 ml

NOTE: The expiration times indicated are in most cases those for chemical activity. In most instances, the final reconstituted product is preservative free so extreme care should be observed to maintain sterility at all times.

Usual adult doses listed are guidelines only. Consult protocols and other references to confirm doses ordered. Dosage schedules may vary widely and influence daily dose quantities. Revised 07/14/2009, 8/25/2011 dsm/pg

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...TUTORIAL 7 (online) LAW OF AGENCY 1. Describe the relationship of a principal and agent? An arrangement in which one entity legally appoints another to act on its behalf. 2. Can an employee be an agent and why? Can because the employee is negotiating with customers on principal’s behalf. 3. Is a sole distributor an agent and why? It is an agent because its role is to become the middle person in distributing products. 4. In what circumstances can a person be an agent of ‘necessity’? It must be an emergency Need to protect principal from loss 5. What is meant by an agency created ‘expressedly’ and one created ‘impliedly’. It is expressed when spoken or written and; It is implied when inferred from circumstances cases 6. What are the consequences if an agent fails in his duties to the principal? He must compensate the principal for any loss resulting. 7. What can an agent do if he is not paid by the principal? Sue the principal 8. Explain what is ‘ratification’ in the law of agency and why would a principal want to ratify the unauthorised acts of an agent. When an agent, without the knowledge or authority of the principal, acts on behalf of the principal, the principal may choose to accept or reject the acts 9.What is meant by agency by ‘estoppel’? Where an agent, who has no authority, does acts to 3rd persons on behalf of principal, the principal is bound by those acts if he has, by his words or conduct induced such...

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