Protocol Index	

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IP PEMETREXED	

Types:      ONCOLOGY TREATMENT
Synonyms:  PEMETREXED, PEM, PAM, ALIMTA, ALI, LUNG, NON, NSCL

Cycle 1	Repeat 1 time	Cycle length: 21 days	Day 1	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION 64	Interval: Once	Occurrences: --	Comments:	Verify Hep B panel status prior to cycle. Date *** of panel. Result positive/negative/pending/unknown:22867

The required components for the hepatitis B panel includes: Hepatitis B surface antigen (HBsAg), total hepatitis B core antibody (anti-HBc), and hepatitis B antibody (anti-HBs).
			Supportive Care
  	cyanocobalamin injection 1,000 mcg	Dose: 1,000 mcg	Route: intramuscular	once for 1 dose	Start: S	End: S  2:30 PM		Instructions:	Begin week 1 of Pemetrexed dose, then every 9 weeks thereafter.			Supportive Care
  	folic acid (FOLVITE) tablet 1 mg	Dose: 1 mg	Route: oral	daily	Start: S					Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		☑	MAGNESIUM LEVEL	Interval: Once	Occurrences: --		☐	LDH	Interval: Once	Occurrences: --		☐	URIC ACID LEVEL	Interval: Once	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: Until discontinued	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Nursing Orders
  	TREATMENT CONDITIONS 14	Interval: Once	Occurrences: --	Comments:	Hold and contact provider if CrCL LESS than 45 mL/min
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ondansetron (ZOFRAN) IV 16 mg	Dose: 16 mg	Route: intravenous	once for 1 dose	Start: S					Chemotherapy
  	PEMEtrexed (ALIMTA) 500 mg/m2 in sodium chloride 0.9 % 100 mL chemo IVPB	Dose: 500 mg/m2	Route: intravenous	once over 10 Minutes for 1 dose			Offset: 30 Minutes	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PEMETREXED DISODIUM 500 MG INTRAVENOUS POWDER FOR SOLUTION	Medications	500 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	100 mL	Yes	Yes				Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.