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Tissue removal and amputation of the toe and the foot - patient information

Description
Information about tissue removal when there is a serious infection in the skin and tissue of the toes and foot
Url
/Media/UHS-website-2019/Patientinformation/Cardiovascular-and-thoracic/Tissue-removal-and-amputation-of-the-toe-and-the-foot-1660-PIL.pdf

Angiogram and angioplasty - patient information

Description
Information about angiogram to assess the blood flow into your leg and angioplasty to improve the blood flow.
Url
/Media/UHS-website-2019/Patientinformation/Cardiovascular-and-thoracic/Angiogram-and-angioplasty-1655-PIL.pdf

Endometrial-Dostarlimab

Description
Chemotherapy Protocol GYNACOLOGICAL CANCER Dostarlimab Regimen  Endometrial - Dostarlimab Indication  Dostarlimab is indicated for p
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Uterine-cancer/Dostarlimab.pdf

Testing for gene variants in inherited breast, ovarian and prostate cancers - patient information

Description
Information about testing for gene variants in inherited breast, ovarian and prostate cancers.
Url
/Media/UHS-website-2019/Patientinformation/Genetics/Testing-for-gene-variants-in-inherited-breast-ovarian-and-prostate-cancers-1980-PIL.pdf

Selective internal radiation therapy (SIRT) - patient information

Description
This factsheet explains what selective internal radiation therapy (SIRT) is, what the cancer treatment involves, and what the possible benefits and
Url
/Media/UHS-website-2019/Patientinformation/Cancercare/Selective-internal-radiation-therapy-SIRT-3094-PIL.pdf

Carfilzomib-Dexamethasone(20) Ver1

Description
Chemotherapy Protocol MYELOMA Carfilzomib-Dexamethasone (20) Regimen • Myeloma – Carfilzomib-Dexamethasone (20) Indication • Carfilzomib in combination with dexamethasone is an option for treating multiple myeloma in adults if the patient has had one previous therapy which did not include bortezomib. • Treatment intent – disease modification • WHO performance status 0, 1, 2 Toxicity Drug Carfilzomib Adverse Effect Anaemia, fatigue, diarrhoea, thrombocytopenia, nausea, pyrexia, dyspnoea, respiratory tract infection, cough and peripheral oedema, confusional states, herpes zoster infection Dexamethasone Weight gain, gastrointestinal disturbances, hyperglycaemia, CNS disturbances, cushingoid changes, glucose intolerance. The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring • FBC, LFT and U&Es prior to day 1 of treatment • Regular monitoring of blood glucose is considered good practice. Version 1 (January 2019) Page 1 of 10 Myeloma-Carfilzomib-Dexamethasone (20) Dose Modifications The dose modifications listed are for haematological, liver and renal function and drug specific toxicities only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be re-escalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. Haematological Dose modifications for haematological toxicity in the table below are for general guidance only. Always refer to the responsible consultant as any dose reductions or delays will be dependent on clinical circumstances and treatment intent. Low counts can be a consequence of bone marrow infiltration as well as drug toxicity. Consider blood transfusion if patient symptomatic of anaemia or has a haemoglobin of less than 8g/dL (80g/L). Prior to starting a new cycle of treatment; - neutrophils should be greater than or equal to 1x109/L - platelets should be greater than or equal to 50x109/L - non-haematological toxicity should resolve to NCI-CTC grade 1 or below or baseline Haematological dose modifications – Carfilzomib This table refers to toxicity during a cycle of treatment (nadir / mid cycle) Neutrophils Dose Greater than or equal to 0.5x109/L 100% • Withhold dose until neutrophils recover to 0.5x109/L or above Less than 0.5x109/L Platelets Greater than 10x109/L • 1st occurrence: After neutrophil recovery restart at current dose level • 2nd occurrence: After neutrophil recovery restart and consider 1 dose level reduction (see table below) Dose 100% • Withhold dose until the platelets are 10x109/L or above Less than 10x109/L • 1st occurrence: After platelet recovery and / or bleeding controlled, continue at current dose level • 2nd occurrence: After platelet recovery and / or bleeding controlled, restart carfilzomib and consider 1 dose level reduction (see table below) Version 1 (January 2019) Page 2 of 10 Myeloma-Carfilzomib-Dexamethasone (20) Hepatic impairment Drug Carfilzomib No information available Dose Renal Impairment Renal dose modifications - Carfilzomib Renal function Creatinine greater than or equal to 2x baseline, and / or CrCl less than 15ml/min, and / or CrCl decreased to less than or equal to 50% of baseline Dose (% of original dose) • Withhold dose • Restart carfilzomib when renal function has recovered to within 25% of baseline (consider 1 dose level reduction) – see table below. Other Other non-haematological toxicity Recommended action Grade 3 or 4 toxicity • Stop until toxicity resolved / returned to baseline • Consider restarting at 1 dose level reduction Carfilzomib dose level reductions:* Normal dose 56mg/m2 1st reduction 45mg/m2 2nd reduction 36mg/m2 3rd reduction 27mg/m2 *Note: carfilzomib dose and dose reductions differ depending on regimen used. Dose reductions or interruptions in therapy are not necessary for those toxicities that are considered unlikely to be serious or life threatening. For example, alopecia, altered taste or nail changes. For all other non-haematological NCI-CTC toxicities refer to manufacturer information. Carfilzomib Infusion reactions Infusion reactions, including life-threatening reactions, have been reported in patients who received carfilzomib. Symptoms may include fever, chills, arthralgia, myalgia, facial flushing, facial oedema, vomiting, weakness, shortness of breath, hypotension, syncope, chest tightness, or angina. These reactions can occur immediately following or up to 24 hours after Version 1 (January 2019) Page 3 of 10 Myeloma-Carfilzomib-Dexamethasone (20) administration of carfilzomib. Dexamethasone should be administered prior to carfilzomib to reduce the incidence and severity of reactions. Monitor for signs and symptoms of an infusion-related reaction. Interrupt or slow the rate of infusion in patients with mild or moderate infusion reactions and consider pre-medications prior to subsequent doses. Dexamethasone Dose Level 2 (starting) 1 Dose 20mg 10mg If recovery from toxicities is prolonged beyond 14 days, then the dose of dexamethasone will be decreased by one dose level. Toxicity Grade (NCI-CTC) Dose modification Dyspepsia 1-2 3 or above Oedema Confusion or mood alteration Muscle weakness 3 or above 2 or above 2 or above Hyperglycaemia 3 or above Acute pancreatitis Other 3 or above Maintain dose and treat with histamine (H2) antagonist or proton pump inhibitor. Decrease by one dose level if symptoms persist. Interrupt dose until symptoms are controlled. Add H2 blocker or proton pump inhibitor and decrease one dose level when dose restarted. Use diuretics as needed and decrease dose by one dose level. Interrupt dose until symptoms resolve. When dose restarted decrease dose by one dose level. Interrupt dose until the muscle weakness is grade 1 or below. Restart with dose decreased by one level. Decrease dose by one dose level. Treat with insulin or oral hypoglycaemic agents as needed Discontinue patient from dexamethasone treatment regimen. Stop dexamethasone dosing until adverse event resolves to grade 2 or below. Resume with dose reduced by one level. Regimen Warning, the day one dexamethasone is incorporated into the regimen as a dose to be administered prior to the carfilzomib by the nursing staff. If the day one carfilzomib is suspended for any reason the schedule of the dexamethasone may need to be adjusted and the administration instructions amended. Version 1 (January 2019) Page 4 of 10 Myeloma-Carfilzomib-Dexamethasone (20) 28 day cycle until disease progression or intolerance occurs (12 cycles will be set in ARIA) Drug Carfilzomib (cycle 1) Dose 20mg/m2 (max 44mg) Days 1, 2 Carfilzomib (cycle 1) 56mg/m2 (max 123mg) 8, 9, 15, 16 Carfilzomib (cycles 2 onwards) 56mg/m2 (max 123mg) 1, 2, 8, 9, 15, 16 Administration IV infusion in 100ml glucose 5% over 30 minutes Dexamethasone 20mg 1, 2, 8, 9, 15, 16, 22, 23 Oral Dose Information • Carfilzomib will be dose banded in accordance with the nationally agreed dose bands (2mg/ml) • Carfilzomib will be dose capped at 2.2m2 • Dexamethasone is available as 500microgram, 2mg and 4mg tablets and as a 2mg/5ml oral liquid. Administration Information • Dexamethasone should be taken in the morning, with or after food Extravasation • Carfilzomib - neutral Additional Therapy • No antiemetics are required. • Carfilzomib pre-hydration with sodium chloride 0.9% 500ml over 30minutes • Carfilzomib post hydration with sodium chloride 0.9% 500ml over 30 minutes • For the treatment of carfilzomib related Infusion reactions - chlorphenamine 10mg intravenous injection once only when required for infusion related reactions - hydrocortisone 100mg intravenous when required for infusion related reactions - salbutamol 2.5mg nebule when required for related bronchospasm - paracetamol 1000mg oral once only when required for infusion related reactions • Consider allopurinol 300mg oral once a day for seven days for the first cycle only Version 1 (January 2019) Page 5 of 10 Myeloma-Carfilzomib-Dexamethasone (20) • Consider anti-infective prophylaxis including; - aciclovir 400mg twice a day oral - co-trimoxazole 960mg once a day oral on Monday, Wednesday and Friday only - fluconazole 50mg once a day oral • Bisphosphonates in accordance with local policies. • Mouthwashes according to local or national policy on the treatment of mucositis. • Gastric protection with a proton pump inhibitor or a H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed. Coding • Procurement – X71.3 • Delivery – X72.2 References 1. National Institute of Health and Clinical Excellence. NICE Technology Appraisal guidance [TA457]. Carfilzomib for previously treated multiple myeloma. 19th July 2017. Available from: https://www.nice.org.uk/guidance/ta457 2. Electronic medicines compendium - Krypolis summary of product characteristics. Last updated April 2018. Available from: https://www.medicines.org.uk/emc/product/5061#POSOLOGY Version 1 (January 2019) Page 6 of 10 Myeloma-Carfilzomib-Dexamethasone (20) REGIMEN SUMMARY Carfilzomib-Dexamethasone (20) Cycle 1, Day 1, 2 1. Dexamethasone 20mg oral 30 minutes prior to the carfilzomib Administration Instructions Administer at least 30 minutes and up to four hours prior to the start of the carfilzomib infusion 2. Sodium chloride 0.9% 500ml intravenous infusion over 30 minutes 3. Carfilzomib 20mg/m2 (maximum 44mg) intravenous infusion in 100ml glucose 5% over 30 minutes 4. Sodium chloride 0.9% 500ml intravenous infusion over 30 minutes 5. Chlorphenamine 10mg intravenous injection once only when required for infusion related reactions. 6. Hydrocortisone 100mg intravenous injection once only when required for infusion related reactions 7. Salbutamol 2.5mg nebule once only when required for infusion related bronchospasm 8. Paracetamol 1000mg oral once only when required for infusion related reactions Administration Instructions Please check if the patient has taken paracetamol. Maximum dose is 4g per 24 hours. There should be 4 hours between doses Cycle 1, Day 8, 9, 15, 16 9. Dexamethasone 20mg oral 30 minutes prior to the carfilzomib Administration Instructions Administer at least 30 minutes and up to four hours prior to the start of the carfilzomib infusion 10. Sodium chloride 0.9% 500ml intravenous infusion over 30 minutes 11. Carfilzomib 56mg/m2 (maximum 123 mg) intravenous infusion in 100ml glucose 5% over 30 minutes 12. Sodium chloride 0.9% 500ml intravenous infusion over 30 minutes 13. Chlorphenamine 10mg intravenous injection once only when required for infusion related reactions. 14. Hydrocortisone 100mg intravenous injection once only when required for infusion related reactions 15. Salbutamol 2.5mg nebule once only when required for infusion related bronchospasm 16. Paracetamol 1000mg oral once only when required for infusion related reactions Administration Instructions Please check if the patient has taken paracetamol. Maximum dose is 4g per 24 hours. There should be 4 hours between doses Version 1 (January 2019) Page 7 of 10 Myeloma-Carfilzomib-Dexamethasone (20) Take home medicines (Cycle 1 Day 1 only) 17. Dexamethasone 20mg once a day on day 22, 23 oral Administration Information Please supply two doses of dexamethasone on day 1 of the cycle, ONE dose to be taken on day 22 and on day 23 of the cycle once a day in the morning. Take with or after food. 18. Co-trimoxazole 960mg once a day on Monday, Wednesday and Friday for 28 days oral Administration Instructions Co-trimoxazole 960mg once a day on Mondays, Wednesdays and Fridays. Please supply 28 days. This may be dispensed as 480mg twice a day on Mondays, Wednesdays and Fridays according to local practice. 19. Aciclovir 400mg twice a day for 28 days oral Administration Instructions Please supply 28 days or an original pack if appropriate 20. Allopurinol 300mg once a day for 7 days oral Administration Instructions Take with or after food with plenty of water. Please supply 7 days. 21. Gastric Protection Administration Instructions The choice of gastric protection is dependent on local formulary choice and may include: - esomeprazole 20mg once a day oral - omeprazole 20mg once a day oral - lansoprazole 15mg once a day oral - pantoprazole 20mg once a day oral - rabeprazole 20mg once a day oral - cimetidine 400mg twice a day oral - famotidine 20mg once a day oral - nizatidine 150mg twice a day oral - ranitidine 150mg twice a day oral Please dispense 28 days or nearest original pack size. Cycles 2 - 12, Days 1, 2, 8, 9, 15, 16 22. Dexamethasone 20mg oral 30 minutes prior to the carfilzomib Administration Instructions Administer at least 30 minutes and up to four hours prior to the start of the carfilzomib infusion 23. Carfilzomib 56mg/m2 (maximum 123mg) intravenous infusion in 100ml glucose 5% over 30 minutes 24. Chlorphenamine 10mg intravenous injection once only when required for infusion related reactions. 25. Hydrocortisone 100mg intravenous injection once only when required for infusion related reactions 26. Salbutamol 2.5mg nebule once only when required for infusion related bronchospasm 27. Paracetamol 1000mg oral once only when required for infusion related reactions Administration Instructions Please check if the patient has taken paracetamol. Maximum dose is 4g per 24 hours. There should be 4 hours between doses Version 1 (January 2019) Page 8 of 10 Myeloma-Carfilzomib-Dexamethasone (20) Take home medicines (Cycles 2-12, Day 1 only) 28. Dexamethasone 20mg once a day on day 22 and 23 oral Administration Information Please supply two doses of dexamethasone on day 1 of the cycle, ONE dose to be taken on day 22 and on day 23 of the cycle, once day in the morning Take with or after food. 29. Co-trimoxazole 960mg once a day on Monday, Wednesday and Friday for 28 days oral Administration Instructions Co-trimoxazole 960mg once a day on Mondays, Wednesdays and Fridays. Please supply 28 days. This may be dispensed as 480mg twice a day on Mondays, Wednesdays and Fridays according to local practice. 30. Aciclovir 400mg twice a day for 28 days oral Administration Instructions Please supply 28 days or an original pack if appropriate 31. Gastric Protection Administration Instructions The choice of gastric protection is dependent on local formulary choice and may include: - esomeprazole 20mg once a day oral - omeprazole 20mg once a day oral - lansoprazole 15mg once a day oral - pantoprazole 20mg once a day oral - rabeprazole 20mg once a day oral - cimetidine 400mg twice a day oral - famotidine 20mg once a day oral - nizatidine 150mg twice a day oral - ranitidine 150mg twice a day oral Please dispense 28 days or nearest original pack size. Version 1 (January 2019) Page 9 of 10 Myeloma-Carfilzomib-Dexamethasone (20) Version Date 1 January 2019 DOCUMENT CONTROL Amendment None Written By Stuart Martin Pharmacist Dr Deborah Wright Pharmacist Approved By Dr Mathew Jenner Consultant Haematologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury Hospitals NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust All actions have been taken to ensure these protocols are correct. However, no responsibility can be taken for errors that occur as a result of following these guidelines. These protocols should be used in conjunction with other references such as the Summary of Product Characteristics and relevant published papers. Version 1 (January 2019) Page 10 of 10 Myeloma-Carfilzomib-Dexamethasone (20)
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Myeloma/carfilzomib-dexamethasone20-ver1.pdf

Carfilzomib(14 day)-Dexamethasone(20) Ver1

Description
Chemotherapy Protocol MYELOMA Carfilzomib (14 day)-Dexamethasone (20) Regimen  Myeloma – Carfilzomib-Dexamethasone (20) Indication 
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Myeloma/carfilzomib14-day-dexamethasone20-ver1.pdf

Going home with a CADD pump - patient information

Description
This factsheet explains what to expect if you are going home with a CADD pump.
Url
/Media/UHS-website-2019/Patientinformation/Cancercare/Going-home-with-a-CADD-pump-3090-PIL.pdf

MyelomaBortezomib IV DexamethasonePabinostatThalidomide 21day Ver1.1

Description
Chemotherapy Protocol MULTIPLE MYELOMA BORTEZOMIB (IV)-DEXAMETHASONE-PANOBINOSTAT-THALIDOMIDE Regimen (21 day) • Multiple Myeloma – Bo
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Myeloma/MyelomaBortezomib-IV-DexamethasonePabinostatThalidomide-21day-Ver1.1.pdf

Durvalumab_14day

Description
Chemotherapy Protocol LUNG CANCER – NON-SMALL CELL (NSCLC) Durvalumab (14 day) Regimen • NSCLC - Durvalumab (14 day) Indication • Stag
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Lung-cancer-non-small-cellNSCLC/Durvalumab-14day.pdf
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