Oral Chemotherapy

Facts and Precautions

ObjectivesObjectives

• State the Facts• Precautions• Administration• Proper disposal

Preparation of Med• Manipulation of tablets such as cutting,

crushing or opening of capsules should be done by trained personnel in the pharmacy, under a bio-safety cabinet. (BSC)

Facts/Precautions

• Oral chemotherapy drugs are hazardous, just as any type of chemotherapy

• Increased risk apply for women who are:

• Breastfeeding• Pregnant• Planning on becoming pregnant

Safe Handling

It is generally assumed that patients receive chemotherapy in traditional health care settings

However, with increased use of oral chemotherapy this paradigm is shifting from primarily ambulatory infusion clinics and physicians offices, to include:

self administration at homeassisted living facilitieslong-term care facilities

Administration of Oral Chemo

• Wash hands prior to donning gloves• Nitrile gloves should be worn while dispensing• Gown if oral chemotherapy is liquid and

splashing may occur • Goggles if splashing may occur• Medication wrapper must go in yellow chemo

container• All other PPE should be disposed of yellow

chemo container

Chemo Waste Container

• Discard wrappers in a disposable chemo waste bag after opening oral chemo medication. If you need these on your unit please call Nancy Jacobs at 356-8736 or Kelly Lawson at 356-7594.

How Alert Appears on Mars

0040 History Missing Schedules!!! (from 8/20/2009 11:00:00 PM)MI ADR a.FLUDARABINE 50mg VIAL (Fludara(Fludarabine))27.5 mg b.0.9% NaCl (0.9% NaCl 100ml IV SOL`N)100 ml INTRAVENOUSLY EVERY 24 HOURS Infuse over 30m, Rate: 202ml/h27.5 mg, 100 ml IV EVERY 24 HOURS Pharmex Warning a.0141 Discard unused portion & change tubing every 12 hours.0142 Nurse: Pregnant women should avoid contact with this medication.0174 CAUTION: Follow procedures for proper handling and disposal of hazardous drugs.b.0005 Take this medication with plenty of water.c.0044 Do NOT chew or crush before swallowing.d.0005 Take this medication with plenty of water.0010 Take with food.0036 Do not chew or crush. Swallow whole.e.0144 Roll gently in your hands to mix well before each injection.f.0062 May cause dizziness Pharmex Warning (per Administration Guideline)Caution: Chemotherapy-<------------ This is the alert on the EMAR that states this is a chemotherapeutic drug.

DRUG ORDER VERIFIED BY TWO NURSES Start: 08/18 11:00, Stop: 08/21 10:59* NOT GIVEN TODAY *

08/19 09:42 Not earlier than 08/20 09:42!

List of Most Common Oral Chemotherapy Medications

• Tykerb• Xeloda• Tarceva• Temodar• Gleevac• Sutent• Nexavaar• Methotrexate

• Capecitabine• Erlotinib• Temazolomide• Imatinib• Lapatanib• Sunitinib• Sorafenib• Rheumatrex

Brand Names Generic Names

Light Sensitive

• Some oral chemotherapy medications may be sent from pharmacy in brown packaging due to their sensitivity to light

Oncology Resource Team

• Rachelle Collins RN, OCN 356-7490• Sheryl Grooms RN, OCN 356-7426• Linda Horner BSN, OCN, PCCN 356-8543• Nancy Jacobs RN, PCCN, OCN 356-8736• Kelly Lawson RN, OCN 356-7594• Kristie Meeker RN, BSN, OCN 356-7466• Connie Wolf RN, OCN 356-7490• Traci Boland RN, OCN 356-7490

References

Goodin, S., (2007, September 7 ). Safe handling of Oral Chemo Agents in Community

Settings http://www.pharmacytimes.com/issue/pharmacy/2007/2007-09/2007-09-6789

Center for Disease Control and Prevention. National Institute for Occupational Safety and

Health. Preventing Occupational Exposure to Antineoplastic and other Occupational

Hazardous Drugs in Health Care Settings. NIOSH publication 2005-165. September

2004. Available at cdc.gov/niosh/docs/2005-165

Safety Quality Service Relationships Performance

Any

questions?questions?