Hospital Tengku Ampuan Rahimah

HOSPITAL TENGKU AMPUAN RAHIMAH
CHEMOTHERAPY TREATMENT CHART

FAC REGIME ( FLUOROURACIL /ADRIAMYCIN /CYCLOPHAMIDE)
CYCLE NO :....
NAME:................... DIAGNOSIS: .............
IC NO :.......... R/N:..... AGE:..... WARD : ....
HEIGHT :....(CM ) WEIGHT:..(KG) BSA (M) : ....
DATE :
NO DETAIL REGIME DOSE DURATION OF TIME TIME
INFUSION START STOP
1 PREMEDICATION
1/2 hr beIore chemotherapy :-
I/V Granisetron 3mg Bolus
I/V Demamethasone 8mg Bolus
2 I/V Adriamycin 50mg/m ...mg with Concurrent
Bolus in ... I/V Normal Saline
3 I/V Fluorouracil 600mg/m ...mg 0.90
Bolus in ... running
4 I/V Cyclophosphamide 600mg/ m ...mg
Bolus in ...
* 8ecycle uay 22 x 6 Cycles

Comments :

Prescribed by : ...........

Checked by : ........... Witness by :......................................

Administered by : ...........

FEC REGIME ( FLUOROURACIL /EPIRUBICIN /CYCLOPHAMIDE)
CYCLE NO :.......
NAME:................... DIAGNOSIS: .............
IC NO :.......... R/N:..... AGE:..... WARD : ....

DATE
NO DETAIL REGIME DOSE DURATION OF TIME TIME
INFUSION START STOP
1 PREMEDICATION
hr beIore chemotherapy
I/V Granisetron 3mg
I/V Dexamethasone 8mg
2 I/V Epirubicn 60mg /m ....mg
Bolus in ...minutes with concurrent
3 I/V Fluorouracil 600mg/m .....mg i/v Normal Saline
Bolus in ...minutes 0.90
4 I/V Cyclphosphamide 600mg/m .....mg running
Bolus in ...minutes
* Recycle Day 22 X 6 Cycles

Comments :



Administered by : ..........

MAYO REGIME ( FLUOROURACIL)
CYCLE NO :.......
NAME:................... DIAGNOSIS: .............
IC NO :.......... R/N:..... AGE:..... WARD : ....

Comments :




DATE & TIME
NO DEATAIL REGIME DAY 1 DAY 2 DAY 3 DAY 4 DAY 5
1 PREMEDICATION
IVB METOCLOPRAMIDE 20 mg
IVB DEXAMETHASONE 8 mg
2 IVB FOLINIC ACID 20 mg/M
Dose : mg
3 IVB FLUROURACIL 375mg/M
Dose : mg
To speciIy time start & complete
* Recycle Day 29 X 6
FOLFOX REGIME ( OXALIPLATIN & DE GRAMMONT REGIME)
CYCLE NO :.......
NAME:................... DIAGNOSIS: .............
IC NO :.......... R/N:..... AGE:..... WARD : ....
DAY DETAIL REGIME DOSE TOTAL TIME TIME SIGN
DOSE START STOP
DAY 1 DATE
IV D5 Ior 1 hour 500ml
2 PREMEDICATION
IV GRANISETRONE 3 mg
IV DEXAMETHASONE 8 mg
3 IV OXALIPLATIN in 250ml D5 85 mg/M
run 1 hour 30min.
4 IV D5 Ior 1 hour 500 ml
5 IV FOLINIC ACID in 500ml 200 mg/M
Normal Saline 0.9 Ior 2 hours
6 IV FLUROURACIL (5-FU) in 400mg/M
bolus
1 st pint
IV FLUROURACIL (5-FU) in
500 mls Ior 11 hour 600mg/M
2 nd pint 22 hrs
IV FLUROURACIL (5-FU) in
500 mls Ior 11 hour
DA 2 DATE
IV FOLINIC ACID in 500 mls 200mg/M
Normal Saline 0.9 Ior 2 hours
2 PREMEDICATION
IV METOCHLOPRAMIDE 20 mg
IV DEXAMETHASONE 8 mg
IV FLUROURACIL (5-FU) 00mg/M
in bolus
1 st pint
IV FLUROURACIL (5-FU)
in 500 mls Normal Saline Ior 11 hour 600mg/M
2 nd pint 22 hrs
IV FLUROURACIL (5-FU)
in 500 mls Normal Saline Ior 11 hour
* CYCLES INTERVAL 2 WEEK
nC1LS ( 18LA1MLn1 Cn ulSCPA8CL )
O 9CS1 CPLMC1PL8A9 x uA AS Cu1 9A1lLn1
1 A8LL1 ML1CCPCLC898CMluL 0 MC 1uS
2 1A8LL1 uLxAML1PASCnL MC 1uS

Comments :




DE GRAMMONT REGIME ( FLUROURACIL)
CYCLE NO :.......
NAME:................... DIAGNOSIS: .............
IC NO :.......... R/N:..... AGE:..... WARD :....
uA uL1AlL 8LClML uCSL 1C1AL 1lML 1lML SlCn
uCSL S1A81 S1C9
DA 1 DA1L
lv lCLlnlC AClu 300 mls 200mg/M
normal Sale 09 for 2 hour
2 kLMLDICA1ICN
lv C8AnlSL18CnL mg
lv uLxAML1PASCnL 8 mg
lv 8Anl1lulnL 30 mg
bolus Z before lv (3lu)
lv lLu8Cu8AClL (3lu) 00mg/M
bolus
sL pL
lv lLu8Cu8AClL (3lu)
300 mls normal Sale for hrs 600mg/M
2 pL 22 hrs
300 mls normal Sale for hrs
DA 2 DA1L
lv lCLlnlC AClu 300ml 200mg/M
normal Sale 09 for 2 hrs
2 kLMLDICA1ICN
lv ML1CCPLC98AMluL 200 mg
lv lLu8Cu8AClL (3lu) 00mg/M
bolus
sL pL
300 mls for hrs 600mg/M
2 pL 22 hrs
300 mls for hrs
* CCLLS ln1L8vAL 2 WLLk

nC1LS ( 18LA1MLn1 Cn ulSCPA8CL )
O 9CS1 CPLMC1PL8A9 x uA AS Cu1 9A1lLn1
1 A8LL1 ML1CCPCLC898CMluL 0 MC 1uS
1A8LL1 uLxAML1PASCnL MC 1uS

Comments :




HYDRATION REGIME AND PREMEDICATION
HIGH DOSE CISPLATIN ( 80 - 120 mg/M/ DAY)
CYCLE NO :.......
NAME:................... DIAGNOSIS: .............
IC NO :.......... R/N:..... AGE:..... WARD :....

uA1L
nC uL1AlL 8LClML uCSL uu8A1lCn Cl 1lML 1lML SlCn
lnluSlCn S1A81 S1C9
lv normal Sale 09 300 mls 2 hours
2 normal sale 09 + 20 mmol kCL hours
(3 ml kCL 0 )
normal sale 09 + 0 mmol hours
MgSC ( 3ml MgSC 30)
MaLol 0 300 mls hours
3 lv C8AnlSL18Cn mg Z before
lv uLxAML1PASCnL 8 mg chemo rugs
bolus amsLraLo
IV VIN8LAS1INL |n bo|us mg
IV 8LLCMCIN |n bo|us mg
7 Norma| Sa||ne S00 m| + mg 2 hours
x CISLA1IN
8 Norma| Sa||ne S00 m| + mg 2 hours
x CISLA1IN
9 normal sale 09 + 20 mmol kCL hours
( 3ml kCL 0 )
0 normal sale 09 + 0 mmol hours
MgSC ( 3ml MgSC 30)
normal sale 09 300ml hours

O II urine output is less than 100ml/hr, to give Mannitol 20 100ml over 30 minutes.
O Advise oral Iluid 2 litres over next 24 hrs aIter IV Iluid is discontinued.

Comments :




INTERMEDIATE DOSE CISPLATIN ( 40 - 80mg/M/ DAY)
CYCLE NO :.......
NAME:................... DIAGNOSIS: .............
IC NO :.......... R/N:..... AGE:..... WARD :....

uA1L
lnluSlCn S1A81 S1C9
normal sale 300 mls + 20 mmol 2 hours
kCL (3 ml kCL 0 )
2 normal sale 300 mls + 0 mmol hours
MgSC ( 3 ml MgSC 30
kLMLDICA1ICN
lv C8AnlSL18Cn mg Z before
lv uLxAML1PASCnL 8 mg chemo rug
bolus amsLraLo
lv MAnnl1CL 20 00 ml 0 m
3 IV Dextrose Sa||ne S00 m| + mg hours
x CISLA1IN
6 IV Norma| Sa||ne S00 m| + mg hours
x CISLA1IN
normal Sale 300 ml + 2 hours
20 mmol kCL (3 ml kCL 0 )
8 normal sale 300 ml + hours
0 mmol MgSC (3 ml MgSC 30

O Advise oral Iluid 1- 2 liter aIter IV Iluid
O There must be NO cardiovascular or renal disease
O II urine output is less than 100ml / hr during chemotherapy to give Mannitol 20 over
30 minutes
O Measures intake /output chart )

Comments :




LOW DOSE CISPLATIN ( 20 - 40 mg/M/ DAY)
CYCLE NO :.......
NAME:................... DIAGNOSIS: .............
IC NO :.......... R/N:..... AGE:..... WARD :....

uA1L
lnluSlCn S1A81 S1C9
lv normal Sale 09 300 ml hour
2 kLMLDICA1ICN Z before
lv C8AnlSL18Cn mg chemo rug
lv uLxAML1PASCnL 8 mg amsLraLo
lv MAnl1CL 20 00 ml 0 muLes
IV Mann|to| 10 + mg hour
x CISLA1IN
3 normal Sale 300ml + hour
0 mmol kCL ( 3ml kCL 0)
6 normal Sale 300ml + hour
0 mmol MgSC (3ml MgSC 30)

O There must be no cardiovascular or renal disease
O Maintain oral Iluid 1 1.5 liter during the subsequent hours.
This can be as out patient treatment
Comments :



SINGLE AGENT DOCETAXEL REGIME
CYCLE NO :.......
NAME:................... DIAGNOSIS: .............
IC NO :.......... R/N:..... AGE:..... WARD :....

uA1L
nC uL1AlL 8LClML uCSL uu8A1lCn Cl 1lML 1lML
lnluSlCn S1A81 S1C9
kLMLDICA1ICN
Cral uexameLhasoe 8 mg 8u
uay 0 uay uay 2
2 lv normal Sale 230 ml Z hours
lv C8AnlSL18Cn mg
lv uLxAML1PASCnL 8 mg
lv uCCL1AxLL 3 mg/M hours
230 ml normal Sale
3 lv normal Sale 230 ml Z hours flushg
* 8ecycle uay 22 x 6 cycles

O Day 0 : Oral Dexamethasone 8 mg taken 12 hours and 6 hours beIore chemotherapy.

Comments :




Hospital Tengku Ampuan Rahimah

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HOSPITAL TENGKU AMPUAN RAHIMAH

CHEMOTHERAPY TREATMENT CHART

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