CHEMOTHERAPY PREPARATION PHARMACY TECHNICIAN TRAINING MODULE INFIRMARY HEALTH

OBJECTIVE To facilitate the training of pharmacy technicians in the safe preparation of cytotoxic agents.

Technicians should be able to demonstrate: Proper use and maintenance of the bio-safety hood or CACI (compounding aseptic containment isolator) Proper use of personal protective equipment An understanding of the special precautions required when preparing cytotoxic agents. Good aseptic technique

Technicians should be able to demonstrate: A recognition of cytotoxic and noncytotoxic agents A recognition of brand and generic names of chemotherapy drugs Preparation of the work area including bags for chemotherapy administration Appropriate reconstitution and drug dilution techniques

Technicians should be able to demonstrate: An ability to read and interpret the drug label and calculate the volume of drug required for the correct dose An understanding of the checks and balances involved in the dispensing process An ability to prioritize work volume The ability to maintain a neat and organized work environment

GENERAL INFORMATION When preparing chemotherapy be sure to use good aseptic technique Additional procedures are put into place to protect the preparer, the administrator and the patient Use the closed system transfer device. It is safer and will make the preparation easier.

GETTING STARTED: Preparation is the key to efficient management of the work flow Make sure all supplies are stocked and accessible Determine the method of preparation, any calculations, fluids, diluents or other supplies needed prior to getting under the bio-safety hood or CACI

GETTING STARTED: Premeds and pre-hydrations should always be prepared first All cytotoxic drugs should be prepared under the bio-safety hood or CACI Use good aseptic technique at all times

EXAMPLES OF ANTI-EMETIC PREMEDS: Ondansetron - Zofran Palonosetron - Aloxi Granisetron – Kytril Dexamethasone Famotidine Diphenhydramine Aprepitant or fosprepitant

Miscellaneous agents Prehydration – fluids with potassium, magnesium calcium Leucovorin Given with fluorouracil Works synergistically Non-hazardous

COMMON CYTOTOXIC AGENTS Adriamycin – doxorubicin Adrucil – fluorouracil, 5-Fu Vepesid – etoposide, VP-16 Taxol – paclitaxel Cytoxan – cyclophoshamide Platinol – cisplatin Camptosar – irinotecan Taxotere - docetaxel

COMMON CYTOTOXIC AGENTS Carboplatin Eloxitin – oxaliplatin Gemzar – gemcitibine Arsenic trioxide

Common drugs used in treatment that are identified as non-hazardous Avastin – bevacizumab Rituxan – rituximab Herceptin – trazatuzumab Erbitux - cetuximab

CYTOTOXIC PREPARATION PPE – Follow established policy for preparation of sterile products Bonnet Booties Gown Gloves – Wash hands thoroughly before gloving. Double gloving is required by AL BOP. Be sure and use a sterile chemotherapy glove mask

Cytotoxic Preparation: Assemble all required elements to be placed under the bio-safety hood or into the CACI Attach and prime correct tubing to bags. Some drugs require the use of non-PVC or Excel bags and tubing. Follow the instructions on the mixing guidelines. Using sterile technique, reconstitute drug if indicated, with sterile water, normal saline, or a provided diluent Use the appropriate closed system transfer device.

Cytotoxic Preparation: Draw up correct dose of drug – Do not inject air into any vial of cytotoxic agent. Place drug vial, syringe and prepared fluid bag (if needed) together in the hood for pharmacist verification Once the medication has been verified, carefully inject into the bag Carefully wipe the bag with an alcohol wipe Bag is now ready to be dispensed for administration

Completion Place used paper material into the plastic bag in the hood and dispose in the trash can All syringes and empty cytotoxic drug vials should be disposed of in the YELLOW bin. All cytotoxic vials containing more than 1/3 of the original solution should be disposed in the BLACK bin Wipe down hood as needed with alcohol Hood should be cleaned once a week by Surface Safe. Label any MDV with expiration date and initials. When preparation is complete, remove PPE and discard. Wash hands thoroughly. Gown can reused throughout the remainder of the day.

Points to Remember Always wear appropriate protective equipment Develop good preparation technique – use the equipment provided Develop a double check system for yourself Be familiar and know how to access appropriate instruction and reference material Ask questions…most of these drugs are very expensive and we need to avoid makeovers