1. CHEMOTHERAPY PREPARATION
PHARMACY TECHNICIAN TRAINING MODULE
INFIRMARY HEALTH

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

3. 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

4. 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

5. 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

6. 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.

7. 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

8. 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

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

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

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

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

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

14. 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

15. 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.

16. 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

17. 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.

18. 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