1. Oral Chemotherapy
Facts and Precautions

2. Objectives
State the Facts
Precautions
Administration
Proper disposal

3. 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)

4. 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

5. 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 home
assisted living facilities
long-term care facilities

6. 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

7. 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 or Kelly Lawson at

8. How Alert Appears on Mars
0040 History Missing Schedules!!! (from 8/20/ :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/h 27.5 mg, 100 ml IV EVERY 24 HOURS Pharmex Warning a.0141 Discard unused portion & change tubing every 12 hours Nurse: Pregnant women should avoid contact with this medication 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 Take with food 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!

9. List of Most Common Oral Chemotherapy Medications
Brand Names
Generic Names
Capecitabine
Erlotinib
Temazolomide
Imatinib
Lapatanib
Sunitinib
Sorafenib
Rheumatrex
Tykerb
Xeloda
Tarceva
Temodar
Gleevac
Sutent
Nexavaar
Methotrexate

10. Light Sensitive
Some oral chemotherapy medications may be sent from pharmacy in brown packaging due to their sensitivity to light

11. Oncology Resource Team
Rachelle Collins RN, OCN
Sheryl Grooms RN, OCN
Linda Horner BSN, OCN, PCCN
Nancy Jacobs RN, PCCN, OCN
Kelly Lawson RN, OCN
Kristie Meeker RN, BSN, OCN
Connie Wolf RN, OCN
Traci Boland RN, OCN

12. References
Goodin, S., (2007, September 7 ). Safe handling of Oral Chemo Agents in Community
Settings
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 September
Available at cdc.gov/niosh/docs/

13. Safety  Quality  Service  Relationships  Performance
Any questions?
Safety  Quality  Service  Relationships  Performance