CANTERBURY HEALTH LIMITED (HAEMATOLOGY DEPARTMENT)

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AML – low dose ARA C / DELIVER TO HDWBMTU
Patient Category:
Y J A P O 1 3 Z / OSP Group:
1 2 3 4 5 6 7 / Doctors Name:
NZMC Reg. No.: / Special Authority Number:
Antiemetics / Weightkg / Heightcm
BSAm2
Dose Modified / NoYes
ADMINISTRATION USE

DAY

/

DATE

/ TIME / CHEMOTHERAPY AGENT / DOSE / ROUTE / INSTRUCTIONS / DR SIGN / GIVEN BY / CHECK / TIME
1 / 0800 / Cytarabine (Ara-C) / 20mg / SC
2000 / Cytarabine (Ara-C) / 20mg / SC
2 / 0800 / Cytarabine (Ara-C) / 20mg / SC
2000 / Cytarabine (Ara-C) / 20mg / SC
3 / 0800 / Cytarabine (Ara-C) / 20mg / SC
2000 / Cytarabine (Ara-C) / 20mg / SC
4 / 0800 / Cytarabine (Ara-C) / 20mg / SC
2000 / Cytarabine (Ara-C) / 20mg / SC
5 / 0800 / Cytarabine (Ara-C) / 20mg / SC
2000 / Cytarabine (Ara-C) / 20mg / SC

Chemotherapy rounding: Cytarabine 10mg

Note: Low dose cytarabine is given for 10 days and repeated every 28 days if counts allow and if a satisfactory response is seen.

AML – low dose ARA C / DELIVER TO HDWBMTU
Patient Category:
Y J A P O 1 3 Z / OSP Group:
1 2 3 4 5 6 7 / Doctors Name:
NZMC Reg. No.: / Special Authority Number:
Antiemetics / Weightkg / Heightcm
BSAm2
Dose Modified / NoYes
ADMINISTRATION USE
DAY /

DATE

/ TIME / CHEMOTHERAPY AGENT / DOSE / ROUTE / INSTRUCTIONS / DR SIGN / GIVEN BY / CHECK / TIME
6 / 0800 / Cytarabine (Ara-C) / 20mg / SC
2000 / Cytarabine (Ara-C) / 20mg / SC
7 / 0800 / Cytarabine (Ara-C) / 20mg / SC
2000 / Cytarabine (Ara-C) / 20mg / SC
8 / 0800 / Cytarabine (Ara-C) / 20mg / SC
2000 / Cytarabine (Ara-C) / 20mg / SC
9 / 0800 / Cytarabine (Ara-C) / 20mg / SC
2000 / Cytarabine (Ara-C) / 20mg / SC
10 / 0800 / Cytarabine (Ara-C) / 20mg / SC
2000 / Cytarabine (Ara-C) / 20mg / SC
Authorised by Clinical Director: S GibbonsPharmacist: B Harden / 20 November 2007
G:\Division\HAE\CLIN\USER\Jen\Chemo charts\AML\AML – low dose ARA C.doc / Ref: 2000
CHEMOTHERAPY
MEDICATION
CHART
C260070