APHON Pediatric Chemotherapy-Biotherapy Renewal

Subcutaneous

Yes

Yes, if liquid could splash

Yes, if inhalation is potential

Yes, sharps protection

Intravenous solution CSTD recommended ( required by USP <800>) Note. CSTD = closed-system transfer device; N/A = not applicable; USP <800> = U.S. Pharmacopeia General Chapter <800>. Yes Yes Yes, if liquid could splash Yes, if inhalation is potential Adapted from NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2016 (U.S. DHHS NIOSH Publication Number 2016-161), National Institute for Occupational Safety and Health, 2016, Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings, U.S. Pharmacopeial Convention, 2016, uspnf.com/notices/general-chapter-hazardous-drugs-handling-healthcare-settings Side Effects Hypersensitivity reactions . These are not commonly seen with oral small molecule inhibitors but may occur with intravenous infusions of bortezomib or temsirolimus. Emesis. Bosutinib (>400 mg/day), crizotinib, dabrafenib, and imatinib (>400 mg/day) are associated with moderate to high emetic risk. Most of the other small molecule inhibitors have minimal to low emetic risk (National Comprehensive Cancer Network [NCCN], 2021). Management of nausea and vomiting caused by small molecule inhibitors follows the same principles as those used for chemotherapy. A number of established antiemetic guidelines are available, and most now include biotherapy agents in the discussion. Nurses who administer these agents should be prepared to give scheduled antiemetics for agents listed as having low or moderate potential for emesis (see Table 4 ). Patients who receive oral agents listed as having minimal or low risk for emesis should be given antiemetics on an as-needed basis (NCCN, 2021). Table 4. Emetogenic Potential of Small Molecule Inhibitors (including percentage of patients who will experience emesis in the absence of antiemetic therapy) Minimal to low (<30% frequency of emesis) Moderate to high (>30% frequency of emesis) Axitinib Bortezomib Bosutinib (<400 mg/day) Dasatinib Erlotinib Everolimus Gefitinib Bosutinib (>400 mg/day) Crizotinib Dabrafenib Imatinib (>400 mg/day)