Cytarabine Delivery Template

CYTARABINE ADMINISTRATION CONSULTATION - 2023-10-15 by Dr. Sarah Johnson, Dr. Emily White for Dr. Thomas Kelly.
Presentation:  
The patient, a 5-year-old Labrador Retriever, presented for follow-up cytarabine administration due to a diagnosis of lymphoma.
Diagnosis:  
Lymphoma  
Enlarged lymph nodes, lethargy  
Biopsy confirmed lymphoma
Pre-cytarabine organ dysfunction:  
Gastrointestinal:  
No history of gastrointestinal issues  
Renal: Baseline creatinine level 1.2 mg/dL, within normal limits  
Hepatic:  
Baseline ALT level 45 U/L, within normal limits  
Baseline bilirubin level 0.8 mg/dL, within normal limits
Current history:  
History related to lymphoma  
Owner is accepting of the condition and reports a good quality of life  
No significant changes in clinical signs since last visit  
General history  
Current quality of life is good  
Presence of lethargy/fatigue: Mild  
Appetite status: Normal  
Presence of vomiting: None  
Presence of diarrhoea: None  
Presence of cough/dyspnoea: None  
Additional owner concerns: None
Current medications:  
To treat lymphoma  
Prednisone, 20 mg, oral, once daily
To treat nausea  
Ondansetron, 4 mg, oral, as needed
To be used if needed  
Metoclopramide, 5 mg, oral, as needed
Physical examination:  
Weight: 30 kg, stable since last visit  
BCS: 5/9, stable since last visit  
MCS: Normal  
Rectal temperature: 101.5°F  
Peripheral lymph nodes: Enlarged  
Cardiorespiratory assessment:  
Mucous membrane color pink, moisture normal, capillary refill time <2 seconds  
Heart rate 90 bpm, regular rhythm  
Presence of heart murmur: None  
Femoral pulse quality: Strong  
Respiratory rate 20 breaths/min, normal breathing effort, clear lung sounds  
Abdominal assessment:  
No abnormalities on palpation
Summary of neurological examination:  
Cranial nerve assessment: Normal  
Spinal pain assessment: None  
Limb proprioception assessment: Normal  
Gait assessment: Normal  
Behavioral signs noted by nurses: None  
Neck palpation and manipulation findings: Normal
Diagnostics planned for today & results:  
Complete blood count was performed in-house.  
Neutropenia: None  
Thrombocytopenia: Mild  
Haemoglobin: 14 g/dL, normal  
Biochemistry was performed in-house.  
Creatinine level 1.2 mg/dL, normal  
ALT level 45 U/L, normal  
Bilirubin level 0.8 mg/dL, normal  
Additional findings: None
General therapeutics information:  
Cytarabine week: 3  
Treatment frequency and rationale: Every 3 weeks to manage lymphoma  
Injecting nurse - Nurse Lisa Brown  
Body weight: 30 kg  
BSA: 1.2 m²
Drug 1: Cytarabine, 100 mg/m²  
Route: IV  
Dosage: 120 mg  
Dose: 120 mg  
Saline: Dilute in 100 mL saline  
Dose double checked by: SJ  
Comment on administration: Administered without complications
Drug 2: Dexamethasone, 2 mg/mL  
Route: IV  
Dosage: 0.5 mg/kg  
Dose: 15 mg  
Comment on administration: Administered as pre-medication
Drug 3: Ondansetron, 2 mg/mL  
Route: IV  
Dosage: 0.1 mg/kg  
Dose: 3 mg  
Comment on administration: Administered to prevent nausea
Drug 4: Metoclopramide, 5 mg/mL  
Route: IV  
Dosage: 0.2 mg/kg  
Dose: 6 mg  
Comment on administration: Administered as needed
Drug 5: Famotidine, 10 mg/mL  
Route: IV  
Dosage: 0.5 mg/kg  
Dose: 15 mg  
Comment on administration: Administered to prevent gastric irritation
Current clinical assessment if remission status:  
Partial remission achieved  
Discussion of differential diagnoses and prognosis: Favorable prognosis with continued treatment
Chronological cytarabine & outcome:  
Cytarabine & Dexamethasone  
2023-09-15: Week 1  
Cytarabine total dose provided: 120 mg, effective  
Dexamethasone dose provided: 15 mg, effective  
2023-10-01: Week 2  
Cytarabine total dose provided: 120 mg, effective  
Dexamethasone dose provided: 15 mg, effective  
Bloods 7 days post showed: Mild thrombocytopenia, monitor closely
Up to date problem list:  
Primary lymphoma location  
Peripheral lymph nodes  
Remission status: Partial  
Treatment requirements: Continued chemotherapy  
Current clinical signs:  
Mild lethargy  
Recent historical signs:  
Improvement in lethargy with treatment  
Signs at home:  
Owner reported mild lethargy  
Diagnostics (imaging at diagnosis) problem list:  
Enlarged lymph nodes on ultrasound
Assessment of problem list:  
1. Lymphoma  
Remission status: Partial  
Discussion of diagnosis certainty: Confirmed by biopsy  
Drug dependence and response to treatment: Responding well  
Prognosis and treatment goals: Favorable, aim for complete remission  
Plan for worsening clinical signs: Increase chemotherapy frequency  
2. QOL  
Owner's assessment of quality of life: Good  
Owner's acceptance of prognosis: Positive  
Owner's concerns about lifespan: Minimal  
Recommendations for maintaining quality of life: Regular exercise, balanced diet  
3. Thrombocytopenia  
Current status: Mild, monitor closely
Updated medications:  
To treat lymphoma  
Prednisone, 20 mg, oral, once daily
To treat nausea  
Ondansetron, 4 mg, oral, as needed
To be used if needed:  
Metoclopramide, 5 mg, oral, as needed
Short term plan:  
Monitoring plan: Weekly CBC  
Plan for acute pain management: NSAIDs as needed  
Planned clinicopathological tests:  
2023-10-22: CBC and biochemistry at in-house lab  
Planned cytarabine:  
2023-11-05: Cytarabine, 120 mg, IV, at clinic
Long term plan:  
Long-term medication requirements: Continue prednisone  
Recommendations for diagnostic tests if acute decline: Repeat imaging and blood tests