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HAZARDOUS PRECAUTIONS: PERSONAL PROTECTIVE EQUIPMENT (PPE)

For Activities Performed Outside of the Pharmacy

Hazardous Type of HD Formulation Activity Double Gloves and Face Protection* Respiratory Protection** (Chemo) Gown

Administering/wasting from unit-dose No, single gloves No Yes, if exposure potential No package only

Tablets, Capsules and Oral Liquids • Cutting, crushing, or otherwise manipulating tablets and capsules*** • Administering/wasting manipulated Yes Yes Yes, if exposure potential Yes Antineoplastic tablets and capsules • Reconstituting oral powders

• Administering/wasting Yes, if exposure potential; Yes, if inhalation Injectables, Topicals and Other • Reconstituting injectable or topical Yes Yes Required with BCG and potential; Dosage Forms powders Talimogene Laherparepvec Required with BCG • Withdrawing from vial or ampoule

Administering/wasting from unit-dose No, single gloves No Yes, if exposure potential No package only

Tablets, Capsules and Oral Liquids • Cutting, crushing, or otherwise manipulating tablets and capsules*** No, single gloves Yes, if exposure potential • Administering/wasting manipulated No Yes Non-Antineoplastic only tablets and capsules • Reconstituting oral powders • Administering/wasting Injectables, Topicals and Other • Reconstituting injectable or topical No, single gloves No Yes, if exposure potential Yes, if inhalation potential Dosage Forms powders only • Withdrawing from vial or ampoule

Handling product when removing from a No, single gloves All formulations No No No sealed transport bag**** only

Contaminated body fluid (up to 48 Handling and disposal Yes Yes Yes, if exposure potential Yes, if inhalation potential All HDs hours after receiving HDs)

Spills and leaks Cleaning Yes Yes Yes Yes

Contaminated clothing, dressings, Disposal and cleaning Follow Standard Precautions linens, and other materials

* Use face shields in combination with goggles to provide a full range of protection against splashes to the face and . Face shields alone do not provide full eye and face protection as splashes to the eyes could still occur. Eye and face protection may be needed in the following examples: (working above eye level, cleaning spills, intraoperative bladder treatments, aerosol/inhalation treatments, disposal of contaminated body fluids). **N-95 Respiratory Mask to be worn when there is risk of splashes, droplets, sprays, or airborne particles (e.g., spills, irrigation solutions, aerosol/inhalation treatments, manipulation of tablets and capsules). A Powered Air Purifying Respirator (PAPR) with chemical cartridge is worn (1) when cleaning large spills (requiring more than one spill ) or (2) for the following when a CSTD cannot be used for administration or when cleaning a spill : , , , , 5- fluorouraci, , , *** Avoid cutting or crushing tablets and opening capsules, whenever possible. Use pill crushers with handles and associated pouches that will contain medications to avoid cross-contamination. If liquid formulation is needed, contact the pharmacy. ****Handling hazardous medications during automated medication cabinet activities (e.g., loading, removing, returning) is considered minimal risk and no PPE is required.

PPE Chart Last Revised: March 2021 1 HAZARDOUS MEDICATION PRECAUTIONS: PERSONAL PROTECTIVE EQUIPMENT (PPE)

For Activities Performed Within the Pharmacy

Perform in Hazardous Biological Respiratory Formulation Activity Type of HD Double Gloves (Chemo) Shoe covers Eye Protection Safety Protection* Gown Cabinet (BSC)** • Receiving • Unpacking No, single All formulations • Checking final preparations All HDs No No No No No gloves only • Transporting within the pharmacy • Placing in storage***

• Cutting, crushing, or otherwise Yes manipulating tablets and capsules (Phenol use All formulations All HDs Yes Yes No No Yes • Reconsituting oral and topical powders double nitrile • Sterile and non-sterile compounding gloves)

• Tablets • Counting or repackaging No, single • Capsules • Pouring liquids from one container to All HDs No No No No No gloves only • Oral or topical liquids another

Spills and leaks • Cleaning spills All HDs Yes Yes Yes Yes Yes N/A

• Monthly cleaning of Biological Safety Cleaning All HDs Yes Yes Yes Yes Yes Yes Cabinet (BSC)

*For monthly cleaning of BSC, large spills (requiring more than one spill kit), or any spill of the following medications, a Powered Air Purifying Respirator (PAPR) with chemical cartridge is worn: Carmustine, Cisplatin, Cyclophosphamide, Etoposide, 5-fluorouraci, Ifosfamide, Nitrogen mustard, Thiotepa. For all other spills, an N-95 respirator is worn. **If BSC is not available, refer to the PPE Chart for Activities Performed Outside of the Pharmacy. Exceptions for compounding in a BSC include sterile formulations of the following non-antineoplastics: , fosphenytoin, oxytocin, , valproate sodium, , and zoledronic acid per Assessments of Risk (AoR); follow Pharmacy SOPs for compounding in a laminar airflow workbench (LAFW) in a non-hazardous (positive pressure) buffer room. ***Handling hazardous medications during automated medication cabinet activities (e.g., loading, removing, returning) is considered minimal risk and no PPE is required.

PPE Chart Last Revised: March 2021 VUMC Hazardous Medication List This document correlates directly with VUMC Policy: Hazardous Medication Handling

Refer to Hazardous Medication Precautions - Personal Protective Equipment (PPE) charts to identify PPE; note separate charts for activities performed outside the pharmacy vs within the pharmacy Note: Antineoplastic medications are highlighted in yellow Generic Name Trade Name(s) [Combination products included, not all Trade Names listed] Epzicom, Triumeq, Trizivir, Ziagen Verzenio abiraterone Yonsa, Zytiga Calquence acitretin Soriatane ado- Kadcyla Gilotrif Alecensa Panretin Piqray Hexalen Letairis AMSA PD anastrozole Arimidex apalutamide Erleada apomorphine Apokyn, Kynmobi Trisenox Ayvakit Inlyta Onureg, Vidaza Azasan, Imuran BCG vaccine Theracys; Tice Vaccine -blmf Blenrep Beleodaq Belrapzo, Bendeka, Treanda Targretin bicalutamide Casodex Mektovi Blenoxane Velcade Tracleer Bosulif Adcetris Alunbrig Busulfex; Myleran Jevtana Dostinex Cabometyx, Cometriq Xeloda Tabrecta Carbatrol, Epitol, Equetro, Tegretol

Last Revised: March 2021 (v.3) 3 VUMC Hazardous Medication List This document correlates directly with VUMC Policy: Hazardous Medication Handling Note: Antineoplastic medications are highlighted in yellow Generic Name Trade Name(s) [Combination products included, not all Trade Names listed] Paraplatin Kyprolis carmustine BiCNU, Gliadel Zykadia cetrorelix Cetrotide Leukeran chloramphenicol Chloromycetin, Econochlor choriogonadotropin Ovidrel cidofovir Vistide CISplatin Platinol-AQ Leustatin; 2-CDA, Mavenclad Clolar clomiPHENE Clomid clonazePAM Klonopin Cotellic colchicine Col-Probenecid, Colcrys, Gloperba, Mitigare Xalkori cyclophosphamide Cytoxan cycloSPORINE Sandimmune; Neoral; Gengraf ARA-C;Cytosar-U cytarabine, liposomal Depocyt, Vyxeos Tafinlar DTIC Vizimpro Cosmegen darolutamide Nubeqa Sprycel Cerubidine, Daunomycin DAUNOrubicin, liposomal Daunoxome, Vyxeos Dacogen, Inqovi deferiprone Ferriprox degarelix Firmagon Zinecard; Totect diethylstilbestrol NA dihydroergotaminie D.H.E 45, Migranal dinoprostone Prepidil Taxotere Adriamycin DOXOrubicin, liposomal Doxil, Lipodox dronedarone Multaq dutasteride Avodart, Jalyn Atripla, Sustiva, Symfi Idhifa

Last Revised: March 2021 (v.3) 4 VUMC Hazardous Medication List This document correlates directly with VUMC Policy: Hazardous Medication Handling Note: Antineoplastic medications are highlighted in yellow Generic Name Trade Name(s) [Combination products included, not all Trade Names listed] Padcev entecavir Baraclude Rozlytrek enzalutamide Xtandi Ellence Balversa Halaven Tarceva eslicarbazepine Aptiom estradiol All trade names estramustine Emcyt, Estracyt estrogens (including conjugated and esterified) All trade names estropipate Ogen etoposide (including phosphate salt form) Etopophos, Toposar, VP 16 Afinitor exemestane Aromasin Bydureon, Byetta fam--nxki Enhertu Inrebic finasteride Propecia, Proscar Gilenya FUDR fluconazole Diflucan Fludara Carac, Fluoroplex, Fluorouracil (5-FU), Efudex, Tolak fluoxymesterone Androxy flutamide Eulexin formaldehyde Formalin fosphenytoin Cerebyx fostamatinib Tavalisse fulvestrant Faslodex GANciclovir Cytovene, Gancyk-rtu, Zirgan ganirelix Antagon Iressa Gemzar, Infugem Mylotarg Xospata gonadotropin (chorionic) Novarel, Pregnyl goserelin Zoladex histrelin Supprelin, Vantas (2N concentrated solution; diluted hydrochloric acid 0.1N, 1.5N, or 0.2N solution; Bernstein test for NG hydroxyurea Droxia, Hydrea, Siklos

Last Revised: March 2021 (v.3) 5 VUMC Hazardous Medication List This document correlates directly with VUMC Policy: Hazardous Medication Handling Note: Antineoplastic medications are highlighted in yellow Generic Name Trade Name(s) [Combination products included, not all Trade Names listed] Imbruvica Firazyr HCL IDArubicin HCL Zydelig ifosfamide Ifex mesylate Gleevec Besponsa Camptosar, Onivyde ISOtretinoin Absorica, Accutane, Amnesteem, Claravis, Myorisan, Zenatane ivabradine Corianor Tibsovo Ixempra Ninlaro Tykerb Vitrakvi Arava Revlimid Lenvima letrozole Femara, Kisqali leuprolide Eligard, Fensolvi, Lupaneta, Lupron recombinant Saxenda, Victoza lomitapide Juxtapid Gleostine lurbinectedin Zepzelca Opsumit -cmkb Margenza mechlorethamine Mustargen, Valchlor megestrol Megace, Megestrol Alkeran, Evomela menotropins Menopur Purinethol, Purixan methIMAazole Tapazole Otrexup, Rasuvo, Reditrex, Trexall, Xatmep methylergonovine Methergine Rydapt miFEPRIStone Korlym, Mifeprex miltefosine Impavido mipomersen Kynamro miSOPROStol Cytotec mitoMYcin Jelmyto, Mitosol, Mutamycin Lysodren Novantrone mycophenoLATE mofetil Cellcept

Last Revised: March 2021 (v.3) 6 VUMC Hazardous Medication List This document correlates directly with VUMC Policy: Hazardous Medication Handling Note: Antineoplastic medications are highlighted in yellow Generic Name Trade Name(s) [Combination products included, not all Trade Names listed] Myfortic nab- -bound particles Abraxane nafarelin Synarel Arranon Nerlynx Viramune Tasigna Ofev Zejula Lynparza Lartruvo omacetaxin Synribo Tagrisso ospemifene Osphena Eloxatin OXcarbazepine Oxtellar, Trileptal OXYtocin Pitocin PACLitaxel Taxol Ibrance Kepivance pamidronate Aredia Farydak Brisdelle, Paxil, Pexeva pasireotide Signifor Votrient disodium Alimta Pemazyre pentetate calcium trisodium N/A Nipent Perjeta, Phesgo Turalio phenol N/A Dibenzyline phenytoin Dilantin, Phenytex Vercite plerixafor Mozobil Polivy Pomalyst Iclusig Folotyn Matulane progestins (including progesterones) All trade names propylthiouracil Propyl-Thyracil

Last Revised: March 2021 (v.3) 7 VUMC Hazardous Medication List This document correlates directly with VUMC Policy: Hazardous Medication Handling Note: Antineoplastic medications are highlighted in yellow Generic Name Trade Name(s) [Combination products included, not all Trade Names listed] raloxifene Evista Azilect Stivarga relugolix Orgovyx ribavirin Virazole, Rebetrol Kisqali riociguat Adempas Qinlock Istodax Rubraca Jakafi -hziy Trodelvy Koselugo Mayzent Rapamune Odomzo Nexavar spironolactone Aldactone, Aldactazide, Carospir streptozocin Zanosar Sutent Astragraf XL, Envarsus XR, Prograf, Protopic Talzenna talimogene laherparepvec Imlygic tamoxifen Soltamox tazemetostat Tazverik temazepam Restoril Temodar Torisel Vumon Aubagio testosterones (including methylTESTOSTERone) All trade names Thalomid thioguanine Tabloid thiotepa Tepadina Xeljanz toPIRAmate Qsymia, Qudexy XR, Topamax, Trokendi XR Hycamtin toremifene Fareston Yondelis Mekinist trastuzumab Herceptin, Herceptin Hylecta, Herzuma, Kanjinti, Ogivri, Phesgo (All Trans Retinoic Acid or ATRA) Retin-A, Vesanoid trifluridine/tipiracil hydrochloride Lonsurf

Last Revised: March 2021 (v.3) 8 VUMC Hazardous Medication List This document correlates directly with VUMC Policy: Hazardous Medication Handling Note: Antineoplastic medications are highlighted in yellow Generic Name Trade Name(s) [Combination products included, not all Trade Names listed] triptorelin Trelstar, Triptodur ulipristal Ella, Logilia Rinvoq uracil mustard NA valGANciclovir Valcyte valproate/valproic acid derivatives (including divalproex) Depakote Valstar Caprelsa Zelboraf Venclexta vigabatrin Sabril, Vigadrone vinBLAStine Marqibo, Vincaspar PFS Navelbine Erivedge voriconazole Vfend Zolinza warfarin Coumadin, Jantoven Combivir, Retrovir, Trizivir Geodon ziv- Zaltrap zoledronic acid Reclast, Zometa zonisamide Zonegran References: 1. National Institute for Occupational Safety and Health (NIOSH) List of Antineoplastic and Other in Healthcare Settings, 2016. Retrieved from http://www.cdc.gov/niosh/topics/antineoplastic/pdf/hazardous-drugs-list_2016-161.pdf 2. Vanderbilt Specialty Pharmacy Drug List, 3. VUMC Safety Policy: Hazardous Medication Handling 4. Pharmacy SOP: Hazardous Medication and Product Handling

Last Revised: March 2021 (v.3) 9