/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/beacon-protocols/,/clinical/cckm-tools/content/beacon-protocols/hem---myeloma/,

/clinical/cckm-tools/content/beacon-protocols/hem---myeloma/name-96911-en.cckm

201611326

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Beacon Protocols,Hem - Myeloma

CSC HEM Carfilzomib(28D:1,2,8,9,15,16) Ver 10-3-16 (HL 4967)

CSC HEM Carfilzomib(28D:1,2,8,9,15,16) Ver 10-3-16 (HL 4967) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Hem - Myeloma


CSC HEM CARFILZOMIB(28D:1,2,8,9,15,16) VER:10-3-16 – Properties
Pre-Cycle – 11/14/2016 through 11/20/2016 (7 days), Planned
Day 1, Pre-Cycle – Planned for 11/14/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S Approximate, Expires-S+365, Routine
CREATININE
Expected-S Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S Approximate, Expires-S+365, Routine
Take Home Medications
ondansetron (ZOFRAN) 8 MG tab
Take 1 tab by mouth every 8 hours as needed., 8 mg, Disp-30 tab, R-5, EVERY 8 HOURS PRN starting S, Local Printer
prochlorperazine (COMPAZINE) 10 MG tab
Take 1 tab by mouth every 6 hours as needed for nausea/vomiting., 10 mg, Disp-30 tab, R-5, EVERY 6 HOURS PRN starting S,
Local Printer
acyclovir (ZOVIRAX) 400 MG tab
Take 1 tab by mouth 2 times daily., 400 mg, Disp-60 tab, R-5, 2 X DAILY starting S, Local Printer
Cycle 1 – 11/21/2016 through 12/18/2016 (28 days), Planned
Day 1, Cycle 1 – Planned for 11/21/2016
Treatment Plan Information
Reference Information (1)
MULTIPLE MYELOMA: Siegel DS, et al. Blood 2010;116(21):985.
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 1 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained and resulted: CBC, ANC, Total Bilirubin, AST and ALT.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1000/µL or Platelets less than 100K/µL or AST greater than or equal to 3X
ULN or ALT greater than or equal to 3X ULN or Total Bilirubin greater than or equal to 2X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 35.8 mg in dextrose 5 % 50 mL bag
35.8 mg (20 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 2 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
DAY 2 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 15 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 16 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS:CBC with DIFF, Creatinine, AST, ALT, Total
Bilirubin; CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
Day 2, Cycle 1 – Planned for 11/22/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 3 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 35.8 mg in dextrose 5 % 50 mL bag
35.8 mg (20 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 1 – Planned for 11/28/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 4 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 35.8 mg in dextrose 5 % 50 mL bag
35.8 mg (20 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9, Cycle 1 – Planned for 11/29/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 5 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 35.8 mg in dextrose 5 % 50 mL bag
35.8 mg (20 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 6 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 1 – Planned for 12/5/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 7 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 35.8 mg in dextrose 5 % 50 mL bag
35.8 mg (20 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 16, Cycle 1 – Planned for 12/6/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 8 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 35.8 mg in dextrose 5 % 50 mL bag
35.8 mg (20 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 2 – 12/19/2016 through 1/15/2017 (28 days), Planned
Day 1, Cycle 2 – Planned for 12/19/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+13 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+13 Approximate, Expires-S+365, Routine
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 9 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

AST/SGOT
Expected-S+13 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+13 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+13 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT, Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1000/µL or Platelets less than 100K/µL or Creatinine increase greater than
or equal to 2X baseline or AST greater than or equal to 3X ULN or ALT greater than or equal to 3X ULN or Total Bilirubin greater
than or equal to 2X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 10 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
DAY 2 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 15 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 16 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS:CBC with DIFF, Creatinine, AST, ALT, Total
Bilirubin; CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
Day 2, Cycle 2 – Planned for 12/20/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 11 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 2 – Planned for 12/26/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 12 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 13 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Day 9, Cycle 2 – Planned for 12/27/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 14 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 2 – Planned for 1/2/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 15 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 16, Cycle 2 – Planned for 1/3/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 16 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 20 mg
20 mg, Oral, ONCE, 1 dose Starting when released
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 3 – 1/16/2017 through 2/12/2017 (28 days), Planned
Day 1, Cycle 3 – Planned for 1/16/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 17 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+13 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+13 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+13 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+13 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+13 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT, Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1000/µL or Platelets less than 100K/µL or Creatinine increase greater than
or equal to 2X baseline or AST greater than or equal to 3X ULN or ALT greater than or equal to 3X ULN or Total Bilirubin greater
than or equal to 2X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 18 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
DAY 2 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 15 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 16 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS:CBC with DIFF, Creatinine, AST, ALT, Total
Bilirubin; CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
Day 2, Cycle 3 – Planned for 1/17/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 19 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 3 – Planned for 1/23/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 20 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 21 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9, Cycle 3 – Planned for 1/24/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 22 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 3 – Planned for 1/30/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 23 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 16, Cycle 3 – Planned for 1/31/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 24 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 4 – 2/13/2017 through 3/12/2017 (28 days), Planned
Day 1, Cycle 4 – Planned for 2/13/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 25 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

CBC WITH DIFFERENTIAL
Expected-S+13 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+13 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+13 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+13 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+13 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT, Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1000/µL or Platelets less than 100K/µL or Creatinine increase greater than
or equal to 2X baseline or AST greater than or equal to 3X ULN or ALT greater than or equal to 3X ULN or Total Bilirubin greater
than or equal to 2X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 26 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
DAY 2 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 15 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 16 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS:CBC with DIFF, Creatinine, AST, ALT, Total
Bilirubin; CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
Day 2, Cycle 4 – Planned for 2/14/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 27 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 4 – Planned for 2/20/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 28 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location
to optimize emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9, Cycle 4 – Planned for 2/21/2017
Treatment Plan Information
Treatment Plan Summary
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 29 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY:
carfilzomib 20 mg/m2 IV Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease
progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 30 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 4 – Planned for 2/27/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 31 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 16, Cycle 4 – Planned for 2/28/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 32 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 5 – 3/13/2017 through 4/9/2017 (28 days), Planned
Day 1, Cycle 5 – Planned for 3/13/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+13 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+13 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+13 Approximate, Expires-S+365, Routine
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 33 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

ALT/SGPT
Expected-S+13 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+13 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT, Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1000/µL or Platelets less than 100K/µL or Creatinine increase greater than
or equal to 2X baseline or AST greater than or equal to 3X ULN or ALT greater than or equal to 3X ULN or Total Bilirubin greater
than or equal to 2X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 34 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
DAY 2 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 15 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 16 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS:CBC with DIFF, Creatinine, AST, ALT, Total
Bilirubin; CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
Day 2, Cycle 5 – Planned for 3/14/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 35 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 5 – Planned for 3/20/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 36 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9, Cycle 5 – Planned for 3/21/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 37 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 38 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 5 – Planned for 3/27/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 39 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 16, Cycle 5 – Planned for 3/28/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 40 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 6 – 4/10/2017 through 5/7/2017 (28 days), Planned
Day 1, Cycle 6 – Planned for 4/10/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+13 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+13 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+13 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+13 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+13 Approximate, Expires-S+365, Routine
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 41 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT, Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1000/µL or Platelets less than 100K/µL or Creatinine increase greater than
or equal to 2X baseline or AST greater than or equal to 3X ULN or ALT greater than or equal to 3X ULN or Total Bilirubin greater
than or equal to 2X ULN.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 42 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
DAY 2 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 8 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 15 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 16 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS:CBC with DIFF, Creatinine, AST, ALT, Total
Bilirubin; CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
Day 2, Cycle 6 – Planned for 4/11/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 43 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 8, Cycle 6 – Planned for 4/17/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 44 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9, Cycle 6 – Planned for 4/18/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 45 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 6 – Planned for 4/24/2017
Treatment Plan Information
Treatment Plan Summary
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 46 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY:
carfilzomib 20 mg/m2 IV Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease
progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 47 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 16, Cycle 6 – Planned for 4/25/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA: 2.2 m2 (per physician discretion); DISEASE: Multiple Myeloma (Advanced); THERAPY: carfilzomib 20 mg/m2 IV
Days 1, 2, 8, 9, 15, 16; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8,
9, 15, 16; CYCLE LENGTH: 28 days; COURSE: until disease progression.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to carfilzomib can occur. For first and second dose, patient should be treated in a location to optimize
emergency care. Monitor patient for hypotension and shortness of breath. See Emergency Medications.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion 250-500 mL
Intravenous, ONCE, 1 dose Starting when released
Prehydration - infuse 250 to 500 mL prior to treatment. Delete prehydration if not needed.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 48 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
48.4 mg (rounded from 48.33 mg = 27 mg/m2 × 1.79 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
MAXIMUM BSA = 2.2m2 (per physician discretion). Administer over 2 to 10 minutes. Hypersensitivity risk. For first and second dose,
patient should be treated in a location to optimize emergency care. See emergency medications. Do not administer as an infusion
with other medicinal products. The intravenous administration line should be flushed with normal saline or Dextrose 5% immediately
before and after carfilzomib administration.
Conditional Orders
sodium chloride 0.9 % infusion 250-500 mL
at 125 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if patient becomes hypotensive.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:20:46 PM Page 49 of 49
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org