/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-96912-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) Dexamethasone Oral(28D:1,8,15,22) Lenalidomide(28D:1-21) VER 10-3-16 (HL 5249)

CSC HEM Carfilzomib(28D:1,2,8,9,15,16) Dexamethasone Oral(28D:1,8,15,22) Lenalidomide(28D:1-21) VER 10-3-16 (HL 5249) - 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)/DEXAMETHASONE ORAL(28D:1,8,15,22)/LENALIDOMIDE(28D:1-21) 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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S Approximate, Expires-S+365, Routine
BUN
Expected-S Approximate, Expires-S+365, Routine
CREATININE
Expected-S Approximate, Expires-S+365, Routine
CALCIUM
Expected-S Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
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
Take Home Medications (delete all that do not apply)
Recommended Medication
Thrombosis Prophylaxis recommended for all patients.
aspirin 325 MG EC tab
Take 1 tab by mouth one time daily., 325 mg, Disp-30 tab, R-11, 1 X DAILY starting S
enoxaparin (LOVENOX) 40 MG/0.4ML injection
Inject 40 mg under skin one time daily., 40 mg, Disp-30 Syringe, R-11, 1 X DAILY starting S
warfarin (COUMADIN) 5 MG tab
Take 1 tab by mouth one time daily at bedtime., 5 mg, Disp-30 tab, R-11, 1 X DAILY (HS) starting S
Take Home Medications
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
ondansetron (ZOFRAN) 8 MG tab
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 1 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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
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: Niesvizky R, et al. Clin Cancer Res 2013;19(18):2248-56.
Reference Information (2)
MULTIPLE MYELOMA: Jakubowiak AJ, et al. Blood 2012;120(9):1801-09.
Reference Information (3)
MULTIPLE MYELOMA: Stewart AK, et al. N Eng J Med 2015;372(2):142-52
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
Treatment Condition A
CYCLE 1 ONLY: Order Urine Pregnancy Test WEEKLY for females of childbearing potential (Day 1, 8, 15, 22, 29 (Day 1 of next
cycle)).
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 1:23:22 PM Page 2 of 60
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.
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): dexamethasone (dispensed Day 1 of Cycle 1)
and lenalidomide (dispensed Day 1 of each Cycle)
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.
Take Home Medications (delete all that do not apply)
lenalidomide (REVLIMID) 25 MG cap
Take by mouth one time daily. Take on Day 1 through 21., Disp-21 cap, R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 15 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 10 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 5 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
Take Home Medications
dexamethasone (DECADRON) 4 MG tab
Take 40 mg by mouth on Day 22., Disp-10 tab, R-5, starting S
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 3 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Follow-Up
DAY 2 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 8 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium. NOTE: Urine Pregnancy test to be ordered by MD when
required. CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium. NOTE: Urine Pregnancy test to be ordered by MD when
required. 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, Electrolytes, Glucose, BUN,
Creatinine, Calcium, Total Bilirubin, AST and ALT, NOTE: Urine Pregnancy test to be ordered by MD when required;
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
Day 2, Cycle 1 – Planned for 11/22/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 4 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 4 mg
4 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) 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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
Treatment Conditions
Treatment Condition A
CYCLE 1 ONLY: Order Urine Pregnancy Test WEEKLY for females of childbearing potential (Day 1, 8, 15, 22, 29 (Day 1 of next
cycle)).
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 5 of 60
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+6 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+6 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+6 Approximate, Expires-S+365, Routine
BUN
Expected-S+6 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+6 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+6 Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
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.
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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 6 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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 1 – Planned for 11/29/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 7 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 4 mg
4 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 1 – Planned for 12/5/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
Treatment Conditions
Treatment Condition A
CYCLE 1 ONLY: Order Urine Pregnancy Test WEEKLY for females of childbearing potential (Day 1, 8, 15, 22, 29 (Day 1 of next
cycle)).
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 8 of 60
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+6 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+6 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+6 Approximate, Expires-S+365, Routine
BUN
Expected-S+6 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+6 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+6 Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
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.
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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 9 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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 1 – Planned for 12/6/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 10 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 4 mg
4 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 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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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
ELECTROLYTES
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 11 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Expected-S+13 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+13 Approximate, Expires-S+365, Routine
BUN
Expected-S+13 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+13 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+13 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
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
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
Treatment Condition A
CYCLE 2 and greater with IRREGULAR periods: Order Urine Pregnancy test every TWO weeks for females of childbearing potential
with irregular periods on Day 15 and 29 (Day 1 of next cycle);
OR CYCLE 2 and greater with REGULAR periods: Order Urine Pregnancy Test every FOUR weeks for females of childbearing
potential with regular periods on Day 29 (Day 1 of next cycle).
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.
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 1:23:22 PM Page 12 of 60
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): dexamethasone (dispensed Day 1 of Cycle 1)
and lenalidomide (dispensed Day 1 of each Cycle)
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.
Take Home Medications (delete all that do not apply)
lenalidomide (REVLIMID) 25 MG cap
Take by mouth one time daily. Take on Day 1 through 21., Disp-21 cap, R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 15 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 10 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 5 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
Take Home Medications
Recommended Medication
Thrombosis Prophylaxis recommended for all patients.
Follow-Up
DAY 2 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 8 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium. CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for
90 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 90 minutes.
DAY 15 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium. CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for
90 minutes.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 13 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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, Electrolytes, Glucose, BUN,
Creatinine, Calcium, Total Bilirubin, AST and ALT; CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
Day 2, Cycle 2 – Planned for 12/20/2016
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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 4 mg
4 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 1:23:22 PM Page 14 of 60
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
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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+6 Approximate, Expires-S+365, Routine
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 15 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

ELECTROLYTES
Expected-S+6 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+6 Approximate, Expires-S+365, Routine
BUN
Expected-S+6 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+6 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+6 Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
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.
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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 1:23:22 PM Page 16 of 60
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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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 4 mg
4 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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 17 of 60
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
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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
Treatment Conditions
Treatment Condition A
CYCLE 2 and greater with IRREGULAR periods: Order Urine Pregnancy test every TWO weeks for females of childbearing potential
with irregular periods on Day 15 and 29 (Day 1 of next cycle);
OR CYCLE 2 and greater with REGULAR periods: Order Urine Pregnancy Test every FOUR weeks for females of childbearing
potential with regular periods on Day 29 (Day 1 of next cycle).
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.
Pre-Labs
CBC WITH DIFFERENTIAL
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 18 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Expected-S+6 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+6 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+6 Approximate, Expires-S+365, Routine
BUN
Expected-S+6 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+6 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+6 Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
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.
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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 1:23:22 PM Page 19 of 60
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 16, Cycle 2 – Planned for 1/3/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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 4 mg
4 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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 20 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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
ELECTROLYTES
Expected-S+13 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+13 Approximate, Expires-S+365, Routine
BUN
Expected-S+13 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+13 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+13 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+13 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+13 Approximate, Expires-S+365, Routine
ALT/SGPT
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 21 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Expected-S+13 Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
Treatment Condition A
CYCLE 2 and greater with IRREGULAR periods: Order Urine Pregnancy test every TWO weeks for females of childbearing potential
with irregular periods on Day 15 and 29 (Day 1 of next cycle);
OR CYCLE 2 and greater with REGULAR periods: Order Urine Pregnancy Test every FOUR weeks for females of childbearing
potential with regular periods on Day 29 (Day 1 of next cycle).
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.
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 22 of 60
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.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): dexamethasone (dispensed Day 1 of Cycle 1)
and lenalidomide (dispensed Day 1 of each Cycle)
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.
Take Home Medications (delete all that do not apply)
lenalidomide (REVLIMID) 25 MG cap
Take by mouth one time daily. Take on Day 1 through 21., Disp-21 cap, R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 15 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 10 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 5 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
Take Home Medications
Recommended Medication
Thrombosis Prophylaxis recommended for all patients.
Follow-Up
DAY 2 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 8 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium. CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for
60 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 15 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium. 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, Electrolytes, Glucose, BUN,
Creatinine, Calcium, Total Bilirubin, AST and ALT; CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
Day 2, Cycle 3 – Planned for 1/17/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
IV Access
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 23 of 60
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 4 mg
4 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 1:23:22 PM Page 24 of 60
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 8, Cycle 3 – Planned for 1/23/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+6 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+6 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+6 Approximate, Expires-S+365, Routine
BUN
Expected-S+6 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+6 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+6 Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 25 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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.
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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 3 – Planned for 1/24/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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 1:23:22 PM Page 26 of 60
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.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 4 mg
4 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 1:23:22 PM Page 27 of 60
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 3 – Planned for 1/30/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
Treatment Conditions
Treatment Condition A
CYCLE 2 and greater with IRREGULAR periods: Order Urine Pregnancy test every TWO weeks for females of childbearing potential
with irregular periods on Day 15 and 29 (Day 1 of next cycle);
OR CYCLE 2 and greater with REGULAR periods: Order Urine Pregnancy Test every FOUR weeks for females of childbearing
potential with regular periods on Day 29 (Day 1 of next cycle).
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+6 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+6 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+6 Approximate, Expires-S+365, Routine
BUN
Expected-S+6 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+6 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+6 Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Parameters
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 28 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
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.
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 29 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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 4 mg
4 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 1:23:22 PM Page 30 of 60
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.
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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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
ELECTROLYTES
Expected-S+13 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+13 Approximate, Expires-S+365, Routine
BUN
Expected-S+13 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+13 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+13 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
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
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
Treatment Condition A
CYCLE 2 and greater with IRREGULAR periods: Order Urine Pregnancy test every TWO weeks for females of childbearing potential
with irregular periods on Day 15 and 29 (Day 1 of next cycle);
OR CYCLE 2 and greater with REGULAR periods: Order Urine Pregnancy Test every FOUR weeks for females of childbearing
potential with regular periods on Day 29 (Day 1 of next cycle).
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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 31 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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.
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): dexamethasone (dispensed Day 1 of Cycle 1)
and lenalidomide (dispensed Day 1 of each Cycle)
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.
Take Home Medications (delete all that do not apply)
lenalidomide (REVLIMID) 25 MG cap
Take by mouth one time daily. Take on Day 1 through 21., Disp-21 cap, R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 15 MG cap
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 32 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 10 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 5 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
Take Home Medications
Recommended Medication
Thrombosis Prophylaxis recommended for all patients.
Follow-Up
DAY 2 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 8 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium. CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for
60 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 15 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium. 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, Electrolytes, Glucose, BUN,
Creatinine, Calcium, Total Bilirubin, AST and ALT; CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
Day 2, Cycle 4 – Planned for 2/14/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 33 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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 4 mg
4 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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 34 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+6 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+6 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+6 Approximate, Expires-S+365, Routine
BUN
Expected-S+6 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+6 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+6 Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
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.
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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 35 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 36 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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 4 mg
4 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 4 – Planned for 2/27/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 37 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Treatment Conditions
Treatment Condition A
CYCLE 2 and greater with IRREGULAR periods: Order Urine Pregnancy test every TWO weeks for females of childbearing potential
with irregular periods on Day 15 and 29 (Day 1 of next cycle);
OR CYCLE 2 and greater with REGULAR periods: Order Urine Pregnancy Test every FOUR weeks for females of childbearing
potential with regular periods on Day 29 (Day 1 of next cycle).
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+6 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+6 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+6 Approximate, Expires-S+365, Routine
BUN
Expected-S+6 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+6 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+6 Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
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.
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 1:23:22 PM Page 38 of 60
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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 1:23:22 PM Page 39 of 60
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.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 4 mg
4 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 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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
IV Access
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 40 of 60
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+13 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+13 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+13 Approximate, Expires-S+365, Routine
BUN
Expected-S+13 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+13 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+13 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
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
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
Treatment Condition A
CYCLE 2 and greater with IRREGULAR periods: Order Urine Pregnancy test every TWO weeks for females of childbearing potential
with irregular periods on Day 15 and 29 (Day 1 of next cycle);
OR CYCLE 2 and greater with REGULAR periods: Order Urine Pregnancy Test every FOUR weeks for females of childbearing
potential with regular periods on Day 29 (Day 1 of next cycle).
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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 41 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): dexamethasone (dispensed Day 1 of Cycle 1)
and lenalidomide (dispensed Day 1 of each Cycle)
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.
Take Home Medications (delete all that do not apply)
lenalidomide (REVLIMID) 25 MG cap
Take by mouth one time daily. Take on Day 1 through 21., Disp-21 cap, R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 15 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 10 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 5 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
Take Home Medications
Recommended Medication
Thrombosis Prophylaxis recommended for all patients.
Follow-Up
DAY 2 FOLLOW-UP
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 42 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 8 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium. CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for
60 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 15 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium. 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, Electrolytes, Glucose, BUN,
Creatinine, Calcium, Total Bilirubin, AST and ALT; CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
Day 2, Cycle 5 – Planned for 3/14/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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 4 mg
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 43 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

4 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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 44 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+6 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+6 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+6 Approximate, Expires-S+365, Routine
BUN
Expected-S+6 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+6 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+6 Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
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.
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 45 of 60
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
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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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 4 mg
4 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 46 of 60
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 15, Cycle 5 – Planned for 3/27/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
Treatment Conditions
Treatment Condition A
CYCLE 2 and greater with IRREGULAR periods: Order Urine Pregnancy test every TWO weeks for females of childbearing potential
with irregular periods on Day 15 and 29 (Day 1 of next cycle);
OR CYCLE 2 and greater with REGULAR periods: Order Urine Pregnancy Test every FOUR weeks for females of childbearing
potential with regular periods on Day 29 (Day 1 of next cycle).
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 1:23:22 PM Page 47 of 60
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+6 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+6 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+6 Approximate, Expires-S+365, Routine
BUN
Expected-S+6 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+6 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+6 Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
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.
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
carfilzomib (KYPROLIS) 48.4 mg in dextrose 5 % 50 mL bag
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 48 of 60
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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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 4 mg
4 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 49 of 60
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 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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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
ELECTROLYTES
Expected-S+13 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+13 Approximate, Expires-S+365, Routine
BUN
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 50 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Expected-S+13 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+13 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+13 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
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
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
Treatment Condition A
CYCLE 2 and greater with IRREGULAR periods: Order Urine Pregnancy test every TWO weeks for females of childbearing potential
with irregular periods on Day 15 and 29 (Day 1 of next cycle);
OR CYCLE 2 and greater with REGULAR periods: Order Urine Pregnancy Test every FOUR weeks for females of childbearing
potential with regular periods on Day 29 (Day 1 of next cycle).
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.
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 1:23:22 PM Page 51 of 60
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): dexamethasone (dispensed Day 1 of Cycle 1)
and lenalidomide (dispensed Day 1 of each Cycle)
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.
Take Home Medications (delete all that do not apply)
lenalidomide (REVLIMID) 25 MG cap
Take by mouth one time daily. Take on Day 1 through 21., Disp-21 cap, R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 15 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 10 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
lenalidomide (REVLIMID) 5 MG cap
Take by mouth one time daily. Take on Day 1 through 21., R-0, 1 X DAILY starting S, Local Printer
Verify compliance with Revlimid REMS Program. Indication is Cancer Treatment. Pharmacist will coordinate drug ordering.
Take Home Medications
Recommended Medication
Thrombosis Prophylaxis recommended for all patients.
Follow-Up
DAY 2 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 8 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium. CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for
60 minutes.
DAY 9 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
DAY 15 FOLLOW-UP
LABS: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium. 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, Electrolytes, Glucose, BUN,
Creatinine, Calcium, Total Bilirubin, AST and ALT; CHEMOTHERAPY ROOM APPOINTMENT: carfilzomib for 60 minutes.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 52 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Day 2, Cycle 6 – Planned for 4/11/2017
Treatment Plan Information
Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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 4 mg
4 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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 53 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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 = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+6 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+6 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+6 Approximate, Expires-S+365, Routine
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 54 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

BUN
Expected-S+6 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+6 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+6 Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
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.
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 55 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory);
THERAPY: carfilzomib 20 mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone
40 mg by mouth Days 1, 8, 15 and 22, lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE
LENGTH: 28 days; COURSE: 1 cycle followed by: THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16,
dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide 5 to 25 mg by mouth once daily Days 1
through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE: Thrombosis prophylaxis
recommended for all patients.
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 4 mg
4 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
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 56 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

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
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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.
Treatment Conditions
Treatment Condition A
CYCLE 2 and greater with IRREGULAR periods: Order Urine Pregnancy test every TWO weeks for females of childbearing potential
with irregular periods on Day 15 and 29 (Day 1 of next cycle);
OR CYCLE 2 and greater with REGULAR periods: Order Urine Pregnancy Test every FOUR weeks for females of childbearing
potential with regular periods on Day 29 (Day 1 of next cycle).
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+6 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+6 Approximate, Expires-S+365, Routine
GLUCOSE
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 57 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Expected-S+6 Approximate, Expires-S+365, Routine
BUN
Expected-S+6 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+6 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+6 Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL or Platelets less than 50K/µL.
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.
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
dexamethasone (DECADRON) tab 40 mg
40 mg, Oral, ONCE, 1 dose Starting when released
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 6 – Planned for 4/25/2017
Treatment Plan Information
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 58 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Treatment Plan Summary
MAXIMUM BSA = 2.2m2 (per physician discretion); DISEASE: Multiple Myeloma (Relapsed/Refractory); THERAPY: carfilzomib 20
mg/m2 IV Days 1, 2 and carfilzomib 27 mg/m2 IV Days 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22,
lenalidomide 5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: 1 cycle followed by:
THERAPY: carfilzomib 27 mg/m2 IV Days 1, 2, 8, 9, 15 and 16, dexamethasone 40 mg by mouth Days 1, 8, 15 and 22, lenalidomide
5 to 25 mg by mouth once daily Days 1 through 21; CYCLE LENGTH: 28 days; COURSE: until disease progression. NOTE:
Thrombosis prophylaxis recommended for all patients.
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 4 mg
4 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 1:23:22 PM Page 59 of 60
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.
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ZZtestonc,Andrew [2428787]
11/21/2016 1:23:22 PM Page 60 of 60
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org