/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/beacon-protocols/,/clinical/cckm-tools/content/beacon-protocols/melanoma/,

/clinical/cckm-tools/content/beacon-protocols/melanoma/name-96984-en.cckm

201611333

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UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Beacon Protocols,Melanoma

CSC Melanoma Trametinib(28D:1-28) VER 10-3-16 (HL 5360)

CSC Melanoma Trametinib(28D:1-28) VER 10-3-16 (HL 5360) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Melanoma


CSC MELANOMA TRAMETINIB (28D:1-28) VER: 10-3-16 – Properties
Pre-Cycle – 11/21/2016 through 11/27/2016 (7 days), Planned
Day 1, Pre-Cycle – Planned for 11/21/2016
Treatment Plan Information
Treatment Plan Summary
DISEASE: Metastatic Melanoma (Advanced, BRAF V600E or BRAF V600K mutation); THERAPY: trametinib 2 mg by mouth once
daily continuously; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential should use a
highly effective contraceptive during therapy and for 4 months after treatment is complete.
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
AST/SGOT
Expected-S Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S Approximate, Expires-S+365, Routine
Pre-Labs (delete all that do not apply)
HCG, QUALITATIVE
Expected-S Approximate, Expires-S+365, Routine
Treatment Conditions
Treatment Condition A
Verify patient has obtained pretreatment ECG and MUGA or ECHO.
Cycle 1 – 11/28/2016 through 12/25/2016 (28 days), Planned
Day 1, Cycle 1 – Planned for 11/28/2016
Treatment Plan Information
Reference Information (1)
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ZZtestonc,Andrew [2428787]
11/28/2016 3:54:00 PM Page 1 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

MELANOMA: Flaherty KT, el at. N Engl J Med 2012;367(2):107-14.
Treatment Plan Summary
DISEASE: Metastatic Melanoma (Advanced, BRAF V600E or BRAF V600K mutation); THERAPY: trametinib 2 mg by mouth once
daily continuously; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential should use a
highly effective contraceptive during therapy and for 4 months after treatment is complete.
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
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for temperature greater than 101.3 F or ANC less than 1000/uL or Creatinine rise of
greater than 0.5 mg/dL above baseline or Creatinine greater than 2 mg/dL or visual disturbances or pulmonary toxicity or diarrhea.
Treatment Condition A
Verify patient has obtained pretreatment ECG and MUGA or ECHO.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate patient to take trametinib 1 hour before or 2 hours after a meal. Do not take a missed dose within 12 hours of the next dose.
Patient Instructions(2)
Educate patient regarding risk of diarrhea, rash, and visual disturbances with trametinib.
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.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): trametinib (dispensed on Day 1 of Cycle 1 only
- subsequent refills will be ordered through the medication activity).
Take Home Medications
trametinib dimethyl sulfoxide (MEKINIST) 2 MG tab
Take 1 tab by mouth one time daily. Take on empty stomach, 1 hour before or 2 hours after a meal., 2 mg, Disp-30 tab, R-0, 1 X
DAILY starting S
Follow-Up
DAY 29 FOLLOW-UP
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ZZtestonc,Andrew [2428787]
11/28/2016 3:54:00 PM Page 2 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN,
Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH; PROCEDURE: ECG and ECHO or MUGA.
Cycle 2 – 12/26/2016 through 1/22/2017 (28 days), Planned
Day 1, Cycle 2 – Planned for 12/26/2016
Treatment Plan Information
Treatment Plan Summary
DISEASE: Metastatic Melanoma (Advanced, BRAF V600E or BRAF V600K mutation); THERAPY: trametinib 2 mg by mouth once
daily continuously; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential should use a
highly effective contraceptive during therapy and for 4 months after treatment is complete.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
BUN
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for temperature greater than 101.3 F or ANC less than 1000/uL or Creatinine rise of
greater than 0.5 mg/dL above baseline or Creatinine greater than 2 mg/dL or visual disturbances or pulmonary toxicity or diarrhea.
Treatment Condition A
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ZZtestonc,Andrew [2428787]
11/28/2016 3:54:00 PM Page 3 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Verify patient has obtained pretreatment ECG and MUGA or ECHO.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor patient for complaints of visual disturbances due to trametinib and need for ophthalmological evaluation.
Monitoring Parameters (2)
Monitor patient for signs and symptoms of pulmonary toxicity (cough, dyspnea, hypoxia, pleural effusion, or infiltrates) due to
trametinib.
Patient Instructions(1)
Educate patient to take trametinib 1 hour before or 2 hours after a meal. Do not take a missed dose within 12 hours of the next dose.
Patient Instructions(2)
Educate patient regarding risk of diarrhea, rash, and visual disturbances with trametinib.
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.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, trametinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN,
Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH.
Cycle 3 – 1/23/2017 through 2/19/2017 (28 days), Planned
Day 1, Cycle 3 – Planned for 1/23/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Metastatic Melanoma (Advanced, BRAF V600E or BRAF V600K mutation); THERAPY: trametinib 2 mg by mouth once
daily continuously; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential should use a
highly effective contraceptive during therapy and for 4 months after treatment is complete.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
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ZZtestonc,Andrew [2428787]
11/28/2016 3:54:00 PM Page 4 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
BUN
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for temperature greater than 101.3 F or ANC less than 1000/uL or Creatinine rise of
greater than 0.5 mg/dL above baseline or Creatinine greater than 2 mg/dL or visual disturbances or pulmonary toxicity or diarrhea.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor patient for complaints of visual disturbances due to trametinib and need for ophthalmological evaluation.
Monitoring Parameters (2)
Monitor patient for signs and symptoms of pulmonary toxicity (cough, dyspnea, hypoxia, pleural effusion, or infiltrates) due to
trametinib.
Patient Instructions(1)
Educate patient to take trametinib 1 hour before or 2 hours after a meal. Do not take a missed dose within 12 hours of the next dose.
Patient Instructions(2)
Educate patient regarding risk of diarrhea, rash, and visual disturbances with trametinib.
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.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, trametinib will be ordered through the medication activity after the initial order.
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ZZtestonc,Andrew [2428787]
11/28/2016 3:54:00 PM Page 5 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN,
Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH; PROCEDURE (every other Cycle): ECG and ECHO or MUGA.
Cycle 4 – 2/20/2017 through 3/19/2017 (28 days), Planned
Day 1, Cycle 4 – Planned for 2/20/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Metastatic Melanoma (Advanced, BRAF V600E or BRAF V600K mutation); THERAPY: trametinib 2 mg by mouth once
daily continuously; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential should use a
highly effective contraceptive during therapy and for 4 months after treatment is complete.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
BUN
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine.
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ZZtestonc,Andrew [2428787]
11/28/2016 3:54:00 PM Page 6 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Treatment Parameters
Hold treatment and notify authorizing prescriber for temperature greater than 101.3 F or ANC less than 1000/uL or
Creatinine rise of greater than 0.5 mg/dL above baseline or Creatinine greater than 2 mg/dL or visual disturbances
or pulmonary toxicity or diarrhea.
Treatment Condition A
Verify patient has obtained pretreatment ECG and MUGA or ECHO obtained every 2 to 3 Cycles beginning Cycle 2.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor patient for complaints of visual disturbances due to trametinib and need for ophthalmological evaluation.
Monitoring Parameters (2)
Monitor patient for signs and symptoms of pulmonary toxicity (cough, dyspnea, hypoxia, pleural effusion, or infiltrates) due to
trametinib.
Patient Instructions(1)
Educate patient to take trametinib 1 hour before or 2 hours after a meal. Do not take a missed dose within 12 hours of the next dose.
Patient Instructions(2)
Educate patient regarding risk of diarrhea, rash, and visual disturbances with trametinib.
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.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, trametinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN,
Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH; PROCEDURE (every other Cycle): ECG and ECHO or MUGA.
Cycle 5 – 3/20/2017 through 4/16/2017 (28 days), Planned
Day 1, Cycle 5 – Planned for 3/20/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Metastatic Melanoma (Advanced, BRAF V600E or BRAF V600K mutation); THERAPY: trametinib 2 mg by mouth once
daily continuously; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential should use a
highly effective contraceptive during therapy and for 4 months after treatment is complete.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
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ZZtestonc,Andrew [2428787]
11/28/2016 3:54:00 PM Page 7 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
BUN
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for temperature greater than 101.3 F or ANC less than 1000/uL or Creatinine rise of
greater than 0.5 mg/dL above baseline or Creatinine greater than 2 mg/dL or visual disturbances or pulmonary toxicity or diarrhea.
Treatment Condition A
Verify patient has obtained pretreatment ECG and MUGA or ECHO obtained every 2 to 3 Cycles beginning Cycle 2.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor patient for complaints of visual disturbances due to trametinib and need for ophthalmological evaluation.
Monitoring Parameters (2)
Monitor patient for signs and symptoms of pulmonary toxicity (cough, dyspnea, hypoxia, pleural effusion, or infiltrates) due to
trametinib.
Patient Instructions(1)
Educate patient to take trametinib 1 hour before or 2 hours after a meal. Do not take a missed dose within 12 hours of the next dose.
Patient Instructions(2)
Educate patient regarding risk of diarrhea, rash, and visual disturbances with trametinib.
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]
11/28/2016 3:54:00 PM Page 8 of 10
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.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, trametinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN,
Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH; PROCEDURE (every other Cycle): ECG and ECHO or MUGA.
Cycle 6 – 4/17/2017 through 5/14/2017 (28 days), Planned
Day 1, Cycle 6 – Planned for 4/17/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Metastatic Melanoma (Advanced, BRAF V600E or BRAF V600K mutation); THERAPY: trametinib 2 mg by mouth once
daily continuously; CYCLE LENGTH: 28 days; COURSE: until disease progression.
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential should use a
highly effective contraceptive during therapy and for 4 months after treatment is complete.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S+28 Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S+28 Approximate, Expires-S+365, Routine
BUN
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
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ZZtestonc,Andrew [2428787]
11/28/2016 3:54:00 PM Page 9 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for temperature greater than 101.3 F or ANC less than 1000/uL or Creatinine rise of
greater than 0.5 mg/dL above baseline or Creatinine greater than 2 mg/dL or visual disturbances or pulmonary toxicity or diarrhea.
Treatment Condition A
Verify patient has obtained pretreatment ECG and MUGA or ECHO obtained every 2 to 3 Cycles beginning Cycle 2.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor patient for complaints of visual disturbances due to trametinib and need for ophthalmological evaluation.
Monitoring Parameters (2)
Monitor patient for signs and symptoms of pulmonary toxicity (cough, dyspnea, hypoxia, pleural effusion, or infiltrates) due to
trametinib.
Patient Instructions(1)
Educate patient to take trametinib 1 hour before or 2 hours after a meal. Do not take a missed dose within 12 hours of the next dose.
Patient Instructions(2)
Educate patient regarding risk of diarrhea, rash, and visual disturbances with trametinib.
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.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, trametinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose, BUN,
Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH; PROCEDURE (every other Cycle): ECG and ECHO or MUGA.
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ZZtestonc,Andrew [2428787]
11/28/2016 3:54:00 PM Page 10 of 10
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Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org