Unique Plan Description: GYNONC Enhertu (fam-trastuzumab deruxtecan-nxki) (MH)
Plan Selection Display: GYNONC Enhertu (fam-trastuzumab deruxtecan-nxki) (MH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2026-07-09 23:03:25
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2026-07-21 15:05:33
Available at all facilities: No

GYNONC Enhertu (fam-trastuzumab deruxtecan-nxki) (
IV Solutions
Chemotherapy PreHydration
	Dextrose 5% in Water IVPB
		100 mL, IVPB, Once, 20 ml/hr
			Comment: Infuse at a rate of 20ml/hr. In Infusion Center
Premeds
	palonosetron/dexamethasone/NS 50mL
		50 mL, EVERY BAG
		0.25 mg, IVPB, Once, infuse over 15 min(s), T;N+30
			Comment: 30 min prior to chemotherapy
		12 mg, EVERY BAG
	fosaprepitant
		150 mg, INT, IVPB, Once, infuse over 30 min(s), T;N+30
			Comment: 30 minutes prior to chemotherapy
	Ativan
		0.5 mg, Tab, BY MOUTH, Once, PRN for anxiety, duration: 1 Dose(s)/Time(s)
			Comment: Give prior to chemotherapy.
		1 mg, Tab, BY MOUTH, Once, PRN for anxiety, duration: 1 Dose(s)/Time(s)
			Comment: Give prior to chemotherapy.
	ondansetron/dexamethasone/NS 50mL
		16 mg, IVPB, Once, Routine, infuse over 15 min(s), 200 ml/hr, T;N+30
			Comment: 30 min prior to chemotherapy
		50 mL, EVERY BAG
		12 mg, EVERY BAG
Chemotherapy Agent
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	Enhertu/D5W 100 mL
		10 mL, EVERY BAG
		5.4 mg/kg, IVPB, Once, infuse over 90 min(s), T;N+60
			Comment: Administer the first infusion over 90 minutes. Infuse with a 0.2-micron filter. DO NOT mix with NS. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: chemo gown, double gloves, face mask, eye protection
		100 mL, EVERY BAG
		4.4 mg/kg, IVPB, Once, infuse over 90 min(s), T;N+60
			Comment: Administer the first infusion over 90 minutes. Infuse with a 0.2-micron filter. DO NOT mix with NS. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: chemo gown, double gloves, face mask, eye protection
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		100 mL, EVERY BAG
		3.2 mg/kg, IVPB, Once, infuse over 90 min(s), T;N+60
			Comment: Administer the first infusion over 90 minutes. Infuse with a 0.2-micron filter. DO NOT mix with NS. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: chemo gown, double gloves, face mask, eye protection
		10 mL, EVERY BAG
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		100 mL, EVERY BAG
		5.4 mg/kg, IVPB, Once, infuse over 30 min(s), T;N+60
			Comment: Administer the first infusion over 90 minutes. Infuse with a 0.2-micron filter. DO NOT mix with NS. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: chemo gown, double gloves, face mask, eye protection
		10 mL, EVERY BAG
		4.4 mg/kg, IVPB, Once, infuse over 30 min(s), T;N+60
			Comment: Administer the first infusion over 90 minutes. Infuse with a 0.2-micron filter. DO NOT mix with NS. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: chemo gown, double gloves, face mask, eye protection
		100 mL, EVERY BAG
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		10 mL, EVERY BAG
		3.2 mg/kg, IVPB, Once, infuse over 30 min(s), T;N+60
			Comment: Administer the first infusion over 90 minutes. Infuse with a 0.2-micron filter. DO NOT mix with NS. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: chemo gown, double gloves, face mask, eye protection
Medications

Patient Care
	Notify MD
		T;N, Contact Provider for further orders if allergic reaction protocol initiated
	Initiate MD Plan for:
		T;N, Allergy Reaction protocol if patient experiences reaction to treatment

CHEMO Reaction Protocol
Vital Signs
	Vital Signs
		Assess vital signs every 2 to 5 minutes until the patient is stable. Place patient into a recumbent position with elevation of the lower extremities if hypotensive
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		Reassess vital signs every 15 minutes x 2, then q30min x 2, or more frequently as needed, I&O, etc until stable
Activity
	Position Patient
		T;N
			Comment: If hypotensive, keep patient supine with legs elevated or bed in Trendelenburg.
IV Solutions
	Sodium Chloride 0.9% IVPB
		500 mL, IV Large Volume, IVPB, DAILY, PRN for see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
		1,000 mL, IV Large Volume, IVPB, DAILY, PRN for see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
Medications
	Benadryl
		50 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give at first sign of hypersensitivity reaction; symptoms may include: hives, rash, itching, and/or facial flushing.
		25 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give at first sign of hypersensitivity reaction; symptoms may include: hives, rash, itching, and/or facial flushing.
	Decadron (MH/WH)
		20 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give 1-2 minutes after diphenhydramine if no improvement or if symptoms worsen to include: hypotension, shortness of breath, facial/lip/tongue swelling, and/or any other signs /symptoms of a severe allergic reaction.
	SOLU-Medrol
		125 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give if dexamethasone unavailable or ineffective and additional steroids are needed, per provider.
	EPINEPHrine
		0.5 mg, Injection, IM-Intramuscular, DAILY, PRN for see comment
			Comment: Give immediately for airway obstruction/anaphylaxis reaction. Or give for hypersensitivity reaction not resolved by diphenhydramine and steroids. May repeat every 10 minutes for up to 3 doses.
		0.5 mg, Injection, SUBCUTANEOUS, DAILY, PRN for see comment
			Comment: Give immediately for airway obstruction/anaphylaxis reaction. Or give for hypersensitivity reaction not resolved by diphenhydramine and steroids. May repeat every 10 minutes for up to 3 doses.
	meperidine
		25 mg, Syringe, IV Push, Once, PRN for see comment
			Comment: For chills and rigors
	morphine  IV
		2 mg, Syringe, IV PUSH, Once, PRN for see comment
			Comment: For chills and rigors
Patient Care
	Notify MD
		T;N, Contact the oncologist if any of the reaction protocol medications are administered to the patient.

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase