Unique Plan Description: ONC Dara-Vd
Plan Selection Display: ONC Dara-Vd
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2026-04-06 09:05:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2026-04-06 09:05:35
Available at all facilities: Yes

ONC Dara-Vd
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
		T+1;0400, Routine, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
		T+1;0400, Routine, Q24H, spec type = Blood
	Uric Acid
		T+1;0400, Routine, spec type = Blood
	Urinalysis
		T;N, Stat, Stat, spec type = Urine
	Pregnancy Test Urine
		T;N, Stat, Stat, Urine Random, spec type = Urine
IV Solutions
	Dextrose 5% in water Chemo flush
		25 mL, IVPB, Q1H, PRN IV line flush, 200 ml/hr
			Comment: To be used for chemo primary line flush bag. Use with cyclophosphamide. Flush line with 25mL at 200mL/hr after each chemo dose.
Medications
	prochlorperazine
		10 mg, Tab, By Mouth, Q8H, PRN nausea and/or vomiting
		10 mg, Injection, IV Push, Q8H, PRN nausea and/or vomiting
			Comment: if unable to take PO
		Option to add ondansetron if prochlorperazine ineffective.(NOTE)*
	ondansetron
		8 mg, Tablet-Disintegrating, By Mouth, Q8H, PRN nausea and/or vomiting
			Comment: if prochlorperazine ineffective
		8 mg, Injection, IV Push, Q8H, PRN nausea and/or vomiting
			Comment: if prochlorperazine ineffective and unable to take PO
Premeds
	acetaminophen
		1,000 mg, Tab, By Mouth, Once, T;N+30
			Comment: give 60 minutes prior to daratumumab/hyaluronidase
		650 mg, Tab, By Mouth, Once, T;N+30
			Comment: give 60 minutes prior to daratumumab/hyaluronidase
	diphenhydrAMINE
		50 mg, Injection, IV Push, Once, T;N+30
			Comment: give 60 minutes prior to daratumumab/hyaluronidase
		25 mg, Injection, IV Push, Once, T;N+30
			Comment: give 60 minutes prior to daratumumab/hyaluronidase
Chemotherapy Agent
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	daratumumab-hyaluronidase-fihj
		1,800 mg, Injection, SUBCUTANEOUS, Once, T;N+90
			Comment: Premedicate with acetaminophen, diphenhydramine, and a steroid 1-3 hours prior to administration. Administer into the subcutaneous tissue of the abdomen over 3-5 minutes.
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	bortezomib
		1.3 mg/m2, Injection, SUBCUTANEOUS, Once, T;N+90
			Comment: Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection
		1.5 mg/m2, Injection, SUBCUTANEOUS, Once, T;N+90
			Comment: Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection
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	dexAMETHasone
		20 mg, Tab, By Mouth, DAILY, T;N+30, duration: 2 Dose(s)/Time(s)
			Comment: Give daily for two days. Administer 60 minutes prior to daratumumab/hyaluronidase when given on the same day.
	dexamethasone IVPB
		20 mg, IVPB, DAILY, T;N+30, duration: 2 Dose(s)/Time(s)
			Comment: If PO not appropriate. Give daily for two days. Administer 60 minutes prior to daratumumab/hyaluronidase when given on the same day.
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	cycloPHOSphamide
		300 mg/m2, Capsule, By Mouth, Once, T;N+90
			Comment: 25mg and 50mg capsules available, round dose appropriately. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: double gloves for intact capsule
	cyclophosphamide/D5W 250mL
		300 mg/m2, IVPB, Once, T;N+90, Infuse Over 30 min(s)
			Comment: If PO not appropriate. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection
		25 mL, EVERY BAG
		250 mL, EVERY BAG
Miscellaneous
Patient Care

	Obtain Consent/Permit for:
		T;N, or verify Consent for Chemotherapy
	Hazardous Drug Precautions
		T;N
	IV-Maintain
		T;N
			Comment: insure 2 means of vascular access
	Oral Care
		BID
			Comment: Strict oral care
	Notify MD
		T;N, Any abnormal baseline vital signs or Symptoms of moderate to severe reaction or severe hypersensitivity.
		T;N, Contact Provider for further orders if allergic reaction protocol initiated.
	Initiate MD Plan for:
		T;N, Chemo Reaction protocol if patient experiences reaction to treatment
Consults/Follow-up
	Pharmacy Consult
		Pharmacist allowed to round doses to nearest measurable volume (0.1 mL) and/or vial size if dose change is not greater than 5% of original calculated dose.

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