DENOSUMAB (XGEVA) INJECTION		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Every 4 weeks	S	 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Provider Communication 	

	
	Interval	Defer Until	Duration	
	☐	Provider communication	Every visit	S	Until discont'd	
		Add Phosphorus and Magnesium in patients with history of hypoparathyroidism, thyroid surgery, parathyroid surgery, malabsorption.		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	Vitamin D 25 hydroxy level	Once	S	1 treatment	
		STAT, Normal, Clinic Collect		
	☐	Basic metabolic panel	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Albumin level	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	hCG qualitative, urine screen	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Ionized calcium	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every visit	S	Until discont'd	
		Instruct patient to report symptoms of chills, fever or pain.		
	☐	Nursing communication	Every visit	S	Until discont'd	
		o Verify lab results within last 14 days: Serum Ca2+. 
	o Notify provider if corrected Ca level is LESS than or EQUAL to 8.5.
	o HOLD for ionized calcium  LESS than 1.11 mmol/L or LESS than 4.7 mg/dL.		
	☐	Nursing communication	Every visit	S	Until discont'd	
		Proceed with treatment prior to Vitamin D resulting.		
	☐	Nursing communication	Every visit	S	Until discont'd	
		Verify patient is on calcium and vitamin D supplementation. Notify provider if the patient is not on calcium and vitamin D supplementation or the patient's calcium level is outside the normal range.		
	☐	Nursing communication: Monitor patient for signs of infusion reaction.  If patient has infusion reaction, stop infusion, notify physician, and administer emergency medications as ordered	Every visit	S	Until discont'd	
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Medications 	

	
	Interval	Defer Until	Duration	
	☐	denosumab (XGEVA) injection 120 mg	Every 4 weeks	S	Until discont'd	
		120 mg, subcutaneous, once, Starting when released		

Hypersensitivity 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 650 mg	PRN	S	Until discont'd	
		650 mg, oral, every 4 hours PRN, mild pain (score 1-3), Starting when released, Until Discontinued
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	diphenhydrAMINE (BENADRYL) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, itching, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 25 mg	PRN	S	Until discont'd	
		25 mg, intravenous, once PRN, for minor infusion reaction, Starting when released, Until Discontinued		
	☐	diphenhydrAMINE (BENADRYL) injection 50 mg	PRN	S	Until discont'd	
		50 mg, intravenous, once PRN, for severe infusion reaction, Starting when released, Until Discontinued		
	☐	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.5 mg	PRN	S	Until discont'd	
		0.5 mL, subcutaneous, once PRN, anaphylaxis, Starting when released, Until Discontinued		
	☐	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	PRN	S	Until discont'd	
		100 mg, intravenous, once PRN, for infusion reaction, Starting when released, Until Discontinued		
	☐	promethazine (PHENERGAN) tablet 25 mg	PRN	S	Until discont'd	
		25 mg, oral, every 6 hours PRN, nausea, vomiting, Starting when released, Until Discontinued		
	☐	sodium chloride 0.9% infusion 250 mL	PRN	S	Until discont'd	
		250 mL, intravenous, once PRN, Hydration, Starting when released, Until Discontinued