PEGLOTICASE (KRYSTEXXA) INFUSION		version 2/27/2025		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Every 2 weeks	S	26 treatments	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Labs 	

	
	Interval	Defer Until	Duration	
	☐	CBC with platelet and differential	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Comprehensive metabolic panel	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		
	☐	Uric acid level	Every visit	S	Until discont'd	
		STAT, Normal, Clinic Collect		

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☐	Insert Peripheral IV or Access Portacath	Every visit	S	Until discont'd	
		No details available for preview		
	☐	Vital signs - T/P/R/BP Per Unit Protocol	Every visit	S	Until discont'd	
		Obtain vital signs every 15 minutes throughout infusion and hydration.  Monitor temperature every 30 minutes during infusion.  Observe patient for 60 minutes following infusion.  Instruct patient to report symptoms of chills, SOB, itching, or pain.		
	☐	Nursing communication: Monitor patient for any signs of MINOR INFUSION REACTION	Every visit	S	Until discont'd	
		Monitor patient for signs of infusion reaction. For MINOR INFUSION REACTIONS: fever, chills, pruritis, urticaria, chest pain, mild hypotension, hypertension, or mild dyspnea. Take the following steps: Stop or SLOW infusion rate by 50%. If symptoms do not resolve within 5-10 minutes, give supportive/emergency medications as ordered, and notify MD. When symptoms resolve, restart medication at 25% of the original rate. After 15-30 minutes gently increase rate and monitor closely until completion.		
	☐	Nursing communication: Monitor patient for signs of SEVERE INFUSION REACTION	Every visit	S	Until discont'd	
		Monitor patient for signs of infusion reaction. For SEVERE INFUSION REACTIONS: severe dyspnea, wheezing, stridor, angioedema, or marked hypotension, Take the following steps: STOP INFUSION, and start Normal Saline IV bolus (as ordered), Notify physician and administer emergency medications (as ordered). Monitor vital signs. Consult physician for further orders.		
	☐	sodium chloride 0.9% flush 10 mL	Every visit	S	Until discont'd	
		10 mL, intravenous, PRN, line care, Starting when released, for 10 doses		
	☐	sodium chloride 0.9% infusion 250 mL	Every visit	S	Until discont'd	
		250 mL, intravenous, at 30 mL/hr, PRN, Flush bag, Starting when released, Until Discontinued		
	☐	Discontinue IV	Every visit	S	Until discont'd	
		No details available for preview		

Pre-Medications 	

	
	Interval	Defer Until	Duration	
	☐	acetaminophen (TYLENOL) tablet 1,000 mg	Every visit	S	Until discont'd	
		1,000 mg, oral, once, Starting when released
	Administer 30 minutes before infusion.
	Maximum of 4 grams of acetaminophen per day from all sources. (Cirrhosis patients maximum: 2 grams per day from all sources).		
	☐	diphenhydrAMINE (BENADRYL) capsule 50 mg	Every visit	S	Until discont'd	
		50 mg, oral, once, Starting when released
	Administer 30 minutes before infusion.		
	☐	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 125 mg	Every visit	S	Until discont'd	
		125 mg, intravenous, once, Starting when released
	Administer 30 minutes before infusion.		

Medications 	

	
	Interval	Defer Until	Duration	
	☐	pegloticase (KRYSTEXXA) 8 mg in sodium chloride 0.9% 250 mL IVPB	Every 2 weeks	S	26 treatments	
		8 mg, intravenous, Administer over: 120 Minutes, 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