PEMIVIBART (PEMGARDA)		version 6/26/2024		

Appointment Requests 	

	
	Interval	Defer Until	Duration	
	☑	Referral to IV Infusion Room	Every 12 weeks	S	Until discont'd	
		Status: Future, Expected: S, Expires: S+365, Clinic Performed
	Urgency of Scheduling: Routine		

Medications 	

	
	Interval	Defer Until	Duration	
	☑	pemivibart 4.5 g in sodium chloride 0.9% 50 mL IVPB	Every 12 weeks	S	1 treatment	
		4.5 g, intravenous, Administer over: 60 Minutes, once, Starting when released
	1.     Discontinue medication, contact provider, and administer emergency medications if patient complains of any of the following: pruritus, flushing, urticaria, erythema, angioedema, diaphoresis, dizziness, tinnitus, wheezing, dyspnea, chest discomfort, and tachycardia
	2.     Attach infusion set including inline 0.2-micron filter to prepared IV bag, then prime the infusion set
	3.     Administer the entire 50 mL infusion using infusion pump or gravity infusion set over a minimum of 60 minutes and administer entire contents of prepared IV bag
	4.     Once infusion is complete, flush line with NS 
	5.     Clinically monitor patients during infusion and observe patients for at least 2 hours after infusion is complete
	Administer entire contents of prepared bag by IV infusion over 60 minutes, using an infusion set containing an inline 0.2-micron filter 

	

Nursing Orders 	

	
	Interval	Defer Until	Duration	
	☑	Nursing communication	Every visit	S	Until discont'd	
		Prior to infusion, assess patient to ensure still meets emergency use authorization (EUA) criteria.  Provide patient with a copy of the "Fact Sheet for Patients, Parents, and Caregivers."		
	☑	Vital signs - T/P/R/BP	Every visit	S	Until discont'd	
		Clinic Performed, Normal
	Clinic performed; Before the infusion and every hour for 3 hours		
	☑	Nursing communication	Every visit	S	Until discont'd	
		Monitor patient  for 2 hours post-infusion for signs of REACTION.		

Emergency Medications 	

	
	Interval	Defer Until	Duration	
	☑	acetaminophen (TYLENOL) tablet 650 mg	Every visit	S	Until discont'd	
		650 mg, oral, PRN, mild pain (score 1-3), headaches, fever, Starting when released, Until Discontinued
	Maximum of 4g per day of APAP from all sources
	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	Every visit	S	Until discont'd	
		25 mg, oral, PRN, itching, Hives, Starting when released, Until Discontinued		
	☑	albuterol sulfate (PROVENTIL) nebulizer solution 2.5 mg	Every visit	S	Until discont'd	
		2.5 mg, nebulization, every 4 hours PRN, wheezing, shortness of breath, Starting when released, Until Discontinued		
	☑	dexAMETHasone (DECADRON) IV 4 mg	Every visit	S	Until discont'd	
		4 mg, intravenous, PRN, For Hypersensitivity, Starting when released, Until Discontinued		
	☑	epINEPHrine (ADRENALIN) 1 mg/mL vial 0.5 mg	Every visit	S	Until discont'd	
		0.5 mg, intramuscular, PRN, anaphylaxis, Starting when released, Until Discontinued