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76 year-old male with significant cardiac history, including NSTEMI and asystole arrest, presented with weakness, dizziness, and chest pain for 3 days, currently chest pain-free. EKG on admission showed subtle changes with <1 mm ST depression in lateral leads. Patient was given Acetylsalicylic Acid 325 mg PO QD, Ativan 0.5 mg x 1, Magnesium Chloride 500 mg x 1, Atenolol 25 mg PO QD, Atorvastatin 80 mg PO QD, Docusate Sodium 100 mg PO BID, Losartan 50 mg PO QD, Amlodipine 10 mg PO QD, Pantoprazole 40 mg PO QD, Lipitor (Atorvastatin) 80 mg PO daily, Colace (Docusate Sodium) 100 mg PO BID, Potassium Chloride IV, Potassium Chloride Immediate Release PO, Magnesium Gluconate (Magnesium Gluconate) 400 mg PO daily, Protonix (Pantoprazole) 40 mg PO daily, ASA 325 mg x 1, and MIBI ordered. Metformin was held and DM protocol was instituted while in house. Patient was at risk for cardiac event and was treated with BB and titrated as tolerated, with Tele monitoring. Nutrition consult was ordered due to recent decrease in appetite and FTT picture. SW was consulted and patient was discussed at length for services at home when discharged. Patient left AMA despite lengthy discussion about his health and risk for MI/death. Number of Doses Required (approximate): 3 for MG GLUCONATE (MAGNESIUM GLUCONATE) and 2 for TERAZOSIN HCL 1 MG PO DAILY. Home meds included ASA 325 mg daily, lipitor 80 mg daily, amlodipine 5 mg daily, protonix 40 mg daily, losartan 50 mg daily, and terazosin 1 mg daily. An override was added on 7/10/07 by KETCHAM, JAKE WALDO, M.D., PH.D. on order for KCL IV (ref # 687673059) with POTENTIALLY SERIOUS INTERACTION: LOSARTAN POTASSIUM & POTASSIUM CHLORIDE Reason for override: md aware, and on 11/8/07 by DERNIER, AUGUSTINE A., P.A.-C. on order for KCL IMMEDIATE RELEASE PO (ref # 856712835) with the same POTENTIALLY SERIOUS INTERACTION. Patient was instructed to resume regular exercise and to avoid grapefruit unless instructed otherwise. He was also given a diet of House/2gm Na/Carbohydrate Controlled/Low saturated fat low cholesterol.
|
Is there a mention of of amlodipine usage/prescription in the record
|
{
"answer_end": [
488
],
"answer_start": [
465
],
"text": [
"Amlodipine 10 mg PO QD,"
]
}
|
Mr. Lewter is a 65-year-old gentleman with a history of non-insulin-dependent diabetes mellitus, hypertension, dyslipidemia, and peripheral vascular disease who presented to Tci Prosamp Memorial Hospital on 5/1/06 with unstable angina. EKG revealed sinus tachycardia with a new incomplete left bundle-branch block and downsloping 1-1.5 mm ST depressions in V3 through V6 and 1 mm depression in aVL. Cardiac catheterization revealed an ostial 100% stenosis in the left circumflex coronary artery, a proximal 60% stenosis and a mid 50% stenosis in the left anterior descending coronary artery, a proximal 80% stenosis and a mid 60% stenosis in the right coronary artery, a right dominant circulation, an ejection fraction of 30%, and collateral flow from the second diagonal to the third marginal in the right posterior left ventricular branch to the second marginal, as well as left ventricular hypokinesis and severe inferior and apical. The patient was not heparinized due to the fact that he was on Coumadin for peripheral vascular disease with a therapeutic INR. On 9/18/06, the patient underwent coronary artery bypass graft x3 with left internal mammary artery to left anterior descending coronary artery, a sequential graft and a vein graft connecting from the aorta to the second obtuse marginal coronary artery and then to the left ventricular branch. He was on medications including Lopressor 37.5 mg b.i.d., aspirin 325 mg daily, Colace 100 mg b.i.d., Pepcid 20 mg IV q.12h., insulin sliding scale, atorvastatin 80 mg daily, glipizide, Avandia, Zestril, metformin, meclizine, lactulose, vitamin C, Protonix, Niaspan, Neurontin, Zincate, and Coumadin for peripheral vascular disease. The patient was started on oral medication of glipizide 5 mg and was covered with a NovoLog sliding scale, was transfused 3 units of packed red blood cells, re-started on Coumadin for his reinsertion, and was started on Flomax 0.4 mg once a day. He had some urinary retention postoperatively and did require Foley catheter placement. He was discharged on Enteric-coated aspirin 81 mg QD, Colace 100 mg b.i.d. while taking Dilaudid, Lasix 40 mg QD x3 doses, glipizide 5 mg daily, Dilaudid 2-4 mg every three hours p.r.n. pain, lisinopril 2.5 mg daily, Niferex 150 mg b.i.d., Toprol-XL 150 mg QD, Lipitor 80 mg daily, Flomax 0.4 mg QD, potassium chloride slow release 10 mEq QD x3 doses with Lasix and Coumadin QD per INR result, and the patient will receive 4 mg of Coumadin this evening for his reinsertion and was instructed to remain on his Flomax until that time. Mr. Jana was discharged to rehab in stable condition and will follow up with his cardiologist Dr. Reuben Duttinger in one week, his heart failure cardiologist Dr. Wilton Durkee on 11/10/06 at 1:30 in the afternoon, and Urology Clinic at the Centsson Medical Center for his urinary retention in one week.
|
What medications have been previously used for the treatment of some urinary retention
|
{
"answer_end": [
1938
],
"answer_start": [
1877
],
"text": [
"his reinsertion, and was started on Flomax 0.4 mg once a day."
]
}
|
A 60 year old Spanish speaking woman with multiple cardiac risk factors and a two to three year history of exertional angina presented complaining of unstable chest pain. Dr. Maximo Bryum in C&O MEDICAL CENTER Clinic initiated an antianginal regimen, however the patient recently stopped taking Aspirin and her symptoms then recurred. The patient was given three sublingual Nitroglycerins after her primary M.D. was called and her pain resolved after approximately 15 minutes. On the 27 of January, 1995, the patient underwent a Dobutamine MIBBE on which she went 6 minutes and 48 seconds reaching a maximal heart rate of 154, a blood pressure of 172/82, with 2 mm ST depressions diffusely and moderate to severe reversible anterior and anteroseptal wall ischemia. Medications on admission included Atenolol 50 mg p.o. q.d., Axid 150 mg p.o. b.i.d., Enteric Coated Aspirin 325 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem 240 mg p.o. q.d., Lisinopril 10 mg p.o. q.d., Lopipd 600 mg p.o. q.d., Lasix 40 mg p.o. q.d., Insulin NPH 75 units sub-q q.a.m., 50 units q.p.m., Insulin Regular 25 units sub-q q.a.m., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, and Omeprazole 20 mg p.o. q.d. The Cardiology Team was consulted and serial CK, MB and EKG's were done, with Heparin initially started given the possibility that this was unstable angina. The patient's Insulin dosages were adjusted in the manner to keep her blood sugars in the approximately 200 range and she was discharged with medications including Enteric Coated Aspirin 325 mg p.o. q.d., Lasix 40 mg p.o. q.d., Lopid 600 mg p.o. q.d., Insulin NPH 100 units sub-q q.a.m., 70 units sub-q q.h.s., Insulin Regular 25 units sub-q q.a.m., Lisinopril 10 mg p.o. q.d., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, Omeprazole 20 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem CD 240 mg p.o. q.d., with follow-up care with her primary M.D., Dr. Jarvis Needy in the RINGBURG RITA'S PROPRES MEMORIAL HOSPITAL Clinic.
|
Is the patient currently or have they ever taken insulin nph
|
{
"answer_end": [
1669
],
"answer_start": [
1634
],
"text": [
"Insulin NPH 100 units sub-q q.a.m.,"
]
}
|
The patient had been taking Ativan of 3-4 mg q.d. for anxiety for the past two months and abruptly stopped taking it on March 1995 after which she started to have feelings of disorientation, and had been taking chloral hydrate 500 to 1000 mg q.h.s. for five days and Compazine with one dose. CURRENT MEDICATIONS: At home, patient took insulin NPH 25 units in the morning with Regular 10 units in the morning, aspirin 81 mg q.d., Lopressor 25 mg b.i.d., Compazine 5 mg q.6h. p.r.n. anxiety of which she took only one dose, and chloral hydrate 500 to 1000 mg q.h.s. for five days. On admission, her laboratory examination was significant for BUN of 17, creatinine of 1.0, glucose was 364, liver function tests were within normal limits, white count was 7.2, hematocrit was 36, and platelet count was 266. Neurology consultation was obtained who felt that patient's peripheral neuropathy was probably secondary to longstanding diabetes but felt that some of her symptomatology could be consistent with porphyria. Psychiatry felt that this episode was consistent with generalized anxiety disorder separated by post dysthymia and suggested phenothiazines which are proven to be safe in porphyria for treatment. She was started on Trilafon 2 to 4 mg p.o. p.r.n. q.6h. for anxiety and Keflex 500 mg p.o. t.i.d. for treatment. The patient was also seen to be orthostatic which was felt to be secondary to dehydration secondary to poor p.o. intake prior to admission and was treated with normal saline boluses and her orthostasis improved. Her Lopressor was also held with this episode of orthostasis. The Watson-Schwartz test done by Dr. Mohar on patient very early in the admission was negative which made an acute porphyria attack very unlikely. These episodes were felt to be secondary to a combination of anxiety attack and rapid taper of Ativan which she had been taking at moderately high doses for the last two months. Patient also developed urinary tract infection symptoms and her urine culture showed greater than 100,000 colonies of E. coli which were pansensitive. She was discharged to home on August in good condition on medications Aspirin 81 mg p.o. q.d., insulin NPH 25 units subcutaneously q.a.m., insulin regular 10 units subcutaneously q.a.m., Trilafon 2 mg p.o. q.6h., and Keflex 500 mg p.o. t.i.d. Follow-up will be with Dr. Dario Rodriquz.
|
Is the patient currently or have they ever taken ativan
|
{
"answer_end": [
85
],
"answer_start": [
21
],
"text": [
"taking Ativan of 3-4 mg q.d. for anxiety for the past two months"
]
}
|
Glen Cooperwood, a 69 year old male with ischemic CMP (EF 25-30%), recent admission for atrial flutter, s/p ablation, and NSVT, was discharged on 6/11/05 at 12:00 PM. The patient was given ACETYLSALICYLIC ACID 81 MG PO QD, INSULIN NPH HUMAN 10 UNITS SC BID, LISINOPRIL 10 MG PO QD, OXYCODONE 5-10 MG PO Q6H PRN Pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, on order for TRICOR PO (ref #76717119), POTENTIALLY SERIOUS INTERACTION: WARFARIN & FENOFIBRATE, MICRONIZED Reason for override: monitoring INR, KEFLEX (CEPHALEXIN) 250 MG PO QID X 12 doses Starting when IV ANTIBIOTICS END, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 25 MG PO QD Food/Drug Interaction Instruction, TRICOR (FENOFIBRATE) 145 MG PO QD, PRILOSEC (OMEPRAZOLE) 20 MG PO QD, DIET: House/Low chol/low sat. fat, ACTIVITY: No heavy lifting and do not lift L elbow above L shoulder x 1 month, Follow up appointment(s) with Dr. Vuckovich on June 10:40am, ALLERGY: NKA, ADMIT DIAGNOSIS: s/p ICD, PRINCIPAL DISCHARGE DIAGNOSIS; Responsible After Study for Causing Admission) s/p ICD, OTHER DIAGNOSIS; Conditions, Infections, Complications, affecting Treatment/Stay CHF (congestive heart failure) CAD (coronary artery disease) s/p CABG (S/P cardiac bypass graft surgery) dm (diabetes mellitus) htn (hypertension) hyperchol (elevated cholesterol) cri (chronic renal dysfunction), OPERATIONS AND PROCEDURES: none, OTHER TREATMENTS/PROCEDURES (NOT IN O.R.): s/p dual chamber ICD, BRIEF RESUME OF HOSPITAL COURSE: 69 y/o man with ischemic CMP (EF 25-30%), recent admit for atrial flutter, s/p ablation, and NSVT. Primary prevention ICD placed without complication. Had short runs of AF during procedure. For coumadin, baby ASA. Also h/o HTN, DM, CRI, CHF. ADDITIONAL COMMENTS: Continue coumadin 5mg each night. Have your INR/coumadin level checked on Monday, March, DISCHARGE CONDITION: Stable, TO DO/PLAN: No dictated summary, ENTERED BY: WEALER, ROYAL R., PA-C (NY43) 6/11/05 @ 10.
|
How much toprol xl ( metoprolol succinate extended release ) does the patient take per day
|
{
"answer_end": [
681
],
"answer_start": [
585
],
"text": [
"TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 25 MG PO QD Food/Drug Interaction Instruction,"
]
}
|
The patient, a 72-year-old male, was admitted for an incarcerated chronic ventral hernia post sigmoid colectomy, colostomy, and Hartmann's operation. His hospital course was complicated by postoperative acute respiratory failure, respiratory acidosis with metabolic acidosis, pleural effusion, hypokalemia, myocardial infarction, thrombocytopenia, and delirium. He had a known history of penile cancer status post penectomy complicated by perineal urethrocutaneous fistula, chronic anemia requiring transfusions, non-insulin-dependant diabetes, hypertension, hypercholesterolemia, obesity, and recurrent UTIs. He was given a suprapubic catheter placed by Urology and was started on TPN after a PICC line was placed. He was scoped by GI on 6/20/07, which showed diffuse gastritis thought to be due to the NG tube, and two ulcers turned out to be bleeding. His discharge medications included Tylenol 325 to 650 mg p.o. q.4 h. p.r.n. pain, DuoNeb 3/0.5 mg q.6 h. p.r.n., amiodarone 400 mg p.o. b.i.d. for six more days and then 400 mg p.o. daily, hold for systolic less than 90, heart rate less than 55, econazole nitrate topical daily, heparin 5000 units subcutaneously q.12 h., Regular Insulin sliding scale subcutaneously q.6 h., Imodium A-D 2 mg p.o. b.i.d., metoclopramide 10 mg p.o. q.i.d., Lopressor 50 mg p.o. q.6 h., hold for systolic less than 90, heart rate less than 55, omeprazole 40 mg p.o. b.i.d., oxycodone 1 mg per 1 mL solution for a total of 5 mg p.o. q.4 h. p.r.n. pain, Carafate 1 gm p.o. q.i.d., and Ambien 2.5 mg p.o. nightly. He was not anti-coagulated for his Atrial Fibrillation due to his risk of GI bleeding, as decided by GI. He was discharged on TPN as his total caloric needs were still not being met by p.o. nutrition and he was in good condition on discharge.
|
Has the pt. ever been on tpn before
|
{
"answer_end": [
1746
],
"answer_start": [
1652
],
"text": [
"He was discharged on TPN as his total caloric needs were still not being met by p.o. nutrition"
]
}
|
Mr. Quigg is a 42-year-old man with history of diabetes, end-stage renal disease on hemodialysis, left Charcot foot complicated by recurrent cellulitis who presented with left lower leg swelling, erythema, and pain. On admission, his temperature was 100.8, heart rate was 111, and blood pressure was 140/70. His left lower extremity had 1+ pitting edema with erythema on the anterior shin and foot. He was uptitrated to 5mg and also lopressor, started on Lyrica and oxycodone for breakthrough pain, and received Fentanyl PCA. His home medications included Colace 100 mg b.i.d., folate 1 mg p.o. daily, gemfibrozil 600 mg b.i.d., Lantus 30 mg subcu q.p.m., Lipitor 80 mg nightly, Nephrocaps, Neurontin 300 mg daily, PhosLo 2001 mg t.i.d., Protonix 40 mg daily, Renagel 3200 mg t.i.d., Requip 2 mg p.o. b.i.d., and Coumadin. His Lipitor was decreased to 20mg due to rhabdomylosis risk, and he was also started on low dose b-blocker to reduce perioperative MI risk prior to his surgery. His Vancomycin was continued given his history of MRSA cellulitis, with a goal of a level less than 20, and he was bridged with heparin with a goal PTT of 60-80. He was restarted on his Lantus and Aspart doses with meals, and his Coumadin was held prior to surgery and decreased to 20mg with a repeat lipid panel in 4-6 weeks. He required antibiotics which were discontinued at this time and he was discharged with dry sterile dressing changes to his residual limb daily, PTT goal 60-80, INR goal 2-3 until stable off of levofloxacin, monitoring of FS and adjustment of DM regimen, monitoring pain scale and decreasing pain medications as pain improves, hemodialysis M/W/F, and follow up with Dr. Carpino voice message left on his medical assistant's voice mail and Dr. Lynes 6/10/06 at 9:30am. Psychiatry service was consulted who recommended low dose Ativan prior to him going for dialysis. He was initially placed on a ketamine drip and given IV Levofloxacin and IV Flagyl to cover gram negatives and anaerobes respectively, and started on oxycontin 80mg tid with oxycodone for breakthrough pain and Lyrica for neuropathic pain. He was comfortable prior to discharge on this current regimen.
|
has there been a prior levofloxacin;
|
{
"answer_end": [
1518
],
"answer_start": [
1472
],
"text": [
"INR goal 2-3 until stable off of levofloxacin,"
]
}
|
Rufus Leanard, a 55-year-old female, was admitted to Hend Ratal/creek Hospital with chest pain on exertion and underwent NSTEMI by enzymes peaking on 8/21/04 with CK 381 and TNI 0.18. She was transferred to Woduatesit General Hospital for catheterization and possible CABG, with her medical history including hypertension, diabetes mellitus, insulin therapy, dyslipidemia, COPD, bronchodilator therapy, asthma, class II angina, class II heart failure, and family history of coronary artery disease. Her physical exam showed carotid 2+ bilaterally, femoral 2+ bilaterally, radial 2+ bilaterally, and dorsalis pedis present by Doppler bilaterally. Laboratory data showed WBC 9.58, hematocrit 30.9, hemoglobin 10.7, platelets 287, PT 13.6, INR 1.0, PTT 36.9, sodium 138, potassium 3.9, chloride 103, CO2 26, BUN 16, creatinine 0.7, glucose 164. Cardiac catheterization data from 3/0/04 showed coronary anatomy, 95% osteo LAD, 40% proximal LAD, 60% proximal ramus, 90% mid circumflex, 90% mid OM1, and right dominant circulation. Preoperative medications included Verapamil 80 mg b.i.d., Avapro 150 mg q.d., aspirin 325 mg q.d. IV heparin, hydrochlorothiazide 50 mg q.d., albuterol 2 puffs b.i.d., fluticasone 2 puffs q.i.d., atorvastatin 10 mg q.d., Celexa 20 mg q.d., ibuprofen 800 mg b.i.d., and NPH insulin 30 units b.i.d. Rufus Leanard underwent an AVR with a 21 Carpentier-Edwards pericardial valve and a CABG x3 LIMA to LAD, SVG1 to PDA, SVG2-OM2 with a Robichek closure, with a bypass time of 201 minutes and a crossclamp time of 156 minutes. On CPB, the patient had severe calcification and adhesions between heart and pericardium, with no complications. Postoperatively, Rufus Leanard was extubated without difficulty and had reasonable saturations on nasal cannula, with chest x-ray appearing wet and diuresis increased. The history of COPD and preoperative COPD medications were restarted, she was in sinus rhythm with a systolic blood pressure of 110 and started on beta-blocker, and given Toradol initially for pain and Percocet for break through pain, with oxygen delivered via nasal cannula at 96% saturation with 3 liters. Postoperative echocardiogram showed an ejection fraction of 55-60%, trace MR, trace TR, no AI, and no regional wall motion abnormalities. Discharge medications included Enteric-coated aspirin 325 mg q.d., Lasix 600 mg q.6h p.r.n. pain, Lopressor 50 mg t.i.d., niferex 150 150 mg b.i.d., simvastatin 20 mg q.h.s., K-Dur 30 mEq b.i.d. and then 20 mEq b.i.d., fluticasone 44 mcg inhaled b.i.d., levofloxacin 500 mg q.d. for 2 days to complete course for UTI, Humalog, insulin on sliding scale, Humalog insulin 12 units subq with breakfast, Humalog insulin 16 units subcutaneous with lunch and dinner, Humalog insulin 62 units subcutaneous q.h.s., and Combivent 2 puffs inhaled q.i.d., Nexium 20 mg q.d., and Lantus insulin 60 mg b.i.d. for 3 days then 40 mg b.i.d. for 3 days, ibuprofen 600 mg q.6h p.r.n. pain. Follow-up appointments were made with Dr. Feder, Dr. Burkhead, and Dr. Saltmarsh, with instructions to make all follow up appointments, wash all wounds daily with soap and water, and watch for signs of infection.
|
Was the patient ever prescribed fluticasone
|
{
"answer_end": [
1221
],
"answer_start": [
1168
],
"text": [
"albuterol 2 puffs b.i.d., fluticasone 2 puffs q.i.d.,"
]
}
|
The patient was admitted on 4/20/2006 with an Altered Mental Status. A team meeting was held on 3/25/06 and the patient was started on 250 mg b.i.d. of Depakote and Haldol was reduced to just Monday-Wednesday-Friday 1 mg before hemodialysis and 1 mg p.r.n. agitation. On 0/16/06, the patient was diagnosed with pneumonia and started on ceftriaxone IV and Flagyl, which was switched to cefpodoxime and Flagyl for discharge. The patient began to spike fevers on 11/29/06 and was started on antibiotics of ceftriaxone and Flagyl, which was switched to cefpodoxime and Flagyl for discharge, and the cefpodoxime should be dosed after dialysis on Monday-Wednesday-Friday. In terms of endocrine, the patient ultimately discontinued on a regimen of 7 units of Lantus q.a.m. and q.p.m. with 5 units aspart q.a.c. breakfast and lunch and 4 units of aspart q.a.c. dinner. His sliding scale was very light and he is only to be covered with one to two units of aspart during the night as insulin stacks in this patient very easily. At the time of discharge, the patient's fingersticks were well controlled in the 100-200 range and his mental status was A&O x3 and appropriate. Medications on discharge included PhosLo 2001 mg p.o. t.i.d., Depakote 250 mg p.o. b.i.d., folate 1 mg p.o. daily, Haldol 1 mg IV on Monday-Wednesday-Friday given prior to hemodialysis, labetalol 350 mg p.o. b.i.d., lisinopril 80 mg p.o. daily, Flagyl 500 mg p.o. t.i.d. for 14 days, thiamine 100 mg p.o. daily, Norvasc 10 mg p.o. daily, gabapentin 300 mg p.o. q.h.s., cefpodoxime 200 mg p.o. three times a week on Monday-Wednesday-Friday for eight doses given after hemodialysis, Nephrocaps one tablet p.o. daily, sevelamer 2004 mg p.o. t.i.d., Advair diskus 250/50 one puff b.i.d., Nexium 20 mg p.o. daily, Lantus 7 units subcutaneous b.i.d. once in the morning and once evening, aspart 4 units subcutaneous before dinner and 5 units subcutaneous before breakfast and 5 units subcutaneous before lunch, aspart sliding scale starting at blood sugar less than 125 give 0 units, blood sugar 125-300 give 0 units, blood sugar 301-350 give 1 unit, blood sugar 351-400 give 2 units, blood sugar 400-450 give 2 units, albuterol butt paste topical daily, and then p.r.n. Tylenol 650 mg p.r.n. pain, headache, or temperature, albuterol inhaler p.r.n. wheezing, Haldol 1 mg
|
Is the patient currently or have they ever taken norvasc
|
{
"answer_end": [
1536
],
"answer_start": [
1452
],
"text": [
"thiamine 100 mg p.o. daily, Norvasc 10 mg p.o. daily, gabapentin 300 mg p.o. q.h.s.,"
]
}
|
This is a 51 year-old female with fibromyalgia, hypertension, and migraine headaches who presented to the Emergency Room with two months of dyspnea at night, paroxysmal nocturnal dyspnea, and orthopnea, and an episode of severe substernal chest pressure associated with shortness of breath after carrying water bottles from her car. In the Emergency Department, V/Q scan was very low probability and lower extremity noninvasive studies were also unremarkable. Her medications on admission included Nortriptyline, methyldopa, hydrochlorothiazide, Zantac, estrogen, Advil, ALternaGEL. She smokes one and one-half packs per day for 30 years. Physical examination showed temperature 97.4, respiratory rate 22, heart rate 100, blood pressure 150/90, anicteric, bibasilar crackles about one-quarter of the way up, regular rate and rhythm with II/VI systolic murmur and no rubs or gallops, benign abdomen, guaiac negative in the Emergency Department, 1+ pedal edema bilaterally, right greater than left, and nonfocal neurological. Laboratory data on admission showed hematocrit 41.6, BUN 13, creatinine 0.6, chest x-ray showed mild pulmonary edema, and electrocardiogram showed normal sinus rhythm at 91, no ischemic changes. She had serial CPKs which were all negative, and was treated with two doses of intravenous Lasix (20 milligrams each) resulting in a moderate diuresis and resolution of her shortness of breath symptoms. An exercise test was done with arm ergometry (30 watts) and her heart rate went from 100 to 129, blood pressure went from 130 systolic to 172, and electrocardiogram showed no ischemic changes. An echocardiogram showed vigorous systolic function of 86%, no valvular lesions, no wall motion abnormalities, and evidence of thickening in her ventricular walls. Given the fact that the patient had an elevated diastolic pressure and did show some early evidence of thickening in her ventricular walls, the decision was then made to begin her on a calcium channel blocker (Verapamil 240 milligrams p.o. q.d.) in addition to her usual medications. She was discharged to home in good condition with discharge medications including Verapamil SR 240 milligrams p.o. q.d., Zantac 300 milligrams q.d., estrogen 1.25 milligrams q.d., Advil 800 milligrams p.o. b.i.d. p.r.n., hydrochlorothiazide 25 milligrams p.o. q.d., methyldopa 250 milligrams q.d., and Nortriptyline 125 milligrams p.o. q.h.s., and an appointment to see a new primary physician at Dowsna Medical Center scheduled for May 1996.
|
has the patient used verapamil in the past
|
{
"answer_end": [
2183
],
"answer_start": [
2144
],
"text": [
" Verapamil SR 240 milligrams p.o. q.d.,"
]
}
|
At the time of admission, the 73-year-old patient presented with altered mental status, intractable explosive diarrhea, congestive heart failure, coronary artery disease, myelodysplastic syndrome, peripheral vascular disease, gastrointestinal bleed, prostate cancer, and macular degeneration. His current medications included Opium Tincture, Aspirin, Lomotil, Lasix, Ditropan, Lopid, Zocor, Atapryl, and Iron. His physical examination was notable for a jugular venous pressure at 5 cm, moist mucous membranes, and soft, nontender, nondistended abdominal examination. His mental status improved quickly with respiratory status significantly with occasional nebulizer treatments of Albuterol and Atrovent. His losartan was held at admission due to acute renal failure, but other outpatient medications were continued. At the time of admission, Kaopectate and Lomotil were started for the guaiac positive brown stool. Chest x-ray was clear, and it was felt that the most likely etiology of his acute worsening of his diarrhea was viral gastroenteritis. He received a 7-day course of Levofloxacin and Flagyl for empiric abdominal coverage and remained afebrile since the time of his antibiotics. An MRI showed proximal disease in the SMA, IMA, and Celiac but overall with good distal flow, and an abdominal CT showed a thick small bowel and dilated gallbladder with stranding. Esophagogastroduodenoscopy revealed Grade IV Gastritis, and the patient was started on Nexium 40 b.i.d. His BUN was in the fifties with a creatinine of 2.2 throughout the hospitalization, and he was discharged on a full p.o. diet and instructed to supplement his diet with high nutrition Boost shakes. At the time of discharge, the patient was oxygenating well with no evidence of fluid overload or infiltrates. Occasional wheezes were noted and he will follow-up with Dr. Venzor following discharge.
|
Is the patient currently or have they ever taken kaopectate
|
{
"answer_end": [
877
],
"answer_start": [
816
],
"text": [
"At the time of admission, Kaopectate and Lomotil were started"
]
}
|
Randy Szalay is a 60 year old female with DMII, PVD, chronic AF and a DDI pacer on coumadin who has had a history of recurrent LE ulcerations. She was admitted to medicine with an RLE ulcer, diabetic foot ulcer with ? osteo (Plain films negative but early signs may be absent). She was started on Unasyn in the ED and tolerated it, but was allergic to quinolones and cephalosporins. A bone scan was ordered, and wound swab cx grew 2+ staph aureus with susceptibilities showing MRSA. An ID consult was recommended to continue Unasyn and switch to PO linezolid since the pt refused to take bactrim stating allergy to the med. An Ortho consult was done for debridement of the wound to viable tissue, and the pt was to follow up with Dr. Linkous her out pt orthopedist for reconstructive therapy of her right foot after a vascular evaluation. On 10/22, the pt developed a rash on her legs attributed to the Unasyn and was treated with BENADRYL (DIPHENHYDRAMINE HCL) 25 MG PO Q6H PRN Itching and the Unasyn was discontinued. At discharge, the pt had shown marked improvement of both cellulitis and ulcer with the medications FUROSEMIDE 40 MG PO QD HOLD IF: sbp<90, LISINOPRIL 10 MG PO QD HOLD IF: sbp<90, GLYBURIDE 2.5 MG PO QD, COUMADIN (WARFARIN SODIUM) 2.5 MG PO QPM, LINEZOLID 600 MG PO BID Food/Drug Interaction Instruction, SIMVASTATIN 20 MG PO QHS Starting ON 10/11/2005 (0/7) and BENADRYL (DIPHENHYDRAMINE HCL) 25 MG PO Q6H PRN Itching. She was also instructed to take antibiotics for 7 days and to avoid high Vitamin-K containing foods, resume regular exercise and follow up with out patient care takers, PCP in 1-2 wks, otho, vascular surg, derm, coumadin clinic, and have daily wet to dry wound dressings.
|
Is there a mention of of coumadin ( warfarin sodium ) usage/prescription in the record
|
{
"answer_end": [
1265
],
"answer_start": [
1224
],
"text": [
"COUMADIN (WARFARIN SODIUM) 2.5 MG PO QPM,"
]
}
|
The patient was admitted on 4/20/2006 with an Altered Mental Status. A team meeting was held on 3/25/06 and the patient was started on 250 mg b.i.d. of Depakote and Haldol was reduced to just Monday-Wednesday-Friday 1 mg before hemodialysis and 1 mg p.r.n. agitation. On 0/16/06, the patient was diagnosed with pneumonia and started on ceftriaxone IV and Flagyl, which was switched to cefpodoxime and Flagyl for discharge. The patient began to spike fevers on 11/29/06 and was started on antibiotics of ceftriaxone and Flagyl, which was switched to cefpodoxime and Flagyl for discharge, and the cefpodoxime should be dosed after dialysis on Monday-Wednesday-Friday. In terms of endocrine, the patient ultimately discontinued on a regimen of 7 units of Lantus q.a.m. and q.p.m. with 5 units aspart q.a.c. breakfast and lunch and 4 units of aspart q.a.c. dinner. His sliding scale was very light and he is only to be covered with one to two units of aspart during the night as insulin stacks in this patient very easily. At the time of discharge, the patient's fingersticks were well controlled in the 100-200 range and his mental status was A&O x3 and appropriate. Medications on discharge included PhosLo 2001 mg p.o. t.i.d., Depakote 250 mg p.o. b.i.d., folate 1 mg p.o. daily, Haldol 1 mg IV on Monday-Wednesday-Friday given prior to hemodialysis, labetalol 350 mg p.o. b.i.d., lisinopril 80 mg p.o. daily, Flagyl 500 mg p.o. t.i.d. for 14 days, thiamine 100 mg p.o. daily, Norvasc 10 mg p.o. daily, gabapentin 300 mg p.o. q.h.s., cefpodoxime 200 mg p.o. three times a week on Monday-Wednesday-Friday for eight doses given after hemodialysis, Nephrocaps one tablet p.o. daily, sevelamer 2004 mg p.o. t.i.d., Advair diskus 250/50 one puff b.i.d., Nexium 20 mg p.o. daily, Lantus 7 units subcutaneous b.i.d. once in the morning and once evening, aspart 4 units subcutaneous before dinner and 5 units subcutaneous before breakfast and 5 units subcutaneous before lunch, aspart sliding scale starting at blood sugar less than 125 give 0 units, blood sugar 125-300 give 0 units, blood sugar 301-350 give 1 unit, blood sugar 351-400 give 2 units, blood sugar 400-450 give 2 units, albuterol butt paste topical daily, and then p.r.n. Tylenol 650 mg p.r.n. pain, headache, or temperature, albuterol inhaler p.r.n. wheezing, Haldol 1 mg
|
What was the dosage prescribed of nexium
|
{
"answer_end": [
1776
],
"answer_start": [
1714
],
"text": [
"Advair diskus 250/50 one puff b.i.d., Nexium 20 mg p.o. daily,"
]
}
|
Mr. Gramby is a 43-year-old man with morbid obesity, type II diabetes, hypertension, hyperlipidemia, chronic renal insufficiency, and severe peripheral arterial disease status post femoral popliteal bypass in July which was complicated by repeated return of cellulitis x 2 who was admitted with cellulitis and volume overload. He was initially treated with courses of intravenous nafcillin and vancomycin for four weeks, having been seen by Vascular Surgery five days prior to admission and had been started on dicloxacillin for a third episode of cellulitis. He had also presented with fluid overload and spironolactone was added to his diuretic regimen. The patient was prescribed Atenolol 100 mg q.d., spironolactone, torsemide 160 mg b.i.d., Hyzaar 50/12.5 q. day, lisinopril 60 mg q. day, Neurontin 1200 mg t.i.d., Norvasc 10 mg q.a.m. and 5 mg q.p.m., Coumadin 8 mg, aspirin, Humalog sliding scale, Percocet, Pletal 100 mg b.i.d., Procrit, Zantac, nitroglycerin p.r.n., and NPH 80 q.a.m. and q.p.m. His torsemide was changed to IV and metolazone was added on the first day of admission and his electrolytes were replaced as needed. He was hypertensive on arrival, which was treated with Hydralazine initially and transitioned to his p.o. home medicines, with Hydralazine p.o. added on hospital day #9 to lower his systolic blood pressure to the range of the 120s-130s. His Coumadin was restarted when his INR was 2.2 and he his now in the therapeutic range and will need to be followed. The patient is on NPH and Humalog, with NPH doses increased to 90 units in the morning and 85 units at night, and the goal for this patient is below 150 particularly given the need for wound healing. Additional antibiotic coverage was added specifically of fluoroquinolone for anti-psuedomonal coverage for his diabetic foot ulcers, with surgical debridement done in the operating room with drainage of pus, but the metal showed could not be located even with fluoroscopy. The patient will complete a 14-day course of levofloxacin and clindamycin for these foot ulcers, and will be discharged home with visiting nursing care for b.i.d. wet-to-dry dressing changes. He will follow up with Jerold Cristopher Blazon, M.D. in one to two weeks, go home with visiting nurse care, and will need to see his nephrologist, vascular surgeons, primary care provider, and Bariatric Surgery following discharge.
|
What is the patient's vancomycin history
|
{
"answer_end": [
486
],
"answer_start": [
394
],
"text": [
"vancomycin for four weeks, having been seen by Vascular Surgery five days prior to admission"
]
}
|
This is a 70-year-old female with a history of coronary artery disease, hypertension, type II diabetes mellitus, and peripheral vascular disease who presented with increasing chest pain over the past month progressing to pain at rest. On admission, the patient had a blood pressure of 230/90 and was treated with IV Lopressor and Diltiazem drip at 10 mg/hr. The patient underwent cardiac catheterization on 2/25/99, revealing stent restenosis of left circumflex artery, a 60 percent left anterior descending artery stenosis, a 70 percent diagonal ostial stenosis, a 40 percent ostial right coronary artery stenosis, and 95 percent ostial posterior descending artery stenosis. The patient was admitted for rule out myocardial infarction and subsequently underwent a coronary artery bypass graft times three with a left internal mammary artery to the left anterior descending artery and saphenous vein graft to obtuse marginal and saphenous vein graft to posterior descending artery. Postoperatively, the patient was treated with IV Lopressor and Diltiazem drip at 10 mg/hr. for a period of atrial fibrillation with a rapid ventricular response and rates in the 150s. The patient was started on MEDICATIONS including Aspirin 325 mg q.d., Atenolol 125 mg p.o. b.i.d., Captopril 100 mg p.o. t.i.d., Colace, Axid 150 mg p.o. b.i.d., Amlodipine 10 mg p.o. q.d., Imdur 120 mg p.o. b.i.d., and insulin NPH 22 units q.a.m. and regular 10 units q.a.m., and anticoagulation with Coumadin. The patient subsequently converted spontaneously to normal sinus rhythm and was started back on Amlodipine for further blood pressure control and was started on Lopressor and Captopril and gradually increased to preoperative doses. The patient continued to experience brief episodes of atrial fibrillation with spontaneous conversion to normal sinus rhythm. At the time of discharge, the patient was advised to follow-up in six weeks with cardiac surgeon, Dr. Standrew, with primary care physician, Dr. Birdsong, in one to two weeks, and with cardiologist, Dr. Shelko, in one to two weeks, with Discharge Medications: Atenolol 125 mg p.o. b.i.d., Captopril 100 mg p.o. t.i.d., Colace 100 mg p.o. t.i.d., Lasix 40 mg p.o. q.d., insulin 22 units NPH subcu q.a.m. and 10 units regular subcu q.a.m., CZI regular insulin sliding scale, Percocet 1 to 2 tablets p.o. q3 - 4h p.r.n. pain, Zantac 150 mg p.o. b.i.d., Coumadin dosed to INR of 2 to 2.5, and Amlodipine 5 mg p.o. q.d.
|
Has this patient ever tried zantac
|
{
"answer_end": [
2385
],
"answer_start": [
2309
],
"text": [
"Percocet 1 to 2 tablets p.o. q3 - 4h p.r.n. pain, Zantac 150 mg p.o. b.i.d.,"
]
}
|
The patient had been taking Ativan of 3-4 mg q.d. for anxiety for the past two months and abruptly stopped taking it on March 1995 after which she started to have feelings of disorientation, and had been taking chloral hydrate 500 to 1000 mg q.h.s. for five days and Compazine with one dose. CURRENT MEDICATIONS: At home, patient took insulin NPH 25 units in the morning with Regular 10 units in the morning, aspirin 81 mg q.d., Lopressor 25 mg b.i.d., Compazine 5 mg q.6h. p.r.n. anxiety of which she took only one dose, and chloral hydrate 500 to 1000 mg q.h.s. for five days. On admission, her laboratory examination was significant for BUN of 17, creatinine of 1.0, glucose was 364, liver function tests were within normal limits, white count was 7.2, hematocrit was 36, and platelet count was 266. Neurology consultation was obtained who felt that patient's peripheral neuropathy was probably secondary to longstanding diabetes but felt that some of her symptomatology could be consistent with porphyria. Psychiatry felt that this episode was consistent with generalized anxiety disorder separated by post dysthymia and suggested phenothiazines which are proven to be safe in porphyria for treatment. She was started on Trilafon 2 to 4 mg p.o. p.r.n. q.6h. for anxiety and Keflex 500 mg p.o. t.i.d. for treatment. The patient was also seen to be orthostatic which was felt to be secondary to dehydration secondary to poor p.o. intake prior to admission and was treated with normal saline boluses and her orthostasis improved. Her Lopressor was also held with this episode of orthostasis. The Watson-Schwartz test done by Dr. Mohar on patient very early in the admission was negative which made an acute porphyria attack very unlikely. These episodes were felt to be secondary to a combination of anxiety attack and rapid taper of Ativan which she had been taking at moderately high doses for the last two months. Patient also developed urinary tract infection symptoms and her urine culture showed greater than 100,000 colonies of E. coli which were pansensitive. She was discharged to home on August in good condition on medications Aspirin 81 mg p.o. q.d., insulin NPH 25 units subcutaneously q.a.m., insulin regular 10 units subcutaneously q.a.m., Trilafon 2 mg p.o. q.6h., and Keflex 500 mg p.o. t.i.d. Follow-up will be with Dr. Dario Rodriquz.
|
What are the different medications that have been used on this patient for anxiety attack
|
{
"answer_end": [
1841
],
"answer_start": [
1784
],
"text": [
"a combination of anxiety attack and rapid taper of Ativan"
]
}
|
Eli Frigge (047-45-81-2) was admitted with lightheadedness and hypertension, and discharged with a principal discharge diagnosis of s/p pacemaker placement and other diagnoses including CAD s/p CABG x 2, RAS c L renal stent, bilateral common iliac artery stents, PAF, and DM. A dual chamber Guidant pacemaker was inserted without difficulty on 10/13, programmed to DDI 60 mode, and BB was initiated with a plan to continue Toprol XL upon discharge. Cardiology recommended dc'ing Aspirin and adding Coumadin with Plavix for anticoagulation, but deferred decision to pt's outpatient cardiologist. The patient was instructed to take ACETYLSALICYLIC ACID 325 MG PO DAILY, LIPITOR (ATORVASTATIN) 80 MG PO DAILY, CLINDAMYCIN HCL 300 MG PO QID X 12 doses starting after IV ANTIBIOTICS END, PLAVIX (CLOPIDOGREL) 75 MG PO DAILY, COLACE (DOCUSATE SODIUM) 100 MG PO BID, NEXIUM (ESOMEPRAZOLE) 40 MG PO DAILY, GLIPIZIDE 2.5 MG PO DAILY, LISINOPRIL 5 MG PO BID HOLD IF: SBP <120, REGLAN (METOCLOPRAMIDE HCL) 10 MG PO TID, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 50 MG PO DAILY with Food/Drug Interaction Instruction, and SENNA TABLETS (SENNOSIDES) 2 TAB PO BID consistently with meals or on an empty stomach. Dulcolax and stool softeners were administered for constipation with good response, and the patient was instructed to continue Clindamycin until running out of pills, call doctor or go to nearest ER if having fever > 100.4, chills, nausea, vomiting, chest pain, shortness of breath, or anything concerning, and to continue stool softeners for constipation and resume all home meds upon discharge. The patient was discharged to home with services in stable condition.
|
Has the pt. ever been on antibiotics before
|
{
"answer_end": [
782
],
"answer_start": [
748
],
"text": [
"starting after IV ANTIBIOTICS END,"
]
}
|
A 57 year old woman with multiple cardiac risk factors presented with substernal chest pain relieved by two sublingual nitroglycerins, nausea, and an acid taste. She was ruled out for myocardial infarction by enzyme sets respectively, with no change in EKGs. Her physical examination was afebrile with a blood pressure of 132/96, pulse 95, on one liter of oxygen, saturation of 97%, and respiratory rate of 20. She was treated with aspirin, beta blockers, and nitroglycerin and was started on Axid for possibility of gastroesophageal reflux disease, as well as provided with Maalox and told to keep the head of the bed elevated. She was continued on Glucotrol for diabetes mellitus and was instructed on risk factor modifications, including diabetes mellitus control, controlling cholesterol and hypertension. Upon discharge she was prescribed Atenolol 100 mg p.o. q.d., Ecasa 325 mg q.d., Glucotrol 20 mg b.i.d., Hydrochlorothiazide 12.5 mg q.d., Trazadone 50 mg q.h.s., aspirin 1 q.d., Lopressor 75 mg q.d., nitroglycerin sublingual p.r.n., Ambien 5 mg q.h.s., and was instructed on the possibility of gastroesophageal reflux disease, as well as to follow-up with Dr. Jonker as an outpatient for further workup and management of gastroesophageal reflux disease, as well as following her for her cardiac disease via the risk factor modification.
|
Is there a mention of of axid usage/prescription in the record
|
{
"answer_end": [
549
],
"answer_start": [
478
],
"text": [
"was started on Axid for possibility of gastroesophageal reflux disease,"
]
}
|
This is a 66-year-old man with spinal sarcoidosis and secondary paraplegia who presented with altered mental status, hypoxemic respiratory failure, and hypotension. He became hypotensive with intubation despite using etomidate with Levophed, and was started on vancomycin, gentamicin, Flagyl, and stress dose steroids with 1 liter of IV fluid. His urine was found to have Proteus, resistant to Macrobid, and Klebsiella, resistant to ampicillin, so he was started on Levophed with a systolic blood pressure in the 130's on 7 to 10 of Levophed and Levofloxacin was continued at 500 mg per day for a total 10-day course on in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, to end on 10/16/2006 for a total course of 10 days. Urology replaced the suprapubic catheter and he was started on maintenance IV fluids until cleared to eat by Speech and Swallow. His home medications included Regular Insulin sliding scale a.c. and at bedtime, NPH 54 units in the morning and 68 units in the night, baclofen 10 mg t.i.d., amitriptyline 25 mg at bedtime, oxybutynin 5 mg t.i.d., gabapentin 300 mg t.i.d., iron sulfate 325 mg t.i.d., vitamin C 500 mg daily, magnesium 420 mg t.i.d., Coumadin 5 mg daily, ranitidine 150 mg b.i.d., and calcium 950 mg daily. He was given a head CT without contrast and a chest x-ray that showed no obvious infiltrate. His INR was found to be elevated and he had a suprapubic catheter obstruction with bilateral hydronephrosis and distended bladder. He was given Nexium and Coumadin for prophylaxis and was started on a low dose of captopril on 8/14/2006 for diabetes, and was started on 12.5 mg b.i.d. metoprolol on 0/14/2006 with good results. He was given NPH 20 b.i.d. through his hospitalization and Regular Insulin sliding scale. His creatinine came down to 1.2 and he was given the new beta-blocker and the ACE inhibitor as well as baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate 325 mg p.o. t.i.d., gabapentin 300 mg p.o. t.i.d., NPH human insulin 54 units in the morning, 68 units in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, magnesium oxide 420 mg p.o. t.i.d., metoprolol 12.5 mg p.o. b.i.d., oxybutynin 5 mg p.o. t.i.d., Panafil ointment t.i.d., and ranitidine 500 mg p.o. b.i.d. He was admitted with severe sepsis due to UTI, suprapubic catheter/ostomy for 12 years, diabetes type II, right DVT, on Coumadin, status post chronic UTI, and CPAP at night for pneumonia with ceftazidime, levofloxacin, and vancomycin. His sugars were controlled with no complications and was able to maintain blood pressures in the 130's. His creatinine was initially 2.7, and after receiving IV fluids, it came down to 1.2. He likely had acute renal failure secondary to postrenal obstructive etiology. His INR was found to be therapeutic and he had half of his home Coumadin dose while he was on levofloxacin, so he was given half of dose and his INRs came down to a nadir of 1.7. At discharge, his hematocrit was 27.2, down from 29, which was closed to his baseline of 34, and his INR was 2.1. He was placed on maintenance IV fluids until cleared to eat by Speech and Swallow, and was given amitriptyline 25 mg p.o. at bedtime, vitamin C 500 mg p.o. daily, baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate
|
Has this patient ever been prescribed gentamicin
|
{
"answer_end": [
292
],
"answer_start": [
246
],
"text": [
"was started on vancomycin, gentamicin, Flagyl,"
]
}
|
Mr. Forde has recovered very well following his elective coronary artery bypass graft procedure and is hemodynamically stable with left lower extremity erythema and tenderness significantly improved 24 hours following initiation of Keflex course. White blood cell count was within normal limits and patient continued to remain afebrile. A course of Keflex was administered on postoperative day seven for sinus rhythm in the high 90s with blood pressure mildly hypertensive, additionally with frequent PVCs noted on telemetry. Mr. Notarnicola continued to remain afebrile and his knee pain has significantly improved. Additionally, of note, Mr. Hovenga's Toprol was increased to 150 mg p.o. daily with an extra 2 mg of magnesium. Mr. Neth is discharged to rehabilitation today having recovered well following his elective CABG procedure. Mr. Marcusen is discharged to rehabilitation today, postoperative day eight, hemodynamically stable, to continue a course of Keflex for left lower extremity erythema and additionally to continue one week of diuresis in the form of low dose Lasix for mild persistent postoperative pulmonary effusions. Mr. Brannigan has been instructed to shower and monitor incisions for signs of increasing infection such as fever, drainage, worsening pain or increase in redness. He is to follow up with his primary care physician for continued evaluation and management of hypertension, dyslipidemia, obesity, obstructive sleep apnea, and uncontrolled Type II diabetes mellitus. Additionally, the patient will follow up with his cardiologist for continued evaluation and management of blood pressure, heart rate, heart rhythm, lipid levels, and for possible future adjustment in medication. Mr. Connin will follow up with his cardiac surgeon, Dr. Quinn Dalio, in six to eight weeks. Additionally, he will follow up with his cardiologist, Dr. Octavio Wulffraat, in two to four weeks and with his primary care physician, Dr. Barrett Mittleman, in one to two weeks. The patient is discharged with medications including Tylenol 325 mg p.o. q.6h. p.r.n. pain for temperature greater than 101 degrees Fahrenheit, amlodipine 5 mg p.o. daily, atorvastatin 10 mg p.o. daily, captopril 6.25 mg p.o. t.i.d., Keflex 500 mg p.o. q.i.d. times total of seven days, last dose on 9/15/06, Colace 100 mg p.o. b.i.d. p.r.n. constipation, enteric-coated aspirin 325 mg p.o. daily, Lasix 40 mg p.o. daily x7 days, hydrochlorothiazide 12.5 mg p.o. daily, NovoLog 3 units subcu AC, Lantus 24 units subcu q. 10 p.m., hold if n.p.o., potassium slow release 20 mEq p.o. daily x7 days, Toprol-XL 150 mg p.o. daily, Niferex 150 mg p.o. b.i.d., oxycodone 5 to 10 mg p.o. q.4h. p.r.n. pain, Ambien 5 mg p.o. nightly p.r.n. insomnia, NovoLog 6 units subcu with breakfast, hold if n.p.o., NovoLog 4 units subcu with lunch, hold if n.p.o., NovoLog 4 units subcu with dinner, hold if n.p.o., NovoLog sliding scale subcu AC, blood sugar less than 125, give 0 units subcu, blood sugar 125 to 150, give 2 units subcu, blood sugar 151 to 200, give 3 units subcu, blood sugar 201 to 250, give 4 units subcu, blood sugar 251 to 300, give 6 units subcu, blood sugar 301 to 350, give 8 units subcu, if blood sugar 351 to 400, NovoLog sliding scale subcu q.h.s. Please recheck blood sugar less than 200, give 0 units subcu, if blood sugar 201 to 250, give 2 units subcu, blood sugar 251 to 300, give 3 units subcu, blood sugar 301 to 350, give 4 units subcu, blood sugar 351 to 400, give 10 units subcu, call physician if blood sugar greater than 400.
|
Was the patient ever prescribed oxycodone
|
{
"answer_end": [
2690
],
"answer_start": [
2626
],
"text": [
"p.o. b.i.d., oxycodone 5 to 10 mg p.o. q.4h. p.r.n. pain, Ambien"
]
}
|
GVERRERO , STAN O 346-21-49-8, a 74 yo woman in remission from Hodgkin's Lymphoma and s/p renal transplant( 11/12 ), was discharged to Home with the attending physician being KERSON , RODNEY S , M.D. and code status being Full code. She was prescribed FESO4 ( FERROUS SULFATE ) 300 MG PO BID, FOLATE ( FOLIC ACID ) 1 MG PO QD, SYNTHROID ( LEVOTHYROXINE SODIUM ) 100 MCG PO QD, PREDNISONE 5 MG PO QAM, ZOCOR ( SIMVASTATIN ) 20 MG PO QHS, NEORAL ( CYCLOSPORINE MICRO ( NEORAL ) ) 100 MG PO BID, LOSARTAN 50 MG PO QD, ATENOLOL 25 MG PO QD, PRILOSEC ( OMEPRAZOLE ) 20 MG PO QD, AMIODARONE 400 MG PO BID, ECASA ( ASPIRIN ENTERIC COATED ) 325 MG PO QD, FLAGYL ( METRONIDAZOLE ) 500 MG PO TID X 2 Days, LEVOFLOXACIN 500 MG PO QD X 2 Days, and DIET: House / Low chol/low sat. fat with instructions for regular exercise and follow up with Dr. Schultheiss ( cardiology ) 5/30/03 scheduled. On order for NEORAL PO ( ref # 55336954 ) with a POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & CYCLOSPORINE override added on 11/0/03 by LIU , HERMAN ANTONIO , M.D., and LOSARTAN PO ( ref # 04133525 ) with a POTENTIALLY SERIOUS INTERACTION: CYCLOSPORINE & LOSARTAN POTASSIUM override added on 11/0/03 by ELVEY , EDMUND LENNY , M.D., Alert overridden: Override added on 5/27/03 by : POTENTIALLY SERIOUS INTERACTION: LEVOFLOXACIN & AMIODARONE HCL Reason for override: aware and POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & LEVOFLOXACIN Reason for override: aware. The patient had a hypoxic episode and EKG changes resolved, requiring 2u PRBCs, and was initially treated with lopressor 5mg IV, eventually rate controlled with dilt drip. PFT's , LFT's and TFT's were completed prior to discharge, and she was instructed to restart ecasa 5d p colonoscopy, as well as to take levofloxacin and flagyl for 5 days, and administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose. Consider anticoagulation for PAF was recommended. On 1/16 she had Afib with RVR to 130s with chest arm pain which is her anginal equivalent. ECG with rate related ischemia ST depression V5-6, L. +Minimal troponin leak to 0.19, which subseq downtrended with nl CK. She was init treated with lopressor 5mg IV but had hypotension to 80's which resolved quickly with IVF. She was eventually rate controlled with dilt drip. She returned to sinus rhythm within the day. Cards c/s'd and recommended amio load. CXR showed no infiltrate/opacity. Levo/Flagyl given empirically x 5days though she remained afeb. Abdominal exam was concerning for focal peritoneal irritation. Her exam improved, and she was tolerating PO well at the time of discharge. She has been afeb and well appearing for several days prior to d/c. Plan to complete 5d abx. As per Dr. Thorburn her colonoscopy was complex, and she had polypectomy of 2.5 cm polyp. Path is pending. If + for cancer, the base looked "clean", so may be feasible to re-scope her for surveillance at a later time, as per GI. Hct after colonoscopy went to 24 ( baseline 30 ); post-transfusion HCt of 30.
|
What types of medications have been tried for paf management
|
{
"answer_end": [
1950
],
"answer_start": [
1901
],
"text": [
"Consider anticoagulation for PAF was recommended."
]
}
|
MAZINGO, THOMAS 281-40-01-4 was admitted for CHF and discharged on 7/14/04. The patient, a 63 year old female with a history of resistant diabetes, morbid obesity, coronary artery disease, and hypertension, presented with one week of shortness of Breath. Examination revealed a respiratory rate of 22, oxygen saturation of 98% on 2L, bibasilar crackles, decreased breath sounds, scattered wheezes, and a normal heart exam. Labs and studies were notable for cardiac enzymes negative x3, BNP marginally elevated at 191, glucose of 286, A1c elevated at 10.3, and TSH of 3.847. An elevated PTT of 64.9 of uncertain significance was also found. The patient was ruled out for ischemia and given low-salt and ADA 1800 diets. She was prescribed Tylenol (Acetaminophen) 650 mg PO Q4H PRN Headache, ECASA (Aspirin Enteric Coated) 325 mg PO QD, Colace (Docusate Sodium) 100 mg PO BID, Lasix (Furosemide) 80 mg PO BID starting today, Insulin NPH Human 110 units SC QAM, NTG 1/150 (Nitroglycerin 1/150 (0.4 mg)) 1 Tab SL Q5min x 3 PRN Chest Pain, Verapamil Sustained Release 240 mg PO BID, Flovent (Fluticasone Propionate) 220 mcg Inh BID, Diovan (Valsartan) 160 mg PO QD, Vioxx (Rofecoxib) 12.5 mg PO QD, Duoneb (Albuterol and Ipratropium Nebulizer) QID with Q2H Albuterol O/N, Lipitor (Atorvastatin) 10 mg PO QD, Prilosec (Omeprazole) 20 mg PO QD, Albuterol Nebulizer 2.5 mg Neb Q2H PRN Shortness of Breath, 3/0.5 mg Inh Q6H PRN Shortness of Breath, and Heparin 5000 SC TID for DVT prophylaxis, as well as 80 IV Lasix in the ED and put out 1200 cc. She was instructed to follow-up with Dr. Ross Ogston on Friday 6/8/04, take Lasix pills twice a day until she sees Dr. Nicoll, and call her doctor if she has fever, chills, shortness of breath, or chest pain.
|
What is her current dose of diovan ( valsartan )
|
{
"answer_end": [
1159
],
"answer_start": [
1127
],
"text": [
"Diovan (Valsartan) 160 mg PO QD,"
]
}
|
Harrison Fullwood was admitted on 4/3/2005 for ICD placement for HCM. On 7/13/05, Medtronic Dual Chamber DDI/ICD was placed under general anesthesia with a CODE STATUS of Full Code and disposition of Home. ECHO 5/13 showed septal thickness 16mm, posterior wall thickness 19mm with preserved EF 65% and LV outflow tract peak gradient 125mmHg. Holter monitoring 0/2 without any arrhythmias. On admission PE, VS 96.4 74 140/90 20 93% RA. Labs/Studies included CBC, BMP, Coags wnl, EKG NSR. TW flat V5/V6 (old), CXR (portable): cardiomegaly, no e/o ptx, PA/lat CXR AM after no ptx, leads in place, no overt failure. The patient was prescribed Albuterol, Advair 250/50 bid, Rhinocort 2 sprays bid, Atrovent 2 puff qid, Singulair 10mg qhs, Nexium 40mg daily, Lasix 20mg daily (inc to 40 or 60 during period), Kcl 20meq daily, Verapamil 120mg daily, Patanol 1-2 OU bid prn, Loratidine 10mg daily, Zocor 20mg qhs, Effexor 75mg daily, Metformin 1250mg bid, Mgoxide 500mg daily, Ambien prn, Amox prior to procedures. On order for Motrin PO (ref# 234611479), the patient had a POSSIBLE allergy to Aspirin; reaction is Unknown. The patient was instructed to take Keflex for a 3 day total course, take all medications with food, and avoid grapefruit unless MD instructs otherwise. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A. ENDO: ISS. restarted Metformin on morning of d/c. NEURO: cont Effexor. On discharge, the patient was prescribed Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Wheezing, Lasix (Furosemide) 20 mg PO QD Starting Today (10/19) with instructions to titrate his dose 20mg/40mg/60mg as he normally does depending on his degree of swelling, Motrin (Ibuprofen) 600 mg PO Q6H PRN Pain, Headache, Magnesium Oxide 560 mg PO QD, Verapamil Sustained Release 120 mg PO QD Starting Today (10/19) with instructions to confirm home dose and resume home dose, Keflex (Cephalexin) 250 mg PO QID X 10 doses, Zocor (Simvastatin) 20 mg PO QHS, Ambien (Zolpidem Tartrate) 10 mg PO QHS PRN Insomnia, Loratadine 10 mg PO QD, Potassium Chloride Slow Rel. (KCl Slow Release) 20 mEq PO QD As per AH Potassium Chloride Policy, each 20 mEq dose to be given with 4 oz of fluid, Metformin 1,250 mg PO BID Starting IN AM (10/19), Rhinocort Aqua (Budesonide Nasal Inhaler) 2 Spray Inh BID, Singulair (Montelukast) 10 mg PO QD, Effexor XR (Venlafaxine Extended Release) 75 mg PO QD Number of Doses Required (approximate): 5, Advair Diskus 250/50 (Fluticasone Propionate/...) 1 Puff Inh BID, Nexium (Esomeprazole) 40 mg PO QD, Oxycodone 10 mg PO Q4H PRN Pain, and Atrovent HFA Inhaler (Ipratropium Inhaler) 2 Puff Inh QID. November of 2004, HF symptoms were controlled on Lasix and at baseline he could work. The patient was also advised to take all medications with food and to avoid grapefruit unless MD instructs otherwise, and to take Keflex for a 3 day total course and to take all other medications as the same. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A.
|
Was the patient ever prescribed metformin 1
|
{
"answer_end": [
2317
],
"answer_start": [
2268
],
"text": [
"Metformin 1,250 mg PO BID Starting IN AM (10/19),"
]
}
|
Shaull Darin was admitted on 8/12/2007 and discharged on 7/17/2007 with a full code status and disposition to home. During his stay, he was prescribed ACETYLSALICYLIC ACID 325 MG PO DAILY, with an Override Notice added on 10/30/07 by LAUB , STERLING B M. , M.D. on order for COUMADIN PO ( ref # 853955570 ) due to a POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, ATENOLOL 37.5 MG PO DAILY, CAPTOPRIL 12.5 MG PO BID, on order for KCL IMMEDIATE RELEASE PO ( ref # 545368405 ) due to a POTENTIALLY SERIOUS INTERACTION: CAPTOPRIL & POTASSIUM CHLORIDE, CELEXA ( CITALOPRAM ) 40 MG PO DAILY, PLAVIX ( CLOPIDOGREL ) 75 MG PO DAILY, DIGOXIN 0.125 MG PO DAILY, EPLERENONE 25 MG PO DAILY, FOLATE ( FOLIC ACID ) 1 MG PO DAILY, LASIX ( FUROSEMIDE ) 60 MG PO BID, Alert overridden: Override added on 10/30/07 by GOODWINE , BUFORD H B. , M.D. on order for LASIX PO ( ref # 145213873 ), NEURONTIN ( GABAPENTIN ) 100 MG PO TID, LORAZEPAM 0.5 MG PO DAILY PRN Anxiety, LOVASTATIN 40 MG PO DAILY, with an Override Notice added on 10/30/07 by PERAULT , SHELBY H M. , M.D. on order for COUMADIN PO ( ref # 853955570 ) due to a POTENTIALLY SERIOUS INTERACTION: LOVASTATIN & WARFARIN, POTENTIALLY SERIOUS INTERACTION: NIACIN , VIT. B-3 & LOVASTATIN, OMEPRAZOLE 20 MG PO DAILY, TEMAZEPAM 15-30 MG PO BEDTIME PRN Insomnia, MULTIVITAMIN THERAPEUTIC ( THERAPEUTIC MULTIVI... ) 1 TAB PO DAILY, COSOPT ( TIMOLOL/DORZOLAMIDE ) 1 DROP OU BID, Alert overridden: Override added on 11/14/07 by LUTHY , LANNY D E. , M.D. on order for COSOPT OU ( ref # 517414331 ), COUMADIN ( WARFARIN SODIUM ) 1 MG PO QPM, TRAVATAN 1 DROP OU BEDTIME Instructions: OU. thanks., amiodarone toxicity, Peripheral neuropathy, restless legs, Spinal, ASA/Plavix, BB. Some concern for ischemia causing his, to 60 bid. Cont Dig/nitrate/BB, ACEi. Checked echo, no change., Rhythym: Tele. Lyte replete78M with significant CAD, iCM EF 15-20%, presenting with SOB, underwent Adenosine MIBI with no focal defects, LHC with no new disease and no interventions, RHC with wedge of 16, PFTs 1992 with no COPD, CR 1.4-1.8, Barrett's on PPI, neuropathy, neurontin, celexa, glaucoma on eye drops, CV, NAS, 2L fluid restrict diet, held coumadin for cath then restarted it with 2mg on 8/1, 1mg on 6/10, INR of 1.7 on d/c, additional comments included measuring daily weights and calling MD if weight increases by more than 5 lbs in one week or 2-3 lbs in one day, continuing coumadin and checking INR on Monday, taking lasix 60 twice a day, and resuming all home medications. Patient discharged in stable condition with instructions to follow up volume status and check INR on 2/21/07. Number of Doses Required ( approximate ): 7. Override Notice: Override added on 10/30/07 by LAUB, STERLING B M. , M.D. on order for COUMADIN PO ( ref # 853955570 ) and Alert overridden: Override added on 11/14/07 by LUTHY , LANNY D E. , M.D. on order for
|
Has this patient ever tried atenolol
|
{
"answer_end": [
395
],
"answer_start": [
369
],
"text": [
"ATENOLOL 37.5 MG PO DAILY,"
]
}
|
This is a 66-year-old man with spinal sarcoidosis and secondary paraplegia who presented with altered mental status, hypoxemic respiratory failure, and hypotension. He became hypotensive with intubation despite using etomidate with Levophed, and was started on vancomycin, gentamicin, Flagyl, and stress dose steroids with 1 liter of IV fluid. His urine was found to have Proteus, resistant to Macrobid, and Klebsiella, resistant to ampicillin, so he was started on Levophed with a systolic blood pressure in the 130's on 7 to 10 of Levophed and Levofloxacin was continued at 500 mg per day for a total 10-day course on in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, to end on 10/16/2006 for a total course of 10 days. Urology replaced the suprapubic catheter and he was started on maintenance IV fluids until cleared to eat by Speech and Swallow. His home medications included Regular Insulin sliding scale a.c. and at bedtime, NPH 54 units in the morning and 68 units in the night, baclofen 10 mg t.i.d., amitriptyline 25 mg at bedtime, oxybutynin 5 mg t.i.d., gabapentin 300 mg t.i.d., iron sulfate 325 mg t.i.d., vitamin C 500 mg daily, magnesium 420 mg t.i.d., Coumadin 5 mg daily, ranitidine 150 mg b.i.d., and calcium 950 mg daily. He was given a head CT without contrast and a chest x-ray that showed no obvious infiltrate. His INR was found to be elevated and he had a suprapubic catheter obstruction with bilateral hydronephrosis and distended bladder. He was given Nexium and Coumadin for prophylaxis and was started on a low dose of captopril on 8/14/2006 for diabetes, and was started on 12.5 mg b.i.d. metoprolol on 0/14/2006 with good results. He was given NPH 20 b.i.d. through his hospitalization and Regular Insulin sliding scale. His creatinine came down to 1.2 and he was given the new beta-blocker and the ACE inhibitor as well as baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate 325 mg p.o. t.i.d., gabapentin 300 mg p.o. t.i.d., NPH human insulin 54 units in the morning, 68 units in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, magnesium oxide 420 mg p.o. t.i.d., metoprolol 12.5 mg p.o. b.i.d., oxybutynin 5 mg p.o. t.i.d., Panafil ointment t.i.d., and ranitidine 500 mg p.o. b.i.d. He was admitted with severe sepsis due to UTI, suprapubic catheter/ostomy for 12 years, diabetes type II, right DVT, on Coumadin, status post chronic UTI, and CPAP at night for pneumonia with ceftazidime, levofloxacin, and vancomycin. His sugars were controlled with no complications and was able to maintain blood pressures in the 130's. His creatinine was initially 2.7, and after receiving IV fluids, it came down to 1.2. He likely had acute renal failure secondary to postrenal obstructive etiology. His INR was found to be therapeutic and he had half of his home Coumadin dose while he was on levofloxacin, so he was given half of dose and his INRs came down to a nadir of 1.7. At discharge, his hematocrit was 27.2, down from 29, which was closed to his baseline of 34, and his INR was 2.1. He was placed on maintenance IV fluids until cleared to eat by Speech and Swallow, and was given amitriptyline 25 mg p.o. at bedtime, vitamin C 500 mg p.o. daily, baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate
|
levofloxacin
|
{
"answer_end": [
2514
],
"answer_start": [
2465
],
"text": [
"and CPAP at night for pneumonia with ceftazidime,"
]
}
|
This is a 51 year-old female with fibromyalgia, hypertension, and migraine headaches who presented to the Emergency Room with two months of dyspnea at night, paroxysmal nocturnal dyspnea, and orthopnea, and an episode of severe substernal chest pressure associated with shortness of breath after carrying water bottles from her car. In the Emergency Department, V/Q scan was very low probability and lower extremity noninvasive studies were also unremarkable. Her medications on admission included Nortriptyline, methyldopa, hydrochlorothiazide, Zantac, estrogen, Advil, ALternaGEL. She smokes one and one-half packs per day for 30 years. Physical examination showed temperature 97.4, respiratory rate 22, heart rate 100, blood pressure 150/90, anicteric, bibasilar crackles about one-quarter of the way up, regular rate and rhythm with II/VI systolic murmur and no rubs or gallops, benign abdomen, guaiac negative in the Emergency Department, 1+ pedal edema bilaterally, right greater than left, and nonfocal neurological. Laboratory data on admission showed hematocrit 41.6, BUN 13, creatinine 0.6, chest x-ray showed mild pulmonary edema, and electrocardiogram showed normal sinus rhythm at 91, no ischemic changes. She had serial CPKs which were all negative, and was treated with two doses of intravenous Lasix (20 milligrams each) resulting in a moderate diuresis and resolution of her shortness of breath symptoms. An exercise test was done with arm ergometry (30 watts) and her heart rate went from 100 to 129, blood pressure went from 130 systolic to 172, and electrocardiogram showed no ischemic changes. An echocardiogram showed vigorous systolic function of 86%, no valvular lesions, no wall motion abnormalities, and evidence of thickening in her ventricular walls. Given the fact that the patient had an elevated diastolic pressure and did show some early evidence of thickening in her ventricular walls, the decision was then made to begin her on a calcium channel blocker (Verapamil 240 milligrams p.o. q.d.) in addition to her usual medications. She was discharged to home in good condition with discharge medications including Verapamil SR 240 milligrams p.o. q.d., Zantac 300 milligrams q.d., estrogen 1.25 milligrams q.d., Advil 800 milligrams p.o. b.i.d. p.r.n., hydrochlorothiazide 25 milligrams p.o. q.d., methyldopa 250 milligrams q.d., and Nortriptyline 125 milligrams p.o. q.h.s., and an appointment to see a new primary physician at Dowsna Medical Center scheduled for May 1996.
|
Why was the patient on calcium channel blocker
|
{
"answer_end": [
2024
],
"answer_start": [
1799
],
"text": [
"the patient had an elevated diastolic pressure and did show some early evidence of thickening in her ventricular walls, the decision was then made to begin her on a calcium channel blocker (Verapamil 240 milligrams p.o. q.d.)"
]
}
|
Patient Mickey Corkill was admitted to the hospital on 5/29/2004 for dizziness and discharged on 7/17/2004. During this time, the patient was given ACETYLSALICYLIC ACID 81 MG PO QD Starting STAT ( 0/17 ), AMIODARONE 200 MG PO QD, DIGOXIN 0.125 MG PO QD, COLACE ( DOCUSATE SODIUM ) 100 MG PO BID, LASIX ( FUROSEMIDE ) 120 MG PO BID, NPH HUMULIN INSULIN ( INSULIN NPH HUMAN ) 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ) 30 MILLILITERS PO QD PRN Constipation, COUMADIN ( WARFARIN SODIUM ) 2 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, NORVASC ( AMLODIPINE ) 10 MG PO QD HOLD IF: SBP < 95, IMDUR ( ISOSORBIDE MONONIT.( SR ) ) 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR ( LOSARTAN ) 100 MG PO QHS Starting STAT ( 4/13 ), PLAVIX ( CLOPIDOGREL ) 75 MG PO QD Starting STAT ( 0/17 ), NEXIUM ( ESOMEPRAZOLE ) 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, Sliding Scale ( subcutaneously ) SC AC+HS, and HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. Due to the potential for serious interactions between WARFARIN and ASPIRIN, WARFARIN and AMIODARONE HCL, DIGOXIN and AMIODARONE HCL, and SIMVASTATIN and WARFARIN, overrides were added on 8/6/04 and 9/23/04 by various physicians, with the MDs being aware that the patient was already on the regimen at home. The patient was also advised to avoid high Vitamin-K containing foods and to avoid grapefruit unless the MD instructed otherwise. The patient's BB was held while in house because of worry about bradyarrhythmia and hypotension. The patient was also continued on home insulin regimen with coverage with insulin sliding scale, and was found to have a TSH of 158 FT4 1.8, FT3 56. The patient was also started on synthroid to be f/u for hypothyroidism and given prophylaxis with Nexium. Treatment included CV, NEURO, ENDO, and Prophylaxis, with the patient to follow-up with various doctors for management of CHF/BP, potential neurovascular etiology of symptoms, and hypothyroidism. The patient was anticoagulated with ACETYLSALICYLIC ACID 81 MG PO QD, AMIODARONE 200 MG PO QD, WARFARIN 2 MG PO QPM, COLACE 100 MG PO BID, LASIX 120 MG PO BID, NPH HUMULIN INSULIN 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA 30 MILLILITERS PO QD PRN Constipation, COUMADIN 2 MG PO QPM, NORVASC 10 MG PO QD HOLD IF: SBP < 95, IMDUR 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR 100 MG PO QHS, PLAVIX 75 MG PO QD, NEXIUM 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, and SIMVASTATIN 80 MG PO QHS HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. The patient was discussed with the cardiologist, and Coreg was held prior to admit for low BP's, with the plan to d/c pt off Coreg and defer to Dr. Doniel for reinstitution of beta blockade. Neuro exam was normal with no focal signs, and no signs of cerebellar dysfunction. The patient was also started on synthroid to be f/u with endocrine for management of hypothyroidism.
|
has the patient had milk of magnesia ( magnesium hydroxide )
|
{
"answer_end": [
493
],
"answer_start": [
414
],
"text": [
"MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ) 30 MILLILITERS PO QD PRN Constipation,"
]
}
|
Ms. Loften is a 62 year old woman with cardiac risk factors including hypertension, diabetes mellitus, postmenopause, and exertional angina for four months. On admission, her medications included Aspirin q.d., Enalapril 20 mg b.i.d., Cardizem 300 mg q.d., Insulin mixed 70/30 with 60 units in the morning and 30 in the evening, and Atenolol 50 mg q.d., with an additional Simvastatin 10 mg q.h.s. She had a history of Penicillin allergy which gave her edema, and a deep venous thrombosis in 1994, chronic renal insufficiency, cholecystectomy and vitiligo. Her family history is significant for brothers who had myocardial infarctions in their 50's and 60's, and a mother who had a myocardial infarction when she was 69. She was admitted for premedication overnight prior to catheterization due to a previous allergic reaction to contrast dye that caused laryngeal edema. On examination, her chest pain radiates to her left arm, is associated with shortness of breath, but no diaphoresis or nausea or vomiting, and is relieved by rest within two minutes or by a sublingual Nitroglycerin, which she has used in the past week x two. The patient underwent successful balloon angioplasty of the mid left anterior descending artery stenosis from 70 percent to 10 percent and had a mild occurrence of chest pain post catheterization which was relieved with two sublinguals, and showed no electrocardiogram changes. On discharge, she was prescribed Aspirin 325 mg q.d., Enalapril 20 mg b.i.d., Cardizem 300 mg q.d., Insulin mixed 70/30 with 60 units in the morning and 30 in the evening, Atenolol 50 mg q.d., and Simvastatin 10 mg q.h.s. She was discharged in stable condition with an appointment the day after discharge with Dr. Mondone.
|
How much simvastatin does the patient take per day
|
{
"answer_end": [
394
],
"answer_start": [
353
],
"text": [
"with an additional Simvastatin 10 mg q.h."
]
}
|
A 83-year-old male patient with a history of CAD, IMI, CABG (2000), HTN, and BPH presented with sore throat, cough, and weakness, and was admitted to a medical service with a diagnosis of viral syndrome. He had an EKG showing A-paced at 69, IMI, normal axis, and no acute ischemic changes, a MIBI showing an EF of 45% and multiple pulmonary nodules, a CXR was negative, and a CT Chest showed several pulmonary nodules in RUL inferiorly, the largest being 0.6cm, and other tiny nodules in the upper lobes bilaterally, 2-3mm, and several small nodes in the mediastinum with no LAD. CTAB, RRR were normal. He was given TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, CEPACOL 1-2 Lozenge PO Q4H PRN Other:sore throat, Vitamin B12 (Cyanocobalamin) 1,000 mcg IM QD x 3 doses, Dipyridamole 25 mg PO QPM, Lasix (Furosemide) 10 mg PO QD, Isordil (Isosorbide Dinitrate) 30 mg PO TID, Ativan (Lorazepam) 3.5 mg PO QHS PRN Insomnia, Inderal (Propranolol HCl) 10 mg PO QID, Norvasc (Amlodipine) 2.5 mg PO QD, Nitroglycerin 0.2% Topical TP BID Instructions: 1 inch, Zetia (Ezetimibe) 10 mg PO QD, Azithromycin 500 mg pack 500 mg PO QD x 4 doses, and Calcium Phosphate, Oral, Reason for override: aware. He had no significant fever or WBC and his symptoms improved on admission with no cough. He was observed O/N with IVF and improved in the morning and will be D/C'd on Azithromycin x 5 days. For the pulmonary nodules, he will follow-up with Dr. Muether as an outpatient for w/u. For Heme, he was given anemia, iron studies, B12, and folate sent and got B12 1000ug IM x 1 and was instructed to follow-up with the doctor's office to get injections for 2 more days, then monthly, likely due to a gastrectomy. He was given instructions to continue TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, CEPACOL 1-2 Lozenge PO Q4H PRN Other:sore throat, Ativan (Lorazepam) 3.5 mg PO QHS PRN Insomnia, Azithromycin 500 mg pack 500 mg PO QD x 4 days, B12 1000ug QD for 2 more days, then qmonth, and to call his doctor if he continues to feel unwell or returns to the hospital, and to go to the doctor's office on Thursday and Friday to receive the B12 injections. He was discharged in a stable condition.
|
Was the patient ever prescribed calcium phosphate
|
{
"answer_end": [
1192
],
"answer_start": [
1140
],
"text": [
"Calcium Phosphate, Oral, Reason for override: aware."
]
}
|
The patient is a 76-year-old female with a history of mitral regurgitation, congestive heart failure, recurrent UTIs, and uterine prolapse who presented with chills and hypotension and was admitted to the Medical ICU for treatment of septic shock. Mean arterial pressures were kept above 65 with Levophed and antibiotics were changed to penicillin 3 million units IV q.4h. and gentamicin 50 mg IV q.8h. An ATEE on 10/19 showed severe mitral regurgitation with posterior leaflet calcifications and linear density concerning for endocarditis, for which a PICC line was placed on 1/19 for a six-week course of penicillin 3 million units IV q.4h. and two-week course of gentamicin 50 mg IV q.8h. until 2/25. The patient was initially treated with Levophed for her hypotension until 11/0, and was placed on Levofloxacin and Vancomycin to treat Gram-positive cocci bacteremia and UTI. She was maintained on telemetry and was found to be a normal sinus rhythm with ectopy, including short once of nonsustained ventricular tachycardia. She was started on Lopressor 12.5 mg t.i.d. on 3/18, and this was increased to 25 mg b.i.d. at discharge, with her heart rates continuing to be between the 70s and the 90s, however, with less episodes of ectopy. Aspirin was given, and Lipitor was initially held for an initial transaminitis presumed to be secondary to shock liver. She had guaiac positive stools in the medical ICU, her hematocrit was stable around 33%, and her iron studies suggested anemia of chronic disease with possibly overlying iron deficiency. She had a normal random cortisol level of 35.3, and her Hemoglobin A1c was 6.5, so she was maintained thereafter only on insulin sliding scale and rarely required any coverage. The patient was kept on Lovenox and Protonix and her DISCHARGE MEDICATIONS include Aspirin 81 mg daily, iron sulfate 325 mg daily, gentamicin sulfate 50 mg IV q.8h. until 2/25 for a two-week course, penicillin G potassium 3 million units IV q.4h. until 0/12 for a six-week course, Lopressor 25 mg b.i.d., Caltrate plus D2 tablets p.o. daily, Lipitor 10 mg daily, and Protonix 40 mg daily. She was discharged to rehabilitation at Acanmingpeerra Virg Tantblu Medical Center in order to be able to get her antibiotic therapy, and her physicians will attempt to add the ACE back onto her medical regimen for better afterload reduction as her blood pressure tolerates, and potentially they will add her back on to the Lasix as well. She will require weekly lab draws to check her electrolytes and CBC while she is on the antibiotics.
|
Has the patient ever had penicillin g potassium
|
{
"answer_end": [
1970
],
"answer_start": [
1906
],
"text": [
"two-week course, penicillin G potassium 3 million units IV q.4h."
]
}
|
Reginald Burgos, a 76-year-old male with MMP, was admitted with chronic diarrhea of unclear etiology, likely malabsorption. He was put on a lactose free diet, NPO, and started on Imodium as diarrhea was not thought to be due to an acute infectious process. Lab tests were WNL. Medications prescribed include Acetylsalicylic Acid 81 mg PO QD, Atenolol 50 mg PO QD (hold if sbp <100, hr <60), Enalapril Maleate 20 mg PO BID (hold if sbp <100), Potassium Chloride on order for KCL Immediate Release PO (ref #61864355), Nifedipine (Extended Release) (Nifedipine (SL...)) 60 mg PO QD (hold if sbp <100, hr <60), Lipitor (Atorvastatin) 20 mg PO QHS, Zantac (Ranitidine HCl) 150 mg PO BID, Metformin 500 mg PO BID, Imodium (Loperamide HCl) 2-4 mg PO Q6H PRN Diarrhea, and Protonix (Pantoprazole) 40 mg PO QD. Follow up appointments were scheduled with Dr. Detillier (GI) 3/5 2pm, colonoscopy 6/18 9:30am, and Dr. Gaboriault (PCP) 0/8 1:30pm. He was treated with Cipro/Flagyl, but diarrhea persisted after the course was completed and he was given Protonix. He was also instructed to take Phosphate Soda the night before the colonoscopy, and to call 522-750-9060 for more directions. Allergies include CLOPIDOGREL and Penicillins. Discharge condition is stable.
|
Has this patient ever been prescribed lipitor ( atorvastatin )
|
{
"answer_end": [
643
],
"answer_start": [
607
],
"text": [
"Lipitor (Atorvastatin) 20 mg PO QHS,"
]
}
|
Mrs. Denman is a 63-year-old, insulin-dependent diabetic with a long history of peripheral vascular disease and multiple surgical procedures. She underwent a right transmetatarsal amputation in 1990 and subsequently underwent a right femoral distal saphenous vein bypass graft in 1991 which was later revised in 1992. In July of this year, she underwent a left superficial femoral artery to anterior tibial artery bypass using non-reversed basilic vein harvested from the right arm and had a large great toe ulcer, possibly attributed to hammertoe, which subsequently underwent a left great toe amputation. On the day prior to admission she was exercising with 4 pound weights on her legs with the physical therapist when she described a cool sensation in her foot and reported that her foot had been blue, and there were no Dopplerable pulses. Admission labs were unremarkable and she was placed on intravenous Heparin until the following morning. During Angiography Suite she was found to have two 95% stenosis in a long segment of the left SFA and the left distal SFA and anterior tibial vein graft was completely thrombosed. She was successfully treated with stent placement and received heparin and urokinase in the Intensive Care Unit overnight with a turn-over pulses of the left leg Doppler. During the remainder of the hospital course, her left foot remained pink and warm with an infection of exposed bone. She was discharged with Vancomycin 1250 mg IV q d, Ofloxacin 200 mg p.o. b.i.d., Coumadin with target INR of 2.0, last target 1.6, then received 10 mg in evening x 2., Percocet 1-2 tablets p.o. q 4 prn, Colace 100 mg p.o. b.i.d., insulin NPH 10 units subcu b.i.d., sliding scale insulin subcu q 4, Isordil 30 mg t.i.d., Zestril 5 mg q d, Lopressor 50 mg b.i.d., Axid 150 mg p.o. b.i.d. and was advised to follow up with Dr. Noah in one to two weeks.
|
has the patient used insulin lente in the past
|
{
"answer_end": [
1681
],
"answer_start": [
1620
],
"text": [
"Colace 100 mg p.o. b.i.d., insulin NPH 10 units subcu b.i.d.,"
]
}
|
This 90+-year-old male with a complex past medical history including CAD, CHF, AF and diabetes mellitus presented to the SICU for removal of chronically MRSA-infected mesh from prior abdominal surgery. He was intubated with etomidate, succinylcholine and kept sedated with Versed and fentanyl. He received intraoperative vancomycin and levofloxacin as well as 2200 mL of lactated Ringer's. In an attempt to reverse anticoagulation, one unit of FFP was begun but then aborted due to hypotension, which resolved with epinephrine injection, likely due to transfusion reaction. Another unit of FFP was administered, with platelets also given at the request of the Plastic Surgery Team in light of aspirin and Plavix, which were continued due to the patient's cardiac stents. Despite bolus Lasix, the patient did develop CHF with symptomatic pulmonary edema and increased oxygen requirement, concomitantly becoming delirious. He developed hypertension refractory to beta-blockade, calcium channel blockers and IV ACE inhibitors, and was thus placed on a nitroglycerin drip, a furosemide drip with ginger blood product resuscitation to address bleeding and an elevated INR, responding well to this regimen and aggressive pulmonary toilet. The patient was advanced to clear liquids, on medications including Amiodarone 200 mg p.o. daily, Calcium, Colace 100 mg by mouth t.i.d., Coumadin alternating doses of 4 mg and 3 mg, Diltiazem CD 360 mg p.o. daily, Aspirin 81 mg p.o. daily, Folate 1 mg p.o. daily, Lisinopril 10 mg p.o. daily, Metamucil p.r.n., Clopidogrel 75 mg p.o. daily, Potassium, Protonix 40 mg p.o. daily, Simvastatin 80 mg p.o. daily, Synthroid 25 mcg p.o. daily, Thiamine 100 mg p.o. daily, Metoprolol SR 100 mg p.o. b.i.d., Zyprexa 2.5 mg at bedtime p.r.n., and Vancomycin for MRSA-infected mesh. He does experience more significant delirium with morphine and less so with sparing Dilaudid p.r.n., and Haldol is written p.r.n. as needed. Weaning off nitroglycerin drip, nitro paste added, hematocrit 25%, one unit of packed red blood cells with Lasix and potassium to be given, RISS, and PICC line consult ordered for anticipated long-term vancomycin. Services following the patient include Medicine, Dr. Harcar, patient's PCP, Cardiology, Dr. Pagliari, and Plastic Surgery, Dr. Dunshie. Patient anticipated to be transferred to the floor on 9/28/06.
|
Was the patient ever given medication for cardiac stents.
|
{
"answer_end": [
770
],
"answer_start": [
693
],
"text": [
"aspirin and Plavix, which were continued due to the patient's cardiac stents."
]
}
|
GOMEY , REGGIE 802-36-83-4, a 70-year-old female with known CAD, DM, and schzioaffective disorder, presented with intermittent chest pain for 12 hours, with diaphoresis and no nausea/vomiting/fever/cough/shortness of breath. She had a recent cardiac workup with a moderate defect in the circumflex, but decided against medical treatment. Upon discharge, the patient was prescribed ACETYLSALICYLIC ACID 325 MG PO DAILY, ATENOLOL 12.5 MG PO QAM HOLD IF: SBP<100 or HR<50, LIPITOR (ATORVASTATIN) 80 MG PO DAILY, COGENTIN (BENZTROPINE MESYLATE) 1 MG PO QAM, THORAZINE (CHLORPROMAZINE HCL) 400 MG PO QAM (on order, ref # 417100958) with a potentially serious interaction with Benztropine Mesylate and Chlorpromazine HCL, ECASA 325 MG PO DAILY, GLIPIZIDE XL 10 MG PO DAILY, SYNTHROID (LEVOTHYROXINE SODIUM) 100 MCG PO DAILY, LISINOPRIL 20 MG PO DAILY HOLD IF: SBP<100, METFORMIN 1,000 MG PO BID HOLD IF: NPO, and TRAZODONE 50 MG PO BEDTIME PRN Insomnia. CVD ROMI x2 with troponin and ck and CKMB were normal and the patient continued her cardiac medications for BP control and ECG showed early R wave but no ST changes. DM was managed with oral hypoglycemics and the patient was prescribed Heparin for prophylaxis. She was also prescribed a diet of House/Low chol/low sat. fat and 2 gram Sodium and given instructions to walk as tolerated. Follow up appointments were scheduled with Dr. Mike Kalafarski on 10/1/06.
|
has the patient had ecasa
|
{
"answer_end": [
738
],
"answer_start": [
716
],
"text": [
"ECASA 325 MG PO DAILY,"
]
}
|
This 75-year-old female vasculopath was admitted for further evaluation of her peripheral vascular disease which was suspected to be contributing to her new ulcerations and progressively worsening bilateral foot pain, foot mottling and wrist pain as an exacerbating factor to likely atheroembolic phenomenon, status post coronary catheterizations earlier in the year. She was placed on broad-spectrum antibiotics and plan was made for an MRA to evaluate her anatomy, unfortunately, the patient was unable to tolerate the MR and did experience some mental status changes that prevented further noninvasive imaging when she received some narcotic following her hemodialysis round. Over the ensuing days she required rather significant doses of Zyprexa and Haldol to contain agitation and delirium, as the patient would also get physical and violent. This appeared to sedate her sufficiently and over the following days, she did manage to calm significantly and returned to her baseline mental status. Cardiology was consulted during this time to optimize her prior to the OR and her primary cardiologist, Dr. Fugle, did make some recommendations including an echocardiogram that showed preserved ejection fraction and no wall motion abnormalities. Her beta blockade was titrated up and she was instructed to follow up with cardiology. She did tolerate hemodialysis throughout this time without undue difficulty and they offered an angiogram to delineate aortic and bilateral lower extremity runoff anatomy. After extensive discussions with the patient and the patient's family, the patient did agree to a left femoral to dorsalis pedis bypass graft which was performed on 0/25/2006 without complication. By time of discharge, she was tolerating a regular diet and ambulating at baseline with her rolling walker. The pain was well controlled with minimal analgesics that were not narcotic based. Medications on admission included Aspirin 325 mg p.o. daily, Plavix 75 mg p.o. daily, Cardizem 60 mg p.o. t.i.d., Lipitor 80 mg daily, Atrovent 2 puffs four times a day, Albuterol 2 puffs b.i.d., Renagel 806 mg p.o. every meal, Allopurinol 100 mg p.o. daily, Zaroxylyn 2.5 mg p.o. daily p.r.n. overload, Lantus 10 units subcutaneous nightly, Regular insulin sliding scale, Valium 5 mg p.o. b.i.d. p.r.n., Isordil 40 mg p.o. t.i.d., Hydralazine 20 mg p.o. t.i.d., Lopressor 75 mg p.o. t.i.d., Zantac 150 mg p.o. b.i.d., Aciphex 20 mg p.o. daily, Neurontin 300 mg p.o. post-dialysis, Metamucil, Nitroglycerine p.r.n., Procrit 40,000 units subcutaneously every week, Lilly insulin pen, unknown dosage 20 units every morning and 10 units every evening, Loperamide 2 tabs p.o. four times a day, Ambien 10 mg p.o. nightly p.r.n., Tylenol 325 mg p.o. every four hours p.r.n. pain, Albuterol inhaler 2 puffs b.i.d., Calcitriol 1.5 mcg p.o. every Monday and every Friday, Darbepoetin alfa 100 mcg subcutaneous every week, Ferrous sulfate 325 mg p.o. t.i.d., Prozac 40 mg p.o. daily, Motrin 400 mg p.o. every eight hours p.r.n. pain, Insulin regular sliding scale, and Sevelamer 800 mg p.o. t.i.d. Discharge instructions included touchdown weightbearing on the left heel, legs are to be elevated as much as possible while sitting or lying down, all home medications were to be resumed except for Lopressor, VNA was ordered to assist with wound care including Betadine paint to incisions daily, showering only, no bathing or immersion in water for prolonged periods of time, and follow-up visits with Dr. Amorose in one to two weeks and Dr. Morici primary care physician in one week.
|
What types of medications have been tried for pain management
|
{
"answer_end": [
2766
],
"answer_start": [
2717
],
"text": [
"Tylenol 325 mg p.o. every four hours p.r.n. pain,"
]
}
|
Mr. Almon is a 51 year old gentleman with history of insulin dependent diabetes mellitus and unstable angina who was doing yard work and experienced an episode of nausea and vomiting along with chest discomfort. His EKG was noted to have an old T wave inversion in lead 3 which was now upright and ST depressions that were normalizing, along with CKs of 974 and MB 24.3 and Troponin level of 1.77. He received aspirin 5 mg of intravenous Lopressor, Heparin drip and Adenosine MIBI. Cardiac catheterization revealed Right dominant system, no significant left main lesions identified, left anterior descending coronary artery with a discreet mid 65% lesion, distal 99% lesion and first diagonal coronary artery with a proximal discrete 70% lesion, left circumflex coronary artery with a distal after the second obtuse marginal discrete 60% lesion, supplying the second obtuse marginal. First marginal coronary artery had an ostial discrete 90% lesion and a second obtuse marginal had an ostial discrete 100% lesion. Right coronary artery had a mid discrete 95% lesion supplying the right posterior descending coronary artery. The patient underwent echocardiogram which revealed mild concentric left ventricular hypertrophy with normal cavity size and left ventricular systolic function mildly reduced with an estimated ejection fraction of 45%, severe hypokinesis of the basal and mid segments of the inferior wall and inferior septum, and severe hypokinesis of the posterior wall, apex and distal anterior wall. He underwent coronary artery bypass graft x 3 with a left internal mammary artery to left anterior descending artery, saphenous vein graft to the obtuse marginal coronary artery and saphenous vein graft to the intermediate coronary artery. Postoperatively, he was extubated on postoperative day number one and transferred to the step down unit, with a T.max of 99. He had serous drainage from the inferior aspect of his sternal incision. He was started on Keflex 500 mg four times a day for 10 days. Discharge medications included Enteric coated aspirin 325 mg once a day, ibuprofen 200 to 800 mg every 4 to 6 h p.r.n. pain, NPH Humulin insulin 44 units in the morning, 14 units in the evening, regular insulin 6 units twice a day, Niferex 150 mg twice a day, potassium chloride 20 mEq once a day, Zocor 40 mg once in the evening, Atenolol 50 mg once a day, Lisinopril 10 mg once a day, Keflex 500 mg four times a day for 10 days for his superficial sternal wound infection and torsemide 60 mg twice a day, and he was discharged to home in stable condition.
|
What is the patient's current dose does the patient take of her niferex
|
{
"answer_end": [
2308
],
"answer_start": [
2206
],
"text": [
"regular insulin 6 units twice a day, Niferex 150 mg twice a day, potassium chloride 20 mEq once a day,"
]
}
|
Ms. Elter is an 83-year-old Spanish-speaking female with history of CAD, distant three-vessel CABG, CRI, NSTEMI in 4/20 and type II diabetes who presented to the ED with PND, dyspnea on exertion, and chest heaviness with no fevers or chills and no sick contacts, and EMS had given her Lasix and Nitrospray. She was briefly on a nonrebreather mask and responded to 80 mg of IV Lasix, with her potassium level reaching 5.8 and Kayexalate administered. Her medications included aspirin, metoprolol, allopurinol, valsartan, glipizide, Lipitor, and nifedipine, with her oxygen saturation eventually reaching the high 90s on a couple of liters of oxygen and her chest x-ray full set negative. She was treated with aspirin, beta-blockers, and statin for coronary artery disease, experienced a CHF flare with an elevated BNP which was managed with Lasix and Diuril, and her after load was reduced with ARB and her previous home calcium channel blocker was weaned off. She had a transient new atrial fibrillation and ventricular ectopy which resolved spontaneously, and was placed on humidified room air with nasal saline sprays and Afrin due to her coronary artery disease. She was transfused a total of 3 units to keep her hematocrit greater than 30 and Coumadin was initially started given her new onset of atrial fibrillation, but ultimately only aspirin was given after consideration of risks versus benefits. She had some constipation which was relieved with stool softeners and the patient received a PPI. Her DM-2 was managed with regular sliding scale insulin with good blood sugar control and her glipizide was held given her worsening creatinine clearance, and her allopurinol was changed to q.72h. from q.o.d. due to the creatinine clearance and she had some left heel and foot pain thought to be secondary to gout, which improved at the time of discharge. Her hematocrit dropped from 29 to 25, her guaiac was negative on the 3/20/04, and she was sent home with VNA support to follow up on her weights and fluid status and with home physical therapy. Her medications at the time of discharge included Lasix 20 mg p.o. q.d., Lipitor 80 mg p.o. q.d., Metoprolol sustained release 100 mg p.o. b.i.d., Colace 100 mg p.o. b.i.d. p.r.n. for constipation, Allopurinol 100 mg p.o. q.72h., Aspirin 325 mg p.o. q.d., and Valsartan 160 mg p.o. q.d.
|
What was the dosage prescribed of lasix
|
{
"answer_end": [
449
],
"answer_start": [
351
],
"text": [
"responded to 80 mg of IV Lasix, with her potassium level reaching 5.8 and Kayexalate administered."
]
}
|
75 yo Spanish speaking F was admitted for pre-syncope and discharged on 9/15/04 with full code status to home with medications including TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, ALBUTEROL INHALER 2 PUFF INH QID Starting Today (2/9), ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, ATENOLOL 25 MG PO BID, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, ZOCOR (SIMVASTATIN) 40 MG PO QHS with food/drug interaction instruction to avoid grapefruit unless MD instructs otherwise and IMDUR (ISOSORBIDE MONONIT.(SR)) 30 MG PO QD with food/drug interaction instruction to give on an empty stomach (give 1hr before or 2hr after food) and ZANTAC (RANITIDINE HCL) 150 MG PO BID and CELEBREX (CELECOXIB) 200 MG PO QD with food/drug interaction instruction to take with food with diet of house/low chol/low sat. fat and activity of walking as tolerated. An EKG showed sinus brady and a TSH test was mildly elevated at 5.3. Labs showed an elevated LDL, cardiac enzymes negative, UA negative, Hct 40 at baseline, and an aMIBI 3/24 showed a small reversible defect of mild intensity in the distal ant wall and apex c/w small area ischemia in the distal LAD. The patient was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, ALBUTEROL INHALER 2 PUFF INH QID Starting Today (2/9), ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, ATENOLOL 25 MG PO BID, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, ZOCOR (SIMVASTATIN) 40 MG PO QHS on order for ZOCOR PO (ref # 63128567), IMDUR (ISOSORBIDE MONONIT.(SR)) 30 MG PO QD, ZANTAC (RANITIDINE HCL) 150 MG PO BID, CELEBREX (CELECOXIB) 200 MG PO QD, NSAIDS, and LOVENOX for DVT ppx. The patient was advised of the benefits of ASA for her and was started on 81mg qd and may benefit from EGD as well as increasing Imdur if persistent hypertension. It is important to call Dr. Mcquade for a follow up appointment within the next 1-2 weeks and to take all medications on the discharge list at the doses specified. The patient presents with pre-syncope, hypothyroidism, asthma, left hip pain, headache and polyarthralgias. The patient was monitored on tele and the atenolol could be a contributing factor to the bradycardia and was switched to bid frequency with 1/2 dose (25mg). GI symptoms include dyspepsia and was started on PPI and checked for H.pylori. Endocrine symptoms included a mildly subtherapeutic levoxyl which was increased to 75mcg qd. Pulmonary symptoms included asthma which was continued on albuterol inhaler PRN and DVT ppx with Lovenox. MSK symptoms included trochanteric bursitis which was treated with Tylenol.
|
Is there a mention of of celebrex usage/prescription in the record
|
{
"answer_end": [
1586
],
"answer_start": [
1544
],
"text": [
"CELEBREX (CELECOXIB) 200 MG PO QD, NSAIDS,"
]
}
|
This 64-year-old male with a history of coronary artery disease, CHF, EF of 15%, status post AVR, and NSTEMI initially presented to outside hospital with chief complaint of shortness of breath and was found to have a BNP of 747 as well as a troponin I of 0.43. He was diuresed, started on Carvedilol and improved, and placed on a heparin drip. His medications on admission included Aspirin 81, Lisinopril 20, Plavix 75, Verapamil 240 sustained release, Gemfibrozil 600 b.i.d., Nystatin 500 b.i.d., Paxil 20 daily, Glipizide 10 daily, Coumadin 4 prior to admission to outside hospital, Carvedilol 6.25 daily, heparin drip and Spironolactone. During his hospital stay, he was continued on Aspirin, Plavix, beta-blocker and ACE inhibitor, which were titrated to effect, started on a statin and continued on Niaspan, and maintained on a nicotine patch. He was also prescribed Spironolactone 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, and Coumadin 5 mg p.o. at night. The patient's diabetes was controlled with regular insulin and placed back on his oral hypoglycemics, which were discontinued on admission and was encouraged to stop smoking. He had runs of ectopy and SVT, so was placed on a heparin drip. Left heart cath revealed wall defect consistent with a right coronary artery infarct and the patient was continued on Spironolactone. He was discharged in a stable condition on Aspirin 325 p.o. daily, Lisinopril 4 mg p.o. daily, Nicotine patch 14 mg per day topical, Spironolactone 25 mg p.o. daily, Paxil 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, Carvedilol 12.5 mg p.o. twice daily, Plavix 75 mg daily, Gemfibrozil 900 mg p.o. twice daily and Coumadin 5 mg p.o. at night, with instructions to follow up with PCP and Cardiology as well as EP, to check his daily weights and report any increases to his PCP, and to arrange to have his INR drawn on 6/21/06 and follow-up INRs to be drawn every seven days.
|
What is the dosage of niaspan
|
{
"answer_end": [
963
],
"answer_start": [
931
],
"text": [
"Niaspan 0.5 gm p.o. twice daily,"
]
}
|
Rayford Turturo, a patient with Congestive Heart Failure, was admitted on 9/6/2004 and discharged on 5/22/2004. During his stay, he was placed on ACETYLSALICYLIC ACID 325 MG PO QD, ALLOPURINOL 100 MG PO QD, DIGOXIN 0.125 MG PO QD, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, TOPROL XL (METOPROLOL (SUST. REL.)) 50 MG PO QD, NEURONTIN (GABAPENTIN) 200 MG PO QD, COZAAR (LOSARTAN) 100 MG PO QD HOLD IF: SBP<100, CELEXA (CITALOPRAM) 20 MG PO QD, LANTUS (INSULIN GLARGINE) 50 UNITS SC QHS, WARFARIN SODIUM 3 MG PO QPM, LIPITOR (ATORVASTATIN) 10 MG PO QD, PRILOSEC (OMEPRAZOLE) 20 MG PO QD, TORSEMIDE 100 MG PO QAM, and TORSEMIDE 50 MG PO QPM. Override notices were added on 1/16/04 for WARFARIN SODIUM PO (ref #94959833), LEVOXYL PO (ref #70031810), and SERIOUS INTERACTIONS with ASPIRIN, LEVOTHYROXINE SODIUM, ALLOPURINOL, and WARFARIN. The patient was also instructed to measure weight daily, follow a fluid restriction of 2 liters, and a House/Low Chol/Low Sat. Fat, House/ADA 1800 cals/dy, and 2 gram Sodium diet. He was encouraged to walk as tolerated, and given follow-up appointments with Dr. Wilfinger (PCP), Corey Ortmeyer (CHF Clinic/Laxo Hospital), and Salvatore Angeli (Pacer/ICD Clinic). The patient also had an EP service place a VVI/R ICD device without complications, and was initially treated with intravenous Lasix until her respiratory status improved. During his stay, his electrolytes and magnesium were monitored and replenished, his coumadin dose decreased while being treated with levofloxacin, and he was instructed to keep appointments, have his INR checked, weight himself daily, follow written EP discharge instructions, and resume regular insulin dose when he resumes his outpatient eating habits.
|
What medicines have previously been tried for dvt
|
{
"answer_end": [
1515
],
"answer_start": [
1449
],
"text": [
"his coumadin dose decreased while being treated with levofloxacin,"
]
}
|
A 59 year-old woman with metastatic breast cancer and a history of pulmonary embolism presented with symptoms of fatigue, lethargy, tachycardia and fever. CXR showed LLL opacity, LUL opacity and hilar fullness on the right with prominent bronchi (?cuffing) and vertebral fractures. She was admitted with bacteremia on 7/0/2006 and treated with whole brain radiotherapy in March 2006 and with weekly Taxol. Restaging studies showed stable visceral disease but progression of bony metastatic disease, so in January 2006, she initiated a second-line Navelbine therapy. At the ER, she was administered 1UPRBC, 1L NS, Levofloxacin 500 mg IV, and placed CVP~20. Her blood pressure systolic initially 120s but decreased to 90s (MAPS>70), and norepinephrine was administered. She was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q6H PRN Pain, Temperature greater than:101, Other:transfusion premedication, ALBUTEROL NEBULIZER 2.5 MG INH Q4H PRN Wheezing, TESSALON PERLES (BENZONATATE) 100 MG PO TID PRN Other:congestion, BENADRYL (DIPHENHYDRAMINE) 12.5 MG PO x1 PRN Other:pre-transfusion, COLACE (DOCUSATE SODIUM) 100 MG PO BID PRN Constipation, ENOXAPARIN 40 MG SC DAILY, NEXIUM (ESOMEPRAZOLE) 40 MG PO DAILY, FLOVENT HFA (FLUTICASONE PROPIONATE) 110 MCG INH BID, INSULIN ASPART Sliding Scale.
|
What is the dosage of the medication the patient was prescribed for bony metastatic disease.
|
{
"answer_end": [
565
],
"answer_start": [
519
],
"text": [
"she initiated a second-line Navelbine therapy."
]
}
|
The patient is a 64 year-old gentleman with a history of chest discomfort, dyspnea on exertion and fatigue who was scheduled for a coronary artery bypass grafting. He had cardiac catheterization at Ryhoagberg Spisus Community Hospital on November, 1999 which demonstrated a 30% tapering lesion of the left main coronary artery, 70% proximal lesion of the left anterior descending coronary artery, 80% lesion distal to D1, 100% occlusion of his left circumflex and a 100% occlusion of his right coronary artery. On March, 1999, he underwent coronary artery bypass grafting times three with a left internal mammary artery to the left anterior coronary artery, saphenous vein graft to the aorta and a saphenous vein graft from the obtuse marginal to the aorta. His intraoperative course was uncomplicated and he was weaned to extubation and he was treated with stress steroids to prevent steroid withdrawal. He was taken back to the operating room for bleeding and was reintubated and was returned in good and stable condition to the intensive care unit on renal Dopamine. He was again extubated and was seen in consultation by the Gastrointestinal Service for a question of gastrointestinal bleed since there was a clot seen on the transesophageal echocardiogram probe at its withdrawal from his first surgery. The Gastrointestinal Service saw any evidence of any upper gastrointestinal bleed and he was maintained on H2 blockers. He was sent to the step down unit on routine postoperative day number two and his Captopril was increased for afterload reduction. He continued to improve and continued to have care for his respiratory situation with continued diuresis and nebulizer treatments and ambulation. He was discharged to the care of Dr. Lou Pineault at Potmend Rehabilitation Hospital, Moorlberl Street with medications including Prednisone 5 mg p.o. twice a day, Enteric coated aspirin 325 mg p.o. q. day, Zantac 150 mg p.o. twice a day, Niferex 150 mg p.o. twice a day, Atrovent nebulizer 0.5 mg four times a day, Timolol eye drops 0.5% one drop in both eyes twice a day, Atenolol 25 mg p.o. twice a day, Captopril 12.5 mg p.o. three times a day, Lasix 40 mg p.o. q. day, Potassium SR 20 mEq p.o. q. day, Simvastatin 40 mg p.o. q. day, and Ibuprofen 200-800 mg as needed for pain q.4-6h.
|
Has the patient had multiple zantac prescriptions
|
{
"answer_end": [
1977
],
"answer_start": [
1945
],
"text": [
"Niferex 150 mg p.o. twice a day,"
]
}
|
The patient was admitted on 4/12/04 with a right plantar surface neurotrophic ulcer, low-grade fevers and chills, and a history of diabetes mellitus, hypertension, distant past of pancreatitis, gout, neuropathy, high cholesterol, and chronic renal insufficiency. Significant labs at the time of admission included a potassium of 4.3, BUN of 38, creatinine of 3.2, and blood glucose of 187. The patient was started on 1. Lantus 100 mg q.p.m., 2. Humalog 20 units q.p.m., 4. Neurontin 300 mg t.i.d., 5. Lisinopril 40 mg q.d., 6. Allopurinol 300 mg q.d., 7. Hydrochlorothiazide 25 mg q.d., 8. Zocor 20 mg q.d., 9. TriCor 50 mg b.i.d., 10. Atenolol 25 mg q.d., 11. Eyedrops prednisolone and atropine, and 12. iron supplementation. The patient underwent an amputation of the third and fourth toe as well as metatarsal heads, and was started on Dr. Tosco's suggested antibiotics, vancomycin, levofloxacin, and Flagyl. To manage temperature greater than 101, the patient was prescribed Tylenol 650 to 1000 mg p.o. q.4h. p.r.n., allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Colace 100 mg p.o. b.i.d., Epogen 10,000 units q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient was seen by Dr. Ulvan in the renal staff and by the diabetes management service by Dr. Clint Holets. Postoperative lab checkup revealed that the patient's creatinine bumped to 4.9 with a BUN of 61, and the renal service was consulted. The patient was given Lopressor 100 mg b.i.d. to control the blood pressure, and was eventually started on PhosLo and Ferrlecit as well as Epogen 10,000 units q. week. Levofloxacin was continued for a one week course, and the patient was discharged to the rehab facility with Tylenol 650 to 1000 mg p.o. q.4h. p.r.n. for temperature greater than 101, allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Lopressor 100 mg p.o. b.i.d., PhosLo 1334 mg p.o. q.a.c., Colace 100 mg p.o. b.i.d., Epogen 10,000 units delivered subcuticularly q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient is to be followed up at the rehab facility at Ing Mansy General Hospital and should follow up with the renal service and Dr. Knaub in two to three weeks and one to two weeks, respectively. The
|
What was the dosage prescribed of epogen 10
|
{
"answer_end": [
1952
],
"answer_start": [
1924
],
"text": [
"Epogen 10,000 units q. week."
]
}
|
The patient, a 60M with newly-diagnosed DM, hyperlipidemia, glaucoma, h/o EtOH abuse, and erectile dysfunction, presented to the ED for the second time in 3 days with unsteadiness and sleepiness. Workup including head CTA and MRI were negative, and he was discharged with Metformin and plans for Holter and TTE. He returned to the ED with BS 277. No fevers, headaches, focal neuro findings, vertigo, visual changes, CP, SOB, n/v, abd pain, dysuria, or joint pain were found. Labs were significant for glucose 314, elevated lipids (Chol 302, Trig 323, LDL 189), and HbA1c 11.1%. EKG had old j-point elevation laterally, physical and neuro exam were normal. Explanations for episodes considered were TIA of posterior circulation vs. seizure, less likely atypical migraine or sleep disorder. At the time of discharge, the patient was stable and feeling very good. He was given ACETYLSALICYLIC ACID 81 MG PO DAILY, LIPITOR (ATORVASTATIN) 10 MG PO DAILY, GLYBURIDE 2.5 MG PO DAILY X 60 doses, METFORMIN 500 MG PO BID, a low-fat house diet, and acyclovir this week but stopped Wed for possible neuro side effects. Aspirin dose was increased from 81 mg to 325 mg qd and a prescription for an automatic BP cuff for monitoring at home was given. To better manage blood sugars, glyburide was added which should be taken once a day in addition to metformin twice a day, and he should check his blood sugars 3-4 times per day. He will followup with Dr. Clesen on Monday, and will be evaluated this week with TTE with bubble-study to r/o intracardiac source or PFO and EEG if Neurology deems possibility of seizure.
|
What medications has patient been on for hyperglycemia in the past
|
{
"answer_end": [
311
],
"answer_start": [
249
],
"text": [
"he was discharged with Metformin and plans for Holter and TTE."
]
}
|
Eli Frigge (047-45-81-2) was admitted with lightheadedness and hypertension, and discharged with a principal discharge diagnosis of s/p pacemaker placement and other diagnoses including CAD s/p CABG x 2, RAS c L renal stent, bilateral common iliac artery stents, PAF, and DM. A dual chamber Guidant pacemaker was inserted without difficulty on 10/13, programmed to DDI 60 mode, and BB was initiated with a plan to continue Toprol XL upon discharge. Cardiology recommended dc'ing Aspirin and adding Coumadin with Plavix for anticoagulation, but deferred decision to pt's outpatient cardiologist. The patient was instructed to take ACETYLSALICYLIC ACID 325 MG PO DAILY, LIPITOR (ATORVASTATIN) 80 MG PO DAILY, CLINDAMYCIN HCL 300 MG PO QID X 12 doses starting after IV ANTIBIOTICS END, PLAVIX (CLOPIDOGREL) 75 MG PO DAILY, COLACE (DOCUSATE SODIUM) 100 MG PO BID, NEXIUM (ESOMEPRAZOLE) 40 MG PO DAILY, GLIPIZIDE 2.5 MG PO DAILY, LISINOPRIL 5 MG PO BID HOLD IF: SBP <120, REGLAN (METOCLOPRAMIDE HCL) 10 MG PO TID, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 50 MG PO DAILY with Food/Drug Interaction Instruction, and SENNA TABLETS (SENNOSIDES) 2 TAB PO BID consistently with meals or on an empty stomach. Dulcolax and stool softeners were administered for constipation with good response, and the patient was instructed to continue Clindamycin until running out of pills, call doctor or go to nearest ER if having fever > 100.4, chills, nausea, vomiting, chest pain, shortness of breath, or anything concerning, and to continue stool softeners for constipation and resume all home meds upon discharge. The patient was discharged to home with services in stable condition.
|
What treatments has patient been on for constipation in the past
|
{
"answer_end": [
1289
],
"answer_start": [
1206
],
"text": [
"Dulcolax and stool softeners were administered for constipation with good response,"
]
}
|
The patient is a 64 year-old gentleman with a history of chest discomfort, dyspnea on exertion and fatigue who was scheduled for a coronary artery bypass grafting. He had cardiac catheterization at Ryhoagberg Spisus Community Hospital on November, 1999 which demonstrated a 30% tapering lesion of the left main coronary artery, 70% proximal lesion of the left anterior descending coronary artery, 80% lesion distal to D1, 100% occlusion of his left circumflex and a 100% occlusion of his right coronary artery. On March, 1999, he underwent coronary artery bypass grafting times three with a left internal mammary artery to the left anterior coronary artery, saphenous vein graft to the aorta and a saphenous vein graft from the obtuse marginal to the aorta. His intraoperative course was uncomplicated and he was weaned to extubation and he was treated with stress steroids to prevent steroid withdrawal. He was taken back to the operating room for bleeding and was reintubated and was returned in good and stable condition to the intensive care unit on renal Dopamine. He was again extubated and was seen in consultation by the Gastrointestinal Service for a question of gastrointestinal bleed since there was a clot seen on the transesophageal echocardiogram probe at its withdrawal from his first surgery. The Gastrointestinal Service saw any evidence of any upper gastrointestinal bleed and he was maintained on H2 blockers. He was sent to the step down unit on routine postoperative day number two and his Captopril was increased for afterload reduction. He continued to improve and continued to have care for his respiratory situation with continued diuresis and nebulizer treatments and ambulation. He was discharged to the care of Dr. Lou Pineault at Potmend Rehabilitation Hospital, Moorlberl Street with medications including Prednisone 5 mg p.o. twice a day, Enteric coated aspirin 325 mg p.o. q. day, Zantac 150 mg p.o. twice a day, Niferex 150 mg p.o. twice a day, Atrovent nebulizer 0.5 mg four times a day, Timolol eye drops 0.5% one drop in both eyes twice a day, Atenolol 25 mg p.o. twice a day, Captopril 12.5 mg p.o. three times a day, Lasix 40 mg p.o. q. day, Potassium SR 20 mEq p.o. q. day, Simvastatin 40 mg p.o. q. day, and Ibuprofen 200-800 mg as needed for pain q.4-6h.
|
Has the patient ever been on captopril
|
{
"answer_end": [
2154
],
"answer_start": [
2113
],
"text": [
"Captopril 12.5 mg p.o. three times a day,"
]
}
|
The patient, Emile Daron 493-31-10-1, was admitted on 3/17/2003 for pancreatitis with a Discharge Date of 2/1/2003 and was placed on a Full Code status and discharged to Home. She had a definite allergy (or sensitivity) to muscle relaxants, skeletal, and possible allergy (or sensitivity) to sulfa. The patient is a 64-year-old with known CAD, atherosclerotic peripheral vascular disease, and type 2 diabetes who presented with 8/10 stabbing back pain 4 days ago without a clear precipitant, which was non-raditating and partially relieved with analgesics. She denied any bowel or bladder incontinence or saddle anesthes ia, fevers, chills, nausea, vomiting, or diarrhea, however she did complain of urinary frequency (on lasix) in the last few days with out any dysuria or urgency. The patient also has increasing shortness of breath over the past month and abdominal distension over the last month, as well as intermittent left sided chest pain that radiates to her left arm. In the ED the patient was ruled out for an aortic dissection, MI, and had a negative D-Dimer, however lipase levels were elevated with normal LFTs. The patient had poor glucose control and her LDL was 151 and her triglycerides were very high, which could be a cause of her pancreatitis. The patient was placed on a House/Adv. as tol. / ADA 1800 cals/day / Very low fat (20gms/day) diet and was encouraged to resume regular exercise. Discharge medications included ACETYLSALICYLIC ACID 81 MG PO QD, AMITRIPTYLINE HCL 30 MG PO QHS, PREMARIN (CONJUGATED ESTROGENS) 0.625 MG PO QD, FLEXERIL (CYCLOBENZAPRINE HCL) 10 MG PO TID PRN Pain, COLACE (DOCUSATE SODIUM) 100 MG PO BID, FLUOXETINE (FLUOXETINE HCL) 40 MG PO QD, GEMFIBROZIL 600 MG PO BID with SERIOUS INTERACTION: SIMVASTATIN & GEMFIBROZIL, NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 10 UNITS SC QAM and NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 50 UNITS SC QHS, LORAZEPAM 1 MG PO QD, AMLODIPINE 10 MG PO QD Food/Drug Interaction Instruction, TOPROL XL (METOPROLOL (SUST. REL.)) 100 MG PO QD, IRBESARTAN 300 MG PO QD, LASIX (FUROSEMIDE) 40 MG PO QD, and LIPITOR (ATORVASTATIN) 80 MG PO QD with SERIOUS INTERACTION: GEMFIBROZIL & ATORVASTATIN CALCIUM, and was instructed to take consistently with meals or on empty stomach and to avoid grapefruit unless MD instructs otherwise. Follow up appointments included Dr. Bouy, vascular surgery, U Daylis Ont, 12:50 pm, Dr. Blaine Wehrley, 11:30 AM 5/14/03, MRI/A of abdomen, SHS Re Na, New Hampshire 59460, 11:20 AM, and Dr. Colleen on 10/2. We changed ATENOLOL to TOPROL XL 100 MG PO QD and AMLODIPINE 10 MG PO QD with Food/Drug Interaction Instruction. Endocrine- Has had poor glucose control. HbA1c 13. We continued NPH HUMULIN INSULIN 10 UNITS SC QAM and started AM NPH as well. Number of Doses Required (approximate): 5. Please take insulin in the morning as well as the night, and ask Dr. Colleen to help with your insulin regimen.
|
Has patient ever been prescribed fluoxetine ( fluoxetine hcl )
|
{
"answer_end": [
1690
],
"answer_start": [
1650
],
"text": [
"FLUOXETINE (FLUOXETINE HCL) 40 MG PO QD,"
]
}
|
Patient is a 71 year old white male with a history of coronary artery disease, angina, and dyspnea on exertion who presents for coronary artery bypass grafting. Patient reports angina since 9/29 described as chest fullness, and cardiac risk factors include a family history, no tobacco, hypertension, diabetes, and hypercholesterolemia. Significant past medical history is adult onset diabetes, diet controlled, and a question of gout with no history in the past. Past surgical history is significant for tonsillectomy and adenoidectomy and appendectomy as a child. Patient underwent a three-vessel coronary artery bypass grafting on 6/13/92 and tolerated the procedure well, ruling out myocardial infarction perioperatively. On discharge, patient was prescribed Levatol 30 mg p.o. q.d., Procardia XL 30 mg p.o. q.d., Colchicine 0.6 mg p.o. q.d., Pepcid 40 mg p.o. q.6h., and Aspirin one tablet p.o. q.d., and instructed to follow-up with Dr. Citrin in the Cardiac Surgical Clinic.
|
has the patient had colchicine
|
{
"answer_end": [
846
],
"answer_start": [
788
],
"text": [
"Procardia XL 30 mg p.o. q.d., Colchicine 0.6 mg p.o. q.d.,"
]
}
|
Vance Prunier, a 57 year old patient with diabetes mellitus, hypertension, hyperlipidemia, and known coronary artery disease, was admitted on 5/30/2001 with worsening exercise capacity. A cath today showed severe native TVD, patent LIMA to LAD, occluded SVG-OM, and radial graft to PDA 80% stenosis. PCI of radial graft lesion with Nir 2.5x15mm and S660 2.5x12mm stents resulting in 0% residual was done and Angioseal was applied to RFA. The patient was discharged on 6/17/2001 in a stable condition with medications EC ASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO QPM, Cipro (Ciprofloxacin) 250 MG PO BID, Insulin NPH Human 30 UNITS SC QAM, Insulin Regular (Human) 18 UNITS SC QAM, Levoxyl (Levothyroxine Sodium) 75 MCG PO QD, Lisinopril 20 MG PO QD, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL Q5 MIN X 3 PRN Chest Pain HOLD IF: SBP<[ ], Pravachol (Pravastatin) 20 MG PO QHS, Amlodipine 5 MG PO QD, Imdur (Isosorbide Mononit.( SR )) 60 MG PO QD, Wellbutrin SR (Bupropion Hcl SR) 150 MG PO BID, Clopidogrel 75 MG PO QD, and 16 hours Integrilin and 30 days Plavix. The patient was instructed to call for any further chest pain, groin pain, swelling or bleeding and was to return to work after an appointment with the local physician. Follow up appointments with Dr. Minear in 1-2 weeks and Dr. Givens were scheduled. The patient was discharged to home.
|
Has this patient ever been on cipro ( ciprofloxacin )
|
{
"answer_end": [
622
],
"answer_start": [
586
],
"text": [
"Cipro (Ciprofloxacin) 250 MG PO BID,"
]
}
|
This is a 69 year-old woman with a history of congestive heart failure and hypertension who presented with a productive cough which was worsening over the past 3-4 days and fever to 101 with chills and shakes and increasing shortness of breath. She had a white blood cell count of 9.3 with 54% polys and 9.6 % eosinophils, a glucose of 377, and a chest x-ray without evidence of congestive heart failure or infiltrate. She was treated in the emergency room with Albuterol nebulizer and plans were to discharge her to home, however, her saturations dropped to 89% on room air with exercise in the emergency room and was admitted for further observation. She was started on intravenous Cefuroxime, and initially improved with decrease in cough and shortness of breath; however, the patient continued to desat with exercise. A repeat chest x-ray was performed which showed no change when compared to the admission film. Her sputum culture grew out Pen-sensitive E-coli and she was continued on her intravenous and then PO antibiotics. She continued to desat with exercise, however, and her cough persisted although she remained afebrile with a slightly elevated white count and moderate peripheral eosinophilia. Her chest exam remained rancorous and the reason for this remained unclear. Given the finding of E-coli in the sputum sample, in addition to the elevated eosinophilia and lack of finding on chest x-ray despite significant findings on chest exam, the possibility of a worm or parasitic disease was raised. She had a Persantine MIBI in March of 1996, on which she had no fixed or reversible defects, and was on nitroglycerin for stable angina - "chest heaviness" after climbing one flight of stairs, relieved by rest and one sublingual nitroglycerin. Her medications on admission included Lasix 40 mg. per day, Insulin 70/30 28 units q a.m. and 5 units q p.m., Verapamil SR 120 mg PO b.i.d., Enteric coated aspirin 325 mg q day, KCL 10 mEq PO q day, Premarin 0.625 mg PO q day, Zestril 20 mg b.i.d., Atenolol, recently discontinued, Tofranil 75 mg PO q HS, Albuterol inhaler two puffs inhaled q.i.d., and Potassium slow release 10 mEq PO q day. She was discharged to home with Albuterol inhaler and instructions to follow up with her primary physician in clinic for further evaluation including PFTs and possible chest CT if symptoms did not abate, and to finish a full ten day course of antibiotics for presumed bronchitis. At the time of discharge the patient's saturation was 92 to 93% on room air and dropping slightly to 90 to 91% with exercise, however she was tolerating this well and was getting relief from her Albuterol inhaler.
|
Has this patient ever been on albuterol inhaler
|
{
"answer_end": [
2218
],
"answer_start": [
2152
],
"text": [
"She was discharged to home with Albuterol inhaler and instructions"
]
}
|
Lucien Lebel, an 889-75-18-3 patient, was admitted to the medical service on 3/26/2005 with a CHF flare and discharged on 6/4/2005 with a full code status and disposition of home with services. Medications prescribed upon discharge included ACETYLSALICYLIC ACID 81 MG PO QD, ATENOLOL 50 MG PO QAM Starting Today July, ENALAPRIL MALEATE 10 MG PO QD, LASIX (FUROSEMIDE) 80 MG PO QD Starting Today November, NPH INSULIN HUMAN (INSULIN NPH HUMAN) 60 UNITS SC QAM and QPM, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, PAXIL (PAROXETINE) 50 MG PO QD, SEROQUEL (QUETIAPINE) 800 MG PO QPM, DEPAKOTE ER (DIVALPROEX SODIUM ER) 1,000 MG PO QPM, LIPITOR (ATORVASTATIN) 60 MG PO QD, and POTENTIALLY SERIOUS INTERACTION: WARFARIN & ATORVASTATIN CALCIUM Reason for override: mda. The patient had a history of Afib, Type 2 DM on insulin, CAD, s/p MI 2000, and A fib/flutter, and was given 25 mg PO Lopressor x 2 in the ED which brought her HR down to 110s. The patient was also prescribed a diet of low cholesterol and saturated fat, ADA 1800 calories per day, 2 grams of sodium, and to measure weight daily, as well as to resume regular exercise, and follow-up appointments were scheduled with Dorsey Deases on 11/2 at 2:30 PM, Dr. Lavern Bringhurst on 2/2, and Dr. Lesley Bertling to draw INR's every 7 days. The patient was advised to follow up with Sol Kragt, the CHF nurse, maintain a careful low salt diet, not drink too many fluids, measure daily weights, be strict about taking insulin, and seek medical attention for any concerning symptoms, with a number of doses required of approximate 4.
|
What is the current dose of paxil ( paroxetine )
|
{
"answer_end": [
539
],
"answer_start": [
508
],
"text": [
"PAXIL (PAROXETINE) 50 MG PO QD,"
]
}
|
Dion Scarberry (926-57-39-3) was admitted on 9/0/2005 with a diagnosis of COPD flare and right heart failure and was discharged on 5/28/05 at 02:00 PM with a disposition of Home w/ services. He had a number of medications including Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17), Elavil (Amitriptyline HCL) 10mg PO QHS, Atenolol 25mg PO QD Starting in AM (7/17), Colace (Docusate Sodium) 100mg PO BID, Furosemide 20mg PO QD Starting Today (6/25), Guaifenesin 10ml PO TID Starting Today (6/25) PRN Other:cough, Oxycodone 5mg PO TID Starting Today (6/25) PRN Pain, Quinine Sulfate 325mg PO HS Starting Today (6/25), Senna Tablets (Sennosides) 2 Tab PO BID, MVI Therapeutic (Therapeutic Multivitamins) 1 Tab PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: will monitor, Zocor (Simvastatin) 20mg PO QHS, Morphine Controlled Release 15mg PO Q12H, Felodipine 5mg PO QD Food/Drug Interaction Instruction, Flonase (Fluticasone Nasal Spray) 1 Spray INH QD, Advair Diskus 500/50 (Fluticasone Propionate/...) 1 Puff INH BID, Caltrate+D (Calcium Carbonate 1,500mg (600...) 1 Tab PO BID, Novolog Mix 70/30 (Insulin Aspart 70/30) 35 Units QAM; 22 Units QPM SC 35 Units QAM 22 Units QPM, Prednisone Taper PO Give 60mg q 24 h X 5 dose(s), then Give 50mg q 24 h X 3 dose(s), then Give 40mg q 24 h X 3 dose(s), then Give 30mg q 24 h X 3 dose(s), then Give 20mg q 24 h X 3 dose(s), then Give 10mg q 24 h X 3 dose(s), then Give 5mg q 24 h X 3 dose(s), then Starting Today (6/25), Combivent (Ipratropium and Albuterol Sulfate) 2 Puff INH QID. He was also given a diet of 4 gram Sodium, activity to resume regular exercise, and follow up appointment(s) with primary care doctor at the BCCMC early next week. He had allergies to Erythromycins and was given Azithromycin and supplemental O2 and Levofloxacin and admitted with a diagnosis of COPD flare. Home meds include Atenolol 25mg PO qd, HCTZ 25mg PO qd, Felodipine 5mg PO qd, Zocor 20mg PO qhs, ASA 81mg PO qd, Advair 1 puff bid, Combivent 2 puffs qid, Loratidine 10mg PO qd, Guqifenesin 600mg PO q12h, Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid, Senna 2 tab PO qd, Calcium+Vim D 125 units PO qd, Elavil 10mg PO qhs. He was treated for COPD flare with supplemental O2, DuoNebs, and steroids and received a V/Q scan which reported a low probability of PE, as well as a cardiac MRI which demonstrated normal cardiac anatomy and function, with an LVEF of 73% and no valvular dysfunction. His diabetes was managed with his home regimen of Novolog and chronic pain and insomnia were managed with his out-pt regimen of morphine and oxycodone, and he was given Elavil for sleep. Because of his history of cancer, he was placed on Lovenox for anticoagulation. Additional Comments include the instruction to use his home oxygen when sleeping at night, the addition of Combivent inhalers and a steroid taper to his medicines, and to stop the hydrochlorathiazide (HCTZ) 25mg and take Lasix 20mg once a day. His discharge condition was stable, and he was instructed to continue Lasix 40mg PO QD at home and D/C home HCTZ, to do a slow prednisone
|
Has the patient ever been on atenolol
|
{
"answer_end": [
369
],
"answer_start": [
327
],
"text": [
"Atenolol 25mg PO QD Starting in AM (7/17),"
]
}
|
The patient had been taking Ativan of 3-4 mg q.d. for anxiety for the past two months and abruptly stopped taking it on March 1995 after which she started to have feelings of disorientation, and had been taking chloral hydrate 500 to 1000 mg q.h.s. for five days and Compazine with one dose. CURRENT MEDICATIONS: At home, patient took insulin NPH 25 units in the morning with Regular 10 units in the morning, aspirin 81 mg q.d., Lopressor 25 mg b.i.d., Compazine 5 mg q.6h. p.r.n. anxiety of which she took only one dose, and chloral hydrate 500 to 1000 mg q.h.s. for five days. On admission, her laboratory examination was significant for BUN of 17, creatinine of 1.0, glucose was 364, liver function tests were within normal limits, white count was 7.2, hematocrit was 36, and platelet count was 266. Neurology consultation was obtained who felt that patient's peripheral neuropathy was probably secondary to longstanding diabetes but felt that some of her symptomatology could be consistent with porphyria. Psychiatry felt that this episode was consistent with generalized anxiety disorder separated by post dysthymia and suggested phenothiazines which are proven to be safe in porphyria for treatment. She was started on Trilafon 2 to 4 mg p.o. p.r.n. q.6h. for anxiety and Keflex 500 mg p.o. t.i.d. for treatment. The patient was also seen to be orthostatic which was felt to be secondary to dehydration secondary to poor p.o. intake prior to admission and was treated with normal saline boluses and her orthostasis improved. Her Lopressor was also held with this episode of orthostasis. The Watson-Schwartz test done by Dr. Mohar on patient very early in the admission was negative which made an acute porphyria attack very unlikely. These episodes were felt to be secondary to a combination of anxiety attack and rapid taper of Ativan which she had been taking at moderately high doses for the last two months. Patient also developed urinary tract infection symptoms and her urine culture showed greater than 100,000 colonies of E. coli which were pansensitive. She was discharged to home on August in good condition on medications Aspirin 81 mg p.o. q.d., insulin NPH 25 units subcutaneously q.a.m., insulin regular 10 units subcutaneously q.a.m., Trilafon 2 mg p.o. q.6h., and Keflex 500 mg p.o. t.i.d. Follow-up will be with Dr. Dario Rodriquz.
|
Has patient ever been prescribed keflex
|
{
"answer_end": [
1318
],
"answer_start": [
1278
],
"text": [
"Keflex 500 mg p.o. t.i.d. for treatment."
]
}
|
The patient was admitted for right leg pain and poor ambulation. She had a history of OA and chronic right sided hip/knee pain with ambulation. On examination, she had pain with ambulation to her right leg, hip, and achy not sharp. X-rays of the right lower extremity joints showed no abnormality, and physical therapy recommended use of a cane. To treat her pain she was given TYLENOL 650mg PO Q6HR ATC and PRN IBUPROFEN. She was maintained on her outpatient cardiovascular medications, including Lisinopril 20 mg PO qd, Hydrochlorothiazide 25 mg PO qd starting today (2/4), Lipitor (Atorvastatin) 10 mg PO qd, Multivitamin Therapeutic (Therapeutic Multivi... ) 1 TAB PO QD, Calcium Carbonate (500 mg elemental Ca++) 500 mg PO TID, and Niacin/Vitamin B3 & Atorvastatin Calcium with an override for awareness of a potentially serious interaction. Blood pressure should be followed up as an outpatient and BP meds titrated as needed. She was cleared to go home with instructions to take TYLENOL at least twice daily to help improve her leg pain, seek medical attention if the leg becomes more red, swollen, or tender, or if there are any fevers or new problems with the leg, and use the cane to assist with walking. She was discharged in stable condition to her son, with instructions to follow up with Lenard Dimmitt for blood pressure, take Tylenol for pain, take Ibuprofen as needed, and call the nurse practitioner within 2 weeks for an appointment.
|
What is the patient's current dose does the patient take of her hydrochlorothiazide
|
{
"answer_end": [
575
],
"answer_start": [
522
],
"text": [
"Hydrochlorothiazide 25 mg PO qd starting today (2/4),"
]
}
|
A 56-year-old morbidly obese female with abdominal skin laxity due to massive weight loss after gastric bypass was admitted to plastics for panniculectomy. The patient tolerated the procedure without difficulty and the post-operative period has been uneventful. At discharge, the patient is afebrile with stable vitals, taking PO's/voiding q shift and has ambulated independently with some difficulty given body habitus. Pain has been well managed and incisions are clean, dry, and intact. JP's with moderate serosanguinous output remain in place. The patient was discharged to rehab in a stable condition, with instructions to continue antibiotics as long as drains are in place, change drain sponges daily, strip drains twice daily, sponge baths only while drains are in place, walking as tolerated, no lifting more than 10 pounds, no jogging, swimming, or aerobics for 4-6 weeks, and to monitor/return for signs of infection. Medications prescribed include TYLENOL (Acetaminophen) 1000 mg PO Q6H, KEFLEX (Cephalexin) 500 mg PO QID, COLACE (Docusate Sodium) 100 mg PO BID, PEPCID (Famotidine) 20 mg PO BID, DILAUDID (Hydromorphone HCL) 2-4 mg PO Q4H PRN Pain, INSULIN REGULAR HUMAN Sliding Scale (subcutaneously) SC Q4H Low Scale, LEVOTHYROXINE SODIUM 75 mcg PO daily, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, MILK OF MAGNESIA (Magnesium Hydroxide) 30 milliliters PO daily PRN Constipation, METOCLOPRAMIDE HCL 10 mg IV Q8H PRN Nausea, QUINAPRIL 20 mg PO daily, SIMETHICONE 40 mg PO QID PRN Upset Stomach, Other:gas, and STYKER PAIN PUMP (Bupivacaine 0.5%) 400 milliliters IV Q24H Instructions: Rate = 4ml/hr. The patient has a probable allergy to Morphine and Code Status is Full Code.
|
Why was the patient on metoclopramide hcl
|
{
"answer_end": [
1468
],
"answer_start": [
1425
],
"text": [
"METOCLOPRAMIDE HCL 10 mg IV Q8H PRN Nausea,"
]
}
|
The patient is a 65-year-old female who presented with the sudden onset of right upper quadrant and epigastric abdominal pain. She had been given some Demerol with some relief but she had persistent pain. An ultrasound two years prior to admission showed sludge in her gallbladder with no other abnormalities noted and an ultrasound on the night of admission showed multiple small stones and a gallbladder with sludge and thickening of the gallbladder wall. She was admitted to the Teeleah Valley Medical Center, given Vistaril, Premarin, Clinoril, and triple intravenous antibiotics, kept NPO, and placed on intravenous hydration. On 10 of May, she underwent an esophagogastroduodenoscopy, a cholecystectomy with an intraoperative cholangiogram, and common bile duct exploration with T-Tube placement. Intraoperatively, she was found to have a large inflamed gallbladder with multiple small cholesterol stones in her gallbladder and two stones in her common duct. Post-operatively, she remained stable and was transferred to the Recovery Room and eventually back to the floor. On 0/30/9l, she was started on sips of clear fluids and was up out of bed voiding on her own. By 10/19/9l, she was tolerating a regular diet. On 1/12/9l, she had a normal T-Tube cholangiogram and was clamped and was discharged to home on 1/9/9l to be followed up by Dr. Tendick in Clinic.
|
Is there history of use of hydration.
|
{
"answer_end": [
645
],
"answer_start": [
585
],
"text": [
"kept NPO, and placed on intravenous hydration. On 10 of May,"
]
}
|
Dion Scarberry (926-57-39-3) was admitted on 9/0/2005 with a diagnosis of COPD flare and right heart failure and was discharged on 5/28/05 at 02:00 PM with a disposition of Home w/ services. He had a number of medications including Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17), Elavil (Amitriptyline HCL) 10mg PO QHS, Atenolol 25mg PO QD Starting in AM (7/17), Colace (Docusate Sodium) 100mg PO BID, Furosemide 20mg PO QD Starting Today (6/25), Guaifenesin 10ml PO TID Starting Today (6/25) PRN Other:cough, Oxycodone 5mg PO TID Starting Today (6/25) PRN Pain, Quinine Sulfate 325mg PO HS Starting Today (6/25), Senna Tablets (Sennosides) 2 Tab PO BID, MVI Therapeutic (Therapeutic Multivitamins) 1 Tab PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: will monitor, Zocor (Simvastatin) 20mg PO QHS, Morphine Controlled Release 15mg PO Q12H, Felodipine 5mg PO QD Food/Drug Interaction Instruction, Flonase (Fluticasone Nasal Spray) 1 Spray INH QD, Advair Diskus 500/50 (Fluticasone Propionate/...) 1 Puff INH BID, Caltrate+D (Calcium Carbonate 1,500mg (600...) 1 Tab PO BID, Novolog Mix 70/30 (Insulin Aspart 70/30) 35 Units QAM; 22 Units QPM SC 35 Units QAM 22 Units QPM, Prednisone Taper PO Give 60mg q 24 h X 5 dose(s), then Give 50mg q 24 h X 3 dose(s), then Give 40mg q 24 h X 3 dose(s), then Give 30mg q 24 h X 3 dose(s), then Give 20mg q 24 h X 3 dose(s), then Give 10mg q 24 h X 3 dose(s), then Give 5mg q 24 h X 3 dose(s), then Starting Today (6/25), Combivent (Ipratropium and Albuterol Sulfate) 2 Puff INH QID. He was also given a diet of 4 gram Sodium, activity to resume regular exercise, and follow up appointment(s) with primary care doctor at the BCCMC early next week. He had allergies to Erythromycins and was given Azithromycin and supplemental O2 and Levofloxacin and admitted with a diagnosis of COPD flare. Home meds include Atenolol 25mg PO qd, HCTZ 25mg PO qd, Felodipine 5mg PO qd, Zocor 20mg PO qhs, ASA 81mg PO qd, Advair 1 puff bid, Combivent 2 puffs qid, Loratidine 10mg PO qd, Guqifenesin 600mg PO q12h, Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid, Senna 2 tab PO qd, Calcium+Vim D 125 units PO qd, Elavil 10mg PO qhs. He was treated for COPD flare with supplemental O2, DuoNebs, and steroids and received a V/Q scan which reported a low probability of PE, as well as a cardiac MRI which demonstrated normal cardiac anatomy and function, with an LVEF of 73% and no valvular dysfunction. His diabetes was managed with his home regimen of Novolog and chronic pain and insomnia were managed with his out-pt regimen of morphine and oxycodone, and he was given Elavil for sleep. Because of his history of cancer, he was placed on Lovenox for anticoagulation. Additional Comments include the instruction to use his home oxygen when sleeping at night, the addition of Combivent inhalers and a steroid taper to his medicines, and to stop the hydrochlorathiazide (HCTZ) 25mg and take Lasix 20mg once a day. His discharge condition was stable, and he was instructed to continue Lasix 40mg PO QD at home and D/C home HCTZ, to do a slow prednisone
|
Has the patient had simvastatin in the past
|
{
"answer_end": [
773
],
"answer_start": [
752
],
"text": [
"SIMVASTATIN & NIACIN,"
]
}
|
The patient is a 68 year old female with a history of long standing hypertension and diabetes who experienced an increase in shortness of breath, dyspnea on exertion and paroxysmal nocturnal dyspnea while in Tempefayscot, Michigan 76498. She was admitted to the Short Stay Unit for evaluation with a systolic blood pressure greater than 200, and was administered Procardia XL 20 mg p.o. x 1, Aspirin, Nitropaste, and IV Lasix, to which she had a significant response. Her past medical history includes a stress echocardiogram which showed mitral regurgitation, hypokinesis of the septum and AV block on exertion with an ejection fraction of about 40%. On admission, she was taking Cardura, Vasotec, and Metoprolol. Her electrocardiogram showed bradycardia at 40 with a left bundle branch pattern and she had 2:1 AV block. Her chest x-ray showed an enlarged heart with pleural effusions and cephalization, and her laboratory data SMA-7 was within normal limits. She underwent pacemaker placement without any difficulty and it was interrogated the day after placement without any problem. She was discharged in stable condition with no reportable disease and no adverse drug reactions on Keflex 250 mg p.o. q.i.d. for 5 days; Norvasc 5 mg p.o. qd; Hydrochlorothiazide 25 mg p.o. qd and Vasotec 20 mg p.o. b.i.d. She will follow-up with her Cardiologist in one week and will probably have her blood pressure medications further adjusted at that point.
|
What is the current dose of vasotec
|
{
"answer_end": [
1309
],
"answer_start": [
1280
],
"text": [
"and Vasotec 20 mg p.o. b.i.d."
]
}
|
This is a 59-year-old female with a history of rheumatic heart disease, endocarditis, diabetes mellitus, hypertension, and congestive heart failure who presented with increasing shortness of breath, nausea, vomiting, and abdominal pain. She was given recent Levaquin for an upper respiratory tract infection, then started on Flagyl for a possible C. difficile infection and was diuresed with IV Lasix with good output per report. She complained of 10/10 abdominal pain and was given some Dilaudid. Her hematocrit at one point required two units of packed red blood cells, and she was placed on a heparin drip at 950 units per hour to maintain a PTT between 60 and 80 secondary to atrial fibrillation that has been rate controlled with a beta-blocker. She was discharged on diltiazem 30 mg q.i.d. and a normal dosing of Nexium 40 mg p.o. q.d. while in-house. She was given Darvon and Codeine as needed for pain, and was prescribed Caltrate plus Vitamin D 600 mg, Maalox tablets, Magnesium oxide 400 mg, Multivitamin, Niferex 150 mg, and Lovenox 60 mg subcutaneously b.i.d. with a renal adjustment and NovoLog 15 units subcutaneously with breakfast and dinner. The patient was instructed to call Dr. Mccutchan office to coordinate her appointment for her valve repair in the next one to two weeks pending her surgeon's return and to call Dr. Doug Schlanger on March 2005 to discuss surgical plans and also to follow up. All her blood cultures should be followed up prior to her surgery and if any of her blood cultures become positive in the interim, a long course of antibiotic therapy should be started and surgery should be delayed at the discussion of the Cardiovascular Service. Her medications included Lasix 40 mg p.o. q.o.d. alternating with 80 mg p.o. Lasix q.o.d., Digoxin 0.125 mg q.o.d. alternating with 0.25 q.o.d., Lisinopril 20 mg p.o. q.d., Coumadin 6 mg p.o. q.o.d. alternating with 4 mg q.o.d., Omeprazole 20 mg b.i.d., Metformin 500 mg daily, Insulin 70/30 65 units q.a.m., 35 units q.p.m., Calcium 600 mg p.o. b.i.d., Magnesium 400 mg p.o. b.i.d., Multivitamin, Iron tablets, Actonel every Wednesday, Caltrate plus vitamin D 600 mg one tablet p.o. b.i.d., Maalox tablets quick dissolve, Magnesium oxide 400 mg p.o. b.i.d., Niferex 150 mg p.o. b.i.d., Colace 100 mg p.o. b.i.d., Senokot three tablets p.o. b.i.d., Codeine 15 mg to 30 mg p.o. q.4h. p.r.n. pain. She was required to increase her dosage of Nexium secondary to GERD-like symptoms and was maintained on a stable regimen of NPH 60 units in the morning, NPH 30 units in the evening, and NovoLog of 15 units in the morning with breakfast and 15 at dinner with a sliding scale. She was also transitioned to Lovenox 60 mg b.i.d. with a renal adjustment and was sent to the ED for diuresis where she was given 60 mg of Lasix.
|
Has the patient ever tried senokot
|
{
"answer_end": [
2295
],
"answer_start": [
2269
],
"text": [
"Colace 100 mg p.o. b.i.d.,"
]
}
|
Lupe Rumble, a 42 year old female with a history of asthma, hypertension, obesity, hyperlipidemia, hyperglycemia, hirsutism, chiari malformation, spinal stenosis, and spinal syrinx, was admitted to the hospital with a recent asthma flare, productive cough, low grade fevers, shortness of breath, and wheezing. Her chest x-ray showed a linear opacity in the right lower lobe most consistent with platelike atelectasis, but could not rule out resolving or new pneumonia. Treatment included ALBUTEROL INHALER 2 PUFF INH QID, ALBUTEROL NEBULIZER 2.5 MG NEB Q4H, Advair Diskus 500/50 (Fluticasone Propionate/...), Combivent (Ipratropium and Albuterol Sulfate) 2 PUFF INH TID, LISINOPRIL 20 MG PO DAILY, Singulair (Montelukast) 10 MG PO DAILY, and a prednisone taper starting at 60 mg q 24 h x 2 doses, then 50 mg daily x 3 days, then 40 mg daily x 3 days, then 30 mg daily x 3 days, then 20 mg daily x 3 days, and then 10 mg daily x 2 days and stop. The peak flow had improved to 250 and ambulating oxygen saturation was 92-94% at discharge. The patient was also advised to try a nicotine patch and was given Lovenox as a prophylaxis. Her lisinopril was increased to 20mg due to hypertension, and she was discharged on order for KCL IMMEDIATE RELEASE PO (ref #) with instructions to continue all home medications, a prednisone taper, nebs, and advair, singulair, albuterol, and combivent. Smoking cessation was encouraged and she was interested in trying a nicotine patch.
|
Has this patient ever been on combivent ( ipratropium and albuterol sulfate )
|
{
"answer_end": [
670
],
"answer_start": [
609
],
"text": [
"Combivent (Ipratropium and Albuterol Sulfate) 2 PUFF INH TID,"
]
}
|
Mr. Quigg is a 42-year-old man with history of diabetes, end-stage renal disease on hemodialysis, left Charcot foot complicated by recurrent cellulitis who presented with left lower leg swelling, erythema, and pain. On admission, his temperature was 100.8, heart rate was 111, and blood pressure was 140/70. His left lower extremity had 1+ pitting edema with erythema on the anterior shin and foot. He was uptitrated to 5mg and also lopressor, started on Lyrica and oxycodone for breakthrough pain, and received Fentanyl PCA. His home medications included Colace 100 mg b.i.d., folate 1 mg p.o. daily, gemfibrozil 600 mg b.i.d., Lantus 30 mg subcu q.p.m., Lipitor 80 mg nightly, Nephrocaps, Neurontin 300 mg daily, PhosLo 2001 mg t.i.d., Protonix 40 mg daily, Renagel 3200 mg t.i.d., Requip 2 mg p.o. b.i.d., and Coumadin. His Lipitor was decreased to 20mg due to rhabdomylosis risk, and he was also started on low dose b-blocker to reduce perioperative MI risk prior to his surgery. His Vancomycin was continued given his history of MRSA cellulitis, with a goal of a level less than 20, and he was bridged with heparin with a goal PTT of 60-80. He was restarted on his Lantus and Aspart doses with meals, and his Coumadin was held prior to surgery and decreased to 20mg with a repeat lipid panel in 4-6 weeks. He required antibiotics which were discontinued at this time and he was discharged with dry sterile dressing changes to his residual limb daily, PTT goal 60-80, INR goal 2-3 until stable off of levofloxacin, monitoring of FS and adjustment of DM regimen, monitoring pain scale and decreasing pain medications as pain improves, hemodialysis M/W/F, and follow up with Dr. Carpino voice message left on his medical assistant's voice mail and Dr. Lynes 6/10/06 at 9:30am. Psychiatry service was consulted who recommended low dose Ativan prior to him going for dialysis. He was initially placed on a ketamine drip and given IV Levofloxacin and IV Flagyl to cover gram negatives and anaerobes respectively, and started on oxycontin 80mg tid with oxycodone for breakthrough pain and Lyrica for neuropathic pain. He was comfortable prior to discharge on this current regimen.
|
What is her current dose of lisinopril
|
{
"answer_end": [
443
],
"answer_start": [
399
],
"text": [
"He was uptitrated to 5mg and also lopressor,"
]
}
|
Rayford Turturo, a patient with Congestive Heart Failure, was admitted on 9/6/2004 and discharged on 5/22/2004. During his stay, he was placed on ACETYLSALICYLIC ACID 325 MG PO QD, ALLOPURINOL 100 MG PO QD, DIGOXIN 0.125 MG PO QD, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, TOPROL XL (METOPROLOL (SUST. REL.)) 50 MG PO QD, NEURONTIN (GABAPENTIN) 200 MG PO QD, COZAAR (LOSARTAN) 100 MG PO QD HOLD IF: SBP<100, CELEXA (CITALOPRAM) 20 MG PO QD, LANTUS (INSULIN GLARGINE) 50 UNITS SC QHS, WARFARIN SODIUM 3 MG PO QPM, LIPITOR (ATORVASTATIN) 10 MG PO QD, PRILOSEC (OMEPRAZOLE) 20 MG PO QD, TORSEMIDE 100 MG PO QAM, and TORSEMIDE 50 MG PO QPM. Override notices were added on 1/16/04 for WARFARIN SODIUM PO (ref #94959833), LEVOXYL PO (ref #70031810), and SERIOUS INTERACTIONS with ASPIRIN, LEVOTHYROXINE SODIUM, ALLOPURINOL, and WARFARIN. The patient was also instructed to measure weight daily, follow a fluid restriction of 2 liters, and a House/Low Chol/Low Sat. Fat, House/ADA 1800 cals/dy, and 2 gram Sodium diet. He was encouraged to walk as tolerated, and given follow-up appointments with Dr. Wilfinger (PCP), Corey Ortmeyer (CHF Clinic/Laxo Hospital), and Salvatore Angeli (Pacer/ICD Clinic). The patient also had an EP service place a VVI/R ICD device without complications, and was initially treated with intravenous Lasix until her respiratory status improved. During his stay, his electrolytes and magnesium were monitored and replenished, his coumadin dose decreased while being treated with levofloxacin, and he was instructed to keep appointments, have his INR checked, weight himself daily, follow written EP discharge instructions, and resume regular insulin dose when he resumes his outpatient eating habits.
|
Has patient ever been prescribed toprol xl ( metoprolol ( sust. rel. ) )
|
{
"answer_end": [
324
],
"answer_start": [
276
],
"text": [
"TOPROL XL (METOPROLOL (SUST. REL.)) 50 MG PO QD,"
]
}
|
A 74-year-old female with pulmonary sarcoid, CHF, and CRI presented with SOB after stopping Lasix several weeks ago. On admission, she was in mildly decompensated CHF and was started on more aggressive diuresis with Lasix 40 IV BID increased to 80 BID on HD2, with Cardiology Service consulting, then increased to Lasix drip at 15/hr on HD3 with I/O goal 1-2 l neg. She did well on this and by HD5 was near her dry weight of 49kg and her drip was transitioned back to PO Lasix. She was continued on Hydralazine, Lopressol and Isordil on HD3, titrated up to 20 TID. She has history of MI with stents and was continued on ASA, Plavix, Zocor, Coumadin (ref#960263524) PO, MVI Therapeutic 1 TAB PO QD, Iron Sulfate 325 MG PO TID, Folate 1 MG PO QD, Calcium Carbonate 500 MG PO TID, Acetylsalicylic Acid 81 MG PO QD, Colace 100 MG PO BID, Prednisone 10 MG PO QAM, Sodium Bicarbonate 325 MG PO TID, Flovent 220 MCG INH BID, Bactrim DS, Plavix 75 MG PO QD, Esomeprazole 40 MG PO QD, Duoneb, Glipizide XL 2.5 MG PO QD, Vit. B-3, Lipitor 40 MG PO QD, Atorvastatin Calcium, Lovenox 50 MG SC QD, and Insulin Regular Human (Sliding Scale subcutaneously SC AC: if BS is 125-150, then give 2 units; if BS is 151-200, then give 3 units; if BS is 201-250, then give 4 units; if BS is 251-300, then give 6 units; if BS is 301-350, then give 8 units; if BS is 351-400, then give 10 units). She was discharged to Wadesdi Ckgart Community Hospital at a euvolemic state with a dry weight of 49kg, continuing on Lasix 80 PO BID unless Cr rises above new baseline of 3.5 or if she gains weight or shows signs of new overload, and Lovenox should be stopped once her INR is >2. Coumadin dose should be adjusted according to INR goal 2-3, and she should be on a renal diet with low potassium and low glucose but with diabetic caloric supplements like GLUCERNA. She should receive a HOT PACK to her neck 2-3x per day and to her vein before blood draw for comfort, physical therapy daily with the goal of gait stability, home safety, and good O2 sats on 2L O2, and VNA services for meds. She should follow up with PCP, renal, and cardiology, and return to the hospital or call doctor if she experiences worsening SOB, fever over 100.5, chest pain, decreased urine output, weight gain over 5 pounds, or any other concerning symptoms. The patient was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, CALCIUM CARBONATE (500 MG ELEMENTAL CA++) 500 MG PO TID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, IRON SULFATE (FERROUS SULFATE) 325 MG PO TID, FOLATE (FOLIC ACID) 1 MG PO QD, LASIX (FUROSEMIDE) 80 MG PO BID, HYDRALAZINE HCL 25 MG PO TID HOLD IF: SBP<90, INSULIN REGULAR HUMAN Sliding Scale (subcutaneously) SC AC, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, LOPRESSOR (METOPROLOL TARTRATE) 12.5 MG PO TID, DILANTIN (PHENYTOIN) 100 MG PO QID, POTENTIALLY SERIOUS INTERACTION: PHENYTOIN & WARFARIN, PREDNISONE 10 MG PO QAM, SODIUM BICARBONATE 325 MG PO TID, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, SERIOUS INTERACTION: SULFAMETHOXAZOLE & WARFARIN, MVI THERAPEUTIC (THERAPE
|
calcium carbonate ( 500 mg elemental ca++ )
|
{
"answer_end": [
777
],
"answer_start": [
745
],
"text": [
"Calcium Carbonate 500 MG PO TID,"
]
}
|
A 63-year-old male with a history of CAD (Coronary Artery Disease) and two prior MIs (Myocardial Infarctions) presented with atypical chest pain and was admitted with a 100% LCx lesion unable to be stented. He was on medical management with Atenolol, Ace-I, and Aspirin (ECASA) 325 mg PO QD until the day of admission when he woke up with left arm and shoulder pain reminiscent of an old MI. Attempts at relief with nitroglycerin 1/150 (0.4 mg) 1 TAB SL q5min x 3 were unsuccessful, so he called EMS. In the ED, EKG and TnI were flat and he was started on heparin for unstable angina. Serial CKs were flat and he had no recurrence of chest pain in the hospital. He is to follow-up with Dr. Tollner with the possibility of ETT-MIBI as an outpatient. Discharge medications included Wellbutrin (Bupropion HCl) 200 mg PO QD, Colace (Docusate Sodium) 100 mg PO BID, FESO4 (Ferrous Sulfate) 300 mg PO BID, and Zocor (Simvastatin) 40 mg PO QHS. Additional instructions included taking the increased dose of Zestril 10 mg PO QD, making a follow-up appointment with Dr. Cyrus in the next week or two, and returning to the hospital if experiencing an increase in chest pain or shortness of breath at rest. The discharge condition was stable and he was discharged home with instructions to do an ETT-MIBI as an outpatient, check K and Cr within 1-2 weeks, and get a referral to GI and EGD as an outpatient.
|
has there been a prior zestril
|
{
"answer_end": [
1020
],
"answer_start": [
938
],
"text": [
"Additional instructions included taking the increased dose of Zestril 10 mg PO QD,"
]
}
|
The patient is a 70 year old white female with a history of long standing hypertension, hypercholesterolemia, and history of tobacco use who presented upon transfer from Ra Memorial Hospital with chief complaint of post MI unstable angina. She had a history of long standing hypertension and had chest pain in the past including at least one previous episode of rule out MI. She was admitted on 22 of April to Hen Mo Gardensworth Sent Hospital with signs and symptoms consistent with acute MI and apparently received salvage therapy with IV Streptokinase and TPA. On 0 of August, the patient presented to Cooker View Home Hospital with an episode of heavy substernal chest pressure relieved with SL and topical nitrates, and her EKG showed no worrisome ischemic changes. She was transferred to CNMC on IV Heparin, IV Nitroglycerin at 140 micrograms per minute, IV Heparin drip, Lopressor, aspirin one a day, beta blockade and aspirin. She had several episodes of typical substernal chest pain with minimal exertion that were relieved with SL Nitroglycerin, and additional episodes of chest pain that were low in intensity but prolonged, each of these requiring several Nitroglycerins and antacids to be relieved. It was felt that the chest pain was treated by the addition of a calcium channel blocker, and her admission labs showed hematocrit 34.2, WBC 6.7, platelets 159,000, PTT 50.0 on IV Heparin. Postcatheterization, the patient showed mild hypertension which was treated by the addition of a calcium channel blocker, and she was also diuresed for fluid overload. Prior to discharge, she had two additional episodes of chest pain that were low in intensity but prolonged. Each of these required several Nitroglycerins and antacids to be relieved. It was felt that the chest pain was unlikely to be cardiac in origin and more likely represented either GI symptomatology or an anxiety reaction. The patient underwent an exercise treadmill test on the modified Bruce protocol which showed no evidence for ischemia. On discharge, she was prescribed Nifedipine XL 90 mg po q am, Lopressor 50 mg po b.i.d., Zantac 150 mg po q hs, aspirin 81 mg po q d, Serax 15 mg po q 6 h or q hs prn, and Nitroglycerin 1/150 grain q 5 minutes x 3 SL prn chest pain. She was discharged to home and is to follow up with her primary care physician, Dr. Gayle Demeritt, and her cardiologist, Dr. Mark Willians, at ACSH. ALLERGIES: Penicillin which causes anaphylaxis. The patient is a 70 year old white female who had a history of long standing hypertension, hypercholesterolemia, and history of tobacco use and presented upon transfer from Ra Memorial Hospital with chief complaint of post MI unstable angina. She was admitted on 22 of April to Hen Mo Gardensworth Sent Hospital and apparently received salvage therapy with IV Streptokinase and TPA. On 0 of August, she presented to Cooker View Home Hospital with an episode of heavy substernal chest pressure relieved with SL and topical nitrates, and her EKG showed no worrisome ischemic changes. Upon transfer to CNMC, she was without chest pain and was given IV Nitroglycerin at 140 micrograms per minute, IV Heparin drip, Lopressor, aspirin one a day, beta blockade and aspirin. She had several episodes of typical substernal chest pain with minimal exertion that were relieved with SL Nitroglycerin, and additional episodes of chest pain that were low in intensity but prolonged, each of these requiring several Nitroglycerins and antacids to be relieved. Her admission labs showed hematocrit 34.2, WBC 6.7, platelets 159,000, PTT 50.0 on IV Heparin. Postcatheterization, the patient showed mild hypertension which was treated by the addition of a calcium channel blocker, and she was also diuresed for fluid overload. Prior to discharge, she had two additional episodes of chest pain that were low in intensity but prolonged. Each of these required several Nitroglycerins and antacids to be relieved. It was felt that the chest pain was unlikely to be cardiac in origin and more likely represented either GI symptomatology or an anxiety reaction. The patient underwent an exercise treadmill test on the modified Bruce protocol which showed no evidence for ischemia. On discharge, she was prescribed Nifedipine XL 90 mg po q am, Lopressor 50 mg po b.i.d., Zantac 150 mg po q hs, aspirin 81 mg po q d, Serax 15 mg po q 6 h or q hs prn, and Nitroglycer
|
What medications have been previously used for prevention of mild hypertension
|
{
"answer_end": [
1302
],
"answer_start": [
1249
],
"text": [
"treated by the addition of a calcium channel blocker,"
]
}
|
This 54 year old gentleman presented to the Wickpro Conch Medical Center with an infected left lower leg pressure ulcer with open and gangrenous muscle exposed through the posterior wound. His past medical history is significant for insulin dependent diabetes mellitus, peripheral vascular disease, coronary artery disease, congestive heart failure, history of atrial fibrillation/flutter, and right sacroiliac joint decubitus ulcer. His physical examination revealed mottled distal extremities, bilateral inspiratory wheezes, and a positive bowel sound. The patient underwent a four vessel coronary artery bypass graft on 6/17/95 and left lower extremity fasciotomy on 11/27/95 and was taken to the Operating Room on 7/25/95 for a preoperative diagnosis of a left lower extremity infected pressure sore. Intraoperatively, the patient was noted to have necrosis of both heads of the gastrocnemius muscle and copious amounts of antibiotic-containing solution was used to irrigate the wound, for which he was started on Ampicillin, Gentamicin, and Flagyl empirically until culture results returned and was taken back on 2/29/95 for a second irrigation and debridement procedure. The patient was placed on Klonopin 1 mg po tid, Tylenol 650 mg p.o. q4h p.r.n. headache, Aspirin 81 mg p.o. qd, Albuterol nebulizer 0.5 cc in 2.5 cc of normal saline q.i.d., Capoten 25 mg p.o. qh, Chloral hydrate 500 mg p.o. q.h.s. p.r.n. insomnia, Clonopin 1 mg p.o. t.i.d., Digoxin 0.375 mg p.o. qd, Colace 100 mg p.o. b.i.d., Insulin NPH 38 units subcu b.i.d., Milk of Magnesia 30 cc p.o. qd p.r.n. constipation, Multivitamins one capsule p.o. qd, Mycostatin 5 cc p.o. q.i.d., Percocet one or two tabs p.o. q3-4h p.r.n. pain, Metamucil one packet p.o. qd, Azmacort six puffs inhaled b.i.d., Axid 150 mg p.o. b.i.d., Ofloxacin 200 mg p.o. b.i.d. x 7 days, and Insulin NPH 38 units in the morning and 38 units at night. The patient was initially ruled out for a myocardial infarction following his first operative procedure and had no episodes of hypotension. He was switched over from Gentamicin to Ofloxacin to continue his antibiotic course and has been followed by the Infectious Disease service, receiving 7 more days of po Ofloxacin as an outpatient. The patient's medications upon discharge include Aspirin 81 mg po qd, Digoxin 0.325 mg po qd, Azmacort 6 puffs inhaled bid, Heparin 5000 units subcu bid, Zantac 150 mg po bid, Lasix 40 mg po qd, Capoten 25 mg q 8, Albuterol nebulizers 0.5 cc in 2.5 cc normal saline qid, NPH insulin 38 units subcu bid, Nystatin swish and swallow 5 cc po qid, Bactrim DS one tab po bid, Tylenol 650 mg po q4h prn headache, Chloral hydrate 500 mg po qhs prn insomnia, Clonopin 1 mg po tid, Colace 100 mg po bid, Milk of Magnesia 30 cc po qd prn constipation, Multivitamins one capsule po qd, Mycostatin 5 cc po qid, Percocet one or two tabs po q3-4h prn pain, Metamucil one packet po qd, Azmacort six puffs inhaled bid, Axid 150 mg po bid, and Ofloxacin 200 mg po bid x 7 days.
|
What is the reason this patient is on milk of magnesia
|
{
"answer_end": [
1627
],
"answer_start": [
1541
],
"text": [
"Milk of Magnesia 30 cc p.o. qd p.r.n. constipation, Multivitamins one capsule p.o. qd,"
]
}
|
Patient Mariano Librizzi was admitted on 4/21/2005 with a viral infection and severe pulmonary hypertension, and discharged on 9/22/2005 to go home. The discharge medications included ECASA (Aspirin Enteric Coated) 81 MG PO QD, with a potentially serious interaction with Warfarin & Aspirin, COLACE (Docusate Sodium) 100 MG PO BID, LASIX (Furosemide) 160 MG PO BID, GLIPIZIDE 10 MG PO BID, OCEAN SPRAY (Sodium Chloride 0.65%) 2 SPRAY NA QID, COUMADIN (Warfarin Sodium) 5 MG PO QPM, JERICH, JOSPEH, M.D. on order for ECASA PO (ref #91585860), ZOLOFT (Sertraline) 150 MG PO QD, AMBIEN (Zolpidem Tartrate) 10 MG PO QHS, KCL SLOW RELEASE 20 MEQ PO BID, ATROVENT NASAL 0.06% (Ipratropium Nasal 0.06%) 2 SPRAY NA TID, NEXIUM (Esomeprazole) 20 MG PO QD, TRACLEER (Bosentan) 125 MG PO BID, VENTAVIS 1 neb NEB Q3H Instructions: during wake hours, ALBUTEROL INHALER 2 PUFF INH Q4H PRN Shortness of Breath, Wheezing, home O2 (8L NC). The patient was also prescribed K-Dur 20 BID, Nexium 20, Lasix 160 BID, Tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft 100, MVI, Oceanspray 2 Spray NA QID, Ambien 10 QHS, Ventavis nebs Q3H, Albuterol Inhaler 2 puff INH Q4H, KCl Slow Release 20 MEQ PO BID, Colace 100 MG PO BID, Atrovent Nasal 0.06%. The diet was House/Low chol/low sat. fat and 4 gram Sodium and they were advised to do walking as tolerated, with serial enzymes/EKG to be continued and Lasix, KCl, ASA 81 also advised. The patient had a history of depression which had been worse of late and was advised to continue Zoloft and Ambien, and to avoid high Vitamin-K containing foods and to give on an empty stomach (give 1hr before or 2hr after food). The patient was followed by the AH service with ACEi, cephalopsporins, GERD nexium prophylaxis and Coumadin for pulmonary microclots on Bx in tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft. The discharge condition was satisfactory.
|
Is there a mention of of coumadin ( warfarin sodium ) usage/prescription in the record
|
{
"answer_end": [
481
],
"answer_start": [
442
],
"text": [
"COUMADIN (Warfarin Sodium) 5 MG PO QPM,"
]
}
|
This is a 69 year-old woman with a history of congestive heart failure and hypertension who presented with a productive cough which was worsening over the past 3-4 days and fever to 101 with chills and shakes and increasing shortness of breath. She had a white blood cell count of 9.3 with 54% polys and 9.6 % eosinophils, a glucose of 377, and a chest x-ray without evidence of congestive heart failure or infiltrate. She was treated in the emergency room with Albuterol nebulizer and plans were to discharge her to home, however, her saturations dropped to 89% on room air with exercise in the emergency room and was admitted for further observation. She was started on intravenous Cefuroxime, and initially improved with decrease in cough and shortness of breath; however, the patient continued to desat with exercise. A repeat chest x-ray was performed which showed no change when compared to the admission film. Her sputum culture grew out Pen-sensitive E-coli and she was continued on her intravenous and then PO antibiotics. She continued to desat with exercise, however, and her cough persisted although she remained afebrile with a slightly elevated white count and moderate peripheral eosinophilia. Her chest exam remained rancorous and the reason for this remained unclear. Given the finding of E-coli in the sputum sample, in addition to the elevated eosinophilia and lack of finding on chest x-ray despite significant findings on chest exam, the possibility of a worm or parasitic disease was raised. She had a Persantine MIBI in March of 1996, on which she had no fixed or reversible defects, and was on nitroglycerin for stable angina - "chest heaviness" after climbing one flight of stairs, relieved by rest and one sublingual nitroglycerin. Her medications on admission included Lasix 40 mg. per day, Insulin 70/30 28 units q a.m. and 5 units q p.m., Verapamil SR 120 mg PO b.i.d., Enteric coated aspirin 325 mg q day, KCL 10 mEq PO q day, Premarin 0.625 mg PO q day, Zestril 20 mg b.i.d., Atenolol, recently discontinued, Tofranil 75 mg PO q HS, Albuterol inhaler two puffs inhaled q.i.d., and Potassium slow release 10 mEq PO q day. She was discharged to home with Albuterol inhaler and instructions to follow up with her primary physician in clinic for further evaluation including PFTs and possible chest CT if symptoms did not abate, and to finish a full ten day course of antibiotics for presumed bronchitis. At the time of discharge the patient's saturation was 92 to 93% on room air and dropping slightly to 90 to 91% with exercise, however she was tolerating this well and was getting relief from her Albuterol inhaler.
|
Has the patient ever had lasix
|
{
"answer_end": [
1847
],
"answer_start": [
1787
],
"text": [
"included Lasix 40 mg. per day, Insulin 70/30 28 units q a.m."
]
}
|
Marcelo Walts was admitted to the medical service for a CHF exacerbation and was given ECASA (Aspirin Enteric Coated) 325 mg PO QD, Captopril 12.5 mg PO TID with a potential serious interaction with Potassium Chloride, Lasix (Furosemide) 40 mg PO TID, Levoxyl (Levothyroxine Sodium) 100 mcg PO QD, Nitroglycerin 1/150 (0.4 mg) 1 tab SL Q5 min x 3 PRN Chest Pain HOLD IF: SBP<[ ], Zocor (Simvastatin) 20 mg PO QHS with a potential serious interaction with Niacin, Vit. B-3, Plavix (Clopidogrel) 75 mg PO QD, Atenolol 25 mg PO QD, Nitropatch (Nitroglycerin Patch) 0.2 mg/hr TP QHS, Glyburide 5 mg PO BID, Isordil (Isosorbide Dinitrate) 10 mg PO BID, and a diet of House/Low Chol/Low Sat. Fat and 4 gram Sodium. Activity was limited to Walking as tolerated, and the patient was also given instructions to give ECASA on an empty stomach, and to avoid grapefruit with Zocor unless instructed otherwise. Upon discharge, the patient was given a Full Code status and was sent Home with a follow up appointment with Sandler on 11/28/02. The patient also underwent cardiac catheterization and stent placement of RCA with the medications Heparin, ASA, Plavix, Metoprolol, nitrates, ACE-I, statin, lasix, and nebs for wheezing, and was monitored for lytes. Upon discharge, the patient was stable and advised to follow up with Dr. Lidstone and Dr. Darlin for post-cath management and overall management of CHF and flash pulmonary edema.
|
Has the patient had multiple nitroglycerin prescriptions
|
{
"answer_end": [
379
],
"answer_start": [
298
],
"text": [
"Nitroglycerin 1/150 (0.4 mg) 1 tab SL Q5 min x 3 PRN Chest Pain HOLD IF: SBP<[ ],"
]
}
|
This is a 72 year old black female with a history of hypertension, angina, adult onset diabetes, and recurrent syncopal events who was treated with Dilantin for less than a year in 1970 and her last episode was in 1989. She was given Nitro Paste and 1 amp of D50 when she experienced a syncopal event on the morning of admission and her fingerstick glucose was checked. Her medications on admission include aspirin one tablet q d, Questran one pack q d, Micronase 5 mg po q d, Betaxolol eye drops bid to each eye, Pilocarpine eye drops tid to each eye, and eye drops bid to each eye. She also receives monthly Vitamin B12 injections and takes nitroglycerin with chest pain. Physical examination revealed pinpoint constriction of her pupils secondary to her glaucoma eyedrops, bibasilar, coarse crackles in the chest, no jugular venous distention, and nonfocal neurologic exam. Laboratory data includes sodium of 143, potassium of 4.3, chloride of 109, bicarbonate of 20, BUN of 21, creatinine of 1.0, glucose of 160, hematocrit of 43.4, white count of 6.45, and normal coagulation factors. Chest X ray showed a calcific aorta, C spine X ray and head CT were negative, and EKG showed no changes from her baseline. The patient was started on Isordil and Lopressor empirically but these were discontinued and her chest pain is relieved with nitroglycerin. She was discharged to home with plans for a repeat 24 hour Holter as an outpatient with diagnoses of syncope, borderline type II diabetes, stable exertional angina, and glaucoma. Discharge medications include aspirin one tablet po q d, Questran one package po q d, Pilocarpine eye drops tid per eye, Betaxolol eye drops bid per eye, eye drops bid per eye, sublingual nitroglycerin prn chest pain, and Naprosyn 375 mg tid prn.
|
Has patient ever been prescribed glaucoma eyedrops.
|
{
"answer_end": [
775
],
"answer_start": [
729
],
"text": [
"her pupils secondary to her glaucoma eyedrops,"
]
}
|
Mr. Quigg is a 42-year-old man with history of diabetes, end-stage renal disease on hemodialysis, left Charcot foot complicated by recurrent cellulitis who presented with left lower leg swelling, erythema, and pain. On admission, his temperature was 100.8, heart rate was 111, and blood pressure was 140/70. His left lower extremity had 1+ pitting edema with erythema on the anterior shin and foot. He was uptitrated to 5mg and also lopressor, started on Lyrica and oxycodone for breakthrough pain, and received Fentanyl PCA. His home medications included Colace 100 mg b.i.d., folate 1 mg p.o. daily, gemfibrozil 600 mg b.i.d., Lantus 30 mg subcu q.p.m., Lipitor 80 mg nightly, Nephrocaps, Neurontin 300 mg daily, PhosLo 2001 mg t.i.d., Protonix 40 mg daily, Renagel 3200 mg t.i.d., Requip 2 mg p.o. b.i.d., and Coumadin. His Lipitor was decreased to 20mg due to rhabdomylosis risk, and he was also started on low dose b-blocker to reduce perioperative MI risk prior to his surgery. His Vancomycin was continued given his history of MRSA cellulitis, with a goal of a level less than 20, and he was bridged with heparin with a goal PTT of 60-80. He was restarted on his Lantus and Aspart doses with meals, and his Coumadin was held prior to surgery and decreased to 20mg with a repeat lipid panel in 4-6 weeks. He required antibiotics which were discontinued at this time and he was discharged with dry sterile dressing changes to his residual limb daily, PTT goal 60-80, INR goal 2-3 until stable off of levofloxacin, monitoring of FS and adjustment of DM regimen, monitoring pain scale and decreasing pain medications as pain improves, hemodialysis M/W/F, and follow up with Dr. Carpino voice message left on his medical assistant's voice mail and Dr. Lynes 6/10/06 at 9:30am. Psychiatry service was consulted who recommended low dose Ativan prior to him going for dialysis. He was initially placed on a ketamine drip and given IV Levofloxacin and IV Flagyl to cover gram negatives and anaerobes respectively, and started on oxycontin 80mg tid with oxycodone for breakthrough pain and Lyrica for neuropathic pain. He was comfortable prior to discharge on this current regimen.
|
has the patient had aspart
|
{
"answer_end": [
1205
],
"answer_start": [
1146
],
"text": [
"He was restarted on his Lantus and Aspart doses with meals,"
]
}
|
The patient is a 71-year-old male with a history of nonischemic dilated cardiomyopathy, diabetes, obstructive sleep apnea, obesity hypoventilation syndrome, and atrial flutter status post ablation. He presented with shortness of breath and a witnessed apneic episode with loss of consciousness and cyanosis. In the Centsshealt Careman Inerist Medical Center Emergency Department, he was found to be saturating 91% on room air and 99% on a nonrebreather with a pH of 7.31 and a PCO2 of 55; he was tried on BiPAP without improvement in either PCO2 or PO2. He was admitted to the CCU with CHF/apnea/sinus arrest and had a history of having stopped his Lasix dose one week prior. He was initially treated with x1 , Solu-Medrol , and DuoNebs in the ED, and ultimately treated with diuresis and a pacemaker placement. On admission, he was maintained on captopril, which was up titrated to 25 mg t.i.d. (held at one point due to the rise in the creatinine), titrated up on metoprolol to 25 mg b.i.d., antibiotics, Allopurinol 100 mg p.o. daily, Iron, Lisinopril, Toprol-XL, Coumadin (discontinued on 2/4/05), Albuterol inhaler p.r.n., Aspirin, Flomax, Hytrin, Colace 100 mg p.o. b.i.d., Ferrous sulfate 325 mg p.o. daily, Heparin 5000 units subcutaneous t.i.d., Lopressor 25 mg p.o. b.i.d., Oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n., Flomax 0.4 mg p.o. daily, Nexium 20 mg p.o. daily, Keflex 250 mg p.o. q.i.d. x12 doses, starting on 7/7/05, Lasix 40 mg p.o. daily, and Regular Insulin sliding scale subcutaneous q.a.c. He was followed by the Electrophysiology Service and had sinus arrest of 8-9 seconds in the setting of apnea in the CCU, and 4 seconds in the setting of apnea on the floor. He underwent pacemaker placement through cephalic veins, and was started on antibiotics following his pacemaker placement, which included cefazolin while in-house, followed by Keflex, and he was expected to stay on Keflex for four days. He was discharged with medications including Albuterol inhaler two puffs inhaled q.i.d. p.r.n. wheezing, Allopurinol 100 mg p.o. daily, Captopril 25 mg p.o. t.i.d., Colace 100 mg p.o. b.i.d., Ferrous sulfate 325 mg p.o. daily, Lasix 40 mg p.o. daily, Heparin 5000 units subcutaneous t.i.d., Regular Insulin sliding scale subcutaneous q.a.c., Lopressor 25 mg p.o. b.i.d., Oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n., Keflex 250 mg p.o. q.i.d. x12 doses, starting on 7/7/05., Flomax 0.4 mg p.o. daily, and Nexium 20 mg p.o. daily.
|
How much nexium does the patient take per day
|
{
"answer_end": [
1377
],
"answer_start": [
1353
],
"text": [
"Nexium 20 mg p.o. daily,"
]
}
|
Patient Isaac Vanover, Jr., a 44-year-old man with a history of CAD s/p MI x2 4/14 with PCI, in stent thrombosis, and re-stenting, was admitted multiple times for CP with associated fatigue and SOB. He was placed on ECASA (Aspirin Enteric Coated) 325 MG PO QD, COLACE (Docusate Sodium) 100 MG PO BID PRN constipation, ENALAPRIL MALEATE 5 MG PO QAM HOLD IF: SBP<100, POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & ENALAPRIL MALEATE (on order for KCL IMMEDIATE RELEASE PO (ref #56599393)), ATIVAN (Lorazepam) 1 MG PO TID Starting Today March PRN anxiety HOLD IF: RR<12 or pt is lethargic, NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain HOLD IF: SBP < 100, ZOLOFT (Sertraline) 100 MG PO QD, ZOCOR (Simvastatin) 20 MG PO QHS, PLAVIX (Clopidogrel) 75 MG PO QD, VIOXX (Rofecoxib) 25 MG PO QD, ZANTAC (Ranitidine HCl) 150 MG PO BID PRN dyspepsia, and ATENOLOL 25 MG PO QD with Food/Drug Interaction Instruction. Managed on Hep, TNG gtt, Plavix, ACE, B blocker, and Demerol, the pain recurred and he was transferred to BVH for cath. Cardiac catheterization on 8/18/02 showed non-obstructive CAD with LMCA, LAD, LCx, and RCA all OK. Pulmonary level of suspicion for PE is low, so D-dimer is sent and PE ruled out. Mild fluid overload was managed with Lasix to keep I/O's 500-1000cc neg. Pain could represent pericarditis, but psychiatric etiology for CP becomes more likely and psychiatric follow-up and treatment for anxiety and depression is recommended. WBC count increased 4/10 but no other sign/symptom of infection, CXR showed no infiltrates, and the patient was discharged stable with instructions to schedule an appointment with the primary doctor within 2-4 weeks, and if chest pain changes in character or is associated with new symptoms, the patient is to notify their doctor or call 911.
|
Why was the patient on zantac ( ranitidine hcl )
|
{
"answer_end": [
862
],
"answer_start": [
810
],
"text": [
"ZANTAC (Ranitidine HCl) 150 MG PO BID PRN dyspepsia,"
]
}
|
The patient is a 65-year-old woman with Dilated Cardiomyopathy secondary to Adriamycin, status post recent admission for increased shortness of breath and left pleural effusion. She returns now with increased cough productive of white phlegm and progressive dyspnea on exertion. Her physical examination revealed Temperature 100.6, Blood Pressure 116/65, Heart Rate 100, Respiratory Rate 18, 02 Saturation 90% on room air. She was started on empiric course of antibiotics including cefotaxime and clarithromycin, in addition to Digoxin 0.25 mg q day, Lasix 80 mg q day, Capoten 50 mg t.i.d., Aspirin one per day, Synthroid 2 gr. per day, Tamoxifen 10 mg b.i.d., Elavil 75 mg q day, K-Dur 1 q day, Biaxin 500 mg p.o. b.i.d., Digoxin 0.125 mg alternating with 0.25 mg q day, Thyroid 2 grains p.o. q day, Coumadin 5 mg p.o. q day, and K-Dur 20 mg p.o. b.i.d., Ambien 10 mg p.o. q h.s. A chest x-ray showed a left pleural effusion which is unchanged, a new right pleural effusion +- consolidation, and a large peripheral, red, right lower lobe opacity, highly suggestive of a right lower lobe pulmonary infarction. She underwent ultrasound guided thoracentesis complicated by a pneumothorax requiring chest tube placement and evaluation of the pleural fluid revealed a transudative effusion with all cultures and cytology remaining negative. She was treated with Ancef for approximately 7 days while the chest tube was in place, and then switched to Adriamycin with good result. She was also started on IV Heparin with achievement of therapeutic PTT prior to switching to oral Coumadin without complications, while lower extremity non-invasives and a cardiac echocardiogram remained negative for deep venous thrombosis and right ventricular thrombus. The patient was discharged to home with followup with Dr. Gunsolus at the Leyer Memorial Hospital.
|
has there been a prior ambien
|
{
"answer_end": [
881
],
"answer_start": [
832
],
"text": [
"K-Dur 20 mg p.o. b.i.d., Ambien 10 mg p.o. q h.s."
]
}
|
The 68-year-old retired social worker was admitted with atrial flutter and NSTEMI and underwent catheterization which revealed 95% OM1, 70% OM2, and LCX lesions stented with 2.5x13-mm, 2.5x13-mm, and 3.5x13-mm DES respectively, to 0% with TIMI 3 flow. Exam showed faint bibasilar crackles, S1S2 intermittent gallop, no LE edema. Initially rate-controlled on beta-blocker and diltiazem for goal rate in 60s; she was discharged on ATENOLOL 100 MG PO QD, LASIX (FUROSEMIDE) 40 MG PO QD, LISINOPRIL 5 MG PO QD with POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL, NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: ATORVASTATIN CALCIUM & WARFARIN, LOVENOX (ENOXAPARIN) 90 MG SC BID with SERIOUS INTERACTION: HEPARIN & ENOXAPARIN SODIUM, FLOVENT (FLUTICASONE PROPIONATE) 110 MCG INH BID, LIPITOR (ATORVASTATIN) 80 MG PO QD with POTENTIALLY SERIOUS INTERACTION: ATORVASTATIN CALCIUM & WARFARIN, PLAVIX (CLOPIDOGREL) 75 MG PO QD, MAGNESIUM OXIDE (241 MG ELEMENTAL MG) 800 MG PO BID, DIET: Patient should measure weight daily, DIET: Fluid restriction, DIET: House / Low chol/low sat. fat, DIET: 4 gram Sodium, and RETURN TO WORK: Not Applicable. Additionally, CONTINGENT UPON 7pm dose of Lovenox, on order for Coumadin PO (ref# 758570817) and on order for Coumadin PO 5 mg QPM (ref# 370510168) were included with instructions to take all medicines as directed and not to miss a single dose of Plavix, due to potentially serious interactions with Aspirin & Warfarin, Potassium Chloride & Nitroglycerin, and Atorvastatin Calcium & Enoxaparin Sodium; as well as a serious interaction with Heparin & Enoxaparin Sodium.
|
Previous potassium chloride
|
{
"answer_end": [
576
],
"answer_start": [
544
],
"text": [
"POTASSIUM CHLORIDE & LISINOPRIL,"
]
}
|
This is a 65-year-old female with a history of coronary artery disease, hypertension, diabetes, IPF diagnosed in 1986, osteoarthritis, and obesity who presented with five days of chest pain/SOB. She was initially put on aspirin, Lopressor 37.5 t.i.d., heparin, oxygen and hooked up to a cardiac monitor and EKG q.d. and was ruled out for unstable angina. Cardiac catheterization revealed LAD ostial 90%, proximal 80%, diag ostial 90%, left circ 90%, 80% lesions, marginal 1, TUB 90%, RCA 50%. The patient underwent PTCA and stent x 2 with good results and remained chest pain free. On admission she was on medications Captopril 50 mg b.i.d., Lasix 40 mg q.d., Lopid 600 mg b.i.d., Axid 150 mg b.i.d., and insulin 70/30 90 q. a.m. and 40 q. p.m. The patient was hypokalemic on 10/23 with a curious whitening on EKG and peak T waves and was treated with insulin, calcium, and Kayexalate x 3. She had a history of colonic polyps but tolerated the aspirin and was put on Nexium prophylaxis. She was then treated with prednisone overnight for IV contrast dye allergy and treated with digoxin and prednisone. The patient was treated with levofloxacin 500 mg q.d. for fourteen days and discharged on medications ASA 325 mg p.o.q.d., atenolol 75 mg p.o. b.i.d., Lasix 40 mg p.o. q.d., Lopid 600 mg p.o. b.i.d., nitroglycerin 1/150 one tab q. 5 minutes x 3 p.r.n. chest pain, Zocor 10 mg p.o. q.h.s., Norvasc 5 mg p.o.q.d., xalatan one drop OU q.h.s., Alphagan one drop OU b.i.d., levofloxacin 500 mg p.o.q.d., clopidogrel 75 mg p.o.q.d., insulin 70/30 90 units q.a.m., 40 units q.p.m. subcu, and Axid 150 mg p.o. b.i.d.
|
Is there a mention of of insulin usage/prescription in the record
|
{
"answer_end": [
869
],
"answer_start": [
810
],
"text": [
"EKG and peak T waves and was treated with insulin, calcium,"
]
}
|
Patient Mickey Corkill was admitted to the hospital on 5/29/2004 for dizziness and discharged on 7/17/2004. During this time, the patient was given ACETYLSALICYLIC ACID 81 MG PO QD Starting STAT ( 0/17 ), AMIODARONE 200 MG PO QD, DIGOXIN 0.125 MG PO QD, COLACE ( DOCUSATE SODIUM ) 100 MG PO BID, LASIX ( FUROSEMIDE ) 120 MG PO BID, NPH HUMULIN INSULIN ( INSULIN NPH HUMAN ) 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ) 30 MILLILITERS PO QD PRN Constipation, COUMADIN ( WARFARIN SODIUM ) 2 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, NORVASC ( AMLODIPINE ) 10 MG PO QD HOLD IF: SBP < 95, IMDUR ( ISOSORBIDE MONONIT.( SR ) ) 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR ( LOSARTAN ) 100 MG PO QHS Starting STAT ( 4/13 ), PLAVIX ( CLOPIDOGREL ) 75 MG PO QD Starting STAT ( 0/17 ), NEXIUM ( ESOMEPRAZOLE ) 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, Sliding Scale ( subcutaneously ) SC AC+HS, and HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. Due to the potential for serious interactions between WARFARIN and ASPIRIN, WARFARIN and AMIODARONE HCL, DIGOXIN and AMIODARONE HCL, and SIMVASTATIN and WARFARIN, overrides were added on 8/6/04 and 9/23/04 by various physicians, with the MDs being aware that the patient was already on the regimen at home. The patient was also advised to avoid high Vitamin-K containing foods and to avoid grapefruit unless the MD instructed otherwise. The patient's BB was held while in house because of worry about bradyarrhythmia and hypotension. The patient was also continued on home insulin regimen with coverage with insulin sliding scale, and was found to have a TSH of 158 FT4 1.8, FT3 56. The patient was also started on synthroid to be f/u for hypothyroidism and given prophylaxis with Nexium. Treatment included CV, NEURO, ENDO, and Prophylaxis, with the patient to follow-up with various doctors for management of CHF/BP, potential neurovascular etiology of symptoms, and hypothyroidism. The patient was anticoagulated with ACETYLSALICYLIC ACID 81 MG PO QD, AMIODARONE 200 MG PO QD, WARFARIN 2 MG PO QPM, COLACE 100 MG PO BID, LASIX 120 MG PO BID, NPH HUMULIN INSULIN 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA 30 MILLILITERS PO QD PRN Constipation, COUMADIN 2 MG PO QPM, NORVASC 10 MG PO QD HOLD IF: SBP < 95, IMDUR 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR 100 MG PO QHS, PLAVIX 75 MG PO QD, NEXIUM 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, and SIMVASTATIN 80 MG PO QHS HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. The patient was discussed with the cardiologist, and Coreg was held prior to admit for low BP's, with the plan to d/c pt off Coreg and defer to Dr. Doniel for reinstitution of beta blockade. Neuro exam was normal with no focal signs, and no signs of cerebellar dysfunction. The patient was also started on synthroid to be f/u with endocrine for management of hypothyroidism.
|
Has the patient had aspirin in the past
|
{
"answer_end": [
1107
],
"answer_start": [
1086
],
"text": [
"WARFARIN and ASPIRIN,"
]
}
|
The patient was admitted on 4/12/04 with a right plantar surface neurotrophic ulcer, low-grade fevers and chills, and a history of diabetes mellitus, hypertension, distant past of pancreatitis, gout, neuropathy, high cholesterol, and chronic renal insufficiency. Significant labs at the time of admission included a potassium of 4.3, BUN of 38, creatinine of 3.2, and blood glucose of 187. The patient was started on 1. Lantus 100 mg q.p.m., 2. Humalog 20 units q.p.m., 4. Neurontin 300 mg t.i.d., 5. Lisinopril 40 mg q.d., 6. Allopurinol 300 mg q.d., 7. Hydrochlorothiazide 25 mg q.d., 8. Zocor 20 mg q.d., 9. TriCor 50 mg b.i.d., 10. Atenolol 25 mg q.d., 11. Eyedrops prednisolone and atropine, and 12. iron supplementation. The patient underwent an amputation of the third and fourth toe as well as metatarsal heads, and was started on Dr. Tosco's suggested antibiotics, vancomycin, levofloxacin, and Flagyl. To manage temperature greater than 101, the patient was prescribed Tylenol 650 to 1000 mg p.o. q.4h. p.r.n., allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Colace 100 mg p.o. b.i.d., Epogen 10,000 units q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient was seen by Dr. Ulvan in the renal staff and by the diabetes management service by Dr. Clint Holets. Postoperative lab checkup revealed that the patient's creatinine bumped to 4.9 with a BUN of 61, and the renal service was consulted. The patient was given Lopressor 100 mg b.i.d. to control the blood pressure, and was eventually started on PhosLo and Ferrlecit as well as Epogen 10,000 units q. week. Levofloxacin was continued for a one week course, and the patient was discharged to the rehab facility with Tylenol 650 to 1000 mg p.o. q.4h. p.r.n. for temperature greater than 101, allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Lopressor 100 mg p.o. b.i.d., PhosLo 1334 mg p.o. q.a.c., Colace 100 mg p.o. b.i.d., Epogen 10,000 units delivered subcuticularly q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient is to be followed up at the rehab facility at Ing Mansy General Hospital and should follow up with the renal service and Dr. Knaub in two to three weeks and one to two weeks, respectively. The
|
Has the pt. ever been on duoneb before
|
{
"answer_end": [
1537
],
"answer_start": [
1450
],
"text": [
"Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing."
]
}
|
Mr. Legions is a 54 year old professor who presented to Menjack Hospital Medical Center with recurrent substernal chest pain one day after coronary artery bypass graft (5 vessel bypass) 8 years ago. His coronary risk factors include a positive family history and a previous diagnosis of hyperlipidemia. He was given Lovastatin 40 mg q q.m. and 20 mg q p.m., as well as enteric-coated aspirin one tablet q day. At Skaggssin Hospital, he was given IV nitroglycerin, IV heparin, Nifedipine SL, and morphine, in addition to aspirin and Lovastatin. The patient's pain was relieved with four sublingual nitroglycerin and an EKG demonstrated one sublingual nitroglycerin and these EKG changes resolved. He was treated symptomatically with Tylenol and started on Biaxin 500 mg po bid, and also received a five day course of oral Biaxin with Cholestyramine one packet po q hs, Lopressor 50 mg po tid, and Sublingual nitroglycerin 1/150 tablets to be taken prn. The patient had episodes of fever, achieving a maximum temperature of 101.4, and a chest x-ray on 0/26/95 demonstrated evidence of early congestive heart failure. The patient was treated with daily doses of IV Lasix with resolution of his rales. He was admitted to the Cardiac Intensive Care Unit on IV heparin and nitroglycerine as well as continuation of his aspirin and Lovastatin. His pain was treated with morphine sulfate and relieved with four sublingual nitroglycerin. An EKG demonstrated one sublingual nitroglycerin and these EKG changes resolved. After 24 hours pain-free, the patient was transferred to the Cardiac Step-Down floor and the IV nitroglycerin and IV heparin were discontinued. An echocardiogram demonstrated inferior and posterior hypokinesis with an ejection fraction of approximately 46%, and the patient underwent a submax MIBI to assess coronary perfusion of the heart. The exercise component of this examination demonstrated EKG changes consistent with ischemic coronary flow. Nuclear imaging demonstrated a fixed apical lateral defect in the patient's heart consistent with a healed or healing transmural infarct. The patient also complained of progressive anterior and lateral thigh pain, symptoms consistent with an upper respiratory viral infection, and rales 4 to 5 cm above the bases bilaterally. He was discharged to home with followup in MERH under Drs. Dwayne Ariel Bremme with the medications Enteric-coated aspirin 325 mg po q day, Cholestyramine one packet po q hs, Lovastatin 20 mg po q hs, Lopressor 50 mg po tid, and Sublingual nitroglycerin 1/150 tablets to be taken prn with chest pain.
|
What treatments has patient been on for chest pain in the past
|
{
"answer_end": [
951
],
"answer_start": [
896
],
"text": [
"Sublingual nitroglycerin 1/150 tablets to be taken prn."
]
}
|
This is a 63-year-old female who presented with bilateral lower extremity edema, increasing shortness of breath, 3+ edema in the extremities, areas of erythematous and shiny shallow ulcerations, significant laboratory data of sodium 147, potassium 3.4, chloride 110, CO2 26, BUN 23, creatinine 1.6, and glucose 69, CBC significant for white count of 6.7, hematocrit 39.4, and platelets of 258, CK 432, troponin less than assay, BNP greater than assay, and D-dimer 50 and 69, chest x-ray showed decreased lung volumes with moderate cardiac enlargement, EKG showed sinus bradycardia with a rate of 59, axis of -36 and no acute changes. The patient has a history of congestive heart failure, deep venous thrombosis bilaterally with PE, acute renal failure, nephrotic syndrome, pneumonia, iron and folate deficiency anemia, paroxysmal atrial fibrillation with rapid ventricular response, nonsustained ventricular tachycardia, insulin-dependent diabetes mellitus, hypertension, cholesterol, chronic knee and back pain, arthroscopic knee surgery bilaterally, gastritis, benign colon polyps greater than 10, cataracts, and glaucoma. She was prescribed Lasix 120 mg p.o. b.i.d., Atenolol 50 mg p.o. q.d., Iron sulfate 300 b.i.d., Folate 1 mg q.d., NPH insulin 20 units q.d., Oxycodone 5 mg to 10 mg q.4-6h. p.r.n. pain., Senna, Multivitamins, Zocor 40 mg p.o. q.d., Norvasc 10 mg p.o. q.d., Accupril 80 mg p.o. q.d., Miconazole 2% topical b.i.d., Celexa 20 mg p.o. q.d., Avandia 8 mg p.o. q.d., Nexium 20 mg p.o. q.d., Albuterol p.r.n., aspirin as well as statin, a low-dose short-acting beta-blocker (Lopressor), an ACE inhibitor with this switched to captopril as a short-acting ACE inhibitor for a goal blood pressure of systolic of 120, an adenosine MIBI, runs of NSVT and Coumadin 5 mg p.o. q.h.s., folate and iron replacement, NPH 20 units for her known diabetes, Bactrim one tablet p.o. b.i.d. for 7 days, Celebrex and other antiinflammatory medications, Colace 100 mg p.o. b.i.d., Prozac 20 mg p.o. q.d., NPH human insulin 20 units subcu q.p.m., Zestril 30 mg p.o. q.d., Senna tablets 2 mg p.o. b.i.d., Aldactone 25 mg p.o. q.d., Multivitamins with minerals one tablet p.o. q.d., Toprol XL p.o. q.d., Imdur 30 mg p.o. q.d., Prednisolone acetate 0.125% one drop OU q.i.d., Albuterol inhaler 2 puffs inhaler q.i.d. p.r.n. wheezing., Miconazole nitrate powder topical b.i.d. p.r.n., Aspirin 81 mg p.o. q.d., and her creatinine continued to rise until 8/3/03, when it reached 2.7, diuresis was put on hold on 3/15/03 and 10/5/03, and her ACE inhibitor dose was halved on 10/5/03, in order to monitor her creatinine function, she was found to have a UTI with E. Coli that was sensitive to Bactrim and she was treated with Bactrim with resolution, for her chronic pain and arthritis, her Celebrex was held given her increased creatinine and she was given oxycodone p.r.n. for pain, joint exam revealed swollen PIP joints of both hands as well as marked swelling over both wrists, and an ANA test came back negative, she was continued on Celexa for depression, a goal INR of 2 to 3 was set for her Coumadin, which was restarted on 4/12/03 for known paroxys
|
Previous toprol xl
|
{
"answer_end": [
2200
],
"answer_start": [
2180
],
"text": [
"Toprol XL p.o. q.d.,"
]
}
|
Mr. Gerache is a 59 yo man with poorly controlled diabetes and asthma who presented with chest pain. He had intermittent chest pain with activity lasting 5 minutes, relieved with rest, as well as shortness of breath when climbing stairs. Cardiac catheterization showed LAD prox 40%, no LCX lesions, no RCA lesions, and R PDA mid 30% lesion. Beta blocker was started, cholesterol was checked (elevated triglycerides 308, total cholesterol 146, HDL 29), statin was started and aspirin was held because of the patient's stated allergy to aspirin (causing asthma type symptoms). He was started on low-dose lisinopril and no prior echo was considered as outpatient. Patient was continued on home regimen of NPH insulin but clearly needs better control of his sugars as outpatient. Hemoglobin A1c is 10.7 and he will need better control of his sugars as outpatient. He has had asthma as a child and no record of PFTs but should obtain as outpatient, with home inhalers continued. Mr. Gaulding currently has good renal function but needs to have his Cr checked after starting the lisinopril. The patient was advised to consider carefully his lifestyle, including diet and exercise plans, and to take medications including VENTOLIN NEBULIZER (ALBUTEROL NEBULIZER) 2.5 MG NEB Q4H PRN Shortness of Breath, ATENOLOL 12.5 MG PO QD Starting IN AM (8/7), NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 60 UNITS QAM; 70 UNITS QPM SC 60 UNITS QAM 70 UNITS QPM, LISINOPRIL 5 MG PO QD, ZOCOR (SIMVASTATIN) 20 MG PO QHS, FLOVENT (FLUTICASONE PROPIONATE) 44 MCG INH BID, COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, and make an appointment with his primary care doctor, take his medications as instructed, and follow up with his cardiologist within 4-6 weeks. He was also placed on a House / Low chol/low sat. fat diet, ADA 2100 cals/dy diet, 2 gram Sodium diet. He was discharged with Full code status and disposition to Home.
|
What his sugars meds has vet tried in past
|
{
"answer_end": [
775
],
"answer_start": [
661
],
"text": [
"Patient was continued on home regimen of NPH insulin but clearly needs better control of his sugars as outpatient."
]
}
|
Loyd O. Karpinsky underwent a laparoscopic adjustable gastric band placement without complication and was transferred to the PACU in stable condition. Her pain was well controlled with PCA analgesia on POD0 and transitioned to po elixir analgesia following a negative upper GI study exhibiting no leaks. She was discharged on LANTUS (INSULIN GLARGINE) 10 UNITS SC QD, RANITIDINE HCL SYRUP 150 MG PO BID, ROXICET ELIXIR (OXYCODONE+APAP LIQUID) 5-10 MILLILITERS PO Q4H PRN Pain, COLACE (DOCUSATE SODIUM) 100 MG PO TID HOLD IF: diarrhea, PHENERGAN (PROMETHAZINE HCL) 25 MG PR Q6H PRN Nausea, and AUGMENTIN SUSP. 250MG/62.5 MG (5ML) (AMOXICIL...) 10 MILLILITERS PO TID Instructions: for five days. At the time of discharge, her pain was well controlled and she was tolerating a stage 2 diet, afebrile, and all incisions were clean dry and intact. She was instructed to take the medications without regard to meals and to resume regular exercise, walking as tolerated. She was also to follow up with Dr. Hinsley in 1-2 weeks and Diabetes Management Service in 3 weeks, and to avoid strenuous activity, swimming, bathing, hot tubbing, and driving or drinking alcohol while taking prescription narcotic (pain) medications.
|
Is the patient currently or have they ever taken pca analgesia
|
{
"answer_end": [
188
],
"answer_start": [
102
],
"text": [
"was transferred to the PACU in stable condition. Her pain was well controlled with PCA"
]
}
|
This 81-year-old Italian-speaking gentleman was admitted to M Valley Medical Center with rising chest pain. Upon admission, his vital signs were normal and his physical examination was unremarkable. Cardiac catheterization revealed 30% mid RCA occlusion, 40% distal RCA, 90% ostial OM1, 90% mid CX, 80% proximal LAD, 99% mid LAD and 60% mid LM. EKG showed normal sinus rhythm and an incomplete right bundle-branch block. During his hospital stay, he was started on beta-blockers, statins, fluid resuscitation and vasopressor administration, subcu insulin, prednisone, Plavix, and antibiotics. He experienced agitation and delirium, for which he was on alcohol drip due to preop history of alcohol use and Haldol was used p.r.n. Later during the hospital stay, he became hypotensive, requiring Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath. He was also on Lopressor 25 orally every 6 hours, Diltiazem 125 mg orally daily, Furosemide 20 mg orally daily, Methylprednisolone 30 mg IV every 8 hours, Atorvastatin 80 mg orally daily, Allopurinol 100 mg orally daily, Ativan 0.5 mg orally at bedtime, Nexium 20 mg orally daily, and Proscar 5 mg orally every night. Tight glycemic control was maintained with Portland protocol in the immediate postop period and subsequently with subcu insulin. Incidental radiologic finding of a renal mass consistent with renal cell carcinoma was also found. Support for the patient's family was provided throughout the hospital course, and the patient was discharged with Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, Nexium 20 mg everyday, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath.
|
Has the pt. ever been on beta-blockers before
|
{
"answer_end": [
488
],
"answer_start": [
447
],
"text": [
"he was started on beta-blockers, statins,"
]
}
|
This is a 51 year-old female with fibromyalgia, hypertension, and migraine headaches who presented to the Emergency Room with two months of dyspnea at night, paroxysmal nocturnal dyspnea, and orthopnea, and an episode of severe substernal chest pressure associated with shortness of breath after carrying water bottles from her car. In the Emergency Department, V/Q scan was very low probability and lower extremity noninvasive studies were also unremarkable. Her medications on admission included Nortriptyline, methyldopa, hydrochlorothiazide, Zantac, estrogen, Advil, ALternaGEL. She smokes one and one-half packs per day for 30 years. Physical examination showed temperature 97.4, respiratory rate 22, heart rate 100, blood pressure 150/90, anicteric, bibasilar crackles about one-quarter of the way up, regular rate and rhythm with II/VI systolic murmur and no rubs or gallops, benign abdomen, guaiac negative in the Emergency Department, 1+ pedal edema bilaterally, right greater than left, and nonfocal neurological. Laboratory data on admission showed hematocrit 41.6, BUN 13, creatinine 0.6, chest x-ray showed mild pulmonary edema, and electrocardiogram showed normal sinus rhythm at 91, no ischemic changes. She had serial CPKs which were all negative, and was treated with two doses of intravenous Lasix (20 milligrams each) resulting in a moderate diuresis and resolution of her shortness of breath symptoms. An exercise test was done with arm ergometry (30 watts) and her heart rate went from 100 to 129, blood pressure went from 130 systolic to 172, and electrocardiogram showed no ischemic changes. An echocardiogram showed vigorous systolic function of 86%, no valvular lesions, no wall motion abnormalities, and evidence of thickening in her ventricular walls. Given the fact that the patient had an elevated diastolic pressure and did show some early evidence of thickening in her ventricular walls, the decision was then made to begin her on a calcium channel blocker (Verapamil 240 milligrams p.o. q.d.) in addition to her usual medications. She was discharged to home in good condition with discharge medications including Verapamil SR 240 milligrams p.o. q.d., Zantac 300 milligrams q.d., estrogen 1.25 milligrams q.d., Advil 800 milligrams p.o. b.i.d. p.r.n., hydrochlorothiazide 25 milligrams p.o. q.d., methyldopa 250 milligrams q.d., and Nortriptyline 125 milligrams p.o. q.h.s., and an appointment to see a new primary physician at Dowsna Medical Center scheduled for May 1996.
|
has there been a prior lasix
|
{
"answer_end": [
1336
],
"answer_start": [
1285
],
"text": [
"two doses of intravenous Lasix (20 milligrams each)"
]
}
|
This is a 70-year-old woman with ischemic cardiomyopathy, coronary artery disease status post MI, insulin-dependent diabetes, peripheral vascular disease, and chronic renal insufficiency who presented in volume overload after a previous admission. She had been diuresed with a Lasix drip at 10 mg per hour and Zaroxolyn at 2.5 mg p.o. daily, and her Lopressor was held for a decompensated heart failure. She was then started on amiodarone and Coumadin for a new paroxysmal atrial fibrillation. Her Lasix drip was increased to 20 mg per hour and the Zaroxolyn was increased to b.i.d. After transition from Zaroxolyn to Diuril, which was given 250 mg IV b.i.d., she was prescribed Ativan 0.5 mg p.o. t.i.d. p.r.n. anxiety, Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Lantus 18 units subcutaneously nightly, Lopressor 25 mg p.o. b.i.d., Procrit 40,000 units subcutaneously every other week, Nitroglycerin sublingual p.r.n. chest pain, Aspirin 81 mg p.o. daily, Vitamin B12 subcutaneous injections at clinic, Iron 325 mg p.o. t.i.d., Metolazone p.r.n., Multivitamin one tablet p.o. daily, Torsemide 100 mg q.a.m. and 50 mg q.p.m., Coumadin 1 mg q.p.m., and Amiodarone 200 mg p.o. daily. Despite the dose of Coumadin being decreased from her home dose of 1 mg q.p.m. to a 0.5 mg q.p.m., her INR continued to rise greater than 200. She was started on q.a.c. NovoLog regimen with her Lantus insulin dose decreased from 18 units to 16 units and the NovoLog sliding scale was started. She was monitored on telemetry with no other events and required repletion of both potassium and magnesium despite her renal insufficiency throughout the admission in the setting of injected insulin in the setting of worsening renal failure, so, studies were also normal. She was continued on Aranesp through the admission and was discharged home on a similar regimen to her home regimen simply to Torsemide after the last discharge as her outpatient p.o. Torsemide regimen of 100 mg p.o. q.a.m. and 50 mg q.p.m., Lantus 12 units subcutaneously nightly, Ativan 0.5 mg p.o. t.i.d., Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Multivitamin one tablet p.o. daily, Coumadin 1 mg q.p.m., Metolazone 2.5 mg p.o. daily as needed for fluid retention, Iron 325 mg p.o. t.i.d., and Aspirin 81 mg p.o. daily. She was maintained on a cardiac diet and prophylaxis with Coumadin and Nexium. Potassium and magnesium were repleted as needed and she was maintained on aspirin and Lipitor throughout the admission. She will follow up with her primary care provider, SRRH Cardiology Clinic, and Renal Clinic.
|
What medications have been previously used for the treatment of a decompensated heart failure.
|
{
"answer_end": [
403
],
"answer_start": [
310
],
"text": [
"Zaroxolyn at 2.5 mg p.o. daily, and her Lopressor was held for a decompensated heart failure."
]
}
|
A 60 year old Spanish speaking woman with multiple cardiac risk factors and a two to three year history of exertional angina presented complaining of unstable chest pain. Dr. Maximo Bryum in C&O MEDICAL CENTER Clinic initiated an antianginal regimen, however the patient recently stopped taking Aspirin and her symptoms then recurred. The patient was given three sublingual Nitroglycerins after her primary M.D. was called and her pain resolved after approximately 15 minutes. On the 27 of January, 1995, the patient underwent a Dobutamine MIBBE on which she went 6 minutes and 48 seconds reaching a maximal heart rate of 154, a blood pressure of 172/82, with 2 mm ST depressions diffusely and moderate to severe reversible anterior and anteroseptal wall ischemia. Medications on admission included Atenolol 50 mg p.o. q.d., Axid 150 mg p.o. b.i.d., Enteric Coated Aspirin 325 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem 240 mg p.o. q.d., Lisinopril 10 mg p.o. q.d., Lopipd 600 mg p.o. q.d., Lasix 40 mg p.o. q.d., Insulin NPH 75 units sub-q q.a.m., 50 units q.p.m., Insulin Regular 25 units sub-q q.a.m., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, and Omeprazole 20 mg p.o. q.d. The Cardiology Team was consulted and serial CK, MB and EKG's were done, with Heparin initially started given the possibility that this was unstable angina. The patient's Insulin dosages were adjusted in the manner to keep her blood sugars in the approximately 200 range and she was discharged with medications including Enteric Coated Aspirin 325 mg p.o. q.d., Lasix 40 mg p.o. q.d., Lopid 600 mg p.o. q.d., Insulin NPH 100 units sub-q q.a.m., 70 units sub-q q.h.s., Insulin Regular 25 units sub-q q.a.m., Lisinopril 10 mg p.o. q.d., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, Omeprazole 20 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem CD 240 mg p.o. q.d., with follow-up care with her primary M.D., Dr. Jarvis Needy in the RINGBURG RITA'S PROPRES MEMORIAL HOSPITAL Clinic.
|
What is the patient's current dose does the patient take of her nitroglycerin 1/150th
|
{
"answer_end": [
411
],
"answer_start": [
335
],
"text": [
"The patient was given three sublingual Nitroglycerins after her primary M.D."
]
}
|
This 54 year old gentleman presented to the Wickpro Conch Medical Center with an infected left lower leg pressure ulcer with open and gangrenous muscle exposed through the posterior wound. His past medical history is significant for insulin dependent diabetes mellitus, peripheral vascular disease, coronary artery disease, congestive heart failure, history of atrial fibrillation/flutter, and right sacroiliac joint decubitus ulcer. His physical examination revealed mottled distal extremities, bilateral inspiratory wheezes, and a positive bowel sound. The patient underwent a four vessel coronary artery bypass graft on 6/17/95 and left lower extremity fasciotomy on 11/27/95 and was taken to the Operating Room on 7/25/95 for a preoperative diagnosis of a left lower extremity infected pressure sore. Intraoperatively, the patient was noted to have necrosis of both heads of the gastrocnemius muscle and copious amounts of antibiotic-containing solution was used to irrigate the wound, for which he was started on Ampicillin, Gentamicin, and Flagyl empirically until culture results returned and was taken back on 2/29/95 for a second irrigation and debridement procedure. The patient was placed on Klonopin 1 mg po tid, Tylenol 650 mg p.o. q4h p.r.n. headache, Aspirin 81 mg p.o. qd, Albuterol nebulizer 0.5 cc in 2.5 cc of normal saline q.i.d., Capoten 25 mg p.o. qh, Chloral hydrate 500 mg p.o. q.h.s. p.r.n. insomnia, Clonopin 1 mg p.o. t.i.d., Digoxin 0.375 mg p.o. qd, Colace 100 mg p.o. b.i.d., Insulin NPH 38 units subcu b.i.d., Milk of Magnesia 30 cc p.o. qd p.r.n. constipation, Multivitamins one capsule p.o. qd, Mycostatin 5 cc p.o. q.i.d., Percocet one or two tabs p.o. q3-4h p.r.n. pain, Metamucil one packet p.o. qd, Azmacort six puffs inhaled b.i.d., Axid 150 mg p.o. b.i.d., Ofloxacin 200 mg p.o. b.i.d. x 7 days, and Insulin NPH 38 units in the morning and 38 units at night. The patient was initially ruled out for a myocardial infarction following his first operative procedure and had no episodes of hypotension. He was switched over from Gentamicin to Ofloxacin to continue his antibiotic course and has been followed by the Infectious Disease service, receiving 7 more days of po Ofloxacin as an outpatient. The patient's medications upon discharge include Aspirin 81 mg po qd, Digoxin 0.325 mg po qd, Azmacort 6 puffs inhaled bid, Heparin 5000 units subcu bid, Zantac 150 mg po bid, Lasix 40 mg po qd, Capoten 25 mg q 8, Albuterol nebulizers 0.5 cc in 2.5 cc normal saline qid, NPH insulin 38 units subcu bid, Nystatin swish and swallow 5 cc po qid, Bactrim DS one tab po bid, Tylenol 650 mg po q4h prn headache, Chloral hydrate 500 mg po qhs prn insomnia, Clonopin 1 mg po tid, Colace 100 mg po bid, Milk of Magnesia 30 cc po qd prn constipation, Multivitamins one capsule po qd, Mycostatin 5 cc po qid, Percocet one or two tabs po q3-4h prn pain, Metamucil one packet po qd, Azmacort six puffs inhaled bid, Axid 150 mg po bid, and Ofloxacin 200 mg po bid x 7 days.
|
What treatments if any has the patient tried for anxiety in the past
|
{
"answer_end": [
1224
],
"answer_start": [
1189
],
"text": [
"was placed on Klonopin 1 mg po tid,"
]
}
|
The patient is a 54-year-old man with nonischemic dilated cardiomyopathy who presents with weight gain, weakness, and azotemia. He was admitted with decompensated heart failure and was treated with dobutamine, seretide, and diuretics with good effect, functioning on ACE inhibitor. Two weeks prior to presentation, Digoxin 0.125 mg q.o.d., Imdur 30 mg q.d., hydralazine 25 mg t.i.d., torsemide was being held, Coumadin 1 mg q.d., carvedilol 3.125 mg b.i.d., allopurinol 100 mg q.d., Glucophage, and glyburide were administered. On 2/19/03, Diuril was added to his regimen and his creatinine was noted to increase from 2.6 to 3.6 and diuretics were subsequently held. The patient was loaded on amiodarone, unfortunately still required low dose dobutamine to maintain his cardiac output and was transferred back to the floor and continued to have decrease urine output on maximal diuretic doses and ionotropes. On 6/8/03, the renal surgery recommended that the dobutamine be stopped in order to enhance renal perfusion and Lasix be increased to 80 mg per hour. He has beyond less invasive measures such as digoxin and ACE inhibitors, and he is now dobutamine dependent dobutamine between 1 and 2.5 mcg/kg/minute to maintain his cardiac output, currently loaded on amiodarone without any further events. He has a chronic osteomyelitis, currently in a six-week course of ceftazidime, vancomycin, Flagyl, and Diflucan for complicated osteomyelitis, end date is on 2/30/03. He has diabetes and was on oral hypoglycemic as an outpatient, however, now this renal function, he has been transitioned over to insulin with his standing doses of Lantus with a lispro sliding scale. The patient was started on TPN for quite severe malnutrition and has increasing albumin with increased appetite. Additionally, he is on maintenance doses of hydrocortisone and was seen by Psychiatry, who suggested starting low dose of Zyprexa in the evening, which has greatly improved his mood. He is planned to be evaluated by Plastic Surgery prior to discharge for final plans whether a flap or healing by secondary retention. The patient currently is stable and would be discharged with home dobutamine and frequent and careful follow up by his primary cardiologist Dr. Mongiovi.
|
Has a patient had lasix
|
{
"answer_end": [
1029
],
"answer_start": [
970
],
"text": [
"be stopped in order to enhance renal perfusion and Lasix be"
]
}
|
The patient is a 59 year old female with multiple cardiac risk factors, including obesity, diabetes mellitus, and cholesterol, who presents with exertional chest discomfort and early positive ETT. The patient underwent catheterization on 2/13/92 and athrectomy of her proximal LAD lesion which was complicated by the onset of severe chest discomfort and 100% occlusion of the LAD. The patient was subsequently brought to the cath lab on 10/9/92 and dilated to a 30% residual with balloon PTCA. The patient's post PTCA course was complicated by several episodes of transient chest discomfort which was relieved both by Mylanta and sublingual TNG. Glucotrol 7.5 mg p.o. q-day, Mevacor 10 mg p.o. q.d., Isoril 10 mg p.o. t.i.d., Propranolol 20 mg p.o. t.i.d., Nitroglycerin sublingual p.r.n., and Glucotrol with NPH subcu q.a.m. were administered, and the patient was treated with Mevacor for hypercholesterolemia. The patient was discharged with medications including Mevacor 10 mg p.o. q-day, Aspirin one p.o. q-day, Glucotrol 20 mg p.o. b.i.d., Isordil 40 mg p.o. t.i.d., Lopressor 200 mg p.o. b.i.d., and NPH 26 units subcutaneously each morning.
|
How much isordil does the patient take per day
|
{
"answer_end": [
1101
],
"answer_start": [
1045
],
"text": [
"Isordil 40 mg p.o. t.i.d., Lopressor 200 mg p.o. b.i.d.,"
]
}
|
This is a 66-year-old man with spinal sarcoidosis and secondary paraplegia who presented with altered mental status, hypoxemic respiratory failure, and hypotension. He became hypotensive with intubation despite using etomidate with Levophed, and was started on vancomycin, gentamicin, Flagyl, and stress dose steroids with 1 liter of IV fluid. His urine was found to have Proteus, resistant to Macrobid, and Klebsiella, resistant to ampicillin, so he was started on Levophed with a systolic blood pressure in the 130's on 7 to 10 of Levophed and Levofloxacin was continued at 500 mg per day for a total 10-day course on in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, to end on 10/16/2006 for a total course of 10 days. Urology replaced the suprapubic catheter and he was started on maintenance IV fluids until cleared to eat by Speech and Swallow. His home medications included Regular Insulin sliding scale a.c. and at bedtime, NPH 54 units in the morning and 68 units in the night, baclofen 10 mg t.i.d., amitriptyline 25 mg at bedtime, oxybutynin 5 mg t.i.d., gabapentin 300 mg t.i.d., iron sulfate 325 mg t.i.d., vitamin C 500 mg daily, magnesium 420 mg t.i.d., Coumadin 5 mg daily, ranitidine 150 mg b.i.d., and calcium 950 mg daily. He was given a head CT without contrast and a chest x-ray that showed no obvious infiltrate. His INR was found to be elevated and he had a suprapubic catheter obstruction with bilateral hydronephrosis and distended bladder. He was given Nexium and Coumadin for prophylaxis and was started on a low dose of captopril on 8/14/2006 for diabetes, and was started on 12.5 mg b.i.d. metoprolol on 0/14/2006 with good results. He was given NPH 20 b.i.d. through his hospitalization and Regular Insulin sliding scale. His creatinine came down to 1.2 and he was given the new beta-blocker and the ACE inhibitor as well as baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate 325 mg p.o. t.i.d., gabapentin 300 mg p.o. t.i.d., NPH human insulin 54 units in the morning, 68 units in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, magnesium oxide 420 mg p.o. t.i.d., metoprolol 12.5 mg p.o. b.i.d., oxybutynin 5 mg p.o. t.i.d., Panafil ointment t.i.d., and ranitidine 500 mg p.o. b.i.d. He was admitted with severe sepsis due to UTI, suprapubic catheter/ostomy for 12 years, diabetes type II, right DVT, on Coumadin, status post chronic UTI, and CPAP at night for pneumonia with ceftazidime, levofloxacin, and vancomycin. His sugars were controlled with no complications and was able to maintain blood pressures in the 130's. His creatinine was initially 2.7, and after receiving IV fluids, it came down to 1.2. He likely had acute renal failure secondary to postrenal obstructive etiology. His INR was found to be therapeutic and he had half of his home Coumadin dose while he was on levofloxacin, so he was given half of dose and his INRs came down to a nadir of 1.7. At discharge, his hematocrit was 27.2, down from 29, which was closed to his baseline of 34, and his INR was 2.1. He was placed on maintenance IV fluids until cleared to eat by Speech and Swallow, and was given amitriptyline 25 mg p.o. at bedtime, vitamin C 500 mg p.o. daily, baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate
|
Was the patient ever prescribed calcium
|
{
"answer_end": [
1270
],
"answer_start": [
1245
],
"text": [
"and calcium 950 mg daily."
]
}
|
Mr. Mauras is a 72-year-old man with history of stable angina, type 2 diabetes, peripheral vascular disease, former smoking history, and history of seizure disorder with cataracts. He had occasional anginal symptoms prior to discharge and took about two nitroglycerins per week. Over the past week, he had escalating chest pain requiring one nitroglycerin per day. The pain was relieved by rest and nitroglycerin. One week prior to admission, his digoxin was stopped and his amiodarone was decreased. His Plavix was stopped and his Coumadin was held. On the morning of admission, he had chest pain and received Lopressor, Enalapril, Lovenox treatment dose and a Plavix load in the ED. He was found to have flash pulmonary edema and in atrial fibrillation with rapid ventricular response and was taken back to the catheterization lab and given four stents to his saphenous vein graft, OM1 with good resolution of his symptoms. He was transferred to the floor and was given an amiodarone load given his ejection fraction and increased ectopy on telemetry. His troponin had been trended down to the 0.2s by discharge and his beta-blocker and ACE inhibitor were titrated to heart rate and blood pressure. Prior to anticipated discharge, he re-developed flash pulmonary edema secondary to atrial fibrillation with rapid ventricular response and was re-loaded with digoxin. He was started on Mucomyst precath with good effect, had a difficult-to-place Foley, and was started on Flomax with good effect. His creatinine on discharge was 1.2, his metformin was held, and he was continued on Lantus with sliding scale insulin. He was given three units of packed red blood cells given his history of CAD and was prescribed with Amiodarone 200 mg, Enteric-coated aspirin 325 mg, Librium 10 mg, Colace 200 mg, Ferrous gluconate 324 mg, Lasix 40 mg, Nitroglycerin one tab, Dilantin 100 mg, Senna two tabs, Coumadin 3 mg, Lipitor 80 mg, Flomax 0.4 mg, Plavix 75 mg, Lantus 14 units, Metformin 500 mg, Ranitidine 150 mg, Digoxin 0.125 mg, Enalapril 10 mg, and Atenolol 50 mg, with follow-up appointments with his PCP, Dr. Kelley Hernon of Electrophysiology on 7/8/05, and Dr. Daft on 9/20/05, and INR checked on 8/4/05 or 7/8/05 with Coumadin adjusted accordingly.
|
Has patient ever been prescribed mucomyst
|
{
"answer_end": [
1452
],
"answer_start": [
1386
],
"text": [
"Mucomyst precath with good effect, had a difficult-to-place Foley,"
]
}
|
This 90+-year-old male with a complex past medical history including CAD, CHF, AF and diabetes mellitus presented to the SICU for removal of chronically MRSA-infected mesh from prior abdominal surgery. He was intubated with etomidate, succinylcholine and kept sedated with Versed and fentanyl. He received intraoperative vancomycin and levofloxacin as well as 2200 mL of lactated Ringer's. In an attempt to reverse anticoagulation, one unit of FFP was begun but then aborted due to hypotension, which resolved with epinephrine injection, likely due to transfusion reaction. Another unit of FFP was administered, with platelets also given at the request of the Plastic Surgery Team in light of aspirin and Plavix, which were continued due to the patient's cardiac stents. Despite bolus Lasix, the patient did develop CHF with symptomatic pulmonary edema and increased oxygen requirement, concomitantly becoming delirious. He developed hypertension refractory to beta-blockade, calcium channel blockers and IV ACE inhibitors, and was thus placed on a nitroglycerin drip, a furosemide drip with ginger blood product resuscitation to address bleeding and an elevated INR, responding well to this regimen and aggressive pulmonary toilet. The patient was advanced to clear liquids, on medications including Amiodarone 200 mg p.o. daily, Calcium, Colace 100 mg by mouth t.i.d., Coumadin alternating doses of 4 mg and 3 mg, Diltiazem CD 360 mg p.o. daily, Aspirin 81 mg p.o. daily, Folate 1 mg p.o. daily, Lisinopril 10 mg p.o. daily, Metamucil p.r.n., Clopidogrel 75 mg p.o. daily, Potassium, Protonix 40 mg p.o. daily, Simvastatin 80 mg p.o. daily, Synthroid 25 mcg p.o. daily, Thiamine 100 mg p.o. daily, Metoprolol SR 100 mg p.o. b.i.d., Zyprexa 2.5 mg at bedtime p.r.n., and Vancomycin for MRSA-infected mesh. He does experience more significant delirium with morphine and less so with sparing Dilaudid p.r.n., and Haldol is written p.r.n. as needed. Weaning off nitroglycerin drip, nitro paste added, hematocrit 25%, one unit of packed red blood cells with Lasix and potassium to be given, RISS, and PICC line consult ordered for anticipated long-term vancomycin. Services following the patient include Medicine, Dr. Harcar, patient's PCP, Cardiology, Dr. Pagliari, and Plastic Surgery, Dr. Dunshie. Patient anticipated to be transferred to the floor on 9/28/06.
|
Has the patient had epinephrine in the past
|
{
"answer_end": [
537
],
"answer_start": [
462
],
"text": [
"then aborted due to hypotension, which resolved with epinephrine injection,"
]
}
|
A 79-year-old male with history of non-insulin dependent diabetes, coronary artery disease, congestive heart failure, hypertension, chronic renal failure, and left toe amputation on 7/1/06 was admitted for debridement and antibiotics. An MRA on 10/3/06 demonstrated on the right a multifocal high-grade stenosis of the proximal, anterior tibial, the tibioperoneal trunk and the proximal, posterior tibial arteries and included peroneal artery at the midcalf, two-vessel runoff and on the left diffuse high-grade stenoses of the anterior tibial, posterior tibial arteries and occlusion of the peroneal artery in the dorsalis pedis. The patient presented with bleeding from the site of the left toe amputation beginning two weeks ago associated with throbbing pain, soreness, erythema and swelling and exacerbated blood pressure when walking and only treated by narcotics. Neuro and Psych: The patient has delirium postoperatively for which he was placed on soft restraints and received Zyprexa. Cardiac: Upon admission, potassium was noted to be elevated and the patient had EKG changes associated with hyperkalemia and received Aspirin, Lopressor, Norvasc, Zocor, Plavix, PhosLo, Prandin for coronary artery disease related event prophylaxis. Blood pressure was controlled with isosorbide dinitrate, Norvasc, lisinopril, and Lopressor. Pulmonary: No events. Maintained oxygen saturation greater than 90% on room air. Renal: Creatinine was stable in the mid 3s and trended down to 2.6 at the time of discharge below his baseline of 4-5. Voiding without difficulty at the time of discharge. Maintained on his renal medications. FEN/GI: Tolerated regular diet. Lactulose and Colace to prevent constipation while taking narcotics, also had Dulcolax p.r.n. Zinc and Vitamin C was started per the Nutrition consult. Hematology: He received heparin for DVT prophylaxis. His hematocrit remained stable. He had some oozing from the right thigh but this resolved with a pressure dressing. ID: He was treated throughout his hospitalization with vancomycin, levofloxacin and Flagyl for methicillin-resistant Staphylococcus aureus that grew from the wound after the first and second irrigation and debridement. The levofloxacin and Flagyl were discontinued prior to discharge. He will continue his vancomycin at the time of discharge. Endocrine: Diabetes controlled. He was maintained on his Prandin and insulin sliding scale for glycemic control. He also received Vitamin D, Calcitriol, Nephrocaps, Epogen, and Aranesp. His incision remained clean, dry and intact without erythema or exudate. He was afebrile with stable signs at the time of discharge. ACTIVITY INSTRUCTIONS: He is nonweightbearing on the left lower extremity to protect the open toe. COMPLICATIONS: None. DISCHARGE LABS: Laboratory tests at the time of discharge include sodium 138, potassium 4.1, chloride 111, bicarbonate 21, BUN 35, creatinine 2.6, calcium 9.0, magnesium 1.9, vancomycin 19.5, white blood cell count 7.3, hemoglobin 9.9, hematocrit 30.2, platelets 221. DISCHARGE MEDICATIONS: His medications at discharge include aspirin 325 mg p.o. daily, vitamin C 500 mg p.o. b.i.d., calcitriol 0.5 mcg p.o. daily, Colace 100 mg p.o. daily, heparin 5000 units subcutaneous t.i.d., isosorbide dinitrate 10 mg p.o. t.i.d., lactulose 30 mL p.o. t.i.d., lisinopril 50 mg p.o. daily, Lopressor 50 mg p.o. q.6h., Prandin 0.5 mg p.o. with each meal, Aranesp 40 mcg subcutaneous every week, sliding scale insulin, insulin aspart 4 units, Tylenol p.r.n., Dilaudid 2-4 mg p.o. q.4h. as needed for pain, milk of magnesia as needed for constipation, Reglan for nausea, oxycodone for pain 5-10 mg p.o. q.4h. hours
|
Why is the patient taking oxycodone
|
{
"answer_end": [
3662
],
"answer_start": [
3619
],
"text": [
"oxycodone for pain 5-10 mg p.o. q.4h. hours"
]
}
|
This 70-year-old woman with a complex medical history, including cerebrovascular accident x two in 1980s without deficits, seizure history probably secondary to ETOH withdrawal, hypertension x 30 years, asthma, gout, and status post repair of subclavian artery stenosis in 1993, presented to the Dagha Medical Center with severe chest pain. A chest CT revealed a 2.3 x 2.8 cm lobulated mass in the right lower lobe involving the pleura, with extensive hilar and mediastinal constitutions consistent with prior granulomatous disease, and tests were positive for multiple precarinal and right peritracheal areas of adenopathy recent from metastatic disease. The patient was admitted to the Thoracic Surgery Service on 3/27/99 and taken to the Operating Room for a video assisted thorascopic right lower lobe lobectomy by Dr. Minick. Postoperatively, the patient did well, with no complications, and was followed by the Internal Medicine Service. The patient went into rapid atrial fibrillation postoperatively, and was successfully converted into a normal sinus rhythm using Diltiazem IV, which was converted to p.o. Diltiazem. The patient's postoperative course was largely unremarkable but for dysrhythmia, and the patient's pain was well controlled with p.o. pain medications, Percocet. Final pathology was read as squamous cell carcinoma, 4.0 cm., moderately differentiated with focal characterization with extensive necrosis. The patient was discharged to home with medications including Adalat 200 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Magnesium Oxide 40 mg t.i.d., Ultram 300 mg q.d., Trazodone 100 mg q.h.s., Azmacort 80 mg p.r.n., aspirin 81 mg q.d., Dyazide 25 mg q.d., nose spray b.i.d., calcium chloride pills q.d., Colchicine 600 mg q.d., cyproheptadine hydrochloride 4 mg b.i.d. q.h.s., anticholesterol med., Albuterol nebulizers 250 mg q.4h., Allopurinol 300 mg q.d., Colchicine 0.6 mg q.d., cyproheptadine hydrochloride by mouth 400 mg q.d., Digoxin 0.125 mg q.d., Diltiazem 30 mg t.i.d., Colace 100 mg t.i.d., Lasix 40 mg p.o. q.d., Percocet 1-2 tablets p.o. q.4h. p.r.n., Dilantin 200 mg p.o. b.i.d., and Trazodone 100 mg p.o. q.h.s., with follow-up with Thoracic Surgery Service as well as with primary care physician and Cardiology as needed.
|
How often does the patient take dyazide
|
{
"answer_end": [
1730
],
"answer_start": [
1663
],
"text": [
"Dyazide 25 mg q.d., nose spray b.i.d., calcium chloride pills q.d.,"
]
}
|
Patient Alequin, Garland, a 57-year-old female with a complex medical history including squamous cell lung cancer, cirrhosis, COPD, HTN, PVD, seizure disorder, history of SDH, large abdominal ventral hernia, and chronic back pain, was admitted to the ED obtunded with decreased BP. She had received all her medications as prescribed in the morning at her nursing home and received Thiamine HCL 100 mg PO daily and Narcan in the ED, becoming more responsive and uncomfortable after Narcan with an elevated ammonia level of 233. To manage her mental status, the patient was given Lactulose 30 Milliliters PO QID Starting Today (5/29) and her narcotic dose was avoided. Pain was effectively controlled with MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Celecoxib 100 mg PO daily Starting Today (5/29) PRN Pain, and a Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily. She was prescribed Vitamin C (Ascorbic Acid) 500 mg PO BID, Folate (Folic Acid) 1 mg PO daily, Lasix (Furosemide) 40 mg PO daily, Flagyl (Metronidazole) 500 mg PO q8h, Aldactone (Spironolactone) 75 mg PO BID with food/drug interaction instruction to give with meals, KCL IV (ref #403310506) with serious interaction of Spironolactone & Potassium Chloride with reason for override monitoring, Thiamine HCL 100 mg PO daily, Multivitamin Therapeutic (Therapeutic Multivitamin) 1 tab PO daily, MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Flovent HFA (Fluticasone Propionate) 220 mcg INH BID, Celecoxib 100 mg PO daily, Keppra (Levetiracetam) 1,000 mg PO BID, Caltrate 600 + D (Calcium Carbonate 1,500 mg (...)), Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily, Novolog (Insulin Aspart) sliding scale (subcutaneously) SC AC with instructions to give 0-10 units subcutaneously based on BS, Maalox-Tablets Quick Dissolve/Chewable 1-2 tab PO Q6H PRN Upset Stomach, Vitamin K (Phytonadione) 5 mg PO daily, Protonix (Pantoprazole) 40 mg PO daily, Toprol XL (Metoprolol Succinate Extended Release) 50 mg PO daily with food/drug interaction instruction to take consistently with meals or on empty stomach, Magnesium Oxide 420 mg PO BID, Metronidazol starting on HD 1, and Vancomycin until speciation of blood cultures. Blood cultures were positive for coag negative staph in 2/4. She was also given Flovent for her known COPD and was discharged with instructions to complete a 14-day course of Cipro and Flagyl and a few changes in her medications, including MSIR every 4 hr as needed, Celebrex, and Lidoderm patch. Follow up with Dr. Vargas, Dr. Megeath, Dr. Blandin, and Dr. Pfleider as scheduled, and with PT at nursing home. Blood counts and calcium should be checked on Monday 3/21 and next week respectively.
|
Has the patient ever tried keppra
|
{
"answer_end": [
1551
],
"answer_start": [
1512
],
"text": [
"Keppra (Levetiracetam) 1,000 mg PO BID,"
]
}
|
This is a 70-year-old woman with ischemic cardiomyopathy, coronary artery disease status post MI, insulin-dependent diabetes, peripheral vascular disease, and chronic renal insufficiency who presented in volume overload after a previous admission. She had been diuresed with a Lasix drip at 10 mg per hour and Zaroxolyn at 2.5 mg p.o. daily, and her Lopressor was held for a decompensated heart failure. She was then started on amiodarone and Coumadin for a new paroxysmal atrial fibrillation. Her Lasix drip was increased to 20 mg per hour and the Zaroxolyn was increased to b.i.d. After transition from Zaroxolyn to Diuril, which was given 250 mg IV b.i.d., she was prescribed Ativan 0.5 mg p.o. t.i.d. p.r.n. anxiety, Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Lantus 18 units subcutaneously nightly, Lopressor 25 mg p.o. b.i.d., Procrit 40,000 units subcutaneously every other week, Nitroglycerin sublingual p.r.n. chest pain, Aspirin 81 mg p.o. daily, Vitamin B12 subcutaneous injections at clinic, Iron 325 mg p.o. t.i.d., Metolazone p.r.n., Multivitamin one tablet p.o. daily, Torsemide 100 mg q.a.m. and 50 mg q.p.m., Coumadin 1 mg q.p.m., and Amiodarone 200 mg p.o. daily. Despite the dose of Coumadin being decreased from her home dose of 1 mg q.p.m. to a 0.5 mg q.p.m., her INR continued to rise greater than 200. She was started on q.a.c. NovoLog regimen with her Lantus insulin dose decreased from 18 units to 16 units and the NovoLog sliding scale was started. She was monitored on telemetry with no other events and required repletion of both potassium and magnesium despite her renal insufficiency throughout the admission in the setting of injected insulin in the setting of worsening renal failure, so, studies were also normal. She was continued on Aranesp through the admission and was discharged home on a similar regimen to her home regimen simply to Torsemide after the last discharge as her outpatient p.o. Torsemide regimen of 100 mg p.o. q.a.m. and 50 mg q.p.m., Lantus 12 units subcutaneously nightly, Ativan 0.5 mg p.o. t.i.d., Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Multivitamin one tablet p.o. daily, Coumadin 1 mg q.p.m., Metolazone 2.5 mg p.o. daily as needed for fluid retention, Iron 325 mg p.o. t.i.d., and Aspirin 81 mg p.o. daily. She was maintained on a cardiac diet and prophylaxis with Coumadin and Nexium. Potassium and magnesium were repleted as needed and she was maintained on aspirin and Lipitor throughout the admission. She will follow up with her primary care provider, SRRH Cardiology Clinic, and Renal Clinic.
|
Has a patient had amiodarone
|
{
"answer_end": [
493
],
"answer_start": [
404
],
"text": [
"She was then started on amiodarone and Coumadin for a new paroxysmal atrial fibrillation."
]
}
|
This 60-year-old male presented with a two week history of paroxysmal nocturnal dyspnea and dyspnea on exertion, possibly related to stress from the recent death of the patient's sister-in-law. His past medical history was significant for hypertension of approximately 10 years, non-insulin dependent diabetes mellitus of approximately 12 years, left Bell's palsy in 1985 treated with prednisone, and type IV hypolipoproteinemia. An EKG showed new anterolateral changes since the EKG taken a year earlier, and he was admitted with a diagnosis of Myocardial Infarction, Congestive Heart Failure, and Hypertension. His medications included Micronase 10 mg po bid, Persantine 60 mg po tid, aspirin one po q d, Lisinopril 5 mg po q d, and Atenolol 50 mg po q d. He had a 20 pack year history of smoking and social ethanol consumption. The patient was managed with gentle Lasix diuresis and the beta blocker was held due to concern for wall motion abnormalities. He was anticoagulated on heparin and loaded on Coumadin, and his medications on discharge included Lasix 40 mg po q d, Captopril 37.5 mg po tid, Ecotrin 325 mg po q d, Coumadin 5 mg po q h.s., magnesium oxide two tablets po q d, Isordil 10 mg po tid with meals, and Micronase 10 mg po bid. The patient was stable on discharge and was to follow up with Dr. Luciano Catignani in his office on Tuesday, 15 of October, at 3 p.m.
|
What is the current dose of ecotrin
|
{
"answer_end": [
1150
],
"answer_start": [
1077
],
"text": [
"Captopril 37.5 mg po tid, Ecotrin 325 mg po q d, Coumadin 5 mg po q h.s.,"
]
}
|
Mr. Boyles is a 73-year-old man with a past medical history significant for extensive coronary artery disease, diabetes, hypertension, hypercholesterolemia, and smoking, who presents with chest pain and is admitted for rule out myocardial infarction. His vital signs are normal, his lungs are clear, his jugular venous pressure is less than 5.0 centimeters, and his PMI is nonpalpable. His cardiac risk factors include age, diabetes, hypertension, cholesterol, smoking, and family history. On the morning of admission, he experienced chest pain for 1-2 minutes, which dissipated. At 7:00 p.m., he took one sublingual nitroglycerin with a decrease of pain and at 11:00 p.m., he took one sublingual nitroglycerin. His medications include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was placed on Plavix, continued aspirin, and restarted Coumadin after heparin and intravenous TNG. Cozaar 25 milligrams q.d. and amlodipine were added, and he was given normal saline intravenous fluids to equalize his ins and outs. His hematocrit dropped to 28.0, and he was transfused two units with an appropriate bump back to 33.0. His diabetes was managed on NPH 30/10 and 4 regular q.p.m., and Rezulin. His genitourinary issue was managed with Finasteride 5 milligrams q.d. and Levofloxacin 500 milligrams q.d. He developed point tenderness in his right knee, and was managed with Colchicine and a prednisone taper starting at 40 milligrams. His medications on discharge include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was taken back for a left subclavian artery stent and a left brachial artery angioplasty, and further managed with catheterization, finding a saphenous vein graft to the diagonal one was 100 percent occluded, SVG to PDA was open, LMA was 30 percent occluded, LAD was 99 percent occluded, diagonal one was 100 percent occluded, and LCX was 80 percent occluded. He was discharged to home in stable condition, with follow-up appointments with his primary doctor, cardiologist, and the doctor who performed the procedure.
|
Has a patient had colchicine
|
{
"answer_end": [
1027
],
"answer_start": [
994
],
"text": [
"Colchicine 0.6 milligrams p.r.n.,"
]
}
|
Vance Prunier, a 57 year old patient with diabetes mellitus, hypertension, hyperlipidemia, and known coronary artery disease, was admitted on 5/30/2001 with worsening exercise capacity. A cath today showed severe native TVD, patent LIMA to LAD, occluded SVG-OM, and radial graft to PDA 80% stenosis. PCI of radial graft lesion with Nir 2.5x15mm and S660 2.5x12mm stents resulting in 0% residual was done and Angioseal was applied to RFA. The patient was discharged on 6/17/2001 in a stable condition with medications EC ASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO QPM, Cipro (Ciprofloxacin) 250 MG PO BID, Insulin NPH Human 30 UNITS SC QAM, Insulin Regular (Human) 18 UNITS SC QAM, Levoxyl (Levothyroxine Sodium) 75 MCG PO QD, Lisinopril 20 MG PO QD, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL Q5 MIN X 3 PRN Chest Pain HOLD IF: SBP<[ ], Pravachol (Pravastatin) 20 MG PO QHS, Amlodipine 5 MG PO QD, Imdur (Isosorbide Mononit.( SR )) 60 MG PO QD, Wellbutrin SR (Bupropion Hcl SR) 150 MG PO BID, Clopidogrel 75 MG PO QD, and 16 hours Integrilin and 30 days Plavix. The patient was instructed to call for any further chest pain, groin pain, swelling or bleeding and was to return to work after an appointment with the local physician. Follow up appointments with Dr. Minear in 1-2 weeks and Dr. Givens were scheduled. The patient was discharged to home.
|
Has a patient had clopidogrel
|
{
"answer_end": [
1030
],
"answer_start": [
1006
],
"text": [
"Clopidogrel 75 MG PO QD,"
]
}
|
Patient Emilio R. Strausberg was admitted on 5/26/2004 with atrial fibrillation and calcaneous fracture and was discharged on 7/18/2004 with discharge orders including ECASA (Aspirin Enteric Coated) 325 MG PO QD, with a potentially serious interaction with Warfarin, Vitamin B12 (Cyanocobalamin) 1,000 MCG PO QD, Digoxin 0.25 MG PO QD, Colace (Docusate Sodium) 100 MG PO BID, Lasix (Furosemide) 60 MG PO BID, Oxycodone 5 MG PO Q6H PRN Pain, Coumadin (Warfarin Sodium) 5 MG PO QPM, with a potentially serious interaction with Atorvastatin, Metoprolol (Sust. Rel.) 300 MG PO QD, Accupril (Quinapril) 20 MG PO QD, Tiazac (Diltiazem Extended Release) 240 MG PO QAM, Lipitor (Atorvastatin) 80 MG PO QD, with a potentially serious interaction with Niacin, Vit. B-3 and Calcium, Niaspan (Nicotinic Acid Sustained Release) 1 GM PO QHS, Lantus (Insulin Glargine) 66 UNITS SC QPM, Insulin Lispro Mix 75/25 74 UNITS SC QAM, Glucometer 1 EA SC x1, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM. Override notices were added on 6/9/04 with reasons such as heart, home med, and home emd. The patient was rate controlled with IV metoprolol and diltiazem, instructed to continue ASA, continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->80), continue lasix, 60 bid (was 40po TID at start of hospitalization), and to continue home insulin. Diabetes education was provided. Mr. Schmider was given ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, with a POTENTIALLY SERIOUS INTERACTION: WARFARIN & ASPIRIN, VITAMIN B12 (CYANOCOBALAMIN) 1,000 MCG PO QD, DIGOXIN 0.25 MG PO QD, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LASIX (FUROSEMIDE) 60 MG PO BID, OXYCODONE 5 MG PO Q6H PRN Pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, on order for ECASA PO (ref # 23344198), on order for LIPITOR PO (ref # 90217884), POTENTIALLY SERIOUS INTERACTION: WARFARIN & ATORVASTATIN CALCIUM Reason for override: home 40mg, METOPROLOL (SUST. REL.) 300 MG PO QD, on order for DILTIAZEM PO (ref # 68655693), POTENTIALLY SERIOUS INTERACTION: METOPROLOL TARTRATE & DILTIAZEM HCL Reason for override: home med, on order for TIAZAC PO (ref # 86614276), on order for DILTIAZEM SUSTAINED RELEASE PO (ref #, ACCUPRIL (QUINAPRIL) 20 MG PO QD, TIAZAC (DILTIAZEM EXTENDED RELEASE) 240 MG PO QAM, LIPITOR (ATORVASTATIN) 80 MG PO QD, POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & NIASPAN (NICOTINIC ACID SUSTAINED RELEASE) 1 GM PO QHS, LANTUS (INSULIN GLARGINE) 66 UNITS SC QPM, INSULIN LISPRO MIX 75/25 74 UNITS SC QAM, GLUCOMETER 1 EA SC x1, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM, as well as continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->
|
What medications has the patient ever tried for pain prevention
|
{
"answer_end": [
440
],
"answer_start": [
409
],
"text": [
"Oxycodone 5 MG PO Q6H PRN Pain,"
]
}
|
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