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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
|
Has this patient ever been on narcotics.
|
{
"answer_end": [
870
],
"answer_start": [
818
],
"text": [
"pressure when walking and only treated by narcotics."
]
}
|
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.
|
Has the patient ever been on nystatin
|
{
"answer_end": [
2577
],
"answer_start": [
2538
],
"text": [
"Nystatin swish and swallow 5 cc po qid,"
]
}
|
Patient Damion Prehn, a 60 year old male with coronary artery disease, hypertension, and hyperlipidemia, was admitted with increasing shortness of breath and intermediate MIBI as an outpatient in the setting of significant deconditioning and multiple cardiac risk factors. In the ED, his temperature was 98.6, his pulse was 70, his blood pressure was 141/69, and his saturation was 94% on room air. He was given ASA and Keflex for LE cellulitis, and his cardiac markers were negative. A cath revealed Subtotal RCA occlusion, 80% OM, and 50% mid LAD, and Cypher stents were placed in mid RCA to os and wedge elevated. EF 45% on stress echo and monitoring revealed 2 episodes of NSVT post-PCI. He was started on Atenolol 125 mg PO daily, Lipitor (Atorvastatin) 80 mg PO daily, Keflex (Cephalexin) 500 mg PO QID, Plavix (Clopidogrel) 75 mg PO daily, Enteric Coated ASA 325 mg PO daily, Lasix (Furosemide) 80 mg PO BID, Potassium Chloride Slow Rel. (KCL Slow Release) 10 MEQ PO daily, LISINOPRIL 5 MG PO DAILY, MICONAZOLE NITRATE 2% CREAM TP BID, MICONAZOLE NITRATE 2% POWDER TOPICAL TP BID, NIASPAN (NICOTINIC ACID SUSTAINED RELEASE) 0.5 GM PO QPM with instructions to take aspirin 30 minutes before-hand to prevent facial flushing. Alerts were overridden due to SERIOUS INTERACTION: MICONAZOLE NITRATE & ATORVASTATIN CALCIUM, POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & ATORVASTATIN CALCIUM, POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & MICONAZOLE NITRATE, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 and POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL. He was discharged on 9/23/06 with code status full code and disposition home, a diet of house/low chol/low sat. fat, and instructions to measure weight daily and resume regular exercise. Follow up appointments were scheduled with Dr. Weakland, Primary Care 1-2 weeks and Dr. Trouser, Cardiology 571-491-1951 Please call in 1-2 days if you do not hear from the office. You must be seen in 2-4 weeks. Allergy is to Shellfish. ASA/Plavix were continued at current doses x 1 year, increased lasix from 40 mg PO daily to 80 mg PO BID, increased b-blocker, continued norvasc, and stopped isordil. Low dose potassium 10mEq was started as increased lasix, and lisinopril 5mg PO daily was started to prevent facial flushing. Patient was instructed to take aspirin 30 minutes before hand to prevent serious interaction between miconazole nitrate and atorvastatin calcium/simvastatin, and potassium chloride immediate rel. PO was ordered. Instructions were given to continue toe cream, check lytes in 2 days, and come to the ER if any concerning symptoms such as trouble breathing, chest pain, or leg swelling. Do NOT discontinue these medications without speaking to your doctor.
|
Has the patient had previous miconazole nitrate 2% cream
|
{
"answer_end": [
1042
],
"answer_start": [
1007
],
"text": [
"MICONAZOLE NITRATE 2% CREAM TP BID,"
]
}
|
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.
|
Has the patient ever tried nitroglycerin 1/150th
|
{
"answer_end": [
411
],
"answer_start": [
335
],
"text": [
"The patient was given three sublingual Nitroglycerins after her primary M.D."
]
}
|
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 the pt. ever been on glucophage before
|
{
"answer_end": [
494
],
"answer_start": [
441
],
"text": [
"3.125 mg b.i.d., allopurinol 100 mg q.d., Glucophage,"
]
}
|
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.
|
Was the patient ever prescribed flagyl.
|
{
"answer_end": [
2403
],
"answer_start": [
2343
],
"text": [
"instructions to complete a 14-day course of Cipro and Flagyl"
]
}
|
Mr. Lumadue is a 68-year-old man with significant cardiac history and vascular disease who came in with a chief complaint of hip pain after a mechanical fall. At that time, his hospital course was complicated by a non-Q wave MI, and Cardiology recommended medical management with Lopressor. An echocardiogram revealed an ejection fraction of 45%, and Dobutamine MIBI revealed a severe fixed perfusion defect in the inferoposterior and inferoseptal left ventricle with an ejection fraction of 26%. His medications included HCTZ 50 mg PO q.d., enteric-coated aspirin 325 mg PO q.d., Zestril 20 mg PO q.d., glyburide 5 mg PO q.d., multivitamins, and cough medicine PRN. Upon admission, his vital signs were afebrile, temperature 97.3, tachycardia, heart rate 106, blood pressure 162/77, oxygenation 94% on room air. X-rays of his left pelvis and femur revealed fracture of the left intertrochanter and subtrochanteric fracture with lesser trochanteric fracture intact by 3 cm, less than five degrees angulation. His femoral head was reduced. During his hospital course, the patient was started on a beta blocker, Ace inhibitor, and continued on an aspirin. He was aggressively diuresed with Lasix for diuresis and was treated with vancomycin, Flagyl, and levofloxacin for presumed aspiration pneumonia. He was continued on Lovenox 60 mg subcu. b.i.d. for prophylaxis against DVT post-hip surgery to continue for six months minimal followed by orthopedic surgery, and restarted on oral hypoglycemics prior to discharge in addition to sliding scale insulin. He was discharged on standing 20 mEq of K-Dur q.d., lisinopril 5 mg PO q.d., hold for systolic blood pressure less than 100, Lasix 100 mg PO q.d., Lovenox 60 mg subcu. b.i.d. x6 months, glipizide 2.5 mg PO q.d., sliding scale insulin, Nexium 20 mg PO q.d., Silvadene wet-to-dry dressing, DuoDerm to left lower leg wound and change q.3 days, and Lopressor 12.5 mg PO t.i.d., hold for systolic blood pressure less than 100. He was maintained on Nexium prophylaxis in the setting of his anticoagulation and on two liters of nasal cannula oxygen at the time of transfer to rehab. Upon discharge, he was instructed to follow up with his primary care physician, orthopedic surgery, cardiology, and pulmonary medicine within two weeks, with labs for a metabolic panel, magnesium, and calcium q.o.d. and physical therapy as needed, with a weightbearing status of non-weightbearing on the left lower extremity and weightbearing as tolerated on the right lower extremity.
|
What is the patient's current dose does the patient take of her glyburide
|
{
"answer_end": [
627
],
"answer_start": [
604
],
"text": [
"glyburide 5 mg PO q.d.,"
]
}
|
This is a 67-year-old male with a history of tremor, hypertension, diabetes, atrial fibrillation, coronary artery disease, benign prostatic hypertrophy, gastroesophageal reflux disease, hiatal hernia, degenerative joint disease, polymyalgia rheumatica, diverticulitis, and osteomyelitis. He was admitted to the hospital with r/o MI and discharged with a diet of House/Low chol/low sat. fat, and instructed to follow up with his primary care doctor one week after d/c from rehab. His medications on admission included Lasix 20 qod, Isordil 40 bid, Prednisone 2 qd, Primidone 50 bid, Norvasc 5 qd, Coreg 25 bid, Flomax 0.4 qd, Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd, Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid, and Medications in ED: NS 500 cc, Aspirin. He was anticoagulated with Lovenox and given aspirin. He had a PICC line placed and was discharged with IV abx. At the tail end of his antibiotic regimen he spiked a fever and was admitted to VOWH. His course of antibiotics was extended and he was discharged to rehab on CEFTRIAXONE 2,000 MG IV QD and Vanc. In the ED, his temperature was normal, EKG demonstrated new ST depressions, and his first set of enzymes were negative. For Neuro, he has a history of tremor and is treated with Primidone and for ID, he was continued on his outpatient regimen of Lantus, standing insulin qAC and insulin SS. For GU, he was continued on Flomax for his BPH. He was discharged to rehab on his admission regimen with no dictated summary and advised to follow up with his PCP within 2 weeks.
|
Has the patient had insulin in the past
|
{
"answer_end": [
1426
],
"answer_start": [
1390
],
"text": [
"standing insulin qAC and insulin SS."
]
}
|
This 79-year-old male was admitted for coronary artery disease and aortic stenosis with a history of hypertension, dyslipidemia, chest radiation, prostate cancer, osteoporosis, and urinary incontinence. A CABG x3 with a LIMA to the LAD, a saphenous vein graft to the PDA, and a saphenous vein graft to the obtuse marginal was done on 10/3/06, while the aortic valve was only found to be mildly stenotic. Postoperatively, he was transferred to the Intensive Care Unit in a stable fashion, and was found to have an inferior lateral ischemia on EKG, which was resolved after cardiac catheterization. He was weaned off pressors and extubated, and started on Lopressor and gentle diuresis. On postoperative day #3, his Norvasc was started and he was transferred to the Step-Down Unit. On postoperative day #4, he was slightly tachycardic with ambulation and his beta-blockers were titrated up, with PA and chest x-ray looking good. He was started on empiric levofloxacin for questionable pneumonia and found suitable for discharge on postoperative day #5, however, he had isolated temperature and his white count was found to be trending and he was hypertensive. A positive blood culture was found from when he had been in the Intensive Care Unit and he was continued on levofloxacin, while he was also started on vancomycin due to left leg cellulitis at the knee. On postoperative day #10, a fluid collection was found above the knee to the mid calf, and he underwent a drainage and irrigation of his left lower extremity saphenous vein donor site. After this procedure, he was transferred back to the Step-Down Unit and was discharged on postoperative day #5.
|
has the patient had lopressor
|
{
"answer_end": [
684
],
"answer_start": [
643
],
"text": [
"started on Lopressor and gentle diuresis."
]
}
|
Patient, a 37 year old male with multiple admissions for atypical chest pain, morbid obesity, restrictive lung disease by PFTs, sleep apnea, and borderline hypertension, came in complaining of SOB and "asthma attack" and anxiety. He responded well to Nebs and Ativan in the ED and was discharged with ECASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO QD with Food/Drug Interaction Instruction to take consistently with meals or on empty stomach, Klonopin (Clonazepam) 1 MG PO TID, Colace (Docusate Sodium) 100 MG PO BID, Prozac (Fluoxetine HCL) 20 MG PO QD, Zestril (Lisinopril) 10 MG PO QD, Niferex-150 150 MG PO BID, Percocet 1 TAB PO Q6H X 7 Days Starting Today (6/1) PRN pain, Azithromycin 250 MG PO QD X 4 Days Starting IN AM (6/1) with Food/Drug Interaction Instruction to take with food, Prednisone Taper PO (60 mg QD X 2 day(s) (0/22/01-09), then 50 mg QD X 2 day(s) (2/26/01-09), then 40 mg QD X 2 day(s) (9/28/01-09), then 30 mg QD X 2 day(s) (4/0/01-09), then 20 mg QD X 2 day(s) (8/26/01-09), then 10 mg QD X 2 day(s) (2/20/01-10), then 5 mg QD X 2 day(s) (3/6/01-10)), on order for Azithromycin PO (ref # 63922816) with Potentially Serious Interaction: Clonazepam & Azithromycin, Prilosec (Omeprazole) 20 MG PO QD, Albuterol Inhaler 2 Puff Inh QID, Atrovent Inhaler (Ipratropium Inhaler) 2 Puff Inh QID, and was instructed to return to work after an appointment with a local physician. He was discharged with a diagnosis of sob of unknown etiology, and other diagnoses included borderline HTN, anxiety disorder, PPD, and morbid obesity.
|
Has patient ever been prescribed prednisone
|
{
"answer_end": [
862
],
"answer_start": [
808
],
"text": [
"Prednisone Taper PO (60 mg QD X 2 day(s) (0/22/01-09),"
]
}
|
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.
|
Did the patient receive coumadin for prophylaxis
|
{
"answer_end": [
2374
],
"answer_start": [
2320
],
"text": [
"cardiac diet and prophylaxis with Coumadin and Nexium."
]
}
|
This 54-year-old female patient with a history of pulmonary emboli in 1971 and 1988 presented with four days of pleuritic chest pain and left arm heaviness. Her past medical history includes dysfunctional uterine bleeding, iron deficiency anemia, lumbosacral disc disease, and a status post laminectomy three times. In July of 1994, she developed the acute onset of intermittent chest pressure and left arm heaviness, associated with night sweats, which progressed to constant and was unrelieved with two Advils. She had a History of Strep Pharyngitis in August of 1994, which was treated with Penicillin, and her medication on admission was Motrin prn. She had no known drug allergies and her past medical history was as pertinent to her admission. After a thrombotic workup, with the exception of the Russell viper venom which was pending at the time of dictation, all tests returned within normal limits. A chest X-ray, VQ scan, and EKG were performed with the VQ scan read as intermediate probability and the EKG revealing a sinus bradycardia at 54 with normal axis and intervals. A pulmonary arteriogram was performed on hospital day number two which revealed a mean RA pressure of 7 mm of mercury, a mean RV pressure of 12 mm of mercury, and no filling defects to suggest a pulmonary embolus. She received Heparin and was started on Naprosyn at 500 mg p.o. b.i.d. on hospital day number two. Coumadin therapy was discussed and the patient was discharged to home on Naprosyn 500 mg p.o. b.i.d. with meals and was to follow up with Dr. Owen Albertine on November, 1994 at 1:30 p.m.
|
Has the patient ever been on naprosyn
|
{
"answer_end": [
1397
],
"answer_start": [
1324
],
"text": [
"was started on Naprosyn at 500 mg p.o. b.i.d. on hospital day number two."
]
}
|
Cristopher Ottilige is a 53 year old woman with a history of diabetes mellitus who presented with abdominal pain and fevers over two weeks duration. On admission, the patient was treated with Lasix 60 mg q day, Glyburide 5 mg q day, Labetalol 200 mg b.i.d., Flagyl 500 mg p.o. q 8 hours, Levofloxacin 500 mg p.o. q 24 hours, Xalatan 1 drop OU q p.m., and Timoptic 0.5% 1 drop OS q day. Physical examination revealed Cervical motion tenderness and Neurologic examination found the patient alert and oriented. Abdominal CT was notable for a 7 x 8 cm low density fluid collection in the region of the right adnexa and a 4 x 8 cm low density fluid collection in the left adnexa. The patient was initially managed on triple antibiotics, ampicillin, gentamicin, and Clindamycin for empiric antimicrobial coverage, with gentamicin eventually being switched to Levofloxacin. Neurologic symptoms of abdominal pain were initially managed with Demerol and Vistaril, and by discharge the patient was without pain and afebrile. The patient was discharged on b.i.d. Flagyl 500 mg p.o. q 8 hours, Levofloxacin 500 mg p.o. q 24 hours, Xalatan 1 drop OU q p.m., and Timoptic 0.5% 1 drop OS q day, with instructions to call the primary care physician for fevers greater than 100.5, chills, nausea, vomiting, and abdominal pain. The patient was referred to the gynecology oncology service for further follow up as an outpatient.
|
Is there history of use of xalatan
|
{
"answer_end": [
1179
],
"answer_start": [
1119
],
"text": [
"Xalatan 1 drop OU q p.m., and Timoptic 0.5% 1 drop OS q day,"
]
}
|
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.
|
Has the patient had previous levofloxacin
|
{
"answer_end": [
1321
],
"answer_start": [
1296
],
"text": [
"LEVOFLOXACIN & AMIODARONE"
]
}
|
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 the patient had previous novolog
|
{
"answer_end": [
1486
],
"answer_start": [
1363
],
"text": [
"NovoLog regimen with her Lantus insulin dose decreased from 18 units to 16 units and the NovoLog sliding scale was started."
]
}
|
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.
|
Has the pt. ever been on magnesium oxide before
|
{
"answer_end": [
1594
],
"answer_start": [
1545
],
"text": [
"Magnesium Oxide 40 mg t.i.d., Ultram 300 mg q.d.,"
]
}
|
The patient is a 76-year-old male with a history of diabetes, hypertension, and CAD status post MI in 2000 who presented to the Emergency Room on 0/0/06 with an ST elevation MI. In the Cath Lab, he was given bicarb, placed on the epi drip, given Lasix and intubated. He was thought to aspirate at the time of intubation secondary to vomiting. A bedside echo revealed global hypokinesis with an EF of 35% and he was placed on a balloon pump, dopamine 16, amio 1, propofol 1, and Integrilin and brought to the floor. On the floor, his blood pressures were difficult to control and his wedge pressure readings indicated a wedge pressure of 47. His MAPs to keep them over 60 required max dopamine, max Levophed, epinephrine and dobutamine. He was arrested multiple times in V-Tach requiring CPR and cardioversion and was found to have in-stent thrombosis in his LAD which was aspirated and bare-metal stent was placed in his LAD and another stent was placed in his diag-2. His family was aware of his prognosis and was there at the time of his arrest at 3:30 in the morning. CPR was initiated and ACLS was done until the family decided to terminate the ACLS and the time of death was 3:47 a.m. on 0/0/06. The cause of death was thought to be cardiogenic shock secondary to ST elevation MI.
|
Was the patient ever prescribed dobutamine.
|
{
"answer_end": [
735
],
"answer_start": [
671
],
"text": [
"required max dopamine, max Levophed, epinephrine and dobutamine."
]
}
|
This is a 48-year-old female who was admitted to the hospital with pneumonia and Klonopin overdose two days prior to admission, having recently completed an antibiotic course at Dale Skin Sonmu Medical Center for pneumonia. She has not taken her lisinopril or methadone in the past. Upon admission, her respiratory rate was 18, O2 saturation 95% on 8 liters of oxygen and she was aggressively given fluids and was started on Levophed for blood pressure support. Her EKG was notable for low voltage on the precordial leads and her saturations were in the high 80's. She was given vancomycin, Levaquin and gentamicin and 3 liters of normal saline. She had a mild troponin elevation on admission, likely secondary to RV strain, and was given a heparin drip with a goal of 60 to 80. Her second PECT showed a small PE to the right upper lobe, but it was not large enough to explain her dramatic presentation. She had severe hypotension and was on two pressors, which were weaned off of on 4/15/06, but had an episode of hypotension when her BiPAP was started. She was given a little bit of low dose dobutamine and then weaned off of that on 3/6/06. She had an elevated eosinophilia on presentation and it was 4% on admission and increased to 8% on 4/21/06. She was empirically covered on admission with vancomycin, levofloxacin and gentamicin. Her antibiotics were given again on 10/16/06 and on 11/13/06. She did complain of bladder spasms while having the Foley in place and was started on Ditropan. She had multiple negative urinalysis and urine cultures. Once the Foley was discontinued, she was able to void and she stopped having bladder spasms. She was started on Monistat for a yeast infection. She did have a history of severe hypertension and her blood pressures were stable, but not high enough to withstand on additional blood pressure lowering medication. It was discussed with her PCP that she perhaps will need this medication restarted as an outpatient. She also had a normal increase in her cortisol level with ACTH stimulation. Her Coumadin was initially given 10, then a dose of 5 and then 2 dose of 7.5. We are continuing her methadone, which has been switched from 20 mg p.o. daily to 10 mg p.o. b.i.d. She was also given a little bit of Ativan while in-house to help with her agitation and anxiety and was initially given a little bit of Haldol, but that was discontinued on 8/4/06 and there was no additional need for that. She was on unfractionated heparin for her presumed PE until 6/15/06 and then changed to Lovenox in the morning and her methadone has been switched from 20 mg p.o. daily to 10 mg p.o. b.i.d. She was given a little bit of low dose lisinopril while in-house. Her blood pressures were stable, but her weight at that time was 157 kg.
|
Previous ativan
|
{
"answer_end": [
2302
],
"answer_start": [
2219
],
"text": [
"She was also given a little bit of Ativan while in-house to help with her agitation"
]
}
|
This is a 67-year-old male with a history of tremor, hypertension, diabetes, atrial fibrillation, coronary artery disease, benign prostatic hypertrophy, gastroesophageal reflux disease, hiatal hernia, degenerative joint disease, polymyalgia rheumatica, diverticulitis, and osteomyelitis. He was admitted to the hospital with r/o MI and discharged with a diet of House/Low chol/low sat. fat, and instructed to follow up with his primary care doctor one week after d/c from rehab. His medications on admission included Lasix 20 qod, Isordil 40 bid, Prednisone 2 qd, Primidone 50 bid, Norvasc 5 qd, Coreg 25 bid, Flomax 0.4 qd, Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd, Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid, and Medications in ED: NS 500 cc, Aspirin. He was anticoagulated with Lovenox and given aspirin. He had a PICC line placed and was discharged with IV abx. At the tail end of his antibiotic regimen he spiked a fever and was admitted to VOWH. His course of antibiotics was extended and he was discharged to rehab on CEFTRIAXONE 2,000 MG IV QD and Vanc. In the ED, his temperature was normal, EKG demonstrated new ST depressions, and his first set of enzymes were negative. For Neuro, he has a history of tremor and is treated with Primidone and for ID, he was continued on his outpatient regimen of Lantus, standing insulin qAC and insulin SS. For GU, he was continued on Flomax for his BPH. He was discharged to rehab on his admission regimen with no dictated summary and advised to follow up with his PCP within 2 weeks.
|
Has the patient had multiple vanc. prescriptions
|
{
"answer_end": [
1135
],
"answer_start": [
1099
],
"text": [
"CEFTRIAXONE 2,000 MG IV QD and Vanc."
]
}
|
A 45-year-old male with morbid obesity presented with chest pain and hypertensive urgency. He was ruled out for MI with negative serial enzymes and EKGs and a cardiac PET showed 2 small areas of reversible ischemia in the mid PDA and distal LAD territory. For CV treatment, he was given Aspirin 81mg PO daily, beta blocker, and HCTZ 25mg PO daily and Atenolol 50mg PO daily for HTN control. For Pulmonary issues, he had very mild asthma exacerbation and a restrictive ventilatory defect from obesity and was given Advair 500/50 BID, Albuterol Nebulizer 2.5 mg neb q2h, Albuterol Inhaler 2 puff inh qid PRN Shortness of Breath and prednisone 60mg QD x 3 doses. For GI issues, he had trace guaiac+ stool and a viral gastroenteritis causing diarrhea and some nausea. For endocrine issues, his A1C was 7.4 and he was educated on low sugar, low carbohydrate diet. For prevention, he was given Lovenox BID. Additional comments included taking HCTZ 25mg daily and Atenolol 50mg daily for blood pressure, eating a low sugar, low carbohydrate diet, and follow-up with cardiology on 11/0. He was discharged in a stable condition with a recommendation for monitor blood sugars and A1C, outpatient colonoscopy, and consider statin therapy, as well as Fluticasone Propionate/Salmeterol 250/50 1 puff inh BID, Albuterol Inhaler 2 puff inh QID, Artificial Tears 2 drop OD TID, Loratadine 10 mg PO QD, Hydrochlorothiazide 25 mg PO QD, Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Albuterol Nebulizer 2.5 mg neb q4h, Acetylsalicylic Acid 81 mg PO daily, and Miconazole Nitrate 2% powder topical TP daily.
|
Why does the patient take lovenox
|
{
"answer_end": [
900
],
"answer_start": [
875
],
"text": [
"he was given Lovenox BID."
]
}
|
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 the patient had multiple elavil prescriptions
|
{
"answer_end": [
696
],
"answer_start": [
638
],
"text": [
"Tamoxifen 10 mg b.i.d., Elavil 75 mg q day, K-Dur 1 q day,"
]
}
|
This is a 66-year-old man with diabetes, hypertension, obesity and non-Hodgkin's lymphoma of the right hip on chemotherapy (R-CHOP) which began on 4/10/06 and will continue for 18 weeks, reporting no complications from ischemic chemotherapy. The patient presented to the emergency room with syncope and was hypotensive on arrival, receiving IV normal saline as volume resuscitation. The second set of cardiac enzymes was positive with a troponin of 2, and an echocardiogram the morning following admission showed a dilated right ventricle consistent with right ventricular strain. A PE protocol CT scan showed a large saddle embolus, and the patient was treated initially with IV heparin, transitioned to Coumadin and then the decision was made to try Lovenox therapy for long-term anticoagulation. Cardiac enzymes normalized and repeat echocardiogram showed mild improvement in right heart function. On admission, the patient's medications were Atenolol 50 daily, lisinopril 5 daily, Protonix 40 daily, metformin 1500 daily, Lantus 60 daily, Humalog 20 before meals, Byetta 5 mcg twice daily, levothyroxine (dose unknown), OxyContin 40 every eight hours, Percocet two tabs every 3 hours as needed for pain and gabapentin (dose unknown).
|
Has a patient had oxycontin
|
{
"answer_end": [
1237
],
"answer_start": [
1124
],
"text": [
"OxyContin 40 every eight hours, Percocet two tabs every 3 hours as needed for pain and gabapentin (dose unknown)."
]
}
|
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.
|
What is her current dose of magnesium oxide
|
{
"answer_end": [
1001
],
"answer_start": [
978
],
"text": [
"Magnesium oxide 400 mg,"
]
}
|
Arron Umbaugh was admitted on 4/30/2001 and discharged on 7/10/2001 with a code status of full code and disposition of home w/ services. The discharge medications included ASA (Acetylsalicylic Acid) 325 mg PO QD, Atenolol 25 mg PO QD Starting Today (1/24) HOLD IF, Colace (Docusate Sodium) 100 mg PO BID, Lasix (Furosemide) 60 mg PO QD Starting Today (1/24) Instructions: Take 60mg per day for 3 days and then change, Zestril (Lisinopril) 7.5 mg PO QD, on order for KCL IMMEDIATE REL. PO (ref # 85723815) POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE Reason for override: will follow, on order for KCL SLOW REL. PO (ref # 68279429), COUMADIN (Warfarin Sodium) 6 mg PO QD, on order for ZOCOR PO (ref # 88249805) POTENTIALLY SERIOUS INTERACTION: WARFARIN & SIMVASTATIN, ZOCOR (Simvastatin) 20 mg PO QHS, on order for ERYTHROMYCIN TP (ref # 53201344) POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & ERYTHROMYCIN, TOPICAL OR OPHTHALMIC, Metformin 1,000 mg PO BID Starting Today (1/24), Prilosec (Omeprazole) 20 mg PO QD, with instructions to take consistently with meals or on empty stomach, and a warning for a potentially serious interaction: Furosemide & Omeprazole, Valacyclovir 1,000 mg PO Q8H X 7 Days, with Tylenol. Please page Dr. Blouir about your eye pain and come to the ED, lasix qd and see Dr. boeshore on wed. as well as daily weights, and to call Dr. Pradel if they can't control their pain due to zoster on your back. The patient was admitted with CHF exacerbation, increased SOB over past few days, orthopnea and PND, with left sided failure and diastolic dysfunction, and IV lasix 40 in ED, which decreased SOB. The patient was also prescribed Metformin 1000 mg PO BID, Prilosec (Omeprazole) 20 mg PO QD, and Valacyclovir 1000 mg PO Q8H X 7 Days with instructions to take consistently with meals or on empty stomach, and a warning for a potentially serious interaction: Furosemide & Omeprazole. Override Notices were added for COUMADIN PO (ref # 29560859), KCL IMMEDIATE REL. PO (ref # 85723815), KCL SLOW REL. PO (ref # 68279429), and ZOCOR PO (ref # 88249805) due to potentially serious interactions: Aspirin & Warfarin, Lisinopril & Potassium Chloride, Warfarin & Simvastatin, respectively. The patient was also instructed to take lasix qd and see Dr. boeshore on wed. as well as daily weights, and to call Dr. Pradel if they can't control their pain due to zoster on their back. The patient was discharged with discharge medications including ASA (Acetylsalicylic Acid) 325 mg PO QD, Atenolol 25 mg PO QD Starting Today (1/24) HOLD IF, Colace (Docusate Sodium) 100 mg PO BID, Lasix (Furosemide) 60 mg PO QD Starting Today (1/24) Instructions: Take 60mg per day for 3 days and then change, Zestril (Lisinopril) 7.5 mg PO QD, COUMADIN (Warfarin Sodium) 6 mg PO QD with instructions to avoid high Vitamin-K containing foods, and ZOCOR (Simvastatin) 20 mg PO QHS with instructions to avoid grapefruit unless MD instructs otherwise.
|
Has the patient ever had omeprazole
|
{
"answer_end": [
1183
],
"answer_start": [
1126
],
"text": [
"potentially serious interaction: Furosemide & Omeprazole,"
]
}
|
This 79-year-old male was admitted for coronary artery disease and aortic stenosis with a history of hypertension, dyslipidemia, chest radiation, prostate cancer, osteoporosis, and urinary incontinence. A CABG x3 with a LIMA to the LAD, a saphenous vein graft to the PDA, and a saphenous vein graft to the obtuse marginal was done on 10/3/06, while the aortic valve was only found to be mildly stenotic. Postoperatively, he was transferred to the Intensive Care Unit in a stable fashion, and was found to have an inferior lateral ischemia on EKG, which was resolved after cardiac catheterization. He was weaned off pressors and extubated, and started on Lopressor and gentle diuresis. On postoperative day #3, his Norvasc was started and he was transferred to the Step-Down Unit. On postoperative day #4, he was slightly tachycardic with ambulation and his beta-blockers were titrated up, with PA and chest x-ray looking good. He was started on empiric levofloxacin for questionable pneumonia and found suitable for discharge on postoperative day #5, however, he had isolated temperature and his white count was found to be trending and he was hypertensive. A positive blood culture was found from when he had been in the Intensive Care Unit and he was continued on levofloxacin, while he was also started on vancomycin due to left leg cellulitis at the knee. On postoperative day #10, a fluid collection was found above the knee to the mid calf, and he underwent a drainage and irrigation of his left lower extremity saphenous vein donor site. After this procedure, he was transferred back to the Step-Down Unit and was discharged on postoperative day #5.
|
Previous vancomycin.
|
{
"answer_end": [
1359
],
"answer_start": [
1286
],
"text": [
"he was also started on vancomycin due to left leg cellulitis at the knee."
]
}
|
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 this patient ever tried isordil
|
{
"answer_end": [
1778
],
"answer_start": [
1682
],
"text": [
"sliding scale insulin subcu q 4, Isordil 30 mg t.i.d., Zestril 5 mg q d, Lopressor 50 mg b.i.d.,"
]
}
|
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.
|
Did the patient ever take any medication for her other: gas in the past
|
{
"answer_end": [
1538
],
"answer_start": [
1495
],
"text": [
"SIMETHICONE 40 mg PO QID PRN Upset Stomach,"
]
}
|
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.
|
What is the dosage of gentamicin sulfate
|
{
"answer_end": [
703
],
"answer_start": [
666
],
"text": [
"gentamicin 50 mg IV q.8h. until 2/25."
]
}
|
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
|
Is there a mention of of coumadin usage/prescription in the record
|
{
"answer_end": [
3149
],
"answer_start": [
3075
],
"text": [
"was set for her Coumadin, which was restarted on 4/12/03 for known paroxys"
]
}
|
A 31-year-old female with a history of Type 2 DM, morbid obesity, and borderline HTN was admitted to the MTCH ED for treatment of hyperglycemia due to poor diabetes management for an entire year and symptoms of polydipsia and polyuria, tingling in her fingers and toes, and worsening vision. Upon further examination, she was also diagnosed with a UTI. The discharge medications included LISINOPRIL 5 MG PO QD, POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL, METFORMIN 1,000 MG PO BID, LEVOFLOXACIN 250 MG PO QD X 1 doses, LANTUS (INSULIN GLARGINE) 20 UNITS SC QD, and an instruction to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose. The patient was discharged with a goal blood glucose of less than 200 mg/dL, an increase of Lantus to 25 mg SC QD, an increase of Metformin to 1000 mg PO BID, and diabetes home medication regimen/glucometer/test strips. HTN: Lisinopril 5 mg PO QD was also prescribed. F/E/N: KCl PO replacement scale. MgSulfate sliding scale.GI: Colace PRN, MOM PRN, and diabetes education, checking sugars TID, self-FSBG checks, and a 30-45 min walk at least 5 times per week were also included in the treatment plan.
|
Did the patient receive lisinopril for htn:
|
{
"answer_end": [
956
],
"answer_start": [
930
],
"text": [
"HTN: Lisinopril 5 mg PO QD"
]
}
|
Ms. Dozois is a 64-year-old female admitted to MICU on 2/19/2005 for neutropenia, nausea, vomiting, abdominal pain, and shortness of breath, requiring intubation and pressors. Her medical problems included severe COPD (on home O2 2 liters baseline sat below 90s), nonsmall cell lung cancer (diagnosed in 1999, status post multiple chemotherapy regimens, most recently ALIMTA from 1/29/2005 to 09), diabetes, obesity, and chronic renal insufficiency. Her MEDICATIONS ON ADMISSION included Avapro, Lipitor, Decadron, ranitidine, Humalog, allopurinol, Alimta, Flonase, Vitamin D, B12, and Colace. She was initially treated with vancomycin, Levaquin, and aztreonam along with Flagyl empirically, and later changed to Levaquin only on 10/25/2005 to treat an enterococcal UTI and possible nosocomial pneumonia. She had thrombocytopenia and required multiple red blood transfusions to maintain her hematocrit greater than 26, though she was never hemodynamically unstable. She also required multiple platelet transfusions to keep her platelets greater than 30,000. She responded well initially to three units of packed red blood cells over 7/28/2005 and 09. However, in the setting of her GI bleed from a sloughing mucosa secondary to resolving neutropenic enteritis and recent chemo, she required multiple further RBC transfusions to keep her hematocrit greater than 30. Hematology was consulted secondary to suboptimal busted platelet levels status post transfusions, which was felt to be secondary to poor marrow response in the setting of recent chemo (workup was negative for other possible causes refractory thrombocytopenia, nystatin, allopurinol, were held given possible worsening of her thrombocytopenia). Surgery was consulted and she was managed conservatively with antibiotics initially and then with bowel rest. TPN was started on 4/21/2005, given her bowel rest for a neutropenic enteritis. She was changed to standing insulin on 10/25/2005 and her Lantus was up titrated along with sliding scale insulin to maintain blood sugars in the 80s to 120s. She is no longer neutropenic and was off Neupogen for one week and will stay and finish the 14-day course of Levaquin for coverage. On discharge her hematocrit and platelets were stable respectively at 29.8 and 46,000 and she had not required a transfusion in greater than 24 hours prior to discharge. Her DISCHARGE MEDICATIONS included Tylenol 650 to 1000 mg PO q. 6h PRN pain, headache, if fever is greater than 101, Peridex mouth wash 10 mL twice a day, nystatin mouth wash 10 mL swish and swallow 4 x day as needed, oxycodone 5 mg PO q. 6h PRN pain, simethicone 80 mg PO q.i.d. PRN gaseousness, trazodone 25 mg PO at bedtime, miconazole nitrate 2% powder topical BID to areas between skin folds including under the right breast, Nexium 20 mg PO daily, Lantus 30 mg subcutaneous daily, DuoNeb 3/0.5 mg Nebs q. 3 h. PRN shortness of breath, aspart 4 units before each meal subcutaneously, folate 3 mg PO daily, Avapro 150 mg PO daily, meclizine 25 mg PO TID, Combivent 2 puffs inhaled q.i.d., Vitamin D 125 0.25 mcg PO daily. She will follow up with infectious disease and hematology for her neutropenia, which has since resolved, and will stay and finish the 14-day course of Levaquin for UTI coverage.
|
Has a patient had colace.
|
{
"answer_end": [
593
],
"answer_start": [
577
],
"text": [
"B12, and Colace."
]
}
|
The patient is a 40 year old female with a history of cholelithiasis who was recently discharged from Asce Medical Center after an incisional hernia repair. She soon after noted onset of right upper quadrant pain, vomiting, and fever and was readmitted with an ultrasound showing two 8-9 mm gallstones in the right upper quadrant. She was treated with intravenous antibiotics but deferred surgery at that time and was discharged home after defervescing. Approximately six weeks prior to admission, she was seen in the Emergency Ward for recurrent right upper quadrant pain without nausea, vomiting, or fever. She was subsequently seen by Dr. Bellman in the Chica Onant Hospital and a cholecystectomy was scheduled on a routine basis. On admission, the patient was afebrile with stable vital signs. Her EKG showed normal sinus rhythm, her chest X-Ray was clear, and her laboratory examination was within normal limits. She was placed under general anesthesia and her intubation was particularly difficult secondary to obesity requiring fiberoptic intubation and Anesthesia elected to place both an A-line and a central venous access. She then underwent a very uncomplicated cholecystectomy and was taken to the Recovery Room in stable condition. She received two doses of Gentamicin as prophylaxis post-operatively and had an unremarkable post-operative course. She was discharged to home on post-operative day number five with an appointment to follow-up in the Ingtondi Community Healthcare.
|
Has the patient ever been on gentamicin
|
{
"answer_end": [
1313
],
"answer_start": [
1245
],
"text": [
"She received two doses of Gentamicin as prophylaxis post-operatively"
]
}
|
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.
|
What is the patient's current dose does the patient take of her colace
|
{
"answer_end": [
1796
],
"answer_start": [
1782
],
"text": [
"Colace 200 mg,"
]
}
|
This 70-year-old female with CHF, coronary artery disease, diabetes, peripheral vascular disease, and chronic renal insufficiency was admitted on 0/5/06 for weakness and confusion. Her hospital course was complicated by worsening cardiac function with minimal improvement on milrinone and decreasing urine output despite diuretics and also gross gastrointestinal bleeding with melanotic stool while she was on Coumadin for atrial fibrillation. In addition, there was concern for sepsis and she was placed on antibiotics with levofloxacin, Flagyl, and vancomycin. She required a transfer to the Cardiac Care Unit on 9/15/06 for further medical therapy for poor cardiac output, a possible need for CVVH, given volume overload in the setting of renal failure, and work-up of GIB. Her code status was DNR/DNI, but was changed to comfort measures only on 1/17/06 due to a large ascending colorectal mass with ulcerations. Being CMO status, she was removed of all pressors and antibiotics and made comfortable sedated on fentanyl and Versed. She was then extubated for comfort with family present and had agonal breathing with episodes of apnea and was given additional sedation for comfort. The patient drew her last breath at 2:20 p.m. with family present and was pronounced dead at 2:20 p.m. on 1/17/06. Family declined autopsy.
|
What medications have been previously used for prevention of worsening cardiac function
|
{
"answer_end": [
284
],
"answer_start": [
205
],
"text": [
"complicated by worsening cardiac function with minimal improvement on milrinone"
]
}
|
The patient had continued to remain stable from an ischemia standpoint and a beta-blocker was added back to his regimen and was titrated to a dose of Lopressor 12.5 mg p.o. t.i.d. He continues on aspirin and statin, and he also continues on Isordil 20 mg p.o. t.i.d. and hydralazine 50 mg p.o. t.i.d. for after load reduction, as well as digoxin at 0.125 mg p.o. q.o.d. The patient was aggressively diuresed with intravenous Lasix and Zaroxolyn followed by conversion to oral diuresis with torsemide at the dose of 100 mg p.o. q.d. He was also found to have atrial clot on transesophageal echocardiogram and thus was started on a heparin drip and transitioned on Coumadin, but after a discussion with the CHF Team, the decision was made not to continue Coumadin anticoagulation and instead he was given aspirin and Plavix at full doses. The patient's medication regimen also includes Colace 100 mg p.o. b.i.d., Folate 1 mg p.o. q.d., Robitussin A-C 5 mL p.o. q.4h. p.r.n. cough, Simethicone 80 mg p.o. q.i.d. p.r.n. upset stomach, Multivitamin one tab p.o. q.d., Compazine 5-10 mg p.o. q.6h. p.r.n. nausea, Tessalon 100 mg p.o. t.i.d. p.r.n. cough, Lipitor 80 mg p.o. q.d., Plavix 75 mg p.o. q.d., Lantus 5 units subcu q.p.m., NovoLog 3 units subcu a.c. and NovoLog sliding scale. The patient is on ACE inhibitor and was restarted on a low-dose beta-blocker at 12.5 mg p.o. t.i.d. as well as his insulin regimen can be adjusted as an outpatient and possibly oral diabetes medications restarted. He is to be discharged to the Com Medical Center for further rehabilitation, with follow-up appointments with Dr. Kyle Yandle in the T Las on 2/28/05 at 08:30 a.m., Dr. Clyde Chatampaya of Elmert Hospital Cardiology 9/26/05 and Raymond Banaag of TRISTONTERN MEDICAL CENTER PCP on 10/3/05 at 01:50 p.m. His sister, Alexis Fernendez, is his health care proxy and is providing substantial social support.
|
Has patient ever been prescribed heparin
|
{
"answer_end": [
672
],
"answer_start": [
613
],
"text": [
"was started on a heparin drip and transitioned on Coumadin,"
]
}
|
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.
|
What medications has patient been on for wheezing in the past
|
{
"answer_end": [
557
],
"answer_start": [
522
],
"text": [
"ALBUTEROL NEBULIZER 2.5 MG NEB Q4H,"
]
}
|
An 81-year-old Russian-speaking male with a history of coronary artery disease, multiple strokes, diabetes mellitus type 2, COPD, atrial fibrillation on anticoagulation and a partial pacemaker, congestive heart failure with an ejection fraction of 45-50%, BPH, and hypertension was admitted to Ghampemaw A Hospital for bacteremia with Streptococcus oralis and was treated with a course of IV penicillin through a PICC line, as well as oral Flagyl empirically for an elevated white count. At the rehab facility, he was treated with some sublingual nitroglycerin, and was brought to the Ellwis Medical Center Emergency Room where he was given IV fluid boluses, treated empirically with vancomycin and ceftazidime, and had a CPAP initiated. A head CT was performed which was negative and a right internal jugular line was placed. He was admitted to medicine for further management and a PEG tube placement was done on 4/2/06. His MEDICATIONS ON ADMISSION included Glucotrol 10 mg p.o. b.i.d. and lisinopril 5 mg p.o. q. day, metformin 500 mg p.o. t.i.d., sublingual nitroglycerin p.r.n., nystatin suspension q.i.d., Zyprexa 2.5 mg p.o. q. h.s., Penicillin G 3 million units IV q. 4h x7 days, Milk of Magnesia, Tylenol p.r.n., Dulcolax p.r.n., Colace p.r.n., atenolol 50 mg q. day, Lipitor 20 mg q. day, Senna liquid q. h.s., Flomax 0.4 q. day. He was initially diuresed mildly with Lasix, started on insulin sliding-scale and Lantus, and was kept on potassium and magnesium scales while in hospital. He was given an empiric 7-day course of Ceptaz and Flagyl for aspiration pneumonia, vancomycin, and his vancomycin was switched to IV penicillin and was continued for a full 3-4 week course on 8/14/07. Coumadin was held peri-procedure when he was getting his PEG placed and vitamin K had been administered in view of his supratherapeutic Coumadin. His Coumadin should be restarted on 9/23/07 and Nexium p.o. t.i.d., Flagyl 500 mg p.o. t.i.d. x10 days which was started on 2/5/06. He was oxygenated quickly with 2 liters of oxygen by nasal cannula, restarted on his home doses of aspirin, statin, beta blocker 2 pump, and ACE inhibitor, and his beta blocker and ACE inhibitor were restarted during his hospital stay. He was discharged to rehabilitation where they will focus primarily on his physical therapy and rehab needs.
|
statin
|
{
"answer_end": [
2113
],
"answer_start": [
2045
],
"text": [
"restarted on his home doses of aspirin, statin, beta blocker 2 pump,"
]
}
|
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--->
|
Has patient ever been prescribed diltiazem hcl
|
{
"answer_end": [
2158
],
"answer_start": [
2114
],
"text": [
"DILTIAZEM HCL Reason for override: home med,"
]
}
|
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.
|
Has patient ever been prescribed motrin ( ibuprofen )
|
{
"answer_end": [
1807
],
"answer_start": [
1755
],
"text": [
"Motrin (Ibuprofen) 600 mg PO Q6H PRN Pain, Headache,"
]
}
|
This is a 67-year-old male with a history of tremor, hypertension, diabetes, atrial fibrillation, coronary artery disease, benign prostatic hypertrophy, gastroesophageal reflux disease, hiatal hernia, degenerative joint disease, polymyalgia rheumatica, diverticulitis, and osteomyelitis. He was admitted to the hospital with r/o MI and discharged with a diet of House/Low chol/low sat. fat, and instructed to follow up with his primary care doctor one week after d/c from rehab. His medications on admission included Lasix 20 qod, Isordil 40 bid, Prednisone 2 qd, Primidone 50 bid, Norvasc 5 qd, Coreg 25 bid, Flomax 0.4 qd, Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd, Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid, and Medications in ED: NS 500 cc, Aspirin. He was anticoagulated with Lovenox and given aspirin. He had a PICC line placed and was discharged with IV abx. At the tail end of his antibiotic regimen he spiked a fever and was admitted to VOWH. His course of antibiotics was extended and he was discharged to rehab on CEFTRIAXONE 2,000 MG IV QD and Vanc. In the ED, his temperature was normal, EKG demonstrated new ST depressions, and his first set of enzymes were negative. For Neuro, he has a history of tremor and is treated with Primidone and for ID, he was continued on his outpatient regimen of Lantus, standing insulin qAC and insulin SS. For GU, he was continued on Flomax for his BPH. He was discharged to rehab on his admission regimen with no dictated summary and advised to follow up with his PCP within 2 weeks.
|
Has a patient had lantus
|
{
"answer_end": [
708
],
"answer_start": [
625
],
"text": [
"Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd,"
]
}
|
This 66-year-old male with a history of CAD, MI, CABG, and PCI was admitted with chest pain and ongoing risk factors. His enzyme on presentation was negative and EKG showed nonspecific T wave flat in II, III and V2-V3. In the ED, he had a BP of 86/118 and was given NITROGLYCERIN 1/150 (0.4 mg) SL q5min x 3 with no relief; his CP was 10/10 and reduced to 4/10 with NITROGLYCERIN. Labs showed elevated BUN/Cr and mild-mod lateral wall ischemia. He was prescribed ASA 325 mg PO QD, AMIODARONE 200 mg PO BID, LOPRESSOR (METOPROLOL TARTRATE) 50 mg PO BID, ISOSORBIDE DINITRATE 30 mg PO TID (hold if sbp<100), IMDUR 60 mg PO BID, PLAVIX 75 mg PO QD, Protonix, KEFLEX (CEPHALEXIN) 500 mg PO QID, Lasix 60 mg PO BID, KCl 40 mg PO QD, Metformin 500 mg PO BID, Micronase 10 mg PO BID, Tylenol with Codeine PRN, and Ativan 5 mg PRN. He was also advised to follow-up with his PCP to discuss starting Coumadin therapy given his history of atrial fibrillation, and was instructed to take PPI for GERD and a PPI and SC Hep for ppx. He was discharged with stable condition, and lab results showed normal WBC and no signs of acute infection. The patient was also advised to continue taking POTASSIUM CHLORIDE & RAMIPRIL, ALTACE (RAMIPRIL) 1.25 mg PO QD, NEXIUM (ESOMEPRAZOLE) 20 mg PO QD, DIET: House/Low chol/low sat. fat, ACTIVITY: Resume regular exercise, and FOLLOW UP APPOINTMENT(S): Please see your PCP in Own within 2 weeks.
|
What is the dosage of lasix
|
{
"answer_end": [
727
],
"answer_start": [
606
],
"text": [
"IMDUR 60 mg PO BID, PLAVIX 75 mg PO QD, Protonix, KEFLEX (CEPHALEXIN) 500 mg PO QID, Lasix 60 mg PO BID, KCl 40 mg PO QD,"
]
}
|
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 there been a prior ceftazidime
|
{
"answer_end": [
1391
],
"answer_start": [
1333
],
"text": [
"currently in a six-week course of ceftazidime, vancomycin,"
]
}
|
Ms. Leezer is a 50 year-old woman with a history of end stage renal disease, status post renal transplant, and a history of coronary artery disease, status post coronary artery bypass grafting. She had an episode of chest pain which was relieved by Nitroglycerin and passed out while saying goodbye to her husband, as well as several episodes of skipped heart beats during and after which she feels short of breath, and slurred speech for a few minutes. On admission her temperature was 98.8, pulse 96, blood pressure 120/70, and respirations 18. During her stay she was given a 250 cc fluid bolus, transfused two units of blood and her hematocrit went up to 31. Laboratory data revealed a sodium of 137, potassium 4.4, chloride 104, bicarbonate 15, BUN 86, creatinine 3.1, ALT 6, AST 11, alkaline phosphatase 44, bilirubin total 0.4, direct bilirubin 0.1, calcium 9.5, cholesterol 360, and HDL 40. An exercise tolerance test MIBI was performed, which was negative for ischemia, and the patient's ejection fraction was approximated to be 69%. Carotid noninvasives revealed moderate internal carotid plaque on the right and mild stenosis of the other arteries. An echocardiogram revealed concentric left ventricular hypertrophy with an ejection fraction of 65%. The patient was taken to Electrophysiology Study which revealed nonsustained ventricular tachycardia with possible right ventricular outflow tract origin. It was hoped that she could be maintained on Lopressor and Verapamil; however, her blood pressure did not tolerate the medication, so she was already on Atenolol for Beta blockade and Verapamil was tried. Her discharge medications included Aspirin 81 mg p.o. q. day, Vitamin C 100 mg p.o. q. day x14 days, Epogen 2,000 subcu q. week, Lasix 60 mg p.o. q. day, Gemfibrozil 300 mg p.o. b.i.d., Lisinopril 5 mg p.o. q. day, Prilosec 20 mg p.o. q. day, Prednisone 5 mg p.o. on even days, 10 mg p.o. on odd days, MVI with minerals one tablet p.o. q. day, Thiamine 50 mg p.o. b.i.d., Bicitra 15 ml p.o. b.i.d., Nephrocaps one tablet p.o. q. day, Cyclosporine 125 mg p.o. in the morning and 100 mg p.o. in the afternoon, Insulin sliding scale, Cellcept 1,000 mg p.o. b.i.d., and Prempro 0.625/0.25 mg p.o. q. day. Her triglycerides were checked during the hospitalization and found to be very high in the 1,500 range, so she was taken off Simvastatin and started on Gemfibrozil. She was discharged in stable condition the next day.
|
What chest pain medications have ever been prescribed for pt. in the VA or mentioned in the record
|
{
"answer_end": [
262
],
"answer_start": [
205
],
"text": [
"episode of chest pain which was relieved by Nitroglycerin"
]
}
|
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 patient had multiple toprol xl ( metoprolol succinate extended release ) prescriptions
|
{
"answer_end": [
1113
],
"answer_start": [
1009
],
"text": [
"TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 50 MG PO DAILY with Food/Drug Interaction Instruction,"
]
}
|
Stettler, Hal 223-66-98-9, an 81 y.o. woman, was admitted to the hospital on 1/15/2004 with pneumonia and discharged on 6/18/2004. Mrs. Marnett presented with chest pain, difficulty speaking, nausea, and lightheadedness and had URI symptoms two weeks prior. On arrival to the floor, a raised, painful area was noted on her L forearm. PMedHx includes H/o agina, Echo (1/29) with EF 55%, abnormal septal motion, mild AR, no MR, mod TR, Holter 0/2 with multiform VE (bigem, cooup), SVE's 1st degree A-V block, D.M. AGA1c 6.1 (6/17), subacute thalamic stroke noted on CT 1/29, Afib - on COUMADIN, Mitral stenosis - MVR St Jude (4/27), CHF, Restrictive lung disease- 5/23 PFTs FVC 1.33, FEV1 0.98, Sigmoid colostomy, Ventral hernia repair, Bladder calcifications on CT urogram (1/29), HTN, RA, and Recent eye hemorrhage. VS: T 98.9 P 103, BP 160/74, RR 20, OxySat 97% 2L NC, FSG 172. On order for COUMADIN PO (ref # 17623917), the patient was prescribed AMIODARONE 200 MG PO QD, GLIPIZIDE 2.5 MG PO QD, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, SARNA TOPICAL TP QD Instructions: to lower extremities, COUMADIN (WARFARIN SODIUM) 2.5 MG PO QOD, HYDROCORTISONE 1% -TOPICAL CREAM TP BID Instructions: to R elbow eczema, LEVOFLOXACIN 250 MG PO QD Starting IN AM (3/0), NIZORAL 2% SHAMPOO (KETOCONAZOLE 2% SHAMPOO) TOPICAL TP tiweek, GUAIFENESIN 10 MILLILITERS PO Q6H Starting Today (2/12) PRN Other:cough, SYNALAR 0.025% CREAM (FLUOCINOLONE 0.025% CREAM) TOPICAL TP BID Instructions: `, PLAQUENIL (HYDROXYCHLOROQUINE) 200 MG PO BID, NORVASC (AMLODIPINE) 10 MG PO QD, and was instructed to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose. POTENTIALLY SERIOUS INTERACTIONS between AMIODARONE HCL & WARFARIN, LEVOFLOXACIN & WARFARIN, and LEVOFLOXACIN & AMIODARONE HCL were Override Notices added on 2/19/04, and an Alert was overridden for POSSIBLE ALLERGY (OR SENSITIVITY) to SULFA. The patient was discharged on 1/29/04 at 05:00 PM contingent upon attending evaluation, and the code status was Full Code with the disposition home with services. The patient was to finish 6 more days of Levo (total 10) and was monitored as an outpatient while on levofloxacin. Her INR was 3 after 2 days of levofloxacin and will be checked again by VNA 3 days, and if fever, SOB, increasing left arm pain, or other symptoms, the patient was to call the doctor, weigh herself daily, and not restart HTN meds until Dr. Schoville tells her to.
|
Has this patient ever tried hydrocortisone 1% -topical cream
|
{
"answer_end": [
1180
],
"answer_start": [
1141
],
"text": [
"HYDROCORTISONE 1% -TOPICAL CREAM TP BID"
]
}
|
Justin Eans, a 56 year old patient with a history of DM, HTN, hypertryglyceridemia and depression, was admitted to the medical service on 11/4/2004 with 2-day h/o increasing abdominal girth, 1-day h/o shortness of breath, pleuritic CP and an increase in nocturia from 2x to 6x. He was given i.v. Lasix for presumed CHF, and his discharge medications included Tylenol (Acetaminophen) 500 mg PO Q6H PRN Pain, Headache, Atenolol 100 mg PO QD, Calcium Citrate 950 mg PO BID, Colace (Docusate Sodium) 100 mg PO BID, Gemfibrozil 600 mg PO BID, Hydrochlorothiazide 25 mg PO QD, NPH Insulin Human (Insulin NPH Human) 15 UNITS SC At 10 p.m. (bedtime), Lisinopril 40 mg PO QD, Niferex-150 150 mg PO BID, Simethicone 80 mg PO QID PRN Upset Stomach, Vitamin E (Tocopherol-DL-Alpha) 1,200 UNITS PO QD, Vitamin B Complex 1 TAB PO QD, Triamcinolone Acetonide 0.5% (Triamcinolone A...) TOPICAL TP QID, Levofloxacin 500 mg PO QD, Miconazole Nitrate 2% Powder Topical TP BID, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, Metformin XR (Metformin Extended Release) 2,000 mg PO QD, Insulin Regular Human Sliding Scale (subcutaneously) SC AC, and Potassium Chloride Immed. Rel. PO (ref #93677429) with the instruction to separate doses by 2 hours. Overrides were added on 0/28/04 and 3/3/04 by WILBY, BRYANT BRYON, M.D., WASHMUTH, SCOTTIE CLEO, M.D., and BEILER, TOMMY L. respectively. Additionally, the patient was instructed to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose and if on tube feeds, to cycle (hold 1 hr before to 2 hr after) and take 2 hours before or 2 hours after dairy products, with a 14-day course of Levofloxacin and to take ASA/NSAIDs for 6 - 8 weeks. He was discharged in satisfactory condition and was instructed to follow up with Endocrine and PCP re diabetes and lipid management, follow up with PCP for management of chronic medical problems, including GERD, gastric erosions, hypertension, and obstructive sleep apnea, and follow up with an outpatient psychiatrist regarding reinitiation of medications.
|
Has this patient ever been treated with maalox-tablets quick dissolve/chewable
|
{
"answer_end": [
1030
],
"answer_start": [
958
],
"text": [
"Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach,"
]
}
|
Patient, a 37 year old male with multiple admissions for atypical chest pain, morbid obesity, restrictive lung disease by PFTs, sleep apnea, and borderline hypertension, came in complaining of SOB and "asthma attack" and anxiety. He responded well to Nebs and Ativan in the ED and was discharged with ECASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO QD with Food/Drug Interaction Instruction to take consistently with meals or on empty stomach, Klonopin (Clonazepam) 1 MG PO TID, Colace (Docusate Sodium) 100 MG PO BID, Prozac (Fluoxetine HCL) 20 MG PO QD, Zestril (Lisinopril) 10 MG PO QD, Niferex-150 150 MG PO BID, Percocet 1 TAB PO Q6H X 7 Days Starting Today (6/1) PRN pain, Azithromycin 250 MG PO QD X 4 Days Starting IN AM (6/1) with Food/Drug Interaction Instruction to take with food, Prednisone Taper PO (60 mg QD X 2 day(s) (0/22/01-09), then 50 mg QD X 2 day(s) (2/26/01-09), then 40 mg QD X 2 day(s) (9/28/01-09), then 30 mg QD X 2 day(s) (4/0/01-09), then 20 mg QD X 2 day(s) (8/26/01-09), then 10 mg QD X 2 day(s) (2/20/01-10), then 5 mg QD X 2 day(s) (3/6/01-10)), on order for Azithromycin PO (ref # 63922816) with Potentially Serious Interaction: Clonazepam & Azithromycin, Prilosec (Omeprazole) 20 MG PO QD, Albuterol Inhaler 2 Puff Inh QID, Atrovent Inhaler (Ipratropium Inhaler) 2 Puff Inh QID, and was instructed to return to work after an appointment with a local physician. He was discharged with a diagnosis of sob of unknown etiology, and other diagnoses included borderline HTN, anxiety disorder, PPD, and morbid obesity.
|
Has the patient had previous prilosec ( omeprazole )
|
{
"answer_end": [
1240
],
"answer_start": [
1206
],
"text": [
"Prilosec (Omeprazole) 20 MG PO QD,"
]
}
|
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 does the patient take regular insulin for
|
{
"answer_end": [
1098
],
"answer_start": [
997
],
"text": [
"The patient's diabetes was controlled with regular insulin and placed back on his oral hypoglycemics,"
]
}
|
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 has the patient been prescribed levofloxacin
|
{
"answer_end": [
2158
],
"answer_start": [
2034
],
"text": [
"vancomycin, levofloxacin and Flagyl for methicillin-resistant Staphylococcus aureus that grew from the wound after the first"
]
}
|
Ms. Hesby is a 36-year-old woman with very poorly controlled type 1 diabetes, end-stage renal disease, right eye blindness, lower extremity neuropathy, gastroparesis, and a history of extensive infections. She presented to Path Community Hospital with a right thigh burn and infection, and was given a prescription for antibiotics, 20 units of IV insulin, 500 mL normal saline boluses, and several 250 mL boluses, as well as 2 amps of calcium gluconate, Kayexalate, albuterol nebs, and Augmentin and IV vancomycin for her right thigh cellulitis. For long-term management, she was prescribed Lantus 24 units subcu each night, NovoLog sliding scale, PhosLo, Nephrocaps, Vitamin D, Sevelamer 1600 t.i.d., Toprol 100 mg p.o. daily, Lisinopril 5 mg p.o. daily, Plavix 75 mg p.o. daily, Keppra 500 mg p.o. b.i.d., Flovent two puffs b.i.d., Albuterol p.r.n., Baclofen 5 mg p.o. t.i.d., and Ambien 10 mg p.o. at bedtime p.r.n. The patient was admitted with a diagnosis of Diabetic Ketoacidosis (DKA) and was stabilized in the MICU on an insulin waves. She was then transitioned to NPH and finally to Lantus 24 units subcu and her hypertension is being managed on her home dose of Lopressor 25 q.i.d. and switched to Captopril, which is being titrated. Her area of cellulitis has completely resolved, and if she becomes acidotic, the patient can be managed with sodium bicarbonate and D5W in small boluses. The patient is taking her Nephrocaps and sevelamer and is receiving prophylaxis with heparin 5000 units subcu t.i.d., however she has consistently refused her heparin. Of note, on the night of 1/26/06, the patient complained of severe cramping, right lower quadrant pain, which is new. She noted this pain has increased rapidly in the setting of diarrhea. Several C. diff studies, which were sent recently have been negative and the patient has had no blood in her diarrhea. Presumed cause is Augmentin, which has been stopped. The patient has continued to eat freely and is passing diarrhea despite her complaints of 10/10 severe abdominal pain. A CT scan of her abdomen was ordered, but she refused to take oral or IV contrast. The results of this CT scan are pending and will be followed up by the new medical team.
|
What treatments if any has the patient tried for prophylaxis in the past
|
{
"answer_end": [
1515
],
"answer_start": [
1420
],
"text": [
"her Nephrocaps and sevelamer and is receiving prophylaxis with heparin 5000 units subcu t.i.d.,"
]
}
|
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.
|
Has the patient had neoral ( cyclosporine micro ( neoral ) ) in the past
|
{
"answer_end": [
492
],
"answer_start": [
437
],
"text": [
"NEORAL ( CYCLOSPORINE MICRO ( NEORAL ) ) 100 MG PO BID,"
]
}
|
Mr. Faiella is a 78 year old man who presented with two episodes of chest pain and had recently undergone a MV and TV repair with SVG to OM1. An EKG showed pacing and a CK revealed a TnI elevated at 0.17, while Adenosine MIBI revealed a fixed inf/lat defect, consistent with LCX disease. He was sent home with Nitroglycerin, and the pain recurred while watching TV, resolving with one Nitroglycerin tablet. CV: Ischemia was ruled out for MI, added Isordil to regimen, ASA, and continue Carvedilol, Captopril. Likely to have CAD, Adenosine MIBI origin, will stop nitrates. Pt was able to amubulate w/o SOB or CP, CHF: euvolemic, continue Lasix, Aldactone, Digoxin. Neuro: recent history of TIA, on Coumadin, may not want to reverse. On order, he was prescribed ECASA (Aspirin Enteric Coated) 325 mg PO QD, Coumadin PO (ref # 44750239), Captopril 12.5 mg PO TID, Aldactone PO (ref # 94240639), Digoxin 0.125 mg PO QOD, Lasix (Furosemide) 80 mg PO BID, Niferex-150 150 mg PO BID, Nitroglycerin 1/150 (0.4 mg) 1 tab SL q5min x 3 PRN chest pain HOLD IF: SBP < 100, Aldactone (Spironolactone) 25 mg PO QD, Coumadin (Warfarin Sodium) 6 mg PO QD, Carvedilol 3.125 mg PO BID HOLD IF: SBP < 100, and Celexa (Citalopram) 20 mg PO QD, with potential serious interactions between Aspirin & Warfarin, Captopril & Spironolactone, and Potassium Chloride & Digoxin. He was instructed to call his cardiologist and return to the emergency department if his chest pain recurs, worsens, or he becomes short of breath, and to make an appointment with Dr. Moxness within the next 1-2 weeks. VNA was asked to oversee medications, check vitals, and draw PT/INR once a week, while PT was asked to help Mr. Muskett regain strength, flexibility, and range of motion. Number of Doses Required (approximate): 5. There were overrides on orders for COUMADIN PO (ref # 44750239) and ALDACTONE PO (ref # 94240639) due to Potentially Serious Interactions: ASPIRIN & WARFARIN, CAPTOPRIL & SPIRONOLACTONE, and POTASSIUM CHLORIDE & SPIRONOLACTONE.
|
Has patient ever been prescribed asa.
|
{
"answer_end": [
472
],
"answer_start": [
407
],
"text": [
"CV: Ischemia was ruled out for MI, added Isordil to regimen, ASA,"
]
}
|
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
|
has the patient had oxycodone
|
{
"answer_end": [
1312
],
"answer_start": [
1267
],
"text": [
"Oxycodone 5 mg to 10 mg q.4-6h. p.r.n. pain.,"
]
}
|
This 66-year-old male with a history of CAD, MI, CABG, and PCI was admitted with chest pain and ongoing risk factors. His enzyme on presentation was negative and EKG showed nonspecific T wave flat in II, III and V2-V3. In the ED, he had a BP of 86/118 and was given NITROGLYCERIN 1/150 (0.4 mg) SL q5min x 3 with no relief; his CP was 10/10 and reduced to 4/10 with NITROGLYCERIN. Labs showed elevated BUN/Cr and mild-mod lateral wall ischemia. He was prescribed ASA 325 mg PO QD, AMIODARONE 200 mg PO BID, LOPRESSOR (METOPROLOL TARTRATE) 50 mg PO BID, ISOSORBIDE DINITRATE 30 mg PO TID (hold if sbp<100), IMDUR 60 mg PO BID, PLAVIX 75 mg PO QD, Protonix, KEFLEX (CEPHALEXIN) 500 mg PO QID, Lasix 60 mg PO BID, KCl 40 mg PO QD, Metformin 500 mg PO BID, Micronase 10 mg PO BID, Tylenol with Codeine PRN, and Ativan 5 mg PRN. He was also advised to follow-up with his PCP to discuss starting Coumadin therapy given his history of atrial fibrillation, and was instructed to take PPI for GERD and a PPI and SC Hep for ppx. He was discharged with stable condition, and lab results showed normal WBC and no signs of acute infection. The patient was also advised to continue taking POTASSIUM CHLORIDE & RAMIPRIL, ALTACE (RAMIPRIL) 1.25 mg PO QD, NEXIUM (ESOMEPRAZOLE) 20 mg PO QD, DIET: House/Low chol/low sat. fat, ACTIVITY: Resume regular exercise, and FOLLOW UP APPOINTMENT(S): Please see your PCP in Own within 2 weeks.
|
What is the patient's current dose does the patient take of her plavix ( clopidogrel )
|
{
"answer_end": [
645
],
"answer_start": [
626
],
"text": [
"PLAVIX 75 mg PO QD,"
]
}
|
The patient is an elderly woman with known coronary artery disease status post coronary artery bypass graft who had her Beta blocker, Pendalol decreased from 5 mg to 2.5 mg prior to this trip to Glension Street. On return to the hospital she developed substernal chest pain that radiated down both arms, which was treated with Amoxicillin given to her by her son who is a physician. At this visit, he did start her on Prinivil and she took a sublingual nitroglycerin that completely relieved her symptoms. Laboratory studies were significant for a white blood cell count of 5.46, hematocrit 40.1, platelets 190, Cardiac Troponin I was 0.0, CK was 102, and Urinalysis was negative. Chest x-ray was clear with no infiltrates, and EKG was normal sinus rhythm with normal intervals and normal axis with a left bundle branch block pattern and first degree atrioventricular block with no change compared to an EKG done on January, 1997. MEDICATIONS ON ADMISSION: 1) Zocor 5 mg p.o. q.h.s., 2) Prinivil 5 mg p.o. q. day., 3) Pendalol 2.5 mg p.o. q. day., 4) Aspirin 325 mg p.o. q. day., 5) Synthroid 0.100 mg p.o. q. Monday, Wednesday and Friday and 0.12 mg p.o. Tuesday, Thursday, Saturday and Sunday., 6) Pepcid p.r.n. From here, she was managed medically with increases in her ACE inhibitor, Statin and the addition of nitrates. After the cardiac catheterization, she developed a large right groin hematoma at the puncture site and a bruit was noted. An ultrasound was done that revealed a pseudoaneurysm of the common femoral artery, which was later surgically repaired. MEDICATIONS ON DISCHARGE: 1) Aspirin 325 mg p.o. q. day., 2) Colace 100 mg p.o. b.i.d., 3) Synthroid 100 mcg p.o. q. Monday, Wednesday and Friday, 112 mcg p.o. q. Tuesday, Thursday, Saturday and Sunday., 4) Lisinopril 10 mg p.o. q. day., 5) Beclomethasone diproprionate double strength spray to each nostril b.i.d., 6) Zocor 20 mg p.o. q.h.s., 7) Toprol XL 75 mg p.o. q. day., 8) Imdur 30 mg p.o. q. day., 9) Augmentin one tablet p.o. q. day for seven additional days. The patient had been having low grade fevers and a cough productive of a green sputum, and experienced diaphoretic episodes, both at rest and exertion, which was relieved by a sublingual nitroglycerin. The latest echocardiogram in May of 1997 showed an ejection fraction of 35% with mid to distal septal and apical akinesis and inferior akinesis with mild mitral regurgitation, and she went 4 minutes and 18 seconds on an exercise tolerance test with Thallium which showed only fixed defects, no reversible defects.
|
What is the reason this patient is on nitroglycerin
|
{
"answer_end": [
303
],
"answer_start": [
238
],
"text": [
"she developed substernal chest pain that radiated down both arms,"
]
}
|
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.
|
blood pressure meds on in past
|
{
"answer_end": [
767
],
"answer_start": [
735
],
"text": [
"norepinephrine was administered."
]
}
|
Ms. Leezer is a 50 year-old woman with a history of end stage renal disease, status post renal transplant, and a history of coronary artery disease, status post coronary artery bypass grafting. She had an episode of chest pain which was relieved by Nitroglycerin and passed out while saying goodbye to her husband, as well as several episodes of skipped heart beats during and after which she feels short of breath, and slurred speech for a few minutes. On admission her temperature was 98.8, pulse 96, blood pressure 120/70, and respirations 18. During her stay she was given a 250 cc fluid bolus, transfused two units of blood and her hematocrit went up to 31. Laboratory data revealed a sodium of 137, potassium 4.4, chloride 104, bicarbonate 15, BUN 86, creatinine 3.1, ALT 6, AST 11, alkaline phosphatase 44, bilirubin total 0.4, direct bilirubin 0.1, calcium 9.5, cholesterol 360, and HDL 40. An exercise tolerance test MIBI was performed, which was negative for ischemia, and the patient's ejection fraction was approximated to be 69%. Carotid noninvasives revealed moderate internal carotid plaque on the right and mild stenosis of the other arteries. An echocardiogram revealed concentric left ventricular hypertrophy with an ejection fraction of 65%. The patient was taken to Electrophysiology Study which revealed nonsustained ventricular tachycardia with possible right ventricular outflow tract origin. It was hoped that she could be maintained on Lopressor and Verapamil; however, her blood pressure did not tolerate the medication, so she was already on Atenolol for Beta blockade and Verapamil was tried. Her discharge medications included Aspirin 81 mg p.o. q. day, Vitamin C 100 mg p.o. q. day x14 days, Epogen 2,000 subcu q. week, Lasix 60 mg p.o. q. day, Gemfibrozil 300 mg p.o. b.i.d., Lisinopril 5 mg p.o. q. day, Prilosec 20 mg p.o. q. day, Prednisone 5 mg p.o. on even days, 10 mg p.o. on odd days, MVI with minerals one tablet p.o. q. day, Thiamine 50 mg p.o. b.i.d., Bicitra 15 ml p.o. b.i.d., Nephrocaps one tablet p.o. q. day, Cyclosporine 125 mg p.o. in the morning and 100 mg p.o. in the afternoon, Insulin sliding scale, Cellcept 1,000 mg p.o. b.i.d., and Prempro 0.625/0.25 mg p.o. q. day. Her triglycerides were checked during the hospitalization and found to be very high in the 1,500 range, so she was taken off Simvastatin and started on Gemfibrozil. She was discharged in stable condition the next day.
|
Why was nitroglycerin. originally prescribed
|
{
"answer_end": [
262
],
"answer_start": [
205
],
"text": [
"episode of chest pain which was relieved by Nitroglycerin"
]
}
|
Patient Omar J. Coolbaugh, a 71-year-old female post cardiac transplant with allograft coronary artery disease, bilateral carotid disease, TIA, diabetes, and obesity, was admitted on 11/8/2007 and discharged on 4/14/2007 with s/p angioplasty and stenting. The medications on admission included Mycophenolate Mofetil 1000 mg PO BID, Oxybutynin Chloride XL 10 mg PO QD, Insulin Glargine 20 units SC QAM, Furosemide PO QD, Clopidogrel 75 mg PO QD, Pravastatin 40 mg PO QHS, Prednisone 5 mg PO QD, Cyclosporine (Sandimmune) 75 mg PO BID, Metoprolol Succinate Extended Release 50 mg PO QD, and Fenofibrate (Tricor) 48 mg PO QD. Elective cardiac catheterization was performed, revealing double vessel disease and successful PTCA/Stenting of LAD was done using XB3.5 guide, BMW, with no residual stenosis. The patient was advised to take Enteric Coated ASA 325 mg PO Daily, Plavix (Clopidogrel) 75 mg PO Daily, Cyclosporine (Sandimmune) 75 mg PO BID, Tricor (Fenofibrate (Tricor)) 48 mg PO Daily, Lasix (Furosemide) 40 mg PO Daily, Insulin Glargine 20 units SC Daily, Toprol XL (Metoprolol Succinate Extended Release) 50 mg PO Daily, CellCept (Mycophenolate Mofetil) 1,000 mg PO BID, Ditropan XL (Oxybutynin Chloride XL) 10 mg PO Daily, Pravachol (Pravastatin) 40 mg PO Bedtime, Prednisolone Sodium Phosphate 5mg/5ml 5 mg PO Daily, and vitamins, with ASA 325 and Plavix for life and other medications at usual doses, plus TNG 0.4 mg (Nitroglycerin 1/150 (0.4 mg)) 1 tab SL q5min x 3 doses PRN Chest Pain. The importance of both aspirin and taking medications consistently was stressed and the patient understands, with diet house/low chol/low sat. fat and activity light activity with no heavy lifting or driving x 2 days, ok to shower, no swimming or bathing x 5 days and lift restrictions of not lifting greater then 10-15 pounds. Follow up appointments were scheduled for Heart Failure Clinic 2-4 weeks and patient was discharged in stable condition and advised to drink plenty of fluids over the next several days, and to call with any questions or concerns.
|
Did the patient receive tng 0.4 mg ( nitroglycerin 1/150 ( 0.4 mg ) ) for chest pain
|
{
"answer_end": [
1497
],
"answer_start": [
1410
],
"text": [
"plus TNG 0.4 mg (Nitroglycerin 1/150 (0.4 mg)) 1 tab SL q5min x 3 doses PRN Chest Pain."
]
}
|
The patient was a 46 year old woman with a history of asthma who was admitted with an asthma exacerbation. She had asthma since childhood and was never intubated nor previously treated with steroids. On admission, her physical examination showed wheezes bilaterally in the lungs. Her laboratory examination showed hematocrit of 41.6, white count of 9.66, and platelets of 199,000. She was treated with steroids, Solu-Medrol and then prednisone 60 milligrams orally, beta agonist, nebulizer and ampicillin, and continued her oral theophylline as she had been using as an outpatient. Her medications on admission were Theo-Dur 200 milligrams by mouth 3 times a day, prednisone 60 milligrams by mouth each day, Albuterol nebulizer, ampicillin 500 milligrams by mouth 3 times a day and Bronkosol. Allergies included sulfa drugs. She slowly improved with decreased wheezing in her breath sounds and increased peak flow from 300. She was discharged on May 3rd with all her usual medications, plus Keflex 500 milligrams by mouth 4 times a day and prednisone 50 milligrams by mouth each day, and was to follow up with her doctor.
|
Has the patient had multiple bronkosol. prescriptions
|
{
"answer_end": [
792
],
"answer_start": [
782
],
"text": [
"Bronkosol."
]
}
|
Patient TEWA, GERMAN M, a 74-year-old African American female with a history of NYHA III CHF (EF 45%), PHT, HTN-CMP, and obesity, was admitted to CAR service on 1/20/2005 for CHF exacerbation and UTI and was discharged on 4/28/2005 with Full Code status. She was prescribed ALLOPURINOL 100 MG PO BID, FERROUS SULFATE 325 MG PO QD, LASIX (FUROSEMIDE) 60 MG PO BID starting today (8/27), HYDRALAZINE HCL 10 MG PO TID (hold if SBP below 90), ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID (hold if SBP below 90), LISINOPRIL 20 MG PO QD (hold if SBP below 90), LIPITOR (ATORVASTATIN) 10 MG PO QD, PROTONIX (PANTOPRAZOLE) 40 MG PO QD, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 75 MG PO QD, LEVAQUIN (LEVOFLOXACIN) 250 MG PO QD, and ACETYLSALICYLIC ACID 325 MG PO QD. Override notices were added on 5/12/05, 10/29/05, and 10/29/05 on order for KCL IMMEDIATE RELEASE PO (ref #03030471, 01642329, 91907761, 15927551) and KCL IV (ref #78178294) for POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE. Food/Drug Interaction Instruction to avoid milk and antacid, take consistently with meals or on empty stomach, and administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose (if on tube feeds, please cycle (hold 1 hr before to 2 hr after) and take 2 hours before or 2 hours after dairy products) was provided, as well as fluid restriction and diurese aggressively with lasix 100 bid, replete lytes, keeping in mind CRI, cont BB, ACEI, and added hydralazine/isordil for CAD, hyperlipidemia: BB, ACEI, statin, ASA; RENAL: CRI with anemia; HEME: Anemia - Given aranesp, FeSO4; HTN: BB, ACEI; ID: UTI, E coli in Ucx, sensitivities pending; and empirically tx with Keflex, changed empirically on HD4 to levo. RHEUM: Gout - allopurinol. The patient was discharged in a satisfactory condition.
|
Has the pt. ever been on lipitor (atorvastatin) before
|
{
"answer_end": [
589
],
"answer_start": [
554
],
"text": [
"LIPITOR (ATORVASTATIN) 10 MG PO QD,"
]
}
|
A 45-year-old man with a history of familial cardiomyopathy and status post cardiac transplant in 2002, and chronic renal insufficiency presented with greater than two weeks of polyuria, polydipsia, blurry vision, muscle cramps, and myalgias and reported approximately a 15-pound weight loss over three weeks with decrease in usual lower extremity edema. On admission, notable for a blood glucose of 1064, creatinine 2.2 from a baseline of 1.8, sodium 130, potassium 4.9. Endocrine service was consulted and the patient was controlled with a combination regimen of Lantus, Novolog q. a.c., combined with a Novolog sliding scale. The patient was discharged with followup with Napoleon Mettee, the diabetic teaching nurse and with Dr. Jonson in the diabetes clinic and with VNA services to assist with home medications. The patient had mild acute gout flare during admission for which he was started on colchicine. The patient was discharged with medications including Calcium carbonate 1250 mg t.i.d., Cartia XT 300 mg daily, CellCept 1500 mg b.i.d., colchicine 0.6 mg daily p.r.n., Neoral 150 mg b.i.d., folate 1 mg daily, K-dur 20 mg daily, magnesium oxide 400 mg b.i.d., methotrexate 2.5 mg daily, Pravastatin 20 mg daily, prednisone 7 mg daily, Rocaltrol 0.25 mg daily, Synthroid 150 mcg daily, Torsemide 40 mg daily, Vitamin C, Vitamin E, and cyclosporin 150 mg b.i.d., Vitamin C 500 mg b.i.d., Rocaltrol 0.25 mcg daily, calcium carbonate 500 mg t.i.d., colchicine 0.3 mg p.o. b.i.d., cyclosporin 150 mg b.i.d., folic acid 1 mg daily, Synthroid 150 mcg daily, magnesium oxide 420 mg b.i.d., prednisone 7.5 mg q.a.m., Vitamin E 400 units daily, Pravachol 20 mg at night, Cartia XT that is diltiazem extended release 300 mg daily, CellCept 1500 mg b.i.d., Lantus insulin (Glargine) 40 units subcutaneous q.a.m., Novolog 12 units before breakfast, Novolog 12 units before lunch, Novolog 14 units before dinner, and Novolog sliding scale q. a.c. The patient demonstrated proper understanding of blood glucose testing and insulin administration prior to discharge.
|
Is there history of use of pravastatin
|
{
"answer_end": [
1224
],
"answer_start": [
1200
],
"text": [
"Pravastatin 20 mg daily,"
]
}
|
Mr. Esbenshade is a 70-year-old Caucasian male with CAD, stented five years ago, known as calcific aortic stenosis with progression of exertional dyspnea. He was admitted to CSS and stabilized for surgery on 9/13/06, which included AVR with a 25 CE magna valve, CABG x2 with LIMA to LAD and SVG1 to PDA, pulmonary vein isolation, and left atrial appendage resection, with no complications. He is currently on 5 liters of O2 and some pulmonary edema, improving with Lasix 20 mg IV t.i.d. and diuresis, on Osmolite tube feeds at 20 mL an hour, with prophylactic antibiotics for chest tubes, medications IV, Toprol 50 mg q.a.m. and 25 mg q.p.m., Coumadin, Lasix 20 mg daily, atorvastatin 20 mg daily, Neurontin 100 mg t.i.d., metformin 1000 mg b.i.d., and glipizide 2.5 mg b.i.d. Cardiac meds include Aspirin, Lopressor, and Coumadin. He has been followed by psych for postoperative confusion/possible suicidal ideation, with Celexa ordered per psych. He is also on Acetaminophen 325-650 mg q. 4h. p.r.n. pain or temperature greater than 101, DuoNeb q. 6h. p.r.n. wheezing, enteric-coated aspirin 81 mg daily, Dulcolax 10 mg PR daily p.r.n. constipation, Celexa 10 mg daily, Colace 100 mg t.i.d., Nexium 20 mg daily, K-Dur 10 mEq daily for five days, Toprol-XL 200 mg b.i.d., miconazole nitrate powder topical b.i.d., Niferex 150 mg b.i.d., simvastatin 40 mg at bedtime, multivitamin therapeutic one tab daily, INR, and Boudreaux's Butt Paste topical apply to effected areas. He has been running a bit fast in Afib and is on Coumadin and aspirin for atrial fibrillation, and is awaiting a rehabilitation bed. Cipro x3 days has been started due to a UA from 10/5/06 with probable enterogram-negative rods. His mood has improved and beta-blocker has been titrated. He has been advised to make all follow-up appointments, local wound care, wash wounds daily with soap and water, shower patient daily, keep legs elevated while sitting/in bed, watch all wounds for signs of infection, redness, swelling, fever, pain, discharge, and to call PCP/cardiologist or Anle Health Cardiac Surgery Service at 282-008-4347 with any questions.
|
Has the patient had multiple o2 prescriptions
|
{
"answer_end": [
449
],
"answer_start": [
390
],
"text": [
"He is currently on 5 liters of O2 and some pulmonary edema,"
]
}
|
This 64-year-old patient had a past medical history of non-small cell lung cancer, status post XRT and chemotherapy, right MC embolic stroke, status post right carotid endarterectomy, Graves’ disease, depression, diabetes, hypertension, asthma, temporal lobe epilepsy, and history of subclavian steal syndrome. On admission, her blood pressure was 66/44, pulse of 100, respiratory rate normal, and blood sugar of 133. She was found to be difficult to arouse and had 1 gm of vancomycin, magnesium and Levaquin 500 mg. Her medication on admission included Mechanical soft diet, aspirin 81 mg, baclofen 5 mg t.i.d., B12 1000 mg daily, iron sulfate 325 mg daily, Cymbalta 20 mg p.o. b.i.d., Neurontin 100 mg b.i.d., Lamictal 200 mg b.i.d., Prilosec 20 daily, levothyroxine, Glucophage 500 once a day, Reglan 10 once a day, niacin 500 once a day, Senna 2 tabs b.i.d., Zocor 20 mg once a day, Nicoderm patch, Colace 100 mg p.o. b.i.d., Lopressor 100 mg p.o. b.i.d., lidoderm 5% patch to the low back, Tylenol, ducolox, Mylanta, lactulose, Seroquel 100 mg, prednisone 50 mg, and Dilaudid 1 mg. She completed a ten-day course of vancomycin for a MRSA urinary tract infection and was treated with tramadol and Tylenol for pain. Her laboratory data showed creatinine of 1, ALT 25, AST 35, hematocrit 33, white count 6.6, and platelets 241,000. She was covered with antibiotics initially, then transitioned over to a ciprofloxacin 700 mg p.o. b.i.d. regime for a total of 12 days for a presumed urinary tract infection. She had a significant polypharmacy and enumerable sedating medications, including baclofen, Dilaudid and trazodone. Her Cymbalta was continued per outpatient follow-up and her Lamictal, as well as her Cymbalta, were maintained for her history of depression. Neurologically, she had a left-sided hemiparesis, as well as agnosia on the left side, and her mental status included intermittent disorientation. She was maintained on Novolog sliding scale for diabetes, QTc monitored with serial EKGs, and prior use of Haldol and other antipsychotics for behavioral modification. She was also continued on a replacement dose levothyroxine for her history of Graves' and a history of radioiodine ablation. For behavioral modification, as well as intermittent agitation and disorientation, the patient was maintained on p.r.n. Seroquel 100 mg p.o. b.i.d., as well as Zydis 5 mg p.o. b.i.d. p.r.n., which was titrated from standing to p.r.n. over the course of her hospitalization in order to try to decrease any sedating medications that may be altering her alertness and orientation.
|
Is the patient currently or have they ever taken seroquel
|
{
"answer_end": [
1012
],
"answer_start": [
1004
],
"text": [
"ducolox,"
]
}
|
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.
|
Has this patient ever been treated with pepcid ( famotidine )
|
{
"answer_end": [
1108
],
"answer_start": [
1075
],
"text": [
"PEPCID (Famotidine) 20 mg PO BID,"
]
}
|
The patient is a 60 year-old woman with adult onset diabetes mellitus, hypertension, and elevated cholesterol admitted with chest pain, bradycardia, and decreased blood pressure. When her blood pressure is elevated, she takes Nifedipine and the pain became three to four out of ten, so she took Cardizem without relief and called EMS. The pain was relieved with the EMTs gave nitroglycerin times two and they found her to have blood pressure of 190/100, heart rate 76, and normal sinus rhythm. They gave two nitrospray, blood pressure decreased to 150/80, heart rate 76, and after two minutes in the vehicle, she had sinus bradycardia at 30-40, blood pressure 120/80. She was given 0.5 mg of Atropine times one without any affect and brought to the hospital with a systolic blood pressure of 100, then suddenly she had bradycardia with heart rate of 30-40 and systolic blood pressure of 75. She was given intravenous fluids and Atropine 0.5 mg times one which increased her blood pressure systolic to 100 and her heart rate increased to 60. On admission, she was given Nifedipine 10 mg p.r.n. for elevated blood pressure, Lasix 20 mg q. day, Glucotrol 15 mg q. day, Cardizem 300 mg q. day, Coumadin 3.75 mg q. day, Colace 100 mg b.i.d., and Iron 325 mg q. day. On discharge, she was given Aspirin 325 mg q. day, Atenolol 50 mg q. day, Lisinopril 10 mg q. day, Pravachol 20 mg q. day, Glucotrol XL 15 mg q. AM, Lasix 20 mg q. day, and Nitroglycerin tablets sublingual p.r.n. chest pain. She underwent exercise tolerance test on a standard Bruce protocol and angiography which showed left main OK, LAD proximal 20%, D2 60%, ostial 90% mid, left circumflex mid 30%, OM2 distal 60-70%, OM1 mild diffuse disease. She underwent PTCA of her diagonal two which went from 90% to 0% stenosis and she received Heparin overnight and the sheaths were pulled on the following day. She is to follow-up in the VERAREA UNIVERSITY HOSPITAL Clinic with Dr. Van Rothenberg.
|
What medications if any has the patient tried for chest pain. in the past
|
{
"answer_end": [
1485
],
"answer_start": [
1434
],
"text": [
"Nitroglycerin tablets sublingual p.r.n. chest pain."
]
}
|
The patient is a 58-year-old female with chronic renal insufficiency, diabetes mellitus, hypertension, and anemia who presented with two weeks of diffuse abdominal pain that acutely worsened one day prior to admission with associated nausea, nonbloody emesis, and chills. She was initially given a seven-day course of ciprofloxacin and oxycodone for pain, but stopped taking them after developing constipation. She currently presents with complaints of diarrhea and was given ampicillin 2 g IV, gentamicin 80 mg IV, Flagyl 500 mg IV and 8 units of insulin. She was put on levofloxacin, vancomycin, and Flagyl as her left foot had been encasted with evidence of underlying infection, and her blood cultures grew MRSA, which is presumed to need eight weeks of vancomycin. She was put on erythromycin with a change to Reglan on 8/6/06 per renal or liver disease and kept on Compazine for nausea. Later, it was determined that the patient was iron deficient and she was put on iron supplementation and darbepoetin initially and changed to erythropoietin later during dialysis. She was maintained on aspirin, a statin, and calcium channel blocker, and started on prophylactic beta-blocker during her hospital course. Her insulin regimen was titrated to good glycemic response, and she was kept on heparin and Nexium. Other medications included Tylenol 650 mg p.o. q.4. p.r.n. headache, Colace 100 mg p.o. b.i.d., Dilaudid 0.4-0.8 mg p.o. q.4. p.r.n. pain, Insulin NPH human 20 units subq b.i.d., Lopressor 50 mg p.o. q.i.d., Senna tablets two tabs p.o. b.i.d., Norvasc 10 mg p.o. daily, Nephrocaps one tab p.o. daily, Insulin Aspart sliding scale subq a.c., Lipitor 80 mg p.o. daily, Protonix 40 mg p.o. daily, Vancomycin 1 g IV three times a week, Reglan 5 mg p.o. q.a.c., Reglan 5 mg p.o. q.h.s., Compazine 5-10 mg p.o. q.6h. p.r.n. nausea, Ergocalciferol 50,000 units p.o. q. week for six weeks, Aspirin 81 mg p.o. daily, Heparin 5000 units subq t.i.d., and Lactulose 30 mL p.o. q.i.d. p.r.n. constipation.
|
Why did the patient have tylenol
|
{
"answer_end": [
1380
],
"answer_start": [
1339
],
"text": [
"Tylenol 650 mg p.o. q.4. p.r.n. headache,"
]
}
|
A 73-year-old male patient with a history of coronary artery disease, ischemic cardiomyopathy, and valvular heart disease was admitted to the Rose-le Medical Center with a large left foot toe ulcer that was nonhealing, and signs and symptoms of decompensated heart failure and acute on chronic renal failure. During his stay, he was treated with Enteric-coated aspirin 325 mg p.o. daily, Amiodarone 200 mg p.o. daily, Colace 100 mg p.o. b.i.d., insulin NPH 7 units q.a.m. and 3 units q.p.m. subcutaneously, Atrovent HFA inhaler 2 puffs inhaled q.i.d. p.r.n. for wheezing, magnesium gluconate sliding scale p.o. daily, oxycodone 5-10 mg p.o. q. 4h. p.r.n. pain, senna tablets one to two tablets p.o. b.i.d. p.r.n. constipation, spironolactone 25 mg p.o. daily, Coumadin 1 mg p.o. every other day, multivitamin therapeutic one tablet p.o. daily, Zocor 40 mg p.o. daily, torsemide 100 mg p.o. daily, OxyContin 10 mg p.o. b.i.d., Cozaar 25 mg p.o. daily, Remeron 7.5 mg p.o. q.h.s., and aspartate insulin sliding scale, as well as being maintained on subcutaneous heparin and Nexium as DVT and GI prophylaxis, Celexa 20 mg p.o. daily, Coumadin 2.5 mg p.o. daily, Diovan 80 mg p.o. daily, Lantus 25 units every day subcutaneous, Lasix 160 mg p.o. b.i.d., Lipitor 20 mg p.o. q.h.s., Lopressor 50 mg p.o. b.i.d., solsite topical, and 25 mg of hydrochlorothiazide b.i.d. 30 minutes prior to meals, in addition to ciprofloxacin, DuoDERM, BKA site healing with continued aspirin, and inhaled ipratropium. Hyponatremia due to heart failure was improved with diuresis, and the patient was maintained on Coumadin with an INR goal of 2-3, adjusted to 1 mg PO every other day. Diabetes mellitus, insulin-dependent, was covered on NPH QAM and QPM with aspartate sliding scale for duration of hospitalization. The patient was restarted on Celexa per PCP for likely depressive mood response to recent bilateral knee amputation, and later started on Remeron 7.5 mg PO daily in place of Celexa. He was initially treated for urinary tract infection with uncomplicated course with ciprofloxacin, and Wound care nurse consulted for BKA wound and small decubitus on his back, was treated with DuoDERM, BKA site healing well. The patient was maintained on subcutaneous heparin and Nexium as DVT and GI prophylaxis during this hospitalization. He was discharged on Enteric-coated aspirin 325 mg p.o. daily, Amiodarone 200 mg p.o. daily, Atrovent one to two puffs inhaled q.i.d. p.r.n. for wheezing, Celexa 20 mg p.o. daily, Coumadin 2.5 mg p.o. daily, Diovan 80 mg p.o. daily, enteric-coated aspirin 325 mg p.o. daily, Lantus 25 units every day subcutaneous, Lasix 160 mg p.o. b.i.d., Lipitor 20 mg p.o. q.h.s., Lopressor 50 mg p.o. b.i.d., therapeutic multivitamin one tablet p.o. daily, solsite topical, and instructed to follow up with psychiatry to assess depressive disorder/adjustment disorder, start beta-blocker at a low-dose in the outpatient setting, and check creatinine and BUN along with electrolytes to make sure patient is doing well on current maintenance diuretic schedule of 100 mg torsemide PO daily and spironolactone. Code status was full code.
|
Has this patient ever been treated with enteric-coated aspirin
|
{
"answer_end": [
417
],
"answer_start": [
346
],
"text": [
"Enteric-coated aspirin 325 mg p.o. daily, Amiodarone 200 mg p.o. daily,"
]
}
|
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.
|
What was the dosage prescribed of amlodipine
|
{
"answer_end": [
1966
],
"answer_start": [
1909
],
"text": [
"AMLODIPINE 10 MG PO QD Food/Drug Interaction Instruction,"
]
}
|
Mr. Neilsen is a 59-year-old morbidly obese man with a history of morbid obesity, paroxysmal atrial fibrillation, ejection fraction of 40 percent, obstructive sleep apnea on continuous positive airway pressure, history of cellulitis, and presenting with progressive lower extremity weakness bilaterally and urinary incontinence. On admission, EMG showed decreased recruitment in the tibialis anterior and gastrocnemius bilaterally, and he was treated with seven days of Bactrim for resolution of his incontinence and he was not anticoagulated at the moment though Coumadin should be a consideration given his risk of stroke. Two weeks prior to admission he noted some lumbar and sacral pain, nonradiating, worse while moving his right leg, and increasing urinary frequency without burning or urinary incontinence. On the night of admission, while getting up from a chair, his right leg gave out and he fell to the floor without injury or head trauma. His laboratory data on admission showed sodium 140, potassium 4.5, chloride 102, bicarbonate 26, BUN 20, creatinine 0.9, glucose 101, white blood cell count of 9 with 76 polys, 4 bands, hematocrit 37.6 and platelet count of 236, and urinalysis showed 3+ blood and positive leukocyte esterase with 15-20 white blood cells, one plus bacteria and one plus squamous cells. He was started on a trial of Lasix p.o. q day to decrease his peripheral edema to help him with rehabilitation, and he was instructed to apply Nystatin powder for his pannus rash. His medications on discharge included Aspirin 325 mg p.o. q day, Colace 100 mg p.o. b.i.d., Lasix 40 mg p.o. q a.m., Indomethacin 25 mg p.o. t.i.d. p.r.n. pain, Lisinopril 15 mg p.o. q day, multivitamin one tablet p.o. q day, Bactrim DS one tablet p.o. t.i.d., Tamsulosin 0.4 mg p.o. q day, and Miconazole 2% topical powder b.i.d., and he was discharged to rehabilitation care for leg strengthening in a stable condition.
|
What treatments if any has the patient tried for his urinary tract infection in the past
|
{
"answer_end": [
512
],
"answer_start": [
436
],
"text": [
"he was treated with seven days of Bactrim for resolution of his incontinence"
]
}
|
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.
|
Has this patient ever been prescribed atenolol
|
{
"answer_end": [
310
],
"answer_start": [
288
],
"text": [
"ATENOLOL 25 MG PO BID,"
]
}
|
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.
|
How often does the patient take caltrate plus vitamin d
|
{
"answer_end": [
961
],
"answer_start": [
915
],
"text": [
"was prescribed Caltrate plus Vitamin D 600 mg,"
]
}
|
This 54-year-old male with ischemic cardiomyopathy, severe pulmonary hypertension, and chronic kidney disease (Cr 2.5) was admitted to MSCH 3 weeks ago for CHF and diuresis and volume resuscitated with creatinine decreasing to 3.9. He was discharged on 8/27/06 at 2:00 PM with a full code status and disposition to home with medications Aspirin Enteric Coated 81 MG PO DAILY, LIPITOR (ATORVASTATIN) 10 MG PO DAILY, COLESTIPOL HYDROCHLORIDE 10 GM PO DAILY, INSULIN GLARGINE 14 UNITS SC DAILY, HUMALOG INSULIN (INSULIN LISPRO) Sliding Scale (subcutaneous) SC AC, IMDUR ER (ISOSORBIDE MONONITRATE (SR)) 60 MG PO DAILY, KLOR-CON (KCL SLOW RELEASE) 20 MEQ PO DAILY (each 20 mEq dose to be given with 4 oz of fluid), TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 50 MG PO BEDTIME, TORSEMIDE 150 MG PO DAILY, metolazone on an as-needed basis for weight, but presented to ED with Cr 5.1, ZEMPLAR 1MG DAILY, Klorcon slow release 20 mEq daily, Flomax 0.4 qd, colestipol 1g qd, toprol-XL 50 qhs, lantus 14 unit sc, humalog scale, and metolazone 5mg as needed with the instructions to take Torsemide and Klor-Con as per his normal routine and to take Flomax, Colestipol, and Toprol-XL consistently with meals or on an empty stomach, and to continue his home medications otherwise. The patient was also advised to return Monday for his second dialysis run and not take Torsemide on Monday with a Number of Doses Required (approximate): 5.
|
What is the current dose of the patient's flomax ( tamsulosin )
|
{
"answer_end": [
970
],
"answer_start": [
938
],
"text": [
"Flomax 0.4 qd, colestipol 1g qd,"
]
}
|
A 57-year-old female with macromastia and abdominal skin laxity s/p massive weight loss 2/2 gastric bypass was admitted to plastic surgery on 5/8/07. On admission, the patient was prescribed 1. ACETAMINOPHEN 1000 MG PO Q6H, 2. LEVOTHYROXINE SODIUM 75 MCG PO QD, 3. QUINAPRIL 20 MG PO QAM, 4. RANITIDINE HCL 150 MG PO QD, 5. MULTIVITAMINS 1 CAPSULE PO QD, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, VITAMIN C ( ASCORBIC ACID ) 500 MG PO BID, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, 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 Q3H PRN Pain (ref #901341233), on order for DILAUDID PO 2-4 MG Q3H (ref #901341233), INSULIN REGULAR HUMAN, supplemental (sliding scale) insulin, If receiving standing regular insulin, please give at same, SYNTHROID ( LEVOTHYROXINE SODIUM ) 75 MCG PO DAILY, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ), REGLAN ( METOCLOPRAMIDE HCL ) 10 MG IV Q6H PRN Nausea, ZOFRAN ( POST-OP N/V ) ( ONDANSETRON HCL ( POST-... ), on order for KCL IV (ref #964491549), POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM CHLORIDE, POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM, SIMETHICONE 80 MG PO QID PRN Upset Stomach, MULTIVITAMIN THERAPEUTIC ( THERAPEUTIC MULTIVI... ) 1 TAB PO DAILY, TIGAN ( TRIMETHOBENZAMIDE HCL ) 200 MG PR Q6H PRN Nausea, ibuprfen. Do not drink/drive/operate machinery with pain medications., Take a stool softener to prevent constipation., 4. Continue your antibiotics as long as you have a drain in place., Sliding Scale (subcutaneously) SC AC+HS Medium Scale, If BS is 125-150, then give 0 units subcutaneously, 30 MILLILITERS PO DAILY PRN Constipation, 1 MG IV Q6H X 2 doses PRN Nausea, Number of Doses Required (approximate): 10, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain. The patient tolerated all procedures without difficulty and post-op period was uneventful, and at discharge, the patient was afebrile with stable vitals, taking po's/voiding q shift, ambulating independently and pain was well-managed with Tigan (Trimethobenzamide HCl) 200 mg PR Q6H PRN Nausea, Tigan (Trimethobenzamide HCl) 300 mg PO Q6H PRN Nausea, Simethicone 80 mg PO QID PRN Upset Stomach, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, 1 mg IV Q6H x 2 doses PRN Nausea, 30 Milliliters PO Daily PRN Constipation and TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, DULCOLAX (Bisacody
|
dilaudid ( hydromorphone hcl )
|
{
"answer_end": [
2120
],
"answer_start": [
2066
],
"text": [
"DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain."
]
}
|
This 64-year-old patient had a past medical history of non-small cell lung cancer, status post XRT and chemotherapy, right MC embolic stroke, status post right carotid endarterectomy, Graves’ disease, depression, diabetes, hypertension, asthma, temporal lobe epilepsy, and history of subclavian steal syndrome. On admission, her blood pressure was 66/44, pulse of 100, respiratory rate normal, and blood sugar of 133. She was found to be difficult to arouse and had 1 gm of vancomycin, magnesium and Levaquin 500 mg. Her medication on admission included Mechanical soft diet, aspirin 81 mg, baclofen 5 mg t.i.d., B12 1000 mg daily, iron sulfate 325 mg daily, Cymbalta 20 mg p.o. b.i.d., Neurontin 100 mg b.i.d., Lamictal 200 mg b.i.d., Prilosec 20 daily, levothyroxine, Glucophage 500 once a day, Reglan 10 once a day, niacin 500 once a day, Senna 2 tabs b.i.d., Zocor 20 mg once a day, Nicoderm patch, Colace 100 mg p.o. b.i.d., Lopressor 100 mg p.o. b.i.d., lidoderm 5% patch to the low back, Tylenol, ducolox, Mylanta, lactulose, Seroquel 100 mg, prednisone 50 mg, and Dilaudid 1 mg. She completed a ten-day course of vancomycin for a MRSA urinary tract infection and was treated with tramadol and Tylenol for pain. Her laboratory data showed creatinine of 1, ALT 25, AST 35, hematocrit 33, white count 6.6, and platelets 241,000. She was covered with antibiotics initially, then transitioned over to a ciprofloxacin 700 mg p.o. b.i.d. regime for a total of 12 days for a presumed urinary tract infection. She had a significant polypharmacy and enumerable sedating medications, including baclofen, Dilaudid and trazodone. Her Cymbalta was continued per outpatient follow-up and her Lamictal, as well as her Cymbalta, were maintained for her history of depression. Neurologically, she had a left-sided hemiparesis, as well as agnosia on the left side, and her mental status included intermittent disorientation. She was maintained on Novolog sliding scale for diabetes, QTc monitored with serial EKGs, and prior use of Haldol and other antipsychotics for behavioral modification. She was also continued on a replacement dose levothyroxine for her history of Graves' and a history of radioiodine ablation. For behavioral modification, as well as intermittent agitation and disorientation, the patient was maintained on p.r.n. Seroquel 100 mg p.o. b.i.d., as well as Zydis 5 mg p.o. b.i.d. p.r.n., which was titrated from standing to p.r.n. over the course of her hospitalization in order to try to decrease any sedating medications that may be altering her alertness and orientation.
|
Has the patient had previous colace
|
{
"answer_end": [
929
],
"answer_start": [
903
],
"text": [
"Colace 100 mg p.o. b.i.d.,"
]
}
|
This 39-year-old female with a history of discoid lupus and pericarditis presented with severe substernal chest pain after having prednisone and Plaquenil discontinued. She first developed arthralgias of various joints, which were treated with aspirin, Motrin and steroids. In 1985, she developed pleuritic substernal chest pain and was diagnosed at Westten Hospital with pericarditis. In 1988, she was seen at the Arthritis Clinic by Dr. Goerlitz and was treated with Plaquenil 200 bid, plus aspirin and Naprosyn. In 22 of May, she was diagnosed with a lupus flare and was put on prednisone 30 q am and in 23 of March, the steroids were tapered off and discontinued. However, she presented with increasing joint pain and had her prednisone restarted with Plaquenil 200 bid, Motrin 80 tid, prednisone 10 q am, Dilantin 200 bid, and prednisone 30 q day. Laboratory examination showed electrolytes within normal limits, CK of 76, white count of 4.7, hematocrit of 30, platelets of 352,000, mean corpuscular volume of 83, ESR of 88, oxygen saturation of 99% on room air, and urinalysis showed specific gravity of 1.026, 2+ protein, 10 to 15 white cells, 8 to 10 red blood cells and a few granular casts. Chest x-ray showed increased heart size, multiple thoracic compression fractures and osteopenia, and electrocardiogram showed sinus rhythm with frequent premature ventricular contractions at a rate of approximately 70. She was ruled out for a myocardial infarction, had an echocardiogram which showed a small amount of pericardial fluid, and was placed back on her Plaquenil 200 bid and prednisone 30 q day. The hematocrit remained stable between 27 and 30 without transfusions or further intervention, and she was discharged on medications including Plaquenil 200 bid, prednisone 20 q day, Dilantin 400 q day, L-thyroxine 0.2 q am, Motrin 800 tid, Carafate, iron and folate for follow-up in Rheumatology Clinic with Dr. Grondin.
|
Is there a mention of of carafate usage/prescription in the record
|
{
"answer_end": [
1859
],
"answer_start": [
1792
],
"text": [
"Dilantin 400 q day, L-thyroxine 0.2 q am, Motrin 800 tid, Carafate,"
]
}
|
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.
|
Has the patient had previous nexium
|
{
"answer_end": [
968
],
"answer_start": [
923
],
"text": [
"The patient was also prescribed K-Dur 20 BID,"
]
}
|
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
|
atenolol
|
{
"answer_end": [
395
],
"answer_start": [
369
],
"text": [
"ATENOLOL 37.5 MG PO DAILY,"
]
}
|
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.
|
What are the different medications that have been used on this patient for wheezing.
|
{
"answer_end": [
2027
],
"answer_start": [
1968
],
"text": [
"Albuterol inhaler two puffs inhaled q.i.d. p.r.n. wheezing,"
]
}
|
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.
|
Has this patient ever been on roxicet
|
{
"answer_end": [
476
],
"answer_start": [
404
],
"text": [
"ROXICET ELIXIR (OXYCODONE+APAP LIQUID) 5-10 MILLILITERS PO Q4H PRN Pain,"
]
}
|
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.
|
What is the current dose of the patient's nitroglycerin
|
{
"answer_end": [
364
],
"answer_start": [
299
],
"text": [
"he had escalating chest pain requiring one nitroglycerin per day."
]
}
|
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 been on acei
|
{
"answer_end": [
1817
],
"answer_start": [
1754
],
"text": [
"to 60 bid. Cont Dig/nitrate/BB, ACEi. Checked echo, no change.,"
]
}
|
Dewey Wittie, a 54 year old Hispanic female with morbid obesity, hypertension, non-insulin dependent diabetes mellitus, and sleep apnea on CPAP, was admitted to the MED service on 8/14/2006 for atypical chest pain. An ETT was performed in the ED with an EF of 55%, not in failure, and htn was controlled with BB and ACEI. She presented with one week history of intermittent left arm pain while washing dishes, lasting 15 minutes, sometimes radiating to her left chest, positional, not associated with shortness of breath, nausea, or vomiting. She responded to sublingual nitroglycerin (within 5-10 minutes) and her first set of cardiac enzymes is negative. She received aspirin and heparin gtt was started. Her home medications included Atenolol 50AM/25PM, Avadia 8, Fluoxetine 20, Metformin 1gm BID, Glyburide 10BID, Lisinopril 20, CaCO3 1200QD, and Amitriptyline 50QHS. She completed a ROMI and exercise tolerance test, which she walked for 2 minutes and 33 seconds at 75% maximum predicted heart rate, and stopped due to fatigue with no EKG changes. She was discharged stable with instructions to follow up with an A1C and lipid profile, and to pursue weight reduction. She was advised to resume regular exercise and make a follow up appointment with their primary care provider. The discharge medications included AMITRIPTYLINE HCL 50 MG PO BEDTIME, ENTERIC COATED ASPIRIN (ASPIRIN ENTERIC COATED) 81 MG PO DAILY, ATENOLOL 50 MG QAM; 25 MG QPM PO 50 MG QAM 25 MG QPM, CALTRATE 600 + D (CALCIUM CARBONATE 1,500 MG (...) 2 TAB PO DAILY, FLUOXETINE HCL 20 MG PO DAILY, LISINOPRIL 20 MG PO DAILY HOLD IF: o, METFORMIN 1,000 MG PO BID, AVADIA 8 UNIT DAILY, and GLYBURIDE 10 MG PO BID. The patient was warned about a potentially serious interaction between lisinopril and potassium chloride. The patient's diet was house/low chol/low sat. fat and ADA 1800 cals/dy, with 4 gram sodium.
|
Why does the patient take bb
|
{
"answer_end": [
321
],
"answer_start": [
215
],
"text": [
"An ETT was performed in the ED with an EF of 55%, not in failure, and htn was controlled with BB and ACEI."
]
}
|
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 patient ever tried glipizide
|
{
"answer_end": [
924
],
"answer_start": [
898
],
"text": [
"GLIPIZIDE 2.5 MG PO DAILY,"
]
}
|
This 54-year-old male with ischemic cardiomyopathy, severe pulmonary hypertension, and chronic kidney disease (Cr 2.5) was admitted to MSCH 3 weeks ago for CHF and diuresis and volume resuscitated with creatinine decreasing to 3.9. He was discharged on 8/27/06 at 2:00 PM with a full code status and disposition to home with medications Aspirin Enteric Coated 81 MG PO DAILY, LIPITOR (ATORVASTATIN) 10 MG PO DAILY, COLESTIPOL HYDROCHLORIDE 10 GM PO DAILY, INSULIN GLARGINE 14 UNITS SC DAILY, HUMALOG INSULIN (INSULIN LISPRO) Sliding Scale (subcutaneous) SC AC, IMDUR ER (ISOSORBIDE MONONITRATE (SR)) 60 MG PO DAILY, KLOR-CON (KCL SLOW RELEASE) 20 MEQ PO DAILY (each 20 mEq dose to be given with 4 oz of fluid), TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 50 MG PO BEDTIME, TORSEMIDE 150 MG PO DAILY, metolazone on an as-needed basis for weight, but presented to ED with Cr 5.1, ZEMPLAR 1MG DAILY, Klorcon slow release 20 mEq daily, Flomax 0.4 qd, colestipol 1g qd, toprol-XL 50 qhs, lantus 14 unit sc, humalog scale, and metolazone 5mg as needed with the instructions to take Torsemide and Klor-Con as per his normal routine and to take Flomax, Colestipol, and Toprol-XL consistently with meals or on an empty stomach, and to continue his home medications otherwise. The patient was also advised to return Monday for his second dialysis run and not take Torsemide on Monday with a Number of Doses Required (approximate): 5.
|
insulin glargine
|
{
"answer_end": [
491
],
"answer_start": [
456
],
"text": [
"INSULIN GLARGINE 14 UNITS SC DAILY,"
]
}
|
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.
|
Previous renagel
|
{
"answer_end": [
808
],
"answer_start": [
715
],
"text": [
"PhosLo 2001 mg t.i.d., Protonix 40 mg daily, Renagel 3200 mg t.i.d., Requip 2 mg p.o. b.i.d.,"
]
}
|
Mr. Barriger is a 73-year-old gentleman who was admitted to the Cardiac Step-Down Floor after being a restrained driver in a motor vehicle collision. His past medical history includes myocardial infarction, hypertension, hypercholesterolemia, diabetes, renal cyst, and cataract, and a past surgical history of coronary stenting and cataract removal. He was prescribed Glyburide 100 mg p.o. b.i.d., Metformin 500 mg p.o. b.i.d., Aspirin 81 mg p.o. q. day., Zocor 80 mg p.o. q. day., Plavix 75 mg p.o. q. day., Prilosec 20 mg p.o. q. day., Isosorbide dinitrate 40 mg p.o. t.i.d., Atenolol 100 mg p.o. q. day., Tylenol 650 mg p.o. q.4h. p.r.n. pain., Colace 100 mg p.o. b.i.d., Ativan 1-2 mg IV p.r.n. anxiety., Oxycodone 5-10 mg p.o. q.6h. p.r.n. pain., Senna tablets 2 p.o. b.i.d., Keflex 250 mg p.o. q.i.d. x12 doses. Keflex should be completed on Monday night., Ambien 5 mg p.o. q.h.s., Tessalon 100 mg p.o. t.i.d. p.r.n. cough., Novalog slides., Maalox 1-2 tabs p.o. q.6h. p.r.n. pain. and Dilaudid 1-2 mg IV q.4h. p.r.n. pain. for pain control. He was also put on Lovenox 40 mg sub-Q. q. day for DVT prophylaxis and aspirin and Plavix for secondary cardiac and neurological prophylaxis. He was also started on Ancef 1 gm q.8h. with a PICC line which was placed later on the day. His pain was well controlled with the combination of Dilaudid and oxycodone and he was encouraged to take several deep breaths per hour to reduce the risk of atelectasis or pneumonia. He was seen by numerous consultants, and his white count improved dramatically and he was afebrile for more than 48 hours while on the Ancef. He was discharged to rehab with appointments with the mentioned doctors.
|
Is there a mention of of lovenox usage/prescription in the record
|
{
"answer_end": [
1087
],
"answer_start": [
1048
],
"text": [
"He was also put on Lovenox 40 mg sub-Q."
]
}
|
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.
|
has the patient used beta-blocker in the past
|
{
"answer_end": [
370
],
"answer_start": [
329
],
"text": [
"Initially rate-controlled on beta-blocker"
]
}
|
This 63-year-old female patient presented with a history of a failed right hip hemiarthroplasty from 1992 and was admitted for a conversion to a total hip replacement. She tolerated the procedure well and was transferred to the Orthopaedic Floor postoperatively for pain control and physical therapy. She progressed rapidly over the next several days and was ambulating with assistance and partial weightbearing with physical therapy. Her wound was clean, dry, and intact with minimal drainage. She was afebrile throughout her hospital course and required one unit of blood during her hospital course to maintain her blood count greater than 30. Her discharge medications were Percocet 1-2 tabs p.o. q. 4-6 p.r.n. and she was also discharged on Coumadin 3.5 mg p.o. q. day and should maintain Coumadin therapy for six weeks time. The patient should have a prothrombin time checked biweekly to maintain an INR between 14 and 17. She was seen back in the office in six weeks time for x-rays and follow-up.
|
What is the current dose of percocet
|
{
"answer_end": [
713
],
"answer_start": [
646
],
"text": [
"Her discharge medications were Percocet 1-2 tabs p.o. q. 4-6 p.r.n."
]
}
|
This is a 67-year-old male with a history of tremor, hypertension, diabetes, atrial fibrillation, coronary artery disease, benign prostatic hypertrophy, gastroesophageal reflux disease, hiatal hernia, degenerative joint disease, polymyalgia rheumatica, diverticulitis, and osteomyelitis. He was admitted to the hospital with r/o MI and discharged with a diet of House/Low chol/low sat. fat, and instructed to follow up with his primary care doctor one week after d/c from rehab. His medications on admission included Lasix 20 qod, Isordil 40 bid, Prednisone 2 qd, Primidone 50 bid, Norvasc 5 qd, Coreg 25 bid, Flomax 0.4 qd, Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd, Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid, and Medications in ED: NS 500 cc, Aspirin. He was anticoagulated with Lovenox and given aspirin. He had a PICC line placed and was discharged with IV abx. At the tail end of his antibiotic regimen he spiked a fever and was admitted to VOWH. His course of antibiotics was extended and he was discharged to rehab on CEFTRIAXONE 2,000 MG IV QD and Vanc. In the ED, his temperature was normal, EKG demonstrated new ST depressions, and his first set of enzymes were negative. For Neuro, he has a history of tremor and is treated with Primidone and for ID, he was continued on his outpatient regimen of Lantus, standing insulin qAC and insulin SS. For GU, he was continued on Flomax for his BPH. He was discharged to rehab on his admission regimen with no dictated summary and advised to follow up with his PCP within 2 weeks.
|
What is the current dose of the patient's colace
|
{
"answer_end": [
784
],
"answer_start": [
709
],
"text": [
"Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid,"
]
}
|
The patient is a 36-year-old G16, P0-0-15-0, who presented at 6 and 4/7 weeks by LMP consistent with ultrasound of the day of admission, as a transfer from the High-Risk Obstetric Clinic, admitted to the Fuller Antepartum Service for diabetic control. She had a history of pre-gestational diabetes, coronary artery disease, recurrent SABs and Hepatitis B, a fibroid uterus, recurrent miscarriages, cervical dysplasia, a molar pregnancy with subsequent choriocarcinoma, and a history of ST elevation myocardial infarction in 2000, which was treated with TPA and angioplasty, and an ejection fraction of 45% in 2002. On the day of admission, the patient was on a Humalog 7 units b.i.d. and Lantus 12 units in the evening, with her fasting sugars in the 150s before admission. She had previously been on Epivir 150 mg p.o. daily, but this had been stopped prior to pregnancy. During the entire hospital stay, the patient was on a Humalog 7 units b.i.d. and Lantus 12 units in the evening, with her fasting sugars in the 150s before admission and her Lantus was increased to 20 units at nighttime, and she was using 8 units three times a day of insulin lispro, in addition to a lispro sliding scale, in order to determine the additional insulin needs as an outpatient. The patient was also prescribed Vitamin B12 100 mcg p.o. daily, Folate 4 mg p.o. daily, and high-dose folic acid, B12 and B6. Aspirin 81 mg p.o. daily was restarted, and the patient was advised to not take any lamivudine until Gastroenterology followup. Oxycodone as required for pain was also prescribed. Cardiology was consulted and the impression was that the thrombosis was likely a combination of her left ventricular hypokinesia related to the previous infarct, as well as her hypercoagulable state. Therefore, their recommendation was to start the patient on Lovenox for the duration of this pregnancy, which adjusted for her weight was a dose of 90 mg daily, followed by a transition to Coumadin postpartum, to be continued for likely long-term, possibly lifelong duration. The patient had her first trimester labs sent on this admission and was started on prenatal vitamins, as well as high-dose folic acid, B12 and B6. Given the patient's history of hepatitis B, an outpatient appointment was being arranged at the time of discharge, with Dr. Lavy, from the Division of Gastroenterology at the Sasspan Hospital. It was decided that the patient should not take any lamivudine until Gastroenterology followup. She also had an 8-cm fibroid on her ultrasound scan and required rare intermittent doses of oxycodone for fibroid pain. The patient was discharged in a stable condition, with followup appointments arranged for the various specialties, on medications of Aspirin 81 mg p.o. daily, Lovenox subcutaneously 90 mg daily, Vitamin B12 100 mcg p.o. daily, Folate 4 mg p.o. daily, Prenatal vitamins one tablet p.o. daily, Lantus 20 units subcutaneously q.p.m. and Insulin lispro 8 units subcutaneously AC, as well as lispro sliding scale, in addition a AC.
|
Was the patient ever prescribed b12
|
{
"answer_end": [
1390
],
"answer_start": [
1367
],
"text": [
"folic acid, B12 and B6."
]
}
|
This is a 62 year old rug salesman who was first diagnosed with exertional chest pain and hospitalized for a strongly positive stress test in 1981. Recently he noticed increasing angina with chest aching, throat aching, and dryness of the throat. On January, 1991 he had an exercise treadmill test which was stopped due to 1 mm ST depression in Leads II, III, F and V4 to V6. He experienced chest discomfort and noticed more frequent anginal pain with throat, chest, and chest pressure in both arms while playing golf. On the day of admission he noticed some pain at work while moving around the office. Medications on admission were LoPressor 50 mg p.o. b.i.d., Isordil 20 mg p.o. t.i.d., Verapamil 80 mg p.o. t.i.d., Xanax 0.25 mg p.o. b.i.d. p.r.n., one aspirin q.d. and p.r.n. nitroglycerin. A percutaneous transluminal coronary angioplasty was performed in which a proximal circumflex was dilated from 95% to 20%, with the only other lesion being a right coronary artery of 30%. He was discharged home in excellent condition on LoPressor 50 mg p.o. b.i.d., Isordil 20 mg p.o. t.i.d., Verapamil 80 mg p.o. t.i.d., one aspirin q.d. and Pepcid 20 mg p.o. b.i.d.
|
has the patient had aspirin
|
{
"answer_end": [
795
],
"answer_start": [
753
],
"text": [
"one aspirin q.d. and p.r.n. nitroglycerin."
]
}
|
A 42-year-old male was admitted on 4/30 with congestive heart failure exacerbation, hyperhomocysteinemia, chronic renal failure, obesity, hypercholesterolemia, h/o DVT, asthma, OSA, and a worsening of his dyspnea of exertion (DOE) to 3 miles of flat ground with a suspicion of multifocal pneumonia (PNA). He had a D-dimer of 1400, BNP of 2009, and Troponin of 0.84-0.54, which was not considered ischemic, and was not treated. On this admission, his D-dimer was 1207, BNP was 2917, and Troponin was not sent. He had a JVP to earlobe, bibasilar rales, no wheezes, and diffuse pitting edema to his bilateral shins. He had a chest X-ray (CXR) showing increased bilat LL opacities to the periphery with some cephalization of vessels and some opacification. An electrocardiogram (ECG) showed 98 bpm with left anterior fascicular block (LAE) and strain. A chest CT scan from 8/18 (comparing to 4/30) showed per pulm c/w scarring/persistent changes after recent multifocal PNA 4/30, no e/o of new primary lung path, and ground glass c/w pulmonary edema. An echocardiogram showed an ejection fraction (EF) of 25%, moderate right ventricular (RV) dysfunction, and severe tricuspid regurgitation (TR). A follow-up cardiac MRI from 10/16 showed an EF of 23%, global hypokinesis, no wall motion abnormality (WMA), normal RV, and no valve disease. In the ED, he received Duonebs, ASA 325, and Lasix 80mg. His shortness of breath was secondary to CHF exacerbation and fluid overload with no evidence of an infectious pulmonary process contributing to his symptoms. His hypertension was most likely due to taking the wrong dose of Coreg (taking QOD instead of BID). On a BID Coreg regimen, his BP was much better controlled. His renal function remained stable but impaired while he was being evaluated for dialysis as an outpatient but no vascular access was placed yet. He was discharged on 6/7/05 with a full code status and disposition to home with food/drug interaction instruction to take consistently with meals or on empty stomach and activity to walk as tolerated with follow up appointments with Dr. Sackrider at ACH 5/6/05 at 1:30 PM scheduled, Dr. Dauphin at CMC 0/4/05 at 1:40 PM scheduled. He was discharged with ACETYLSALICYLIC ACID 81 MG PO QD, on order for COUMADIN PO (ref #55946845) to address a POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, PHOSLO (CALCIUM ACETATE) 667 MG PO TID, FOLATE (FOLIC ACID) 1 MG PO QD, DIOVAN (VALSARTAN) 160 MG PO QD prescribed by his cardiologist, CARVEDILOL 6.25 MG PO BID HOLD IF: HR < 60, or SBP < 100, NEPHROCAPS (NEPHRO-VIT RX) 1 TAB PO QD, with an alert overridden: Override added on 4/7/05 by ALAMIN, NORMAN B., M.D. POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: MD Aware, LIPITOR (ATORVASTATIN) 20 MG PO QD with an alert overridden: Override added on 6/7/05 by: POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & ATORVASTATIN CALCIUM Reason for override: home med, and LASIX (FUROSEMIDE) 80 MG PO BID, with a d/c JVP 10cm. He had not been taking his Lasix for 2d prior to d/c. Pt was instructed to diurese further at home on Lasix 80 BID and continue on Coumadin for his h/o recent DVT (4/30) and INR 2-3.
|
has the patient had coreg
|
{
"answer_end": [
1674
],
"answer_start": [
1608
],
"text": [
"dose of Coreg (taking QOD instead of BID). On a BID Coreg regimen,"
]
}
|
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.
|
Is there a mention of of lasix drip usage/prescription in the record
|
{
"answer_end": [
341
],
"answer_start": [
248
],
"text": [
"She had been diuresed with a Lasix drip at 10 mg per hour and Zaroxolyn at 2.5 mg p.o. 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 is the patient's current dose does the patient take of her warfarin sodium
|
{
"answer_end": [
515
],
"answer_start": [
487
],
"text": [
"WARFARIN SODIUM 3 MG PO QPM,"
]
}
|
This is a 67-year-old male with a history of tremor, hypertension, diabetes, atrial fibrillation, coronary artery disease, benign prostatic hypertrophy, gastroesophageal reflux disease, hiatal hernia, degenerative joint disease, polymyalgia rheumatica, diverticulitis, and osteomyelitis. He was admitted to the hospital with r/o MI and discharged with a diet of House/Low chol/low sat. fat, and instructed to follow up with his primary care doctor one week after d/c from rehab. His medications on admission included Lasix 20 qod, Isordil 40 bid, Prednisone 2 qd, Primidone 50 bid, Norvasc 5 qd, Coreg 25 bid, Flomax 0.4 qd, Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd, Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid, and Medications in ED: NS 500 cc, Aspirin. He was anticoagulated with Lovenox and given aspirin. He had a PICC line placed and was discharged with IV abx. At the tail end of his antibiotic regimen he spiked a fever and was admitted to VOWH. His course of antibiotics was extended and he was discharged to rehab on CEFTRIAXONE 2,000 MG IV QD and Vanc. In the ED, his temperature was normal, EKG demonstrated new ST depressions, and his first set of enzymes were negative. For Neuro, he has a history of tremor and is treated with Primidone and for ID, he was continued on his outpatient regimen of Lantus, standing insulin qAC and insulin SS. For GU, he was continued on Flomax for his BPH. He was discharged to rehab on his admission regimen with no dictated summary and advised to follow up with his PCP within 2 weeks.
|
Has patient ever been prescribed norvasc
|
{
"answer_end": [
644
],
"answer_start": [
564
],
"text": [
"Primidone 50 bid, Norvasc 5 qd, Coreg 25 bid, Flomax 0.4 qd, Prilosec OTC 20 qd,"
]
}
|
The 68-year-old female patient presented with lower extremity swelling and erythema at the lower pole of her sternal wound, and her past medical history includes hypertension, diabetes, hypothyroidism, hypercholesterolemia, COPD, GERD, depression, history of GI bleed on Coumadin therapy, and pulmonary hypertension. On admission, the patient was started on 1. Toprol 25 p.o. daily., 2. Valsartan 40 mg p.o. daily., 3. Aspirin 81 mg p.o. daily., 4. Plavix 75 mg p.o. daily., 6. Lasix 40 mg p.o. b.i.d., 7. Spironolactone 25 mg p.o. daily., 8. Simvastatin 20 mg p.o. daily., 9. Nortriptyline 50 mg p.o. daily., 10. Fluoxetine 20 mg p.o. daily., 11. Synthroid 88 mcg p.o. daily., and a Lasix drip and Diuril with antibiotics for coverage of possible lower extremity cellulitis. After transthoracic echocardiogram revealed an ejection fraction of 40% to 45% and a stable mitral valve, the patient was started on a Lasix drip and Diuril with improvement of symptoms, and the Pulmonary team was consulted and recommended regimen of Advair and steroid taper for her COPD, and she was empirically covered for pneumonia with levofloxacin and Flagyl and continued to diurese well on a Lasix drip. Her preadmission cardiac meds, as well as her Coumadin for atrial fibrillation, were restarted, and the patient required ongoing aggressive diuresis to eventually achieve a fluid balance of is negative 1 liter daily. Liver function tests, as well as amylase and lipase, were checked and noted to be normal, and the patient's nausea and vomiting resolved when her bowels began to move. The patient was discharged to home in good condition on hospital day #8 with medications including Enteric-coated aspirin 81 mg p.o. daily, Zetia 10 mg p.o. daily, Fluoxetine 20 mg p.o. daily, Advair Diskus one puff nebulized b.i.d., Lasix 60 mg p.o. b.i.d., NPH insulin 30 units subcutaneously q.p.m., NPH insulin 20 units subcutaneously q.a.m., Potassium slow release 30 mEq p.o. daily, Levofloxacin 500 mg p.o. q.24 h. x4 doses, Levothyroxine 88 mcg p.o. daily, Toprol-XL 100 mg p.o. daily, Nortriptyline 50 mg p.o. nightly, Prednisone taper 30 mg q.24 h. x3 doses, 20 mg q.24 h. x3 doses followed by a 10 mg q.24 h. x3 doses, then 5 mg q.24 h. x3 doses, Simvastatin 40 mg p.o. nightly, Diovan 20 mg p.o. daily, and Coumadin to be taken as directed to maintain INR 2 to 2.5 for atrial fibrillation, with followup appointments with her cardiologist, Dr. Schwarzkopf in one to two weeks with her cardiac surgeon, Dr. Carlough in four to six weeks, and VNA will monitor her vital signs, weight, and wounds, and the patient's INR and Coumadin dosing will be followed by S Community Hospital Anticoagulation Service at 300-135-5841.
|
Is there history of use of zetia
|
{
"answer_end": [
1736
],
"answer_start": [
1713
],
"text": [
"Zetia 10 mg p.o. daily,"
]
}
|
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.
|
Has the patient ever been on zincate
|
{
"answer_end": [
1692
],
"answer_start": [
1638
],
"text": [
"Zincate, and Coumadin for peripheral vascular disease."
]
}
|
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 the pt. ever been on zaroxolyn before
|
{
"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."
]
}
|
This 66-year-old male with a history of CAD, MI, CABG, and PCI was admitted with chest pain and ongoing risk factors. His enzyme on presentation was negative and EKG showed nonspecific T wave flat in II, III and V2-V3. In the ED, he had a BP of 86/118 and was given NITROGLYCERIN 1/150 (0.4 mg) SL q5min x 3 with no relief; his CP was 10/10 and reduced to 4/10 with NITROGLYCERIN. Labs showed elevated BUN/Cr and mild-mod lateral wall ischemia. He was prescribed ASA 325 mg PO QD, AMIODARONE 200 mg PO BID, LOPRESSOR (METOPROLOL TARTRATE) 50 mg PO BID, ISOSORBIDE DINITRATE 30 mg PO TID (hold if sbp<100), IMDUR 60 mg PO BID, PLAVIX 75 mg PO QD, Protonix, KEFLEX (CEPHALEXIN) 500 mg PO QID, Lasix 60 mg PO BID, KCl 40 mg PO QD, Metformin 500 mg PO BID, Micronase 10 mg PO BID, Tylenol with Codeine PRN, and Ativan 5 mg PRN. He was also advised to follow-up with his PCP to discuss starting Coumadin therapy given his history of atrial fibrillation, and was instructed to take PPI for GERD and a PPI and SC Hep for ppx. He was discharged with stable condition, and lab results showed normal WBC and no signs of acute infection. The patient was also advised to continue taking POTASSIUM CHLORIDE & RAMIPRIL, ALTACE (RAMIPRIL) 1.25 mg PO QD, NEXIUM (ESOMEPRAZOLE) 20 mg PO QD, DIET: House/Low chol/low sat. fat, ACTIVITY: Resume regular exercise, and FOLLOW UP APPOINTMENT(S): Please see your PCP in Own within 2 weeks.
|
What is the dosage of plavix
|
{
"answer_end": [
727
],
"answer_start": [
606
],
"text": [
"IMDUR 60 mg PO BID, PLAVIX 75 mg PO QD, Protonix, KEFLEX (CEPHALEXIN) 500 mg PO QID, Lasix 60 mg PO BID, KCl 40 mg PO QD,"
]
}
|
This 82-year-old RHM with a history of HTN, DM-2, CAD, and AVR (on Coumadin until 3/29) presented to the WTSMC ER for further work-up after receiving Mannitol. On exam, his VS were T: afebrile, BP: 145/64, P: 60, RR: 18, O2 sat: 97%r.a., HEENT anicteric and MMM without lesions, OP clear, neck supple with no LAD, CV had s1s2 paced, pronounce S2, 3/6 systolic murmur, 2/6 diastolic, resp CTAB, abd +BS Soft/NT/ND, ext no C/C/E, s/p above amputation, MS awake and alert, oriented to date, place, and self, attention DOW backwards, memory registration 3/3, recall 2/3 at 5 min 3/3 with prompting, language fluent, +comprehension, +repetition, +naming intact, nondominant no neglect to DSS, able to salute/brush teeth, CN II, III - pupils 3`2 bilaterally, VFF by confrontation; III, IV, VI - EOMI, no ptosis, no nystagmus; V - sensation intact to LT/PP, corneal reflex intact; VII - mild right facial weakness; VIII - hears finger rub; IX, X - voice dysarthric, palate elevates symmetrically, gag intact; XI - SCM/Trapezii 5/5 B; XII - tongue protrudes midline, motor right pronator drift, no asterixis, normal bulk and tone, no tremor, rigidity or bradykinesia, strength 5/5, DTRs C56, C6, C7, L34, S12, Plantar L2, 2, 2, 1, 0, amputated R1, 1, 1, 1, 0, up, sensory decreased LT, temperature, vibration distally up to knees, coord finger tap rapid & symm, FNF & finger follow intact (for weakness), foot tap rapid & symm, gait deferred. LABS showed Sodium 141 mmol/L, Potassium 4.7 mmol/L, Chloride 103 mmol/L, Total CO2 29 mmol/L, Anion Gap 9 mmol/L, CK 33 U/L, CKMB Quant 1.7 ng/mL, Calcium 9.0 mg/dL, Magnesium 1.6 mg/dL, cTn-I See Result Below ng/mL, and Glucose 130 mg/dL. Medications prescribed were COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN SBP>160mmHg, Insulin Regular Human Sliding Scale (subcutaneously) SC qAC, qHS, Lisinopril 20 mg PO QD, Magnesium Gluconate 500 mg PO BID, Milk of Magnesia (Magnesium Hydroxide) 30 mL PO QD PRN Constipation, Metoprolol Tartrate 25 mg PO TID starting in PM on 0/17, Xalatan (Latanoprost) 1 drop OU QPM, Flomax (Tamsulosin) 0.4 mg PO QD, Nexium (Esomeprazole) 20 mg PO QD, Glipizide 10 mg PO QD, Zocor 20 mg QD, Metformin 1000 mg BID, Niferex 150 BID, ASA 81 PO QD, and BRIMONIDINE 0.2% BID. Neurologic exam was stable with persistent dysarthria, right pronator drift, and mild right leg weakness; patient was evaluated by PT/OT and deemed appropriate candidate for acute rehab. Cardiovascular continued to be in atrial fibrillation, pacemaker was firing, but had an episode of HR 30's x few seconds, and HR 40's-50's for rest of night. EKG unchanged from admission, atrial fibrillation, left anterior fascicular block, some PVCs. Plan was to admit to NICU and transfer to the floor, control BP with home regimen and keep SBP<140, hold ASA and Coumadin, and hold Metformin for now and add insulin sliding scale. Medications included COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN other: SBP>160
|
Is there a mention of of insulin regular human usage/prescription in the record
|
{
"answer_end": [
1882
],
"answer_start": [
1822
],
"text": [
"Insulin Regular Human Sliding Scale (subcutaneously) SC qAC,"
]
}
|
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