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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.
|
Is there history of use of iron products
|
{
"answer_end": [
1488
],
"answer_start": [
1422
],
"text": [
"instructed to administer iron products a minimum of 2 hours before"
]
}
|
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.
|
Has this patient ever tried levothyroxine
|
{
"answer_end": [
2037
],
"answer_start": [
2005
],
"text": [
"Levothyroxine 88 mcg p.o. daily,"
]
}
|
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 ever been on colace ( docusate sodium )
|
{
"answer_end": [
331
],
"answer_start": [
292
],
"text": [
"COLACE (Docusate Sodium) 100 MG PO BID,"
]
}
|
Mr. Wolfinbarger is a 55 year old male with Coronary Artery Disease who was admitted to Enreen Dallout Medical Center for cardiac catheterization. His Past Medical History includes non-Hodgkin's lymphoma, status bone marrow transplant and chemotherapy in 1992 and 1993; history of hypercholesterolemia, hypertension, insulin dependent diabetes, gastroesophageal reflux disorder and chronic renal insufficiency. He is allergic to Benadryl. His medications on admission included Toprol XL 200 mg q.d. Procardia XL 90 mg q.d, Lipitor 20 mg q.d., aspirin 325 mg q.d., Zantac 150 mg b.i.d., NPH humulin insulin 32 units each morning and 18 units each evening subcutaneously, Valium 5 mg q.d., Minipress 1 mg b.i.d. His physical examination was within normal limits, no varicosities. He underwent harvesting of the left radial artery for graft and a coronary artery bypass grafting x three with a left internal mammary artery to the left anterior descending coronary artery, saphenous vein graft from the posterior descending coronary artery to the aorta and a radial artery from the saphenous vein graft to the obtuse marginal coronary artery. Postoperatively, he had an episode of rapid atrial flutter and was chemically converted to sinus rhythm with Corvert and has remained in sinus rhythm on Lopressor and diltiazem for 24 hours. His saphenous vein harvest site showed some slight erythema to be treated with antibiotics by mouth. He is discharged on Axid 150 mg b.i.d, Lipitor 20 mg q.d., NPH Humulin insulin 32 Units every morning, 18 Units every evening; Diltiazem 60 mg t.i.d., Lopressor 150 mg b.i.d., enteric coated aspirin 125 mg once a day, Valium 5 mg once a day, Keflex 500 mg four times a day for 7 days, Percocet 1 to 2 tablets every four hours as needed for pain.
|
Has this patient ever tried toprol xl
|
{
"answer_end": [
522
],
"answer_start": [
477
],
"text": [
"Toprol XL 200 mg q.d. Procardia XL 90 mg q.d,"
]
}
|
Mr. Quigg is a 42-year-old man with history of diabetes, end-stage renal disease on hemodialysis, left Charcot foot complicated by recurrent cellulitis who presented with left lower leg swelling, erythema, and pain. On admission, his temperature was 100.8, heart rate was 111, and blood pressure was 140/70. His left lower extremity had 1+ pitting edema with erythema on the anterior shin and foot. He was uptitrated to 5mg and also lopressor, started on Lyrica and oxycodone for breakthrough pain, and received Fentanyl PCA. His home medications included Colace 100 mg b.i.d., folate 1 mg p.o. daily, gemfibrozil 600 mg b.i.d., Lantus 30 mg subcu q.p.m., Lipitor 80 mg nightly, Nephrocaps, Neurontin 300 mg daily, PhosLo 2001 mg t.i.d., Protonix 40 mg daily, Renagel 3200 mg t.i.d., Requip 2 mg p.o. b.i.d., and Coumadin. His Lipitor was decreased to 20mg due to rhabdomylosis risk, and he was also started on low dose b-blocker to reduce perioperative MI risk prior to his surgery. His Vancomycin was continued given his history of MRSA cellulitis, with a goal of a level less than 20, and he was bridged with heparin with a goal PTT of 60-80. He was restarted on his Lantus and Aspart doses with meals, and his Coumadin was held prior to surgery and decreased to 20mg with a repeat lipid panel in 4-6 weeks. He required antibiotics which were discontinued at this time and he was discharged with dry sterile dressing changes to his residual limb daily, PTT goal 60-80, INR goal 2-3 until stable off of levofloxacin, monitoring of FS and adjustment of DM regimen, monitoring pain scale and decreasing pain medications as pain improves, hemodialysis M/W/F, and follow up with Dr. Carpino voice message left on his medical assistant's voice mail and Dr. Lynes 6/10/06 at 9:30am. Psychiatry service was consulted who recommended low dose Ativan prior to him going for dialysis. He was initially placed on a ketamine drip and given IV Levofloxacin and IV Flagyl to cover gram negatives and anaerobes respectively, and started on oxycontin 80mg tid with oxycodone for breakthrough pain and Lyrica for neuropathic pain. He was comfortable prior to discharge on this current regimen.
|
has there been a prior gemfibrozil
|
{
"answer_end": [
883
],
"answer_start": [
823
],
"text": [
"His Lipitor was decreased to 20mg due to rhabdomylosis risk,"
]
}
|
Mr. Mauras is a 72-year-old man with history of stable angina, type 2 diabetes, peripheral vascular disease, former smoking history, and history of seizure disorder with cataracts. He had occasional anginal symptoms prior to discharge and took about two nitroglycerins per week. Over the past week, he had escalating chest pain requiring one nitroglycerin per day. The pain was relieved by rest and nitroglycerin. One week prior to admission, his digoxin was stopped and his amiodarone was decreased. His Plavix was stopped and his Coumadin was held. On the morning of admission, he had chest pain and received Lopressor, Enalapril, Lovenox treatment dose and a Plavix load in the ED. He was found to have flash pulmonary edema and in atrial fibrillation with rapid ventricular response and was taken back to the catheterization lab and given four stents to his saphenous vein graft, OM1 with good resolution of his symptoms. He was transferred to the floor and was given an amiodarone load given his ejection fraction and increased ectopy on telemetry. His troponin had been trended down to the 0.2s by discharge and his beta-blocker and ACE inhibitor were titrated to heart rate and blood pressure. Prior to anticipated discharge, he re-developed flash pulmonary edema secondary to atrial fibrillation with rapid ventricular response and was re-loaded with digoxin. He was started on Mucomyst precath with good effect, had a difficult-to-place Foley, and was started on Flomax with good effect. His creatinine on discharge was 1.2, his metformin was held, and he was continued on Lantus with sliding scale insulin. He was given three units of packed red blood cells given his history of CAD and was prescribed with Amiodarone 200 mg, Enteric-coated aspirin 325 mg, Librium 10 mg, Colace 200 mg, Ferrous gluconate 324 mg, Lasix 40 mg, Nitroglycerin one tab, Dilantin 100 mg, Senna two tabs, Coumadin 3 mg, Lipitor 80 mg, Flomax 0.4 mg, Plavix 75 mg, Lantus 14 units, Metformin 500 mg, Ranitidine 150 mg, Digoxin 0.125 mg, Enalapril 10 mg, and Atenolol 50 mg, with follow-up appointments with his PCP, Dr. Kelley Hernon of Electrophysiology on 7/8/05, and Dr. Daft on 9/20/05, and INR checked on 8/4/05 or 7/8/05 with Coumadin adjusted accordingly.
|
has the patient used lipitor in the past
|
{
"answer_end": [
1921
],
"answer_start": [
1907
],
"text": [
"Lipitor 80 mg,"
]
}
|
Mr. Royce Meidlinger is a 78-year-old male who was admitted on 11/12/05 with ADMISSION MEDICATIONS including Atenolol 25 mg daily, allopurinol 300 mg daily, and Flomax 0.8 mg daily. Cardiovascularly, he was on aspirin and had a pacemaker for sick sinus and was saturating well on 2 liters of oxygen delivered by Dobbhoff. Respiratorily, white count at preop baseline was afebrile completing 21 day course of linezolid for EC bacteremia and chest x-ray improved after adding low-dose Lasix. Renally, there was a postoperative increase in creatinine requiring dopamine 2 mcg, continued high chest tube output and an official echo report showed moderate TR, with no changes from prior echos. Hematology was treated with aspirin and anticoagulation and he had left upper extremity DVT as well, was started on argatroban, PTT to be therapeutic, with argatroban dose increased from 0.1 to 0.2, bridging to Coumadin, and argatroban dose reduced to maintain PTT of 50. He had profuse GI bleeding requiring 3 units of packed red blood cells, 2 units packed red blood cells with improvement in hematocrit, NG-tube aspiration with melena, and was HIT positive with worsening clinical syndrome. Foley was put in place with Lasix for reduced urine output and left hand demarcated with argatroban dose increased from 0.1 to 0.2, bridging to Coumadin, restarting Coumadin, postop day #51, patient went to OR with plastics for toe finger amputations/left hand debridement, holding tube feeds, was on triple antibiotic therapy for sputum/blood culture, and rehabilitation when restarting Coumadin. Postop day #54
|
Previous aspirin.
|
{
"answer_end": [
744
],
"answer_start": [
689
],
"text": [
"Hematology was treated with aspirin and anticoagulation"
]
}
|
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
|
has the patient used kcl iv in the past
|
{
"answer_end": [
1168
],
"answer_start": [
1131
],
"text": [
"on order for KCL IV (ref #964491549),"
]
}
|
Mr. Boyles is a 73-year-old man with a past medical history significant for extensive coronary artery disease, diabetes, hypertension, hypercholesterolemia, and smoking, who presents with chest pain and is admitted for rule out myocardial infarction. His vital signs are normal, his lungs are clear, his jugular venous pressure is less than 5.0 centimeters, and his PMI is nonpalpable. His cardiac risk factors include age, diabetes, hypertension, cholesterol, smoking, and family history. On the morning of admission, he experienced chest pain for 1-2 minutes, which dissipated. At 7:00 p.m., he took one sublingual nitroglycerin with a decrease of pain and at 11:00 p.m., he took one sublingual nitroglycerin. His medications include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was placed on Plavix, continued aspirin, and restarted Coumadin after heparin and intravenous TNG. Cozaar 25 milligrams q.d. and amlodipine were added, and he was given normal saline intravenous fluids to equalize his ins and outs. His hematocrit dropped to 28.0, and he was transfused two units with an appropriate bump back to 33.0. His diabetes was managed on NPH 30/10 and 4 regular q.p.m., and Rezulin. His genitourinary issue was managed with Finasteride 5 milligrams q.d. and Levofloxacin 500 milligrams q.d. He developed point tenderness in his right knee, and was managed with Colchicine and a prednisone taper starting at 40 milligrams. His medications on discharge include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was taken back for a left subclavian artery stent and a left brachial artery angioplasty, and further managed with catheterization, finding a saphenous vein graft to the diagonal one was 100 percent occluded, SVG to PDA was open, LMA was 30 percent occluded, LAD was 99 percent occluded, diagonal one was 100 percent occluded, and LCX was 80 percent occluded. He was discharged to home in stable condition, with follow-up appointments with his primary doctor, cardiologist, and the doctor who performed the procedure.
|
What is the current dose of the patient's finasteride
|
{
"answer_end": [
1027
],
"answer_start": [
994
],
"text": [
"Colchicine 0.6 milligrams p.r.n.,"
]
}
|
This is a 46-year-old morbidly obese female with a history of insulin-dependent diabetes mellitus complicated by BKA on two prior occasions, who was admitted to the MICU with BKA, urosepsis, and a non-Q-wave MI. On presentation to the Emergency Department, her vital signs were notable for a blood pressure of 189/92, pulse rate of 120, respiratory rate of 20, and an O2 sat of 90%. She was given insulin, sublingual nitroglycerin x three, 4 mg of morphine, 5 mg of Lopressor, and started on a heparin drip and IV antibiotics, and admitted to the MICU for further management. Her past medical history included insulin-dependent diabetes mellitus for how many years, positive ethanol use, approximately one drink per week, and denied IV drug use or other illicit drug use. She was placed on an insulin drip and hydrated with intravenous fluids, with improvement, and eventually transitioned to NPH with insulin sliding scale coverage. Despite escalating her dose of NPH up to 65 U subcu b.i.d. on the day of discharge, she continued to have elevated blood sugars >200 and required coverage with insulin sliding scale. This issue will need to be addressed as an outpatient. She was also placed on cefotaxime for gram negative coverage, with both her blood cultures and urine cultures growing out E. coli which were sensitive to cefotaxime and gentamycin. As she initially continued to be febrile and continued to have positive blood cultures, one dose of gentamycin was given for synergy, and she was eventually transitioned to p.o. levofloxacin and will take 7 days of p.o. levofloxacin to complete a total 14-day course of antibiotics for urosepsis. She was initially placed on aspirin, heparin, and a beta blocker, and once her creatinine normalized, an ACE inhibitor was also added. Heparin was discontinued once the concern for PE was alleviated, and her beta blocker and ACE inhibitor were titrated up for a goal systolic blood pressure of <140 and a pulse of <70. On admission, the patient was on several pain medicines, including amitriptyline, Flexeril, and Valium for reported history of sciatica and low back pain, which were discontinued and she was placed on Neurontin for likely diabetic neuropathy. She was also placed on GI prophylaxis with Carafate and treated symptomatically with Imodium p.r.n. diarrhea. The patient was discharged with enteric coated aspirin 325 mg p.o. q.d., NPH Humulin insulin 65 U subcu b.i.d., human insulin sliding scale: for blood sugars 151-200 give 4 U, for blood sugars 201-250 give 6 U, for blood sugars 251-300 give 8 U, for blood sugars 301-350 give 10 U, Imodium 2 mg p.o. q. 6 hrs. p.r.n. diarrhea, Niferex 150 mg p.o. b.i.d., nitroglycerin 1/150 one tab sublingual q. 5 min. x 3 p.r.n. chest pain, multivitamin one tab p.o. q.d., simvastatin 10 mg p.o. q.h.s., Neurontin 600 mg p.o. t.i.d., levofloxacin 500 mg p.o. q.d. x 5 days, Toprol XL 400 mg p.o. q.d., lisinopril 40 mg p.o. q.d. The patient was evaluated by the physical therapist, who noted her to walk around the hospital without significant difficulty.
|
Is there history of use of enteric coated aspirin
|
{
"answer_end": [
2394
],
"answer_start": [
2354
],
"text": [
"enteric coated aspirin 325 mg p.o. q.d.,"
]
}
|
This 54 year old gentleman presented to the Wickpro Conch Medical Center with an infected left lower leg pressure ulcer with open and gangrenous muscle exposed through the posterior wound. His past medical history is significant for insulin dependent diabetes mellitus, peripheral vascular disease, coronary artery disease, congestive heart failure, history of atrial fibrillation/flutter, and right sacroiliac joint decubitus ulcer. His physical examination revealed mottled distal extremities, bilateral inspiratory wheezes, and a positive bowel sound. The patient underwent a four vessel coronary artery bypass graft on 6/17/95 and left lower extremity fasciotomy on 11/27/95 and was taken to the Operating Room on 7/25/95 for a preoperative diagnosis of a left lower extremity infected pressure sore. Intraoperatively, the patient was noted to have necrosis of both heads of the gastrocnemius muscle and copious amounts of antibiotic-containing solution was used to irrigate the wound, for which he was started on Ampicillin, Gentamicin, and Flagyl empirically until culture results returned and was taken back on 2/29/95 for a second irrigation and debridement procedure. The patient was placed on Klonopin 1 mg po tid, Tylenol 650 mg p.o. q4h p.r.n. headache, Aspirin 81 mg p.o. qd, Albuterol nebulizer 0.5 cc in 2.5 cc of normal saline q.i.d., Capoten 25 mg p.o. qh, Chloral hydrate 500 mg p.o. q.h.s. p.r.n. insomnia, Clonopin 1 mg p.o. t.i.d., Digoxin 0.375 mg p.o. qd, Colace 100 mg p.o. b.i.d., Insulin NPH 38 units subcu b.i.d., Milk of Magnesia 30 cc p.o. qd p.r.n. constipation, Multivitamins one capsule p.o. qd, Mycostatin 5 cc p.o. q.i.d., Percocet one or two tabs p.o. q3-4h p.r.n. pain, Metamucil one packet p.o. qd, Azmacort six puffs inhaled b.i.d., Axid 150 mg p.o. b.i.d., Ofloxacin 200 mg p.o. b.i.d. x 7 days, and Insulin NPH 38 units in the morning and 38 units at night. The patient was initially ruled out for a myocardial infarction following his first operative procedure and had no episodes of hypotension. He was switched over from Gentamicin to Ofloxacin to continue his antibiotic course and has been followed by the Infectious Disease service, receiving 7 more days of po Ofloxacin as an outpatient. The patient's medications upon discharge include Aspirin 81 mg po qd, Digoxin 0.325 mg po qd, Azmacort 6 puffs inhaled bid, Heparin 5000 units subcu bid, Zantac 150 mg po bid, Lasix 40 mg po qd, Capoten 25 mg q 8, Albuterol nebulizers 0.5 cc in 2.5 cc normal saline qid, NPH insulin 38 units subcu bid, Nystatin swish and swallow 5 cc po qid, Bactrim DS one tab po bid, Tylenol 650 mg po q4h prn headache, Chloral hydrate 500 mg po qhs prn insomnia, Clonopin 1 mg po tid, Colace 100 mg po bid, Milk of Magnesia 30 cc po qd prn constipation, Multivitamins one capsule po qd, Mycostatin 5 cc po qid, Percocet one or two tabs po q3-4h prn pain, Metamucil one packet po qd, Azmacort six puffs inhaled bid, Axid 150 mg po bid, and Ofloxacin 200 mg po bid x 7 days.
|
What is the current dose of the patient's milk of magnesia
|
{
"answer_end": [
1578
],
"answer_start": [
1506
],
"text": [
"Insulin NPH 38 units subcu b.i.d., Milk of Magnesia 30 cc p.o. qd p.r.n."
]
}
|
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.
|
Why does the patient take dobutamine.
|
{
"answer_end": [
693
],
"answer_start": [
641
],
"text": [
"His MAPs to keep them over 60 required max dopamine,"
]
}
|
A 58-year-old woman with multiple cardiac risk factors (uncontrolled DM2 10.3 HgbAIC, HTN, lipids), Asthma, Sleep Apnea, and 1 week of worsening DOE was admitted for r/o MI. Her BP was elevated at 150-160's/80-90 and was stabilized with IV lopressor and nitro paste. Her CV- cardiac enz was neg x3- ASA, no BB secondary Asthma. She was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, AMITRIPTYLINE HCL 25 MG PO QHS, FUROSEMIDE 40 MG PO QD, GLYBURIDE 10 MG PO BID, NOVOLIN INNOLET 70/30 (INSULIN 70/30 (HUMAN)) 100 UNITS SC BID (Number of Doses Required (approximate): 8), NORVASC (AMLODIPINE) 10 MG PO QD, and LIPITOR (ATORVASTATIN) 10 MG PO QD. An override notice was added on 6/23/04 by GASTINEAU, RAMIRO, M.D. for CLOTRIMAZOLE 1% CREAM TP (ref # 17426481) due to SERIOUS INTERACTION: ATORVASTATIN CALCIUM & CLOTRIMAZOLE, and an override was added on 6/23/04 by ARDELEAN, TRACY, M.D. for LIPITOR PO (ref # 90735952) due to Pt. having a PROBABLE allergy to SIMVASTATIN; reaction is myalgia. The patient was discharged with a diagnosis of r/o MI, SOB multifactorial deconditioning, pulmon disease, HTN, uncontrolled DM, Sleep Apnea, Asthma, and was given instructions to call her doctor if having chest pain, worsening shortness of breath with exertion or at rest, new onset back/shoulder pain, worsening fatigue or any other concerns. She was also prescribed a diet of House/ADA 2100 cals/dy and told to walk as tolerated. She was told to call her PCP to schedule an out patient Cardiac MIBI with adenosine.
|
Has the patient ever been on atorvastatin calcium
|
{
"answer_end": [
820
],
"answer_start": [
784
],
"text": [
"ATORVASTATIN CALCIUM & CLOTRIMAZOLE,"
]
}
|
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.
|
What was the dosage prescribed of singulair ( montelukast )
|
{
"answer_end": [
2413
],
"answer_start": [
2377
],
"text": [
"Singulair (Montelukast) 10 mg PO QD,"
]
}
|
The patient was admitted for right leg pain and poor ambulation. She had a history of OA and chronic right sided hip/knee pain with ambulation. On examination, she had pain with ambulation to her right leg, hip, and achy not sharp. X-rays of the right lower extremity joints showed no abnormality, and physical therapy recommended use of a cane. To treat her pain she was given TYLENOL 650mg PO Q6HR ATC and PRN IBUPROFEN. She was maintained on her outpatient cardiovascular medications, including Lisinopril 20 mg PO qd, Hydrochlorothiazide 25 mg PO qd starting today (2/4), Lipitor (Atorvastatin) 10 mg PO qd, Multivitamin Therapeutic (Therapeutic Multivi... ) 1 TAB PO QD, Calcium Carbonate (500 mg elemental Ca++) 500 mg PO TID, and Niacin/Vitamin B3 & Atorvastatin Calcium with an override for awareness of a potentially serious interaction. Blood pressure should be followed up as an outpatient and BP meds titrated as needed. She was cleared to go home with instructions to take TYLENOL at least twice daily to help improve her leg pain, seek medical attention if the leg becomes more red, swollen, or tender, or if there are any fevers or new problems with the leg, and use the cane to assist with walking. She was discharged in stable condition to her son, with instructions to follow up with Lenard Dimmitt for blood pressure, take Tylenol for pain, take Ibuprofen as needed, and call the nurse practitioner within 2 weeks for an appointment.
|
Has the patient had previous tylenol (acetaminophen)
|
{
"answer_end": [
422
],
"answer_start": [
378
],
"text": [
"TYLENOL 650mg PO Q6HR ATC and PRN IBUPROFEN."
]
}
|
Vance Prunier, a 57 year old patient with diabetes mellitus, hypertension, hyperlipidemia, and known coronary artery disease, was admitted on 5/30/2001 with worsening exercise capacity. A cath today showed severe native TVD, patent LIMA to LAD, occluded SVG-OM, and radial graft to PDA 80% stenosis. PCI of radial graft lesion with Nir 2.5x15mm and S660 2.5x12mm stents resulting in 0% residual was done and Angioseal was applied to RFA. The patient was discharged on 6/17/2001 in a stable condition with medications EC ASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO QPM, Cipro (Ciprofloxacin) 250 MG PO BID, Insulin NPH Human 30 UNITS SC QAM, Insulin Regular (Human) 18 UNITS SC QAM, Levoxyl (Levothyroxine Sodium) 75 MCG PO QD, Lisinopril 20 MG PO QD, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL Q5 MIN X 3 PRN Chest Pain HOLD IF: SBP<[ ], Pravachol (Pravastatin) 20 MG PO QHS, Amlodipine 5 MG PO QD, Imdur (Isosorbide Mononit.( SR )) 60 MG PO QD, Wellbutrin SR (Bupropion Hcl SR) 150 MG PO BID, Clopidogrel 75 MG PO QD, and 16 hours Integrilin and 30 days Plavix. The patient was instructed to call for any further chest pain, groin pain, swelling or bleeding and was to return to work after an appointment with the local physician. Follow up appointments with Dr. Minear in 1-2 weeks and Dr. Givens were scheduled. The patient was discharged to home.
|
What is the dosage of wellbutrin sr ( bupropion hcl sr )
|
{
"answer_end": [
1005
],
"answer_start": [
958
],
"text": [
"Wellbutrin SR (Bupropion Hcl SR) 150 MG PO BID,"
]
}
|
The patient is a 46-year-old gentleman with End stage renal disease thought to be secondary to hepatitis C virus positive, on chronic hemodialysis who was admitted status post fall and seizure. On the day of admission, he complained of feeling dizzy and slumped onto the floor, and was given 500 ccs of normal saline and was no longer orthostatic, comfortably sitting up in the bed. Past medical history reveals mild mental retardation since about 10 years ago, movement disorder (tics) on Stelazine, end stage renal disease thought to be secondary to hypertension, status post parathyroidectomy for secondary hyperparathyroidism, partial thyroidectomy for goiter incidentally found at surgery, status post partial gastrectomy for peptic ulcer disease in the 1960's, history of MRSA from wound in 1988, hepatitis B surface antibody positive and hepatitis C virus positive. Medications on admission included Calcium carbonate, 1250 mg PO tid; nephrocaps, 1 PO qd; DHT, 0.2 mg PO qd; and Stelazine, 2 mg PO tid. There are no known allergies and the patient was a former smoker with a history of alcohol abuse but no IV drug use. Vital signs showed lying blood pressure of 96/60, pulse 80, sitting up blood pressure 104/70, pulse 96, temperature 97.5, O2 sat 95% on room air, JVD of 4 cms, no lymphadenopathy, chest clear to auscultation, heart revealed S1, S2, normal rate and rhythm with a 1/6 systolic murmur best heard at the left upper sternal border, no CVA tenderness, abdomen soft, non-tender, no masses, bowel sounds positive, guaiac negative with brown stool, tender, edematous dorsal aspect of right foot, with full range of motion at the ankle joint, left extremity benign, neuro exam was grossly nonfocal. Laboratory data revealed sodium 142, potassium 4.8, chloride 94, bicarb 32, BUN 38, creatinine 8.6, glucose 168, white count of 8.82, hematocrit 35, platelets 246, calcium 9.7. Chest x-ray revealed mild pulmonary vascular redistribution with no significant CHF and no infiltrates, ankle x-rays on the right revealed no fracture or dislocation, EKG revealed normal sinus rhythm at a rate of 76, axis 2 degrees, some 1 mm ST elevations in I and AVL, T-waves flat in lead III. The patient was observed overnight, put on an oral renal diet, checking orthostatics frequently, and underwent dialysis again with no orthostasis. Right foot films revealed non-displaced fractures of the second, third, fourth and fifth metatarsal bones, and Orthopaedic service was consulted who put the patient in a bivalve cast with a toe plate. Physical therapy was consulted and the patient was allowed to sit in a chair and engage in non-weight bearing activities and his foot was elevated on three pillows for 72 hours, and discharged on his medications from admission to a rehab/skilled nursing facility per wishes of patient, family and per recommendation of physical therapy.
|
What is the patient's current dose does the patient take of her dht
|
{
"answer_end": [
981
],
"answer_start": [
915
],
"text": [
"carbonate, 1250 mg PO tid; nephrocaps, 1 PO qd; DHT, 0.2 mg PO qd;"
]
}
|
This 75-year-old female vasculopath was admitted for further evaluation of her peripheral vascular disease which was suspected to be contributing to her new ulcerations and progressively worsening bilateral foot pain, foot mottling and wrist pain as an exacerbating factor to likely atheroembolic phenomenon, status post coronary catheterizations earlier in the year. She was placed on broad-spectrum antibiotics and plan was made for an MRA to evaluate her anatomy, unfortunately, the patient was unable to tolerate the MR and did experience some mental status changes that prevented further noninvasive imaging when she received some narcotic following her hemodialysis round. Over the ensuing days she required rather significant doses of Zyprexa and Haldol to contain agitation and delirium, as the patient would also get physical and violent. This appeared to sedate her sufficiently and over the following days, she did manage to calm significantly and returned to her baseline mental status. Cardiology was consulted during this time to optimize her prior to the OR and her primary cardiologist, Dr. Fugle, did make some recommendations including an echocardiogram that showed preserved ejection fraction and no wall motion abnormalities. Her beta blockade was titrated up and she was instructed to follow up with cardiology. She did tolerate hemodialysis throughout this time without undue difficulty and they offered an angiogram to delineate aortic and bilateral lower extremity runoff anatomy. After extensive discussions with the patient and the patient's family, the patient did agree to a left femoral to dorsalis pedis bypass graft which was performed on 0/25/2006 without complication. By time of discharge, she was tolerating a regular diet and ambulating at baseline with her rolling walker. The pain was well controlled with minimal analgesics that were not narcotic based. Medications on admission included Aspirin 325 mg p.o. daily, Plavix 75 mg p.o. daily, Cardizem 60 mg p.o. t.i.d., Lipitor 80 mg daily, Atrovent 2 puffs four times a day, Albuterol 2 puffs b.i.d., Renagel 806 mg p.o. every meal, Allopurinol 100 mg p.o. daily, Zaroxylyn 2.5 mg p.o. daily p.r.n. overload, Lantus 10 units subcutaneous nightly, Regular insulin sliding scale, Valium 5 mg p.o. b.i.d. p.r.n., Isordil 40 mg p.o. t.i.d., Hydralazine 20 mg p.o. t.i.d., Lopressor 75 mg p.o. t.i.d., Zantac 150 mg p.o. b.i.d., Aciphex 20 mg p.o. daily, Neurontin 300 mg p.o. post-dialysis, Metamucil, Nitroglycerine p.r.n., Procrit 40,000 units subcutaneously every week, Lilly insulin pen, unknown dosage 20 units every morning and 10 units every evening, Loperamide 2 tabs p.o. four times a day, Ambien 10 mg p.o. nightly p.r.n., Tylenol 325 mg p.o. every four hours p.r.n. pain, Albuterol inhaler 2 puffs b.i.d., Calcitriol 1.5 mcg p.o. every Monday and every Friday, Darbepoetin alfa 100 mcg subcutaneous every week, Ferrous sulfate 325 mg p.o. t.i.d., Prozac 40 mg p.o. daily, Motrin 400 mg p.o. every eight hours p.r.n. pain, Insulin regular sliding scale, and Sevelamer 800 mg p.o. t.i.d. Discharge instructions included touchdown weightbearing on the left heel, legs are to be elevated as much as possible while sitting or lying down, all home medications were to be resumed except for Lopressor, VNA was ordered to assist with wound care including Betadine paint to incisions daily, showering only, no bathing or immersion in water for prolonged periods of time, and follow-up visits with Dr. Amorose in one to two weeks and Dr. Morici primary care physician in one week.
|
What is the dosage of sevelamer
|
{
"answer_end": [
3080
],
"answer_start": [
3052
],
"text": [
"Sevelamer 800 mg p.o. t.i.d."
]
}
|
This 81-year-old Italian-speaking gentleman was admitted to M Valley Medical Center with rising chest pain. Upon admission, his vital signs were normal and his physical examination was unremarkable. Cardiac catheterization revealed 30% mid RCA occlusion, 40% distal RCA, 90% ostial OM1, 90% mid CX, 80% proximal LAD, 99% mid LAD and 60% mid LM. EKG showed normal sinus rhythm and an incomplete right bundle-branch block. During his hospital stay, he was started on beta-blockers, statins, fluid resuscitation and vasopressor administration, subcu insulin, prednisone, Plavix, and antibiotics. He experienced agitation and delirium, for which he was on alcohol drip due to preop history of alcohol use and Haldol was used p.r.n. Later during the hospital stay, he became hypotensive, requiring Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath. He was also on Lopressor 25 orally every 6 hours, Diltiazem 125 mg orally daily, Furosemide 20 mg orally daily, Methylprednisolone 30 mg IV every 8 hours, Atorvastatin 80 mg orally daily, Allopurinol 100 mg orally daily, Ativan 0.5 mg orally at bedtime, Nexium 20 mg orally daily, and Proscar 5 mg orally every night. Tight glycemic control was maintained with Portland protocol in the immediate postop period and subsequently with subcu insulin. Incidental radiologic finding of a renal mass consistent with renal cell carcinoma was also found. Support for the patient's family was provided throughout the hospital course, and the patient was discharged with Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, Nexium 20 mg everyday, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath.
|
Has the patient taken any medications for pain management
|
{
"answer_end": [
889
],
"answer_start": [
835
],
"text": [
"Toradol orally 10 mg every 4 hours as needed for pain,"
]
}
|
Patient Scotty P. Orpen, a 76 year-old female with a history of MI (1984), PVD, CVA, DVT, and supraglottic laryngeal SCC who underwent XRT in 2002, presented to the ED with "stabbing pins" CP which initially started next to the L breast in the midaxillary line that radiated to her breast, sternum, neck, and back around to the L midaxillary line. The patient was given ASA, NTG (partial relief, but dropped BP), heparin bolus & cont infusion, FAMOTIDINE 20 MG PO BID, LASIX (FUROSEMIDE) 80 MG PO QD, MOTRIN (IBUPROFEN) 300 MG PO Q6H, ZOCOR (SIMVASTATIN) 20 MG PO QHS, ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, and MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach. The patient was also instructed to take the syrup form of MOTRIN with food, and to avoid grapefruit with ZOCOR unless otherwise instructed by the MD. The patient was given a low cholesterol/low saturated fat diet and a 2 gram sodium diet, and instructed to resume regular exercise. The rib film preliminary read was without fracture but did have some loss of height of vertebral bodies suggestive of compression fractures which she was treated with Motrin for muscular pain. The suspicion for CHF and PE was low and no anticoagulation was given, and she was ruled out for MI while in the house. Her pain was thought to be musculoskeletal in origin and was treated with NSAIDS. The patient was discharged with instructions to follow up with Dr. Haddow within 1 week of discharge, to call for an appointment, and to continue to take all of her medications as directed.
|
Has the pt. ever been on ntg before
|
{
"answer_end": [
412
],
"answer_start": [
348
],
"text": [
"The patient was given ASA, NTG (partial relief, but dropped BP),"
]
}
|
A 45-year-old female with a history of IDDM, sleep apnea, asthma on chronic prednisone, HTN, and CAD s/p NSTEMI in 6/10 with a stent to the LAD presented with 3 days of worsening dyspnea and chest pressure. She was treated for an asthma exacerbation with Prednisone 40 mg PO QAM x 10 doses, Instructions: Taper: 40mg for 2 days, then 35mg for 2days, then 30mg for 2days, then 25mg for 2days, then 20mg, ECASA (ASPIRIN ENTERIC COATED) 325 mg PO QD, CARDIZEM SR (DILTIAZEM SUSTAINED RELEASE) 120 mg PO QD, Override Notice: Override added on 0/9/05 by DUHART, RANDY M., M.D. on order for LOPRESSOR PO (ref #31219927), POTENTIALLY SERIOUS INTERACTION: DILTIAZEM HCL & METOPROLOL TARTRATE Reason for override: aware, HYDROCHLOROTHIAZIDE 25 MG PO QD, LISINOPRIL 30 MG PO QD, on order for POTASSIUM CHLORIDE IMMED. REL. PO (ref #73021085), POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE Reason for override: aware, LORAZEPAM 0.5 MG PO BID PRN Anxiety, LOPRESSOR (METOPROLOL TARTRATE) 12.5 MG PO BID, on order for CARDIZEM SR PO (ref #76249027), on order for CARDIZEM PO (ref #49626929), COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, ADVAIR DISKUS 500/50 (FLUTICASONE PROPIONATE/...), ATOVAQUONE 750 mg PO BID, NAPROSYN (NAPROXEN) 250-500 mg PO BID PRN Pain, CALCIUM CARB + D (600MG ELEM CA + VIT D/200 IU), ZOLOFT 1 TAB PO QD, Alert overridden: Override added on 4/2/05 by : POTENTIALLY SERIOUS INTERACTION: CLOPIDOGREL BISULFATE & NAPROXEN Reason for override: musculoskeletal pain, diabetes mellitus 2/2 chronic steroid use, Ischemia: continue Zocor, Clopidogrel, ECASA, nitrates as needed., Pump: continue lisinopril, HCTZ, Cardizem, Lopressor 12.5 mg PO BID, presentation. Never hospitalized, chronic prednisone therapy, s/p gentle diuresis, Pred, nebs with improvement of symptoms, D-dimer < 200, admission peak flow 150 (baseline NL 300-350), at discharge 275-300, ambulatory O2 sat WNL., Musculoskeletal workup showed reproducible sternal pain on palpation consistent with costochondritis and Naprosyn PRN pain, Psych: Continue Zoloft for depression and Lorazepam for anxiety, PPx was managed with PPI., Discharge condition was stable. Plan was to assess efficacy of Prednisone 20 mg upon completion of taper, status of dyspnea/asthma symptoms on low dose beta-blocker, chest pain/costochondritis with PRN NSAIDs, and ENDO: Chronic steroid use, Insulin SS in-house. -calcium/vit D supplement, with food/drug interaction instruction to give with meals and take with food, to resume regular exercise, and follow up appointments with Dr. BALVANZ, PCP in 2 weeks and ENDO indefinitely.
|
Has this patient ever been prescribed zocor
|
{
"answer_end": [
1620
],
"answer_start": [
1554
],
"text": [
"Ischemia: continue Zocor, Clopidogrel, ECASA, nitrates as needed.,"
]
}
|
The patient is a 61-year-old man with a history of ischemic cardiomyopathy and congestive heart failure, who was initially treated with afterload reduction, digoxin and Lasix. A PA line was placed with RA 8, RV 76/4, TA 80/36, pulmonary capillary wedge pressure 34, and cardiac index 1.49. He was then treated with dobutamine, intravenous TNG, and nitroprusside with symptomatic relief and hemodynamic stabilization with wedge pressure falling to 18. TNG and Nipride were successfully weaned, however, the patient remained dobutamine dependent. One week prior to transfer, the patient was admitted to Ment Hospital for management of his congestive heart failure and grew gram positive cocci from two blood cultures. He was then started on vancomycin and defervesced, and subsequently grew gram negative rods in one out of four blood culture specimens. These were gram negative enteric rods, pan-sensitive, for which the patient was started on ampicillin 2 gm IV q. 6. At the time of discharge, the patient was stable, dobutamine dependent, without chest pain, able to ambulate from chair to commode without shortness of breath, palpitations, or light-headedness. His medications at time of discharge included dobutamine at 15 mcg per kilogram per minute; captopril 25 mg p.o. t.i.d.; digoxin 0.125 mg p.o. q.d.; Lasix 160 mg p.o. b.i.d.; potassium chloride 20 mEq p.o. b.i.d.; Coumadin 1 mg p.o. q.d.; Atrovent, two puffs q.i.d.; Azmacort, eight puffs b.i.d.; Pepcid 20 mg p.o. b.i.d.; Colace 100 mg p.o. t.i.d.; vancomycin 1 gm q. 12, discontinued 9-23 a.m. after 14 days; ampicillin 2 gm IV q. 6 (24 of June equals day number five); Halcion 0.125 p.o. q.h.s. prn; Serax 15 mg p.o. q. 6 hours prn. The patient's condition at time of discharge is fair and will be continuing care in the coronary care unit of the hospital inpatient near patient's home under the care of Doctor Daren Swasey.
|
Is the patient currently or have they ever taken tng
|
{
"answer_end": [
343
],
"answer_start": [
290
],
"text": [
"He was then treated with dobutamine, intravenous TNG,"
]
}
|
This is a 46-year-old morbidly obese female with a history of insulin-dependent diabetes mellitus complicated by BKA on two prior occasions, who was admitted to the MICU with BKA, urosepsis, and a non-Q-wave MI. On presentation to the Emergency Department, her vital signs were notable for a blood pressure of 189/92, pulse rate of 120, respiratory rate of 20, and an O2 sat of 90%. She was given insulin, sublingual nitroglycerin x three, 4 mg of morphine, 5 mg of Lopressor, and started on a heparin drip and IV antibiotics, and admitted to the MICU for further management. Her past medical history included insulin-dependent diabetes mellitus for how many years, positive ethanol use, approximately one drink per week, and denied IV drug use or other illicit drug use. She was placed on an insulin drip and hydrated with intravenous fluids, with improvement, and eventually transitioned to NPH with insulin sliding scale coverage. Despite escalating her dose of NPH up to 65 U subcu b.i.d. on the day of discharge, she continued to have elevated blood sugars >200 and required coverage with insulin sliding scale. This issue will need to be addressed as an outpatient. She was also placed on cefotaxime for gram negative coverage, with both her blood cultures and urine cultures growing out E. coli which were sensitive to cefotaxime and gentamycin. As she initially continued to be febrile and continued to have positive blood cultures, one dose of gentamycin was given for synergy, and she was eventually transitioned to p.o. levofloxacin and will take 7 days of p.o. levofloxacin to complete a total 14-day course of antibiotics for urosepsis. She was initially placed on aspirin, heparin, and a beta blocker, and once her creatinine normalized, an ACE inhibitor was also added. Heparin was discontinued once the concern for PE was alleviated, and her beta blocker and ACE inhibitor were titrated up for a goal systolic blood pressure of <140 and a pulse of <70. On admission, the patient was on several pain medicines, including amitriptyline, Flexeril, and Valium for reported history of sciatica and low back pain, which were discontinued and she was placed on Neurontin for likely diabetic neuropathy. She was also placed on GI prophylaxis with Carafate and treated symptomatically with Imodium p.r.n. diarrhea. The patient was discharged with enteric coated aspirin 325 mg p.o. q.d., NPH Humulin insulin 65 U subcu b.i.d., human insulin sliding scale: for blood sugars 151-200 give 4 U, for blood sugars 201-250 give 6 U, for blood sugars 251-300 give 8 U, for blood sugars 301-350 give 10 U, Imodium 2 mg p.o. q. 6 hrs. p.r.n. diarrhea, Niferex 150 mg p.o. b.i.d., nitroglycerin 1/150 one tab sublingual q. 5 min. x 3 p.r.n. chest pain, multivitamin one tab p.o. q.d., simvastatin 10 mg p.o. q.h.s., Neurontin 600 mg p.o. t.i.d., levofloxacin 500 mg p.o. q.d. x 5 days, Toprol XL 400 mg p.o. q.d., lisinopril 40 mg p.o. q.d. The patient was evaluated by the physical therapist, who noted her to walk around the hospital without significant difficulty.
|
has there been a prior antibiotics
|
{
"answer_end": [
575
],
"answer_start": [
511
],
"text": [
"IV antibiotics, and admitted to the MICU for further management."
]
}
|
This 75-year-old female vasculopath was admitted for further evaluation of her peripheral vascular disease which was suspected to be contributing to her new ulcerations and progressively worsening bilateral foot pain, foot mottling and wrist pain as an exacerbating factor to likely atheroembolic phenomenon, status post coronary catheterizations earlier in the year. She was placed on broad-spectrum antibiotics and plan was made for an MRA to evaluate her anatomy, unfortunately, the patient was unable to tolerate the MR and did experience some mental status changes that prevented further noninvasive imaging when she received some narcotic following her hemodialysis round. Over the ensuing days she required rather significant doses of Zyprexa and Haldol to contain agitation and delirium, as the patient would also get physical and violent. This appeared to sedate her sufficiently and over the following days, she did manage to calm significantly and returned to her baseline mental status. Cardiology was consulted during this time to optimize her prior to the OR and her primary cardiologist, Dr. Fugle, did make some recommendations including an echocardiogram that showed preserved ejection fraction and no wall motion abnormalities. Her beta blockade was titrated up and she was instructed to follow up with cardiology. She did tolerate hemodialysis throughout this time without undue difficulty and they offered an angiogram to delineate aortic and bilateral lower extremity runoff anatomy. After extensive discussions with the patient and the patient's family, the patient did agree to a left femoral to dorsalis pedis bypass graft which was performed on 0/25/2006 without complication. By time of discharge, she was tolerating a regular diet and ambulating at baseline with her rolling walker. The pain was well controlled with minimal analgesics that were not narcotic based. Medications on admission included Aspirin 325 mg p.o. daily, Plavix 75 mg p.o. daily, Cardizem 60 mg p.o. t.i.d., Lipitor 80 mg daily, Atrovent 2 puffs four times a day, Albuterol 2 puffs b.i.d., Renagel 806 mg p.o. every meal, Allopurinol 100 mg p.o. daily, Zaroxylyn 2.5 mg p.o. daily p.r.n. overload, Lantus 10 units subcutaneous nightly, Regular insulin sliding scale, Valium 5 mg p.o. b.i.d. p.r.n., Isordil 40 mg p.o. t.i.d., Hydralazine 20 mg p.o. t.i.d., Lopressor 75 mg p.o. t.i.d., Zantac 150 mg p.o. b.i.d., Aciphex 20 mg p.o. daily, Neurontin 300 mg p.o. post-dialysis, Metamucil, Nitroglycerine p.r.n., Procrit 40,000 units subcutaneously every week, Lilly insulin pen, unknown dosage 20 units every morning and 10 units every evening, Loperamide 2 tabs p.o. four times a day, Ambien 10 mg p.o. nightly p.r.n., Tylenol 325 mg p.o. every four hours p.r.n. pain, Albuterol inhaler 2 puffs b.i.d., Calcitriol 1.5 mcg p.o. every Monday and every Friday, Darbepoetin alfa 100 mcg subcutaneous every week, Ferrous sulfate 325 mg p.o. t.i.d., Prozac 40 mg p.o. daily, Motrin 400 mg p.o. every eight hours p.r.n. pain, Insulin regular sliding scale, and Sevelamer 800 mg p.o. t.i.d. Discharge instructions included touchdown weightbearing on the left heel, legs are to be elevated as much as possible while sitting or lying down, all home medications were to be resumed except for Lopressor, VNA was ordered to assist with wound care including Betadine paint to incisions daily, showering only, no bathing or immersion in water for prolonged periods of time, and follow-up visits with Dr. Amorose in one to two weeks and Dr. Morici primary care physician in one week.
|
Has the patient had tylenol in the past
|
{
"answer_end": [
2766
],
"answer_start": [
2717
],
"text": [
"Tylenol 325 mg p.o. every four hours p.r.n. pain,"
]
}
|
This 66 year old African American woman presented with an acute stroke and was brought in by her daughter. She had a CTA done which showed questionable luminal narrowing of the distal left middle cerebral artery, and was given a 9 mg bolus dose of intravenous TPA over two minutes and 81 mg given over the following hour. Her past medical history includes diet controlled diabetes, obesity, hypertension, ulcerative colitis, a prior MI in 1988, and a possible old stroke. Her medications are aspirin 325 mg and Asacol, although she was unsure of the dose. Blood pressure was 138/76, heart rate was 80 and paced, and she had a right field compromise difficulty crossing the midline with a right upper motor neuron seventh weakness and decreased power on the right side of the face. After the TPA, her language returned completely to normal. Protocol for the stroke was followed, including blood pressure monitoring, nasal oxygen, and no antiplatelet therapy for 24 hours. Head of bed was raised to 30 degrees and a head CT was repeated the following morning. An echocardiogram showed normal ventricular size and systolic function, trace aortic insufficiency, trace mitral regurgitation, and persistent atrial flutter. She was coumadinized and discharged without rehabilitation on 0/21/99 on Coumadin with a plan for complete cardioversion within one month.
|
When was the last time that the patient received oxygen
|
{
"answer_end": [
1007
],
"answer_start": [
949
],
"text": [
"therapy for 24 hours. Head of bed was raised to 30 degrees"
]
}
|
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.
|
Did the patient ever take any medication for her ++seizure disorder in the past
|
{
"answer_end": [
1551
],
"answer_start": [
1512
],
"text": [
"Keppra (Levetiracetam) 1,000 mg PO BID,"
]
}
|
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.
|
Previous keflex
|
{
"answer_end": [
817
],
"answer_start": [
781
],
"text": [
"Keflex 250 mg p.o. q.i.d. x12 doses."
]
}
|
Jonas G Fosselman was admitted from office on 4/1/01 for infected L THR. Aspiration demonstrated purulent material, and he was started on Ceftriaxone per ID consult recs. with MIC to both PCN and Ceftriaxone pending. MRI of pelvis completed 10/10/01 as pre-op eval. TU Cardiology was consulted for pre-op clearance given extensive H/O cardiomyopathy and unstentable CAD per last cardiac cath 8/7. On further d/w PT, he was adament about being allowed to be D/C home on Abx for August holiday. Given that his clinical picture was much improved on antibiotics, both Dr Salkeld and ID MD agreed to this on provision that he return immediately for any evidence of progressing infection. His R hip pain and exam were much improved by time of discharge. Will plan for IV lon line to be placed prior to D/C for home dosing of QD Ceftriaxone. ID to be re-consulted on admission post-op 10/5 for re-eval of abx choice. By that time it is presumed that the MIC for PCN/CTX will be available for ascertation of proper long-term Abx care. Discharge medications included TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN headache, VENTOLIN (ALBUTEROL INHALER) 1-2 PUFF INH QID PRN sob/wheeze, ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, ATENOLOL 25 MG PO QD Food/Drug Interaction Instruction Take consistently with meals or on empty stomach., CEFTRIAXONE 2,000 MG IV QD (Number of Doses Required (approximate): 2), COLACE (DOCUSATE SODIUM) 100 MG PO BID, ENALAPRIL (ENALAPRIL MALEATE) 2.5 MG PO QD, PERCOCET 1-2 TAB PO Q4H PRN pain, ZOCOR (SIMVASTATIN) 5 MG PO QHS Food/Drug Interaction Instruction Avoid grapefruit unless MD instructs otherwise., ISOSORBIDE MONONITRATE 30 MG PO QD Food/Drug Interaction Instruction Give on an empty stomach (give 1hr before or 2hr after food) (Number of Doses Required (approximate): 15), and NEXIUM (ESOMEPRAZOLE) 20 MG PO QD. Discharge instructions included IV Abx, D/C home with services for QD CTX dosing, IV long line placement, re-admission for removal of infected hardware and spacer placement 9/24/01, and IV Ceftriaxone per VNA 2 Gr IV QD for 10/9/01. Return immediately for increasing temps/shaking chills/pain at R hip. Discharge condition was stable. Follow-up appointment(s) included Dr Lobato 9/24/01, VH pre-admit for OR I&D/removal hardware. 9/24/01 scheduled, and Return to Work after eval by Dr Ashurst. Allergy: Shellfish, Morph
|
What is her current dose of enalapril ( enalapril maleate )
|
{
"answer_end": [
1478
],
"answer_start": [
1435
],
"text": [
"ENALAPRIL (ENALAPRIL MALEATE) 2.5 MG PO QD,"
]
}
|
The patient is a 50 year old man with unstable angina who was referred to the Rhalca Medical Center for cardiac catheterization and coronary artery bypass grafting. He had a four-year history of coronary artery disease and described episodes of chest pain occurring approximately q. two months as well as evidence of shortness of breath due to chronic obstructive pulmonary disease. On admission, he was taking NTG on a twice daily basis for exertional angina and was given intravenous NTG, heparin, and Diltiazem by an EMT. His cardiac risk factors included an 80-pack year smoking history, family history of heart disease, hypercholesterolemia, and non-insulin-dependent diabetes mellitus. His past medical history was notable for interstitial lung disease, hyperlipidemia, GERD, chronic bronchitis, and obstructive sleep apnea. Medications on admission included Cardizem 120mg p.o.b.i.d., Mevacor 20mg p.o.b.i.d., Pepcid 40mg p.o.q.d., Ventolin and Seldane taken on a prn basis. Allergies were NKDA. An ETT Thallium demonstrated reperfusion abnormalities in the inferior and anterior walls. He underwent cardiac catheterization demonstrating 80% distal stenosis of the left main as well as the origin of the LAD with additional occlusion of the midportion of the LAD and distal carotid, 80% stenosis of midportion of left circumflex and proximal occlusion of the right coronary. On the 26th of May, he received double coronary artery bypass graft including pedicle LIMA bypass to the LAD and LAD patch angioplasty with a single aortocoronary saphenous vein bypass graft to the obtuse marginal. He had a low-grade fever and leukocytosis up to 20,000 for which he was started on an empiric course of cefuroxime and clindamycin 300mg p.o.q.i.d. He was evaluated by the Dental Service and prescribed a course of penicillin for a possible periodontal abscess of tooth #32. He was encouraged to see his cardiologist for follow-up and return to Dr. Donnie Daidone office for completion of his antibiotics. Discharge medications included Aspirin 325mg q.d., Diltiazem 120mg p.o.t.i.d., Colace 100mg t.i.d., iron sulfate 300mg t.i.d., Lasix 80mg p.o.b.i.d., Mevacor 20mg p.o.b.i.d., MVI one p.o.q.d., Percocet one to two tabs. q. 4 prn, KCl 40mil/eq p.o.b.i.d., and ciprofloxacin 500mg p.o.b.i.d. X 10 days taken with clindamycin 300mg p.o.q.i.d.
|
What medicines have previously been tried for a low-grade fever
|
{
"answer_end": [
1711
],
"answer_start": [
1662
],
"text": [
"he was started on an empiric course of cefuroxime"
]
}
|
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.
|
Is the patient currently or have they ever taken lasix ( furosemide )
|
{
"answer_end": [
1024
],
"answer_start": [
990
],
"text": [
"Lasix (Furosemide) 40 mg PO Daily,"
]
}
|
This is a 66-year-old man with spinal sarcoidosis and secondary paraplegia who presented with altered mental status, hypoxemic respiratory failure, and hypotension. He became hypotensive with intubation despite using etomidate with Levophed, and was started on vancomycin, gentamicin, Flagyl, and stress dose steroids with 1 liter of IV fluid. His urine was found to have Proteus, resistant to Macrobid, and Klebsiella, resistant to ampicillin, so he was started on Levophed with a systolic blood pressure in the 130's on 7 to 10 of Levophed and Levofloxacin was continued at 500 mg per day for a total 10-day course on in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, to end on 10/16/2006 for a total course of 10 days. Urology replaced the suprapubic catheter and he was started on maintenance IV fluids until cleared to eat by Speech and Swallow. His home medications included Regular Insulin sliding scale a.c. and at bedtime, NPH 54 units in the morning and 68 units in the night, baclofen 10 mg t.i.d., amitriptyline 25 mg at bedtime, oxybutynin 5 mg t.i.d., gabapentin 300 mg t.i.d., iron sulfate 325 mg t.i.d., vitamin C 500 mg daily, magnesium 420 mg t.i.d., Coumadin 5 mg daily, ranitidine 150 mg b.i.d., and calcium 950 mg daily. He was given a head CT without contrast and a chest x-ray that showed no obvious infiltrate. His INR was found to be elevated and he had a suprapubic catheter obstruction with bilateral hydronephrosis and distended bladder. He was given Nexium and Coumadin for prophylaxis and was started on a low dose of captopril on 8/14/2006 for diabetes, and was started on 12.5 mg b.i.d. metoprolol on 0/14/2006 with good results. He was given NPH 20 b.i.d. through his hospitalization and Regular Insulin sliding scale. His creatinine came down to 1.2 and he was given the new beta-blocker and the ACE inhibitor as well as baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate 325 mg p.o. t.i.d., gabapentin 300 mg p.o. t.i.d., NPH human insulin 54 units in the morning, 68 units in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, magnesium oxide 420 mg p.o. t.i.d., metoprolol 12.5 mg p.o. b.i.d., oxybutynin 5 mg p.o. t.i.d., Panafil ointment t.i.d., and ranitidine 500 mg p.o. b.i.d. He was admitted with severe sepsis due to UTI, suprapubic catheter/ostomy for 12 years, diabetes type II, right DVT, on Coumadin, status post chronic UTI, and CPAP at night for pneumonia with ceftazidime, levofloxacin, and vancomycin. His sugars were controlled with no complications and was able to maintain blood pressures in the 130's. His creatinine was initially 2.7, and after receiving IV fluids, it came down to 1.2. He likely had acute renal failure secondary to postrenal obstructive etiology. His INR was found to be therapeutic and he had half of his home Coumadin dose while he was on levofloxacin, so he was given half of dose and his INRs came down to a nadir of 1.7. At discharge, his hematocrit was 27.2, down from 29, which was closed to his baseline of 34, and his INR was 2.1. He was placed on maintenance IV fluids until cleared to eat by Speech and Swallow, and was given amitriptyline 25 mg p.o. at bedtime, vitamin C 500 mg p.o. daily, baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate
|
Is the patient currently or have they ever taken gentamicin
|
{
"answer_end": [
292
],
"answer_start": [
246
],
"text": [
"was started on vancomycin, gentamicin, Flagyl,"
]
}
|
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 oxycodone
|
{
"answer_end": [
660
],
"answer_start": [
572
],
"text": [
"magnesium gluconate sliding scale p.o. daily, oxycodone 5-10 mg p.o. q. 4h. p.r.n. pain,"
]
}
|
Rayford Turturo, a patient with Congestive Heart Failure, was admitted on 9/6/2004 and discharged on 5/22/2004. During his stay, he was placed on ACETYLSALICYLIC ACID 325 MG PO QD, ALLOPURINOL 100 MG PO QD, DIGOXIN 0.125 MG PO QD, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, TOPROL XL (METOPROLOL (SUST. REL.)) 50 MG PO QD, NEURONTIN (GABAPENTIN) 200 MG PO QD, COZAAR (LOSARTAN) 100 MG PO QD HOLD IF: SBP<100, CELEXA (CITALOPRAM) 20 MG PO QD, LANTUS (INSULIN GLARGINE) 50 UNITS SC QHS, WARFARIN SODIUM 3 MG PO QPM, LIPITOR (ATORVASTATIN) 10 MG PO QD, PRILOSEC (OMEPRAZOLE) 20 MG PO QD, TORSEMIDE 100 MG PO QAM, and TORSEMIDE 50 MG PO QPM. Override notices were added on 1/16/04 for WARFARIN SODIUM PO (ref #94959833), LEVOXYL PO (ref #70031810), and SERIOUS INTERACTIONS with ASPIRIN, LEVOTHYROXINE SODIUM, ALLOPURINOL, and WARFARIN. The patient was also instructed to measure weight daily, follow a fluid restriction of 2 liters, and a House/Low Chol/Low Sat. Fat, House/ADA 1800 cals/dy, and 2 gram Sodium diet. He was encouraged to walk as tolerated, and given follow-up appointments with Dr. Wilfinger (PCP), Corey Ortmeyer (CHF Clinic/Laxo Hospital), and Salvatore Angeli (Pacer/ICD Clinic). The patient also had an EP service place a VVI/R ICD device without complications, and was initially treated with intravenous Lasix until her respiratory status improved. During his stay, his electrolytes and magnesium were monitored and replenished, his coumadin dose decreased while being treated with levofloxacin, and he was instructed to keep appointments, have his INR checked, weight himself daily, follow written EP discharge instructions, and resume regular insulin dose when he resumes his outpatient eating habits.
|
has the patient used cozaar ( losartan ) in the past
|
{
"answer_end": [
410
],
"answer_start": [
362
],
"text": [
"COZAAR (LOSARTAN) 100 MG PO QD HOLD IF: SBP<100,"
]
}
|
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.
|
What is the patient's current dose does the patient take of her cozaar
|
{
"answer_end": [
978
],
"answer_start": [
926
],
"text": [
"Cozaar 25 mg p.o. daily, Remeron 7.5 mg p.o. q.h.s.,"
]
}
|
Ms. Veltin is a 72 year old woman with a PAST MEDICAL HISTORY significant for coronary artery disease, diabetes, and hypertension. On admission, her CURRENT MEDICATIONS included Atenolol 50 b.i.d., hydrochlorothiazide 25 q.d., Lisinopril 40 q.d., simvastatin 10 q.d., metformin 500 q.d., and NPH 43 q.a.m. and 24 q.p.m., while her PAST MEDICAL HISTORY was significant for diabetes for which she took insulin and checked her sugars at home which ran 170 range to 200 range. During admission, she was maintained on metformin, her blood pressure was controlled with Lisinopril at 40 milligrams, she was given nifedipine extended release 120 q.d., and her sugars at home on her regimen of 43 q.a.m. and 24 q.p.m. were in control. She was also maintained on her aspirin and simvastatin, and given Lasix 20 q.d. times seven days and four liters through admission with Lasix at 40 intravenously. Her cardiovascular evaluation showed three vessel disease, diastolic dysfunction, and pulmonary artery systolic pressure of 36 plus RA, but no wall motion abnormalities. Her blood pressure regimen was advanced with the addition of Atenolol 50 b.i.d. and titration up to 120 milligrams q.d. of nifedipine extended release. For congestive heart failure, she diuresed approximately four liters through admission with Lasix at 40 intravenously and would be discharged on a seven day course of Lasix at 20 p.o. q.d. Pulmonary evaluation showed hypoxia on admission to 85% on room air, D-dymer greater than 1000, V/Q scan low probability, negative lower extremity noninvasives, chest CT without interstitial lung disease, and pulmonary function tests consistent with restrictive picture. Endocrine evaluation revealed that she was maintained on metformin during admission and also on half of her dose of NPH given her decreased p.o. intake. She took insulin and checked her sugars at home, which were 170 to 200, and she was discharged on her normal regimen of 43 q.a.m. and 24 q.p.m. of NPH. Discharge medications included Atenolol 50 b.i.d., hydrochlorothiazide 25 q.d., Lisinopril 40 q.d., nifedipine extended release 120 q.d., metformin 500 q.d., NPH 43 q.a.m. and 24 q.p.m., simvastatin 10 q.d., aspirin 325 q.d., and Lasix 20 milligrams p.o. q.d. times seven days. She was discharged in stable condition on March, 2000 and will follow up with Dr. Nakajima, her primary care doctor, and Dr. Klang, her cardiologist.
|
What medicines have previously been tried for diabetes
|
{
"answer_end": [
1872
],
"answer_start": [
1824
],
"text": [
"She took insulin and checked her sugars at home,"
]
}
|
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.
|
How much amiodarone does the patient take per day
|
{
"answer_end": [
973
],
"answer_start": [
922
],
"text": [
"the patient was prescribed AMIODARONE 200 MG PO QD,"
]
}
|
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 prednisone prescriptions
|
{
"answer_end": [
465
],
"answer_start": [
428
],
"text": [
"then prednisone 60 milligrams orally,"
]
}
|
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.
|
Has the patient had previous imdur
|
{
"answer_end": [
2036
],
"answer_start": [
1912
],
"text": [
"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."
]
}
|
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 been on plavix ( clopidogrel )
|
{
"answer_end": [
819
],
"answer_start": [
783
],
"text": [
"PLAVIX (CLOPIDOGREL) 75 MG PO DAILY,"
]
}
|
The patient is a 70-year-old woman with a history of Congestive Heart Failure due to diastolic dysfunction, Crohn's colitis, right breast carcinoma, diabetes mellitus, obstructive sleep apnea, gastroesophageal reflux disease, hypercholesterolemia, and osteoarthritis. She was admitted with volume overload for diuresis, having developed fluid retention with gradual worsening, shortness of breath and lower extremity edema. During the hospitalization, she was started on IV Lasix along with Zaroxolyn and oral torsemide, and heparin while starting anticoagulation with Coumadin. The patient was also treated for a urinary tract infection with IV levofloxacin, which was subsequently changed to p.o. cefixime which she completed a five-day course of. Her diabetes mellitus was maintained with insulin subcutaneous injections. Upon discharge she was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o. q.h.s., Vitamin E 400 U p.o. q.d., Coumadin 5 mg p.o. q.h.s., multivitamins 1 tablet p.o. q.d., Zocor 40 mg p.o. q.h.s., insulin 70/30 35 U subcu. q.a.m., Neurontin 300 mg p.o. q.a.m., 100 mg p.o. at 2:00 p.m., 300 mg p.o. q.h.s., Serevent inhaled 1 puff b.i.d., torsemide 100 p.o. q.a.m., Trusopt 1 drop b.i.d., Flonase nasal 1-2 sprays b.i.d., Xalatan 1 drop ocular q.h.s., Pulmicort inhaled 1 puff b.i.d., Celebrex 100 mg p.o. b.i.d., Avandia 4 mg p.o. q.d., Hyzaar 12.5 mg/50 mg 1 tablet p.o. q.d., Nexium 20 mg p.o. q.d., potassium chloride 20 mEq p.o. b.i.d., Suprax 400 mg p.o. q.d. x4 days, albuterol inhaled 2 puffs q.i.d. p.r.n. wheezing, miconazole 2% powder applied topically on skin b.i.d. for itching. During the hospitalization, she responded with a brisk diuresis over the course of the admission, resulting in a 5.2 kg weight decline and estimated 15 liters of fluid removed. Atrial fibrillation was noted and anticoagulated with IV heparin and Coumadin, reaching a therapeutic INR of 2.5 within 4-5 days. Urinalysis showed evidence of an urinary tract infection with 20-30 white blood cells and was leukocyte esterase positive, and a urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin and the patient had been started on IV levofloxacin and subsequently changed to p.o. cefixime. The patient completed a five-day course of p.o. cefixime while in the hospital and was discharged on that medicine to complete a 10-day course. Of note, the initial symptoms the patient presented with indicated a bacterial urinary tract infection. Subsequent urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin. The patient has a long history of diabetes requiring insulin treatment and was followed by an endocrinologist at the Kingnix Lowemar W.kell Medical Center, and her blood sugars were maintained with insulin subcutaneous injections. Upon discharge, the patient was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o.
|
Has a patient had miconazole 2% powder
|
{
"answer_end": [
1796
],
"answer_start": [
1730
],
"text": [
"miconazole 2% powder applied topically on skin b.i.d. for itching."
]
}
|
The patient is a 50 year old man with unstable angina who was referred to the Rhalca Medical Center for cardiac catheterization and coronary artery bypass grafting. He had a four-year history of coronary artery disease and described episodes of chest pain occurring approximately q. two months as well as evidence of shortness of breath due to chronic obstructive pulmonary disease. On admission, he was taking NTG on a twice daily basis for exertional angina and was given intravenous NTG, heparin, and Diltiazem by an EMT. His cardiac risk factors included an 80-pack year smoking history, family history of heart disease, hypercholesterolemia, and non-insulin-dependent diabetes mellitus. His past medical history was notable for interstitial lung disease, hyperlipidemia, GERD, chronic bronchitis, and obstructive sleep apnea. Medications on admission included Cardizem 120mg p.o.b.i.d., Mevacor 20mg p.o.b.i.d., Pepcid 40mg p.o.q.d., Ventolin and Seldane taken on a prn basis. Allergies were NKDA. An ETT Thallium demonstrated reperfusion abnormalities in the inferior and anterior walls. He underwent cardiac catheterization demonstrating 80% distal stenosis of the left main as well as the origin of the LAD with additional occlusion of the midportion of the LAD and distal carotid, 80% stenosis of midportion of left circumflex and proximal occlusion of the right coronary. On the 26th of May, he received double coronary artery bypass graft including pedicle LIMA bypass to the LAD and LAD patch angioplasty with a single aortocoronary saphenous vein bypass graft to the obtuse marginal. He had a low-grade fever and leukocytosis up to 20,000 for which he was started on an empiric course of cefuroxime and clindamycin 300mg p.o.q.i.d. He was evaluated by the Dental Service and prescribed a course of penicillin for a possible periodontal abscess of tooth #32. He was encouraged to see his cardiologist for follow-up and return to Dr. Donnie Daidone office for completion of his antibiotics. Discharge medications included Aspirin 325mg q.d., Diltiazem 120mg p.o.t.i.d., Colace 100mg t.i.d., iron sulfate 300mg t.i.d., Lasix 80mg p.o.b.i.d., Mevacor 20mg p.o.b.i.d., MVI one p.o.q.d., Percocet one to two tabs. q. 4 prn, KCl 40mil/eq p.o.b.i.d., and ciprofloxacin 500mg p.o.b.i.d. X 10 days taken with clindamycin 300mg p.o.q.i.d.
|
Has the pt. ever been on antibiotics. before
|
{
"answer_end": [
2001
],
"answer_start": [
1941
],
"text": [
"Dr. Donnie Daidone office for completion of his antibiotics."
]
}
|
The patient is a 55-year-old man with a history of smoking and a left sided hemisphere stroke, who underwent a right-sided femoral to popliteal bypass graft in February of 1986 for severe claudication. He was readmitted in March of 1988 for increase in pain in the calves and again in February of 1988 for graft stenosis and underwent angioplasty. He presented in July of 1989 with progressive pain and three months of rest pain in the right calf and claudication of the left calf. He also has a history of chest pain, esophageal reflux, anxiety disorder, chronic low back pain, peptic ulcer disease, herniated nucleus pulposus, and cholecystectomy. On admission, medications included Pepcid, 40 mg at h.s.; trazodone, 15 mg at h.s.; Carafate, one q.i.d.; nitroglycerin p.r.n. and Flexeril, 10 mg q eight hours p.r.n. back pain. Allergies include QUESTION OF PENICILLIN AND QUESTION OF DYE. He was taken to the Operating Room in March of 1990 for a right reverse saphenous bypass graft from the in situ vein graft to below the knee popliteal artery, and discharged with excellent palpable pulses.
|
Has the patient taken medication for back pain
|
{
"answer_end": [
828
],
"answer_start": [
756
],
"text": [
"nitroglycerin p.r.n. and Flexeril, 10 mg q eight hours p.r.n. back pain."
]
}
|
A 59 year-old woman with metastatic breast cancer and a history of pulmonary embolism presented with symptoms of fatigue, lethargy, tachycardia and fever. CXR showed LLL opacity, LUL opacity and hilar fullness on the right with prominent bronchi (?cuffing) and vertebral fractures. She was admitted with bacteremia on 7/0/2006 and treated with whole brain radiotherapy in March 2006 and with weekly Taxol. Restaging studies showed stable visceral disease but progression of bony metastatic disease, so in January 2006, she initiated a second-line Navelbine therapy. At the ER, she was administered 1UPRBC, 1L NS, Levofloxacin 500 mg IV, and placed CVP~20. Her blood pressure systolic initially 120s but decreased to 90s (MAPS>70), and norepinephrine was administered. She was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q6H PRN Pain, Temperature greater than:101, Other:transfusion premedication, ALBUTEROL NEBULIZER 2.5 MG INH Q4H PRN Wheezing, TESSALON PERLES (BENZONATATE) 100 MG PO TID PRN Other:congestion, BENADRYL (DIPHENHYDRAMINE) 12.5 MG PO x1 PRN Other:pre-transfusion, COLACE (DOCUSATE SODIUM) 100 MG PO BID PRN Constipation, ENOXAPARIN 40 MG SC DAILY, NEXIUM (ESOMEPRAZOLE) 40 MG PO DAILY, FLOVENT HFA (FLUTICASONE PROPIONATE) 110 MCG INH BID, INSULIN ASPART Sliding Scale.
|
What medication has the patient take for blood pressure
|
{
"answer_end": [
767
],
"answer_start": [
735
],
"text": [
"norepinephrine was administered."
]
}
|
This 70-year-old woman with no known CAD, cardiac RF: HTN, DM, hyperchol., current tob., H/O PAF on no anticoag 2/2 distant h/o LGIB, a/w palpitations followed by 10 hrs of chest pain was admitted on 1/10/2001 and treated medically with lovenox/integrilin (refused cath) for NSTE MI. In the ED, pain was relieved with NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 and SLNG, and 2" NTP. EKG with TWflattening v5-6 but no ST elevations, and CK160, TnI 0.3. During her stay, she was on heparin, integrelin for NSTE MI, ASA, BB, ACEI, statin, nexium, colace, and levofloxacin for UTI, and lovenox for DVT proph. Her blood pressure was titrated to 130-160 and HCTZ was added for better control because her HR was in the 50's, and a repeat echo was done to check for any changes in function. Upon discharge, she will be on ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, MICRONASE (GLYBURIDE) 5 MG PO QD, HCTZ (HYDROCHLOROTHIAZIDE) 25 MG PO QD, NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3, ZOCOR (SIMVASTATIN) 20 MG PO QHS, LEVOFLOXACIN 250 MG PO QD X 4 Days, ZESTRIL (LISINOPRIL) 20 MG PO QD, ATENOLOL 50 MG PO QD Food/Drug Interaction Instruction, PRILOSEC (OMEPRAZOLE) 20 MG PO QD, and POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL, POTENTIALLY SERIOUS INTERACTION: HYDROCHLOROTHIAZIDE & OMEPRAZOLE, and SLNG PRN. She was also instructed to take atenolol consistently with meals or on empty stomach and to avoid grapefruit unless MD instructs otherwise. Follow up appointments were scheduled with Dr. Truman Thro 1-2 wks, Dr. Stevie Gilani, cardiology, Mon, 1/2/02 1:00 pm, and Bock 0/12/02.
|
What medication did the patient take for rx. nste mi.
|
{
"answer_end": [
294
],
"answer_start": [
237
],
"text": [
"lovenox/integrilin (refused cath) for NSTE MI. In the ED,"
]
}
|
The patient is a 42-year-old white man who presented with complaints of fever to 103 and chills, a productive cough, and groin pain lasting three days. At age three, he was diagnosed with Wilms' tumor on the left, which was resected and subsequently treated with wide field radiation, after which he developed radiation-induced tyroid cancer, at which time he underwent subtotal thyroidectomy. In May of 1997, he underwent living related donor renal transplantation for chronic renal failure, however, the postoperative course was complicated by cytomegalovirus infection, presenting with diarrhea and requiring hospitalization in February 1997. He was treated with ganciclovir and subsequently maintained on Cytovene. He had one fever spike on hospital day one and Levaquin was initiated on hospital day three along with intravenous antibiotics, after which he was switched to oral antibiotics, including Levaquin and Augmentin. His blood pressures were stabilized at 130/80 with the initiation of a second antihypertensive medication, Nifedipine XL, for which he was maintained for two days at 30 mg. Hematologic studies revealed that he was continued on anticoagulation for atrial fibrillation at 4 mg daily with an INR remaining in his goal parameters. His creatinine level was 2.5 and his cyclosporine level was 303 on admission, reaching a maximum of 19.8 on hospital day four. Endocrine studies revealed a TSH of 0.02, a T4 of 6.0, and a THPR of 1.47. The patient's pulmonary status improved on oxygen and on intravenous antibiotics, and all studies for atypical organisms were negative. Prior to discharge, the patient's pulmonary status had returned to baseline and had entirely resolved. The patient was discharged on Augmentin 250/125 mg t.i.d., Levaquin 250 mg q.d., CellCept 500 mg b.i.d., Neoral 100 mg b.i.d., Prednisone 10 mg q.d., Synthroid 125 mcg q.d., INP insulin 14 units subcu q.a.m., regular insulin subcu p.r.n., Axid 150 mg q.d., nadolol 80 mg q.d., nifedipine XL 30 mg q.d., Coumadin 4 mg q.d., and iron sulfate 300 mg q.d., and follow-up was scheduled for bone densitometry in July 1998, with Dr. Clinton Ardizone in January 1998, and with Dr. Win in March.
|
How much inp insulin does the patient take per day
|
{
"answer_end": [
1954
],
"answer_start": [
1872
],
"text": [
"INP insulin 14 units subcu q.a.m., regular insulin subcu p.r.n., Axid 150 mg q.d.,"
]
}
|
The patient is a 64 year-old gentleman with a history of chest discomfort, dyspnea on exertion and fatigue who was scheduled for a coronary artery bypass grafting. He had cardiac catheterization at Ryhoagberg Spisus Community Hospital on November, 1999 which demonstrated a 30% tapering lesion of the left main coronary artery, 70% proximal lesion of the left anterior descending coronary artery, 80% lesion distal to D1, 100% occlusion of his left circumflex and a 100% occlusion of his right coronary artery. On March, 1999, he underwent coronary artery bypass grafting times three with a left internal mammary artery to the left anterior coronary artery, saphenous vein graft to the aorta and a saphenous vein graft from the obtuse marginal to the aorta. His intraoperative course was uncomplicated and he was weaned to extubation and he was treated with stress steroids to prevent steroid withdrawal. He was taken back to the operating room for bleeding and was reintubated and was returned in good and stable condition to the intensive care unit on renal Dopamine. He was again extubated and was seen in consultation by the Gastrointestinal Service for a question of gastrointestinal bleed since there was a clot seen on the transesophageal echocardiogram probe at its withdrawal from his first surgery. The Gastrointestinal Service saw any evidence of any upper gastrointestinal bleed and he was maintained on H2 blockers. He was sent to the step down unit on routine postoperative day number two and his Captopril was increased for afterload reduction. He continued to improve and continued to have care for his respiratory situation with continued diuresis and nebulizer treatments and ambulation. He was discharged to the care of Dr. Lou Pineault at Potmend Rehabilitation Hospital, Moorlberl Street with medications including Prednisone 5 mg p.o. twice a day, Enteric coated aspirin 325 mg p.o. q. day, Zantac 150 mg p.o. twice a day, Niferex 150 mg p.o. twice a day, Atrovent nebulizer 0.5 mg four times a day, Timolol eye drops 0.5% one drop in both eyes twice a day, Atenolol 25 mg p.o. twice a day, Captopril 12.5 mg p.o. three times a day, Lasix 40 mg p.o. q. day, Potassium SR 20 mEq p.o. q. day, Simvastatin 40 mg p.o. q. day, and Ibuprofen 200-800 mg as needed for pain q.4-6h.
|
Why is the patient taking ibuprofen
|
{
"answer_end": [
2295
],
"answer_start": [
2248
],
"text": [
"Ibuprofen 200-800 mg as needed for pain q.4-6h."
]
}
|
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
|
Is the patient currently or have they ever taken acetylsalicylic acid
|
{
"answer_end": [
188
],
"answer_start": [
151
],
"text": [
"ACETYLSALICYLIC ACID 325 MG PO DAILY,"
]
}
|
76 year-old male with significant cardiac history, including NSTEMI and asystole arrest, presented with weakness, dizziness, and chest pain for 3 days, currently chest pain-free. EKG on admission showed subtle changes with <1 mm ST depression in lateral leads. Patient was given Acetylsalicylic Acid 325 mg PO QD, Ativan 0.5 mg x 1, Magnesium Chloride 500 mg x 1, Atenolol 25 mg PO QD, Atorvastatin 80 mg PO QD, Docusate Sodium 100 mg PO BID, Losartan 50 mg PO QD, Amlodipine 10 mg PO QD, Pantoprazole 40 mg PO QD, Lipitor (Atorvastatin) 80 mg PO daily, Colace (Docusate Sodium) 100 mg PO BID, Potassium Chloride IV, Potassium Chloride Immediate Release PO, Magnesium Gluconate (Magnesium Gluconate) 400 mg PO daily, Protonix (Pantoprazole) 40 mg PO daily, ASA 325 mg x 1, and MIBI ordered. Metformin was held and DM protocol was instituted while in house. Patient was at risk for cardiac event and was treated with BB and titrated as tolerated, with Tele monitoring. Nutrition consult was ordered due to recent decrease in appetite and FTT picture. SW was consulted and patient was discussed at length for services at home when discharged. Patient left AMA despite lengthy discussion about his health and risk for MI/death. Number of Doses Required (approximate): 3 for MG GLUCONATE (MAGNESIUM GLUCONATE) and 2 for TERAZOSIN HCL 1 MG PO DAILY. Home meds included ASA 325 mg daily, lipitor 80 mg daily, amlodipine 5 mg daily, protonix 40 mg daily, losartan 50 mg daily, and terazosin 1 mg daily. An override was added on 7/10/07 by KETCHAM, JAKE WALDO, M.D., PH.D. on order for KCL IV (ref # 687673059) with POTENTIALLY SERIOUS INTERACTION: LOSARTAN POTASSIUM & POTASSIUM CHLORIDE Reason for override: md aware, and on 11/8/07 by DERNIER, AUGUSTINE A., P.A.-C. on order for KCL IMMEDIATE RELEASE PO (ref # 856712835) with the same POTENTIALLY SERIOUS INTERACTION. Patient was instructed to resume regular exercise and to avoid grapefruit unless instructed otherwise. He was also given a diet of House/2gm Na/Carbohydrate Controlled/Low saturated fat low cholesterol.
|
Previous protonix ( pantoprazole )
|
{
"answer_end": [
756
],
"answer_start": [
717
],
"text": [
"Protonix (Pantoprazole) 40 mg PO daily,"
]
}
|
This 79 year old male was admitted to OCMC on 8/9/05 with a 1 cm left renal stone that had caused left hip and flank pain with nausea and vomiting. His cardiologist, Dr. Cannizzo, was consulted and Coumadin was held for the operation. It was originally planned to reverse INR with FFP, but the patient felt throat tightness after 5 minutes of FFP transfusion and FFP was stopped. He then underwent laser lithotripsy and stent placement on 8/0/50 and tolerated the procedure well. Post-op, he had frequent PVC but cardiac enzyme was negative. On POD2, he tolerated regular diet and was ready to be discharged home with Bactrim and low dose Coumadin. He was also noticed to have an enlarged prostate and needs to follow up with Dr. Domebo for further management. The discharge medications included CAPSAICIN 0.025 % TP BID (apply to legs), LASIX (FUROSEMIDE) 40 MG PO QD, MICRONASE (GLYBURIDE) 2.5 MG PO QD, L-THYROXINE (LEVOTHYROXINE SODIUM) 50 MCG PO QD, POTENTIALLY SERIOUS INTERACTION: DIGOXIN & LEVOTHYROXINE SODIUM (Reason for override: home), PYRIDIUM (PHENAZOPYRIDINE HCL) 100 MG PO TID (PRN Other:bladder/stent pain), PROBENECID 1,500 MG PO BID, COZAAR (LOSARTAN) 75 MG PO QD (HOLD IF: sbp <100), FLOMAX (TAMSULOSIN) 0.4 MG PO QD, NEXIUM (ESOMEPRAZOLE) 40 MG PO QD, BACTRIM DS (TRIMETHOPRIM/SULFAMETHOXAZOLE DOU...) 1 TAB PO Q24H, and Number of Doses Required (approximate): 5. He was advised to follow up with his PCP for INR check and Coumadin dose adjustment, take Coumadin at 3 mg for tonight and tomorrow night, resume his regular Coumadin dose schedule, call his Coumadin clinic on Monday for follow up regarding to blood check and Coumadin dosage adjustment, no lifting more than 10 lbs., no driving while on narcotics, and call Urology office 865-655-3733 for appointment and questions.
|
What medications has the patient been prescribed for inr
|
{
"answer_end": [
379
],
"answer_start": [
235
],
"text": [
"It was originally planned to reverse INR with FFP, but the patient felt throat tightness after 5 minutes of FFP transfusion and FFP was stopped."
]
}
|
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.
|
Did the patient ever take any medication for her anxiety. in the past
|
{
"answer_end": [
2302
],
"answer_start": [
2219
],
"text": [
"She was also given a little bit of Ativan while in-house to help with her agitation"
]
}
|
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.
|
What is her current dose of levofloxacin
|
{
"answer_end": [
540
],
"answer_start": [
504
],
"text": [
"LEVOFLOXACIN 250 MG PO QD X 1 doses,"
]
}
|
A 63-year-old male with a history of CAD (Coronary Artery Disease) and two prior MIs (Myocardial Infarctions) presented with atypical chest pain and was admitted with a 100% LCx lesion unable to be stented. He was on medical management with Atenolol, Ace-I, and Aspirin (ECASA) 325 mg PO QD until the day of admission when he woke up with left arm and shoulder pain reminiscent of an old MI. Attempts at relief with nitroglycerin 1/150 (0.4 mg) 1 TAB SL q5min x 3 were unsuccessful, so he called EMS. In the ED, EKG and TnI were flat and he was started on heparin for unstable angina. Serial CKs were flat and he had no recurrence of chest pain in the hospital. He is to follow-up with Dr. Tollner with the possibility of ETT-MIBI as an outpatient. Discharge medications included Wellbutrin (Bupropion HCl) 200 mg PO QD, Colace (Docusate Sodium) 100 mg PO BID, FESO4 (Ferrous Sulfate) 300 mg PO BID, and Zocor (Simvastatin) 40 mg PO QHS. Additional instructions included taking the increased dose of Zestril 10 mg PO QD, making a follow-up appointment with Dr. Cyrus in the next week or two, and returning to the hospital if experiencing an increase in chest pain or shortness of breath at rest. The discharge condition was stable and he was discharged home with instructions to do an ETT-MIBI as an outpatient, check K and Cr within 1-2 weeks, and get a referral to GI and EGD as an outpatient.
|
What is the dosage of feso4 ( ferrous sulfate )
|
{
"answer_end": [
899
],
"answer_start": [
861
],
"text": [
"FESO4 (Ferrous Sulfate) 300 mg PO BID,"
]
}
|
Reginald Burgos, a 76-year-old male with MMP, was admitted with chronic diarrhea of unclear etiology, likely malabsorption. He was put on a lactose free diet, NPO, and started on Imodium as diarrhea was not thought to be due to an acute infectious process. Lab tests were WNL. Medications prescribed include Acetylsalicylic Acid 81 mg PO QD, Atenolol 50 mg PO QD (hold if sbp <100, hr <60), Enalapril Maleate 20 mg PO BID (hold if sbp <100), Potassium Chloride on order for KCL Immediate Release PO (ref #61864355), Nifedipine (Extended Release) (Nifedipine (SL...)) 60 mg PO QD (hold if sbp <100, hr <60), Lipitor (Atorvastatin) 20 mg PO QHS, Zantac (Ranitidine HCl) 150 mg PO BID, Metformin 500 mg PO BID, Imodium (Loperamide HCl) 2-4 mg PO Q6H PRN Diarrhea, and Protonix (Pantoprazole) 40 mg PO QD. Follow up appointments were scheduled with Dr. Detillier (GI) 3/5 2pm, colonoscopy 6/18 9:30am, and Dr. Gaboriault (PCP) 0/8 1:30pm. He was treated with Cipro/Flagyl, but diarrhea persisted after the course was completed and he was given Protonix. He was also instructed to take Phosphate Soda the night before the colonoscopy, and to call 522-750-9060 for more directions. Allergies include CLOPIDOGREL and Penicillins. Discharge condition is stable.
|
What is has been given for treatment of her diarrhea
|
{
"answer_end": [
760
],
"answer_start": [
708
],
"text": [
"Imodium (Loperamide HCl) 2-4 mg PO Q6H PRN Diarrhea,"
]
}
|
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 patient ever been on keflex
|
{
"answer_end": [
1759
],
"answer_start": [
1696
],
"text": [
"empirically tx with Keflex, changed empirically on HD4 to levo."
]
}
|
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.
|
Why is the patient on aspirin
|
{
"answer_end": [
252
],
"answer_start": [
169
],
"text": [
"She first developed arthralgias of various joints, which were treated with aspirin,"
]
}
|
This 63-year-old male was transferred from LMC with a positive stress test and a history of CABG LIMA-D1, V-OM1, V-OM2, V Y-graft to PDA and PLV. Upon admission, he was diagnosed with CAD and presented with exertional angina. A nuclear stress revealed inferior scar and small area of anterior ischemia, and he was then transferred to CTMC for a cath. His medications on transfer included Dilantin 300/300/250, Glyburide 10 BID, Metformin 850 TID, Toprol 100 Daily, ASA 325 Daily, Isordil 20 TID, Lasix 20 QOD, Lipitor 40 Daily, Neurontin, Celondin 300 TID, Digoxin 0.25 Daily, and Benazepril 10 Daily. His hospital course included CV: Cath LIMA-LAD, DM: holding Metformin and restarting Glyburide and RISS, Neuro: Cont Neurontin 300 TID, Dilantin 200/200/250, and Celondin, and he was switched to Plavix 75 Daily, Atorva to Simva in house, Benazepril to Lisinopril 10, and Digoxin 0.25. He was discharged with instructions to take all medications as prescribed, with a full code status and disposition of Home. Medications at discharge included DIGOXIN 0.25 MG PO DAILY, LASIX (FUROSEMIDE) 20 MG PO EVERY OTHER DAY, GLYBURIDE 10 MG PO BID, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, DILANTIN (PHENYTOIN) 200 MG QAM; 250 MG QPM PO BEDTIME, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 100 MG PO DAILY Food/Drug Interaction Instruction, NEURONTIN (GABAPENTIN) 300 MG PO TID, PLAVIX (CLOPIDOGREL) 75 MG PO DAILY, BENAZEPRIL 10 MG PO DAILY, GLUCOPHAGE (METFORMIN) 850 MG PO TID, and CELONTIN (METHSUXIMIDE) 300 MG PO TID.
|
What is her current dose of benazepril
|
{
"answer_end": [
1443
],
"answer_start": [
1417
],
"text": [
"BENAZEPRIL 10 MG PO DAILY,"
]
}
|
Vance Prunier, a 57 year old patient with diabetes mellitus, hypertension, hyperlipidemia, and known coronary artery disease, was admitted on 5/30/2001 with worsening exercise capacity. A cath today showed severe native TVD, patent LIMA to LAD, occluded SVG-OM, and radial graft to PDA 80% stenosis. PCI of radial graft lesion with Nir 2.5x15mm and S660 2.5x12mm stents resulting in 0% residual was done and Angioseal was applied to RFA. The patient was discharged on 6/17/2001 in a stable condition with medications EC ASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO QPM, Cipro (Ciprofloxacin) 250 MG PO BID, Insulin NPH Human 30 UNITS SC QAM, Insulin Regular (Human) 18 UNITS SC QAM, Levoxyl (Levothyroxine Sodium) 75 MCG PO QD, Lisinopril 20 MG PO QD, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL Q5 MIN X 3 PRN Chest Pain HOLD IF: SBP<[ ], Pravachol (Pravastatin) 20 MG PO QHS, Amlodipine 5 MG PO QD, Imdur (Isosorbide Mononit.( SR )) 60 MG PO QD, Wellbutrin SR (Bupropion Hcl SR) 150 MG PO BID, Clopidogrel 75 MG PO QD, and 16 hours Integrilin and 30 days Plavix. The patient was instructed to call for any further chest pain, groin pain, swelling or bleeding and was to return to work after an appointment with the local physician. Follow up appointments with Dr. Minear in 1-2 weeks and Dr. Givens were scheduled. The patient was discharged to home.
|
lisinopril
|
{
"answer_end": [
767
],
"answer_start": [
744
],
"text": [
"Lisinopril 20 MG PO QD,"
]
}
|
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 taken medication for pulmonary edema
|
{
"answer_end": [
500
],
"answer_start": [
428
],
"text": [
"some pulmonary edema, improving with Lasix 20 mg IV t.i.d. and diuresis,"
]
}
|
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.
|
Has the patient ever been on xylatan drops
|
{
"answer_end": [
385
],
"answer_start": [
325
],
"text": [
"Xalatan 1 drop OU q p.m., and Timoptic 0.5% 1 drop OS q day."
]
}
|
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 dosage of klor-con ( kcl slow release )
|
{
"answer_end": [
710
],
"answer_start": [
616
],
"text": [
"KLOR-CON (KCL SLOW RELEASE) 20 MEQ PO DAILY (each 20 mEq dose to be given with 4 oz of fluid),"
]
}
|
Lucien Lebel, an 889-75-18-3 patient, was admitted to the medical service on 3/26/2005 with a CHF flare and discharged on 6/4/2005 with a full code status and disposition of home with services. Medications prescribed upon discharge included ACETYLSALICYLIC ACID 81 MG PO QD, ATENOLOL 50 MG PO QAM Starting Today July, ENALAPRIL MALEATE 10 MG PO QD, LASIX (FUROSEMIDE) 80 MG PO QD Starting Today November, NPH INSULIN HUMAN (INSULIN NPH HUMAN) 60 UNITS SC QAM and QPM, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, PAXIL (PAROXETINE) 50 MG PO QD, SEROQUEL (QUETIAPINE) 800 MG PO QPM, DEPAKOTE ER (DIVALPROEX SODIUM ER) 1,000 MG PO QPM, LIPITOR (ATORVASTATIN) 60 MG PO QD, and POTENTIALLY SERIOUS INTERACTION: WARFARIN & ATORVASTATIN CALCIUM Reason for override: mda. The patient had a history of Afib, Type 2 DM on insulin, CAD, s/p MI 2000, and A fib/flutter, and was given 25 mg PO Lopressor x 2 in the ED which brought her HR down to 110s. The patient was also prescribed a diet of low cholesterol and saturated fat, ADA 1800 calories per day, 2 grams of sodium, and to measure weight daily, as well as to resume regular exercise, and follow-up appointments were scheduled with Dorsey Deases on 11/2 at 2:30 PM, Dr. Lavern Bringhurst on 2/2, and Dr. Lesley Bertling to draw INR's every 7 days. The patient was advised to follow up with Sol Kragt, the CHF nurse, maintain a careful low salt diet, not drink too many fluids, measure daily weights, be strict about taking insulin, and seek medical attention for any concerning symptoms, with a number of doses required of approximate 4.
|
Has the patient ever been on paxil ( paroxetine )
|
{
"answer_end": [
539
],
"answer_start": [
508
],
"text": [
"PAXIL (PAROXETINE) 50 MG PO QD,"
]
}
|
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.
|
How often does the patient take nephrocaps
|
{
"answer_end": [
1612
],
"answer_start": [
1582
],
"text": [
"Nephrocaps one tab p.o. daily,"
]
}
|
The patient was admitted on 5/5/2006 with a history of mechanical fall, with the attending physician being Dr. Clemente Armand Bolstad, with a full code status and disposition of Rehabilitation. Medications on Admission included Amiodarone 100 QD, Colace 100 bid, lasix 40mg QD, Glyburide 5mg bid, Plaquenil 200mg bid, Isordil 20mg tid, Lisinopril 20mg QD, Coumadin 5mg 3dys/week, 2.5mg 4dys/week, Norvasc 10mg QD, Neurontin 300mg TID, with APAP prn. An override was added on 10/2/06 by Gerad E. Dancy, PA for POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & WARFARIN with the reason for override being monitoring. The patient was rehydrated with IVF and PO's were encouraged, holding Glypizide while in house, Novolog sliding scale was started on 1/2, Low dose NPH 6 units BID was started on 1/2, bridged with lovenox and INR therapeutic 1/2 and restarted on home regimen of 5/2.5mg variable dose. Pain was controlled with TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Pain, Headache. A CT pelvis showed a right adnexal cyst which will need further characterization by US and outpatient follow up. The patient has an extensive cardiac history and the fall is not likely related to a cardiac issue as it appears mechanical, with no syncope, chest pain, etc. She was diagnosed with an NSTEMI with a small TnI leak, likely demand related in the setting of hypovolemia and the fall. Enzymes trended down. She was dry on admission and rehydrated with IVF, PO's encouraged, and became euvolemic by 1/2. Her JVP was up to 12cm, although it was difficult to gauge her volume status due to TR. She had a prolonged QT on admission, on telemetry, of unclear etiology, possibly starvation. This was monitored on telemetry until ROMI and drugs that confound were avoided. The QTc resolved to low 500s and a DDD pacer was functioning with V-pacing at 60bpm. Additional medications included NATURAL TEARS (ARTIFICIAL TEARS) 2 DROP OU BID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, PLAQUENIL SULFATE (HYDROXYCHLOROQUINE) 200 MG PO BID, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, LISINOPRIL 20 MG PO DAILY HOLD IF: SBP <110, MILK OF MAGNESIA (MAGNESIUM HYDROXIDE) 30 MILLILITERS PO DAILY PRN Constipation, COUMADIN (WARFARIN SODIUM) 2.5 MG PO QPM, NORVASC (AMLODIPINE) 10 MG PO DAILY HOLD IF: SBP <110, NEURONTIN (GABAPENTIN) 300 MG PO TID, NEXIUM (ESOMEPRAZOLE) 20 MG PO DAILY, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, DULCOLAX RECTAL (BISACODYL RECTAL) 10 MG PR DAILY PRN Constipation, CLOTRIMAZOLE 1% TOPICAL TOPICAL TP BID, GLYBURIDE 5 MG PO BID, LASIX (FUROSEMIDE) 20 MG PO DAILY, and corrected pt restarted on lasix 20 qd on d/c. A PT consult was obtained 3/21 and to follow daily at rehab. Labs showed Na 146, CK 3320, CKMB 12.9, Trop 0.23--->0.10, AST 107, Cr 1.2-->1.6. Pain was controlled with TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Pain, Headache, rehydrated with IVF, po's encouraged, holding Glypizide while in house, Novolog sliding scale was started on 1/2, Low dose NPH 6 units BID was started on 1/2, bridged with lovenox and INR therapeutic 1/2 and restarted on home regimen of 5/2.5mg variable
|
Has this patient ever been treated with neurontin
|
{
"answer_end": [
435
],
"answer_start": [
415
],
"text": [
"Neurontin 300mg TID,"
]
}
|
This is a 42 year old female nurse with morbid obesity who was admitted on 0/25/95 due to concern for her being at high risk of skin breakdown and infection. A panniculectomy was performed by Dr. Stanczyk without any complications. During the hospital course, the patient was treated with MEDICATIONS: Paxil, 60 mg P O q AM; Diabeta, 5 mg P O q AM; Trazadone, 100 mg q h.s.; Ultram, 100 mg q 4-6 hours prn; Reglan, 10 mg q 6 hours prn nausea; Bactroban ointment b.i.d.; Lotrisone cream b.i.d. topically; Afrin nasal spray q 12 hours PRN; Proventil inhalers, two puffs PRN; IV Ancef t.i.d.; Hibiclenz showers and sub-q Heparin. Preoperatively, her pulmonary function was assessed and found to have an FEV-1 of 53% of predicted; FVC of 57% of predicted and an FEV-1/FVC of 93% of predicted. Postoperatively, the patient was transferred to the ICU and received two (2) units of autologous red blood cells and two (2) units of blood with a hematocrit reaching 29%. On postoperative day five, two of the four Jackson-Pratt drains were removed and the patient was discharged in good condition on postoperative day six with plans for home visiting nurse for dressing changes daily and P O Keflex while two Jackson-Pratt drains were in. The patient was prescribed DISCHARGE MEDICATIONS: 1) Keflex, 500 mg P O q.i.d.; 2) Percocet one to two P O q 4 hours prn pain; 3) Lotrisone topically, TP b.i.d.; 4) Paxil, 60 mg P O q AM; 5) Azmacort, four puffs inhaled q.i.d.; 6) Bactroban topically TP b.i.d.; 7) Diabeta, 5 mg P O q AM; 8) Ferrous Sulfate, 300 mg P O t.i.d.; 9) Proventil inhaler, two puffs inhaled q.i.d. for follow-up in outpatient clinic with Dr. Bartles in one (1) week.
|
bactroban ointment
|
{
"answer_end": [
469
],
"answer_start": [
443
],
"text": [
"Bactroban ointment b.i.d.;"
]
}
|
The patient is a 74 year-old gentleman with a history of aortic stenosis, non-insulin dependent diabetes mellitus, hypertension, and hypercholesterolemia who underwent a cardiac catheterization and aortic valve replacement on July, 2001. His echocardiogram revealed severe aortic stenosis with mitral annular calcification, left ventricular hypertrophy, 1+ aortic insufficiency, and a mild tricuspid regurgitation with an ejection fraction of 55%. His past medical history is notable for non-insulin dependent diabetes mellitus, depression, hypertension, hypercholesterolemia, and gout. The patient had no known drug allergies and was taking Simvastatin, Lopressor 50 mg p.o. b.i.d., Allopurinol 300 mg once a day, Lasix 40 mg three times a day, Captopril, Potassium replacement, and a Multivitamin upon admission. His physical examination was unremarkable, with a right carotid bruit and palpable distal pulses. He was seen in consultation by Oral Medicine for carious teeth, and his coronary arteriogram demonstrated a 50% lesion of his left anterior descending coronary artery, 60% second diagonal, and a 60% lesion of the right coronary artery. He underwent aortic valve replacement with a #23 Carpentier-Edwards bioprosthetic valve and coronary artery bypass grafting times two with saphenous vein graft to the left anterior descending coronary artery and the saphenous vein graft to the posterior descending. His postoperative course was complicated only by mild confusion which has cleared and he is to be discharged to rehabilitation in good condition on Enteric coated aspirin 325 mg p.o. q. day, Lithium 300 mg twice a day, Potassium supplementation 20 mEq once a day, Pravachol 40 mg once a day, Glyburide 1.25 mg twice a day, Parnate 10 mg twice a day, and Lasix 20 mg once a day. He is to be discharged to the care of Dr. Kim E Scow, Cardiovascular Division at Hany Medical Center.
|
Has the patient ever tried lopressor
|
{
"answer_end": [
683
],
"answer_start": [
627
],
"text": [
"and was taking Simvastatin, Lopressor 50 mg p.o. b.i.d.,"
]
}
|
A 79-year-old female with a history of diabetes mellitus, congestive heart failure, coronary artery disease, chronic renal insufficiency, and anemia, status post five years of TAMOXIFEN TREATMENT, was admitted to Darnbo Hospital on 7/29/97 after sudden onset of shortness of breath unrelieved by one sublingual nitroglycerin. This shortness of breath was managed with IV Lasix and IV nitroglycerin, saturating at 99% on 100% oxygen, and IV heparin at 1,300 units per hour. Her blood pressure was stabilized on IV nitroglycerin with TRANSFER MEDICATIONS: Lopressor 25 mg PO BID started three weeks ago, Axid 150 mg PO BID, enteric coated aspirin 325 mg PO QD, Isordil 30 mg PO QID, hydralazine 50 mg PO QID, Lasix 40 mg PO QD, Timoptic 0.25% one GTT OU BID, Serax 30 mg PO QHS PRN insomnia, and nitroglycerin 1/150 one tablet sublingual Q 5 minutes times three PRN chest pain. She underwent cardiac catheterization on 11/4/97 with PTCA plus stent placement to her RCA with a good result and is on Ticlid for two weeks. Her blood pressure was well controlled in her target range of 140-160 systolic blood pressure on hydralazine, Lasix, and Lopressor. She was found to have an iron deficiency anemia treated with Niferex 150 mg PO BID and may benefit from Epogen as an outpatient. She was discharged to home in stable condition to follow up with her cardiologist and primary care physician based on previously scheduled appointments. Discharge medications included enteric coated aspirin 325 mg PO QD, Lasix 40 mg PO QD, hydralazine 50 mg PO QID, Isordil 30 mg PO TID, Lopressor 25 mg PO BID, nitroglycerin 1/150 one tablet sublingual Q 5 minutes times three PRN chest pain, Timoptic 0.25% one drop OU BID, Axid 150 mg PO QD, and Ticlid 250 mg PO BID for two weeks. Also, Niferex tablet 150 mg PO BID. Discharge instructions included that the patient have her CBC checked at two weeks and four weeks given her Ticlid therapy.
|
Has the patient had multiple serax prescriptions
|
{
"answer_end": [
789
],
"answer_start": [
757
],
"text": [
"Serax 30 mg PO QHS PRN insomnia,"
]
}
|
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.
|
has the patient had senna tablets
|
{
"answer_end": [
780
],
"answer_start": [
752
],
"text": [
"Senna tablets 2 p.o. b.i.d.,"
]
}
|
This 63-year-old male was transferred from LMC with a positive stress test and a history of CABG LIMA-D1, V-OM1, V-OM2, V Y-graft to PDA and PLV. Upon admission, he was diagnosed with CAD and presented with exertional angina. A nuclear stress revealed inferior scar and small area of anterior ischemia, and he was then transferred to CTMC for a cath. His medications on transfer included Dilantin 300/300/250, Glyburide 10 BID, Metformin 850 TID, Toprol 100 Daily, ASA 325 Daily, Isordil 20 TID, Lasix 20 QOD, Lipitor 40 Daily, Neurontin, Celondin 300 TID, Digoxin 0.25 Daily, and Benazepril 10 Daily. His hospital course included CV: Cath LIMA-LAD, DM: holding Metformin and restarting Glyburide and RISS, Neuro: Cont Neurontin 300 TID, Dilantin 200/200/250, and Celondin, and he was switched to Plavix 75 Daily, Atorva to Simva in house, Benazepril to Lisinopril 10, and Digoxin 0.25. He was discharged with instructions to take all medications as prescribed, with a full code status and disposition of Home. Medications at discharge included DIGOXIN 0.25 MG PO DAILY, LASIX (FUROSEMIDE) 20 MG PO EVERY OTHER DAY, GLYBURIDE 10 MG PO BID, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, DILANTIN (PHENYTOIN) 200 MG QAM; 250 MG QPM PO BEDTIME, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 100 MG PO DAILY Food/Drug Interaction Instruction, NEURONTIN (GABAPENTIN) 300 MG PO TID, PLAVIX (CLOPIDOGREL) 75 MG PO DAILY, BENAZEPRIL 10 MG PO DAILY, GLUCOPHAGE (METFORMIN) 850 MG PO TID, and CELONTIN (METHSUXIMIDE) 300 MG PO TID.
|
Is the patient currently or have they ever taken isordil ( isosorbide dinitrate )
|
{
"answer_end": [
1184
],
"answer_start": [
1140
],
"text": [
"ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID,"
]
}
|
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 the patient had rhinocort in the past
|
{
"answer_end": [
692
],
"answer_start": [
639
],
"text": [
"Albuterol, Advair 250/50 bid, Rhinocort 2 sprays bid,"
]
}
|
Ms. Heit is a 67-year-old female who received a heart transplant in March 2006 and was transferred from an outside hospital after sustaining a right hip fracture. On admission, her plain films revealed a nondisplaced right femoral fracture and her EKG showed sinus tachycardia. She was given MEDICATIONS ON ADMISSION: Neoral 150 mg b.i.d., prednisone 8 mg daily, CellCept 1500 mg b.i.d., Protonix 20 mg daily, Pravachol 40 mg daily, diltiazem 360 mg daily, multivitamin one daily, magnesium oxide 400 mg daily, calcium and vitamin D 1800 mg daily, Fosamax weekly on Mondays, Colace 100 mg daily, Zocor 20 mg daily, Dulcolax 10 mg as needed for constipation, vitamin E 400 units daily, and vitamin C 500 mg b.i.d. She had a history of heparin-induced thrombocytopenia, which was treated with fondaparinux daily prior to the procedure and then discharged on aspirin for four weeks postprocedure. She underwent a dynamic hip screw procedure which was uncomplicated and allowed her to begin weightbearing on postoperative day 1, and was transfused with 2 units of packed red blood cells on the day after surgery with appropriate hematocrit rise. She received additional 2 units of packed red blood cells prior to discharge. DISCHARGE MEDICATIONS: Tylenol 650 mg every four hours as needed for pain, Protonix 40 mg daily, Pravachol 40 mg daily, Neoral (cyclosporine) 150 mg b.i.d., diltiazem extended release 360 mg daily, Caltrate plus D one tablet daily, Neoral (cyclosporine) 150 mg b.i.d., diltiazem extended release 360 mg daily, Fosamax 70 mg weekly, Dulcolax p.r. 10 mg as needed for constipation, and oxycodone 5-10 mg every six hours as needed for pain. She will continue her home medication regimen, be maintained on aspirin 325 mg for four weeks to prevent clot formation postsurgery, and take oxycodone as needed for pain. She has a followup appointment with orthopedic surgery, and will also be closely followed by transplant clinic in the Angeles with a walker and should continue aspirin 325 mg daily.
|
What medications has this patient tried for constipation
|
{
"answer_end": [
684
],
"answer_start": [
615
],
"text": [
"Dulcolax 10 mg as needed for constipation, vitamin E 400 units daily,"
]
}
|
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 patient's current dose does the patient take of her lovenox
|
{
"answer_end": [
708
],
"answer_start": [
625
],
"text": [
"Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd,"
]
}
|
The patient is a 57 year-old female with dilated cardiomyopathy who is admitted for transplant evaluation. She initially presented with substernal chest pain in 1991, which was thought to be a myocardial infarction and Streptokinase was given; however details are not known. An echocardiogram showed an ejection fraction of 35-40% with evidence of an anteroseptal myocardial infarction, and an ETT Thallium showed fixed anteroseptal and apical defects. Upon admission, her ejection fraction was 15%, and a bicycle test achieved 5 minutes and 33 seconds with a maximal heart rate of 108 and a VO2 of 6.4 ml per kg per minute. Her past medical history is significant for 1) History of bronchitis, 2) History of cardiomyopathy, 3) Non-insulin dependent diabetes mellitus, 4) Status post hysterectomy at age 40, 5) Status post cholecystectomy, 6) Status post appendectomy, 7) History of panic disorders, 8) History of agoraphobia, and 9) History of alcohol use. Medication on admission included Coumadin 2.5 mg p.o. four times a week and 5 mg p.o. three times a week, Digoxin 0.125 mg p.o. q. day, Enalapril 10 mg p.o. b.i.d., Micronase 2.5 mg p.o. q. day, Multivitamins one tablet p.o. q. day, Lasix 40 mg p.o. b.i.d., and Xanax 0.5 mg p.o. q.i.d. p.r.n. The patient was briefly transferred to the Coronary Care Unit secondary to her elevated pulmonary capillary wedge pressure and the presence of her Swan-Ganz catheter, and was diuresed with good response. As part of the patient's transplant evaluation, she had a PPD with controls placed which showed that her PPD was negative and her controls were positive, and she underwent a Dental consult as well as a Psychiatric consult, and Thyrology showed a cytomegalovirus IgG being positive, a cytomegalovirus IgM being equivocal, and Epstein-Barr virus anti-VCA IgG at 640, an Epstein-Barr virus anti-VCA IgM being less than 10 and a mucal screen being greater than or equal to 32, a varicella zoster titer of 512, a Toxoplasma IgG being positive, and a Toxoplasma IgM being negative. Abdominal ultrasound showed a mildly dilated common bile and pancreatic duct and showed that this patient was status post cholecystectomy. Medication on discharge included Tylenol 650 mg p.o. q.4h. p.r.n. headache, Xanax 0.5 mg p.o. q.i.d., Digoxin 0.125 mg p.o. q. day, Enalapril 12.5 mg p.o. b.i.d., Lasix 40 mg p.o. b.i.d., Micronase 1.25 mg p.o. q. day, Multivitamins one tablet p.o. q. day, and Coumadin 2.5 mg p.o. q. day on even days and 5 mg p.o. q. day on odd days. The patient was instructed that she should increase her diuresis at home if she noticed an increase in her weight and was instructed to see a physician for continued for weight increases due to fluid accumulation. The patient had no known drug allergies and had been on Heparin during this hospitalization, and she did experience some hematuria toward the end of her hospitalization which was felt to be secondary to Foley trauma while she was in the Coronary Care Unit. While the patient maybe a good transplant candidate, it was felt that her weight was a negative factor in her potential for transplant.
|
Has the patient had previous micronase
|
{
"answer_end": [
1190
],
"answer_start": [
1123
],
"text": [
"Micronase 2.5 mg p.o. q. day, Multivitamins one tablet p.o. q. day,"
]
}
|
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 patient ever been prescribed duoneb
|
{
"answer_end": [
2900
],
"answer_start": [
2814
],
"text": [
"Lantus 30 mg subcutaneous daily, DuoNeb 3/0.5 mg Nebs q. 3 h. PRN shortness of breath,"
]
}
|
Dion Scarberry (926-57-39-3) was admitted on 9/0/2005 with a diagnosis of COPD flare and right heart failure and was discharged on 5/28/05 at 02:00 PM with a disposition of Home w/ services. He had a number of medications including Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17), Elavil (Amitriptyline HCL) 10mg PO QHS, Atenolol 25mg PO QD Starting in AM (7/17), Colace (Docusate Sodium) 100mg PO BID, Furosemide 20mg PO QD Starting Today (6/25), Guaifenesin 10ml PO TID Starting Today (6/25) PRN Other:cough, Oxycodone 5mg PO TID Starting Today (6/25) PRN Pain, Quinine Sulfate 325mg PO HS Starting Today (6/25), Senna Tablets (Sennosides) 2 Tab PO BID, MVI Therapeutic (Therapeutic Multivitamins) 1 Tab PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: will monitor, Zocor (Simvastatin) 20mg PO QHS, Morphine Controlled Release 15mg PO Q12H, Felodipine 5mg PO QD Food/Drug Interaction Instruction, Flonase (Fluticasone Nasal Spray) 1 Spray INH QD, Advair Diskus 500/50 (Fluticasone Propionate/...) 1 Puff INH BID, Caltrate+D (Calcium Carbonate 1,500mg (600...) 1 Tab PO BID, Novolog Mix 70/30 (Insulin Aspart 70/30) 35 Units QAM; 22 Units QPM SC 35 Units QAM 22 Units QPM, Prednisone Taper PO Give 60mg q 24 h X 5 dose(s), then Give 50mg q 24 h X 3 dose(s), then Give 40mg q 24 h X 3 dose(s), then Give 30mg q 24 h X 3 dose(s), then Give 20mg q 24 h X 3 dose(s), then Give 10mg q 24 h X 3 dose(s), then Give 5mg q 24 h X 3 dose(s), then Starting Today (6/25), Combivent (Ipratropium and Albuterol Sulfate) 2 Puff INH QID. He was also given a diet of 4 gram Sodium, activity to resume regular exercise, and follow up appointment(s) with primary care doctor at the BCCMC early next week. He had allergies to Erythromycins and was given Azithromycin and supplemental O2 and Levofloxacin and admitted with a diagnosis of COPD flare. Home meds include Atenolol 25mg PO qd, HCTZ 25mg PO qd, Felodipine 5mg PO qd, Zocor 20mg PO qhs, ASA 81mg PO qd, Advair 1 puff bid, Combivent 2 puffs qid, Loratidine 10mg PO qd, Guqifenesin 600mg PO q12h, Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid, Senna 2 tab PO qd, Calcium+Vim D 125 units PO qd, Elavil 10mg PO qhs. He was treated for COPD flare with supplemental O2, DuoNebs, and steroids and received a V/Q scan which reported a low probability of PE, as well as a cardiac MRI which demonstrated normal cardiac anatomy and function, with an LVEF of 73% and no valvular dysfunction. His diabetes was managed with his home regimen of Novolog and chronic pain and insomnia were managed with his out-pt regimen of morphine and oxycodone, and he was given Elavil for sleep. Because of his history of cancer, he was placed on Lovenox for anticoagulation. Additional Comments include the instruction to use his home oxygen when sleeping at night, the addition of Combivent inhalers and a steroid taper to his medicines, and to stop the hydrochlorathiazide (HCTZ) 25mg and take Lasix 20mg once a day. His discharge condition was stable, and he was instructed to continue Lasix 40mg PO QD at home and D/C home HCTZ, to do a slow prednisone
|
Was the patient ever prescribed lovenox
|
{
"answer_end": [
2790
],
"answer_start": [
2711
],
"text": [
"Because of his history of cancer, he was placed on Lovenox for anticoagulation."
]
}
|
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.
|
How much guaifenesin does the patient take per day
|
{
"answer_end": [
1381
],
"answer_start": [
1326
],
"text": [
"GUAIFENESIN 10 MILLILITERS PO Q6H Starting Today (2/12)"
]
}
|
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.
|
When was the last time that the patient received levofloxacin
|
{
"answer_end": [
2004
],
"answer_start": [
1962
],
"text": [
"Levofloxacin 500 mg p.o. q.24 h. x4 doses,"
]
}
|
This is a 55-year-old female with a history of diabetes mellitus type 2 (DMII) who was admitted for recurrent left lower extremity (LE) ulcerations and cellulitis of the right foot. She was treated with IV Unasyn for 5 days and switched to Linezolid 600MG PO BID as an outpatient medication. COUMADIN (WARFARIN SODIUM) 5MG PO QPM, NEXIUM (ESOMEPRAZOLE) 20MG PO QD, ACETYLSALICYLIC ACID 325MG PO QD, SIMVASTATIN 20MG PO QHS, GLYBURIDE 2.5MG PO QD HOLD IF: NPO, LISINOPRIL 10MG PO QD HOLD IF: SBP<95, SARNA TOPICAL TP QD, MICONAZOLE NITRATE 2% POWDER TOPICAL TP BID were prescribed. POTENTIALLY SERIOUS INTERACTIONS: WARFARIN & CIPROFLOXACIN, WARFARIN & SIMVASTATIN, WARFARIN & ASPIRIN, LISINOPRIL & POTASSIUM CHLORIDE Reason for override: as needed were noted. Bone scan and plain films from prior hospitalizations were consulted and Instructions for bilateral lower extremity rash were given. She was discharged on 7/15/05 with disposition home and diet with no restrictions, told to resume regular exercise and arrange INR to be drawn on 10/13/05 with follow-up INR's to be drawn every 7 days.
|
Previous coumadin ( warfarin sodium )
|
{
"answer_end": [
330
],
"answer_start": [
292
],
"text": [
"COUMADIN (WARFARIN SODIUM) 5MG PO QPM,"
]
}
|
Mr. Almon is a 51 year old gentleman with history of insulin dependent diabetes mellitus and unstable angina who was doing yard work and experienced an episode of nausea and vomiting along with chest discomfort. His EKG was noted to have an old T wave inversion in lead 3 which was now upright and ST depressions that were normalizing, along with CKs of 974 and MB 24.3 and Troponin level of 1.77. He received aspirin 5 mg of intravenous Lopressor, Heparin drip and Adenosine MIBI. Cardiac catheterization revealed Right dominant system, no significant left main lesions identified, left anterior descending coronary artery with a discreet mid 65% lesion, distal 99% lesion and first diagonal coronary artery with a proximal discrete 70% lesion, left circumflex coronary artery with a distal after the second obtuse marginal discrete 60% lesion, supplying the second obtuse marginal. First marginal coronary artery had an ostial discrete 90% lesion and a second obtuse marginal had an ostial discrete 100% lesion. Right coronary artery had a mid discrete 95% lesion supplying the right posterior descending coronary artery. The patient underwent echocardiogram which revealed mild concentric left ventricular hypertrophy with normal cavity size and left ventricular systolic function mildly reduced with an estimated ejection fraction of 45%, severe hypokinesis of the basal and mid segments of the inferior wall and inferior septum, and severe hypokinesis of the posterior wall, apex and distal anterior wall. He underwent coronary artery bypass graft x 3 with a left internal mammary artery to left anterior descending artery, saphenous vein graft to the obtuse marginal coronary artery and saphenous vein graft to the intermediate coronary artery. Postoperatively, he was extubated on postoperative day number one and transferred to the step down unit, with a T.max of 99. He had serous drainage from the inferior aspect of his sternal incision. He was started on Keflex 500 mg four times a day for 10 days. Discharge medications included Enteric coated aspirin 325 mg once a day, ibuprofen 200 to 800 mg every 4 to 6 h p.r.n. pain, NPH Humulin insulin 44 units in the morning, 14 units in the evening, regular insulin 6 units twice a day, Niferex 150 mg twice a day, potassium chloride 20 mEq once a day, Zocor 40 mg once in the evening, Atenolol 50 mg once a day, Lisinopril 10 mg once a day, Keflex 500 mg four times a day for 10 days for his superficial sternal wound infection and torsemide 60 mg twice a day, and he was discharged to home in stable condition.
|
What is the dosage of potassium chloride
|
{
"answer_end": [
2368
],
"answer_start": [
2271
],
"text": [
"potassium chloride 20 mEq once a day, Zocor 40 mg once in the evening, Atenolol 50 mg once a day,"
]
}
|
The patient is a 61-year-old man with a history of ischemic cardiomyopathy and congestive heart failure, who was initially treated with afterload reduction, digoxin and Lasix. A PA line was placed with RA 8, RV 76/4, TA 80/36, pulmonary capillary wedge pressure 34, and cardiac index 1.49. He was then treated with dobutamine, intravenous TNG, and nitroprusside with symptomatic relief and hemodynamic stabilization with wedge pressure falling to 18. TNG and Nipride were successfully weaned, however, the patient remained dobutamine dependent. One week prior to transfer, the patient was admitted to Ment Hospital for management of his congestive heart failure and grew gram positive cocci from two blood cultures. He was then started on vancomycin and defervesced, and subsequently grew gram negative rods in one out of four blood culture specimens. These were gram negative enteric rods, pan-sensitive, for which the patient was started on ampicillin 2 gm IV q. 6. At the time of discharge, the patient was stable, dobutamine dependent, without chest pain, able to ambulate from chair to commode without shortness of breath, palpitations, or light-headedness. His medications at time of discharge included dobutamine at 15 mcg per kilogram per minute; captopril 25 mg p.o. t.i.d.; digoxin 0.125 mg p.o. q.d.; Lasix 160 mg p.o. b.i.d.; potassium chloride 20 mEq p.o. b.i.d.; Coumadin 1 mg p.o. q.d.; Atrovent, two puffs q.i.d.; Azmacort, eight puffs b.i.d.; Pepcid 20 mg p.o. b.i.d.; Colace 100 mg p.o. t.i.d.; vancomycin 1 gm q. 12, discontinued 9-23 a.m. after 14 days; ampicillin 2 gm IV q. 6 (24 of June equals day number five); Halcion 0.125 p.o. q.h.s. prn; Serax 15 mg p.o. q. 6 hours prn. The patient's condition at time of discharge is fair and will be continuing care in the coronary care unit of the hospital inpatient near patient's home under the care of Doctor Daren Swasey.
|
Has the patient had multiple nitroprusside prescriptions
|
{
"answer_end": [
343
],
"answer_start": [
290
],
"text": [
"He was then treated with dobutamine, intravenous TNG,"
]
}
|
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.
|
Did the patient receive allopurinol for thrombocytopenia
|
{
"answer_end": [
1672
],
"answer_start": [
1607
],
"text": [
"thrombocytopenia, nystatin, allopurinol, were held given possible"
]
}
|
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 the patient used atrovent in the past
|
{
"answer_end": [
769
],
"answer_start": [
693
],
"text": [
"Atrovent 2 puff qid, Singulair 10mg qhs, Nexium 40mg daily, Lasix 20mg 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 this patient ever been prescribed colace
|
{
"answer_end": [
1461
],
"answer_start": [
1392
],
"text": [
"Lopressor 37.5 mg b.i.d., aspirin 325 mg daily, Colace 100 mg b.i.d.,"
]
}
|
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.
|
Is there a mention of of flovent usage/prescription in the record
|
{
"answer_end": [
833
],
"answer_start": [
808
],
"text": [
"Flovent two puffs b.i.d.,"
]
}
|
Mr. Serafine is a 78-year-old gentleman with class III heart failure and aortic stenosis. He was admitted to the Intensive Care Unit on 3 mcg of epinephrine and insulin and Precedex. He was prescribed Atenolol 12.5 mg daily, aspirin 325 mg daily, metformin 500 mg b.i.d., and Humalog insulin 12 units q.i.d., intravenous Lasix but had weaned Lasix drip and had intermittent boluses of 40 mg IV to promote diuresis with good result. He was also found to have a positive urinary tract infection and was started on ciprofloxacin for a total of five days. The patient at one point required 5 liters of nasal cannula to get his saturations in the 90s. He was prescribed three days, Motrin 400 mg q.8h. p.r.n. pain, NovoLog 24 units subq q.a.c., Lantus 60 units subcutaneous q.10 p.m., Toprol-XL 300 mg daily, patient was also discharged on NovoLog sliding scale subcutaneous q.a.c. with doses of Lasix 40 mg b.i.d., baby aspirin 81 mg daily, and potassium chloride slow release 20 mEq b.i.d. for three days. He was then discharged to home in stable condition with visiting nurse and medications including Atenolol 12.5 mg daily, aspirin 325 mg daily, metformin 500 mg b.i.d., and Humalog insulin 12 units q.i.d., Ciprofloxacin 500 mg q.6h. for remaining four doses, baby aspirin 81 mg daily, Lasix 40 mg b.i.d., for three days along with potassium chloride slow release 20 mEq b.i.d. for three days, Motrin 400 mg q.8h. p.r.n. pain, NovoLog 24 units subq q.a.c., Lantus 60 units subcutaneous q.10 p.m., Toprol-XL 300 mg daily, and NovoLog sliding scale subcutaneous q.a.c. His beta-blocker was increased with good result and he underwent a minimally invasive aortic valve replacement with a 25-mm Carpentier-Edwards pericardial valve. He was then to follow up with Dr. Collin Hyman in six weeks and his cardiologist Dr. Louie W Eilders in one week.
|
What medications have been previously used for the treatment of diuresis
|
{
"answer_end": [
373
],
"answer_start": [
309
],
"text": [
"intravenous Lasix but had weaned Lasix drip and had intermittent"
]
}
|
This 66-year-old male with a complicated medical history of DM2, CHB with pacer and evidence of clot on pacer wire, and non-compliance with medications and diet was admitted to the ED with symptoms of abdominal pain and SOB with FS of 500-600. On admission, his VS were 99.5, 101/62, 70s, SaO2 96% on room air. His exam was GEN: elderly ill appearing male in NAD; HEENT: Anicteric sclera, PERRL, dry mucous membranes, poor dentition; NECK: Supple, no adenopathy, JVP flat; CHEST: CTA bilaterally; CV: RRR with diffuse PMI, Nl S1, S2 S3 present; ABD: Reducible ventral hernia, NT, ND, bowel sounds present; EXT: No edema or wounds; SKIN: No rashes; EKG: paced; CXR: clear with NAD; ABD CT: small ventral hernia, gallstones, ectasia of the infrarenal aorta, RLL inflammatory changes suggestive of PNA; VQ: Low probability; LABS: Creatinine of 2.2 that dropped to 1.5 with hydration (BL 1.2-1.3). HCT 41.6 with drop after aggressive hydration. Lipase of 132 but has chronic pancreatitis and is now normalizing. UA and ACE negative. The patient received 5 liters of IVF and 36U of insulin in the ED, his blood pressure stabilized with volume, and was transferred to the medical floor. He was started on ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, FOLATE (FOLIC ACID) 1 MG PO QD Starting Today (9/24), LISINOPRIL 30 MG PO QD, THIAMINE HCL 100 MG PO QD, MVI THERAPEUTIC (THERAPEUTIC MULTIVITAMINS) 1 TAB PO QD, LEVOFLOXACIN 500 MG PO QD Starting Today (9/24), LANTUS (INSULIN GLARGINE) 20 UNITS SC QD, LASIX (FUROSEMIDE) 40 MG PO QD, LIPITOR (ATORVASTATIN) 20 MG PO QD, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, and CREON 20 (PANCRELIPASE 20000U) 4 CAPSULE PO TID, with Override Notices added on 4/24/04 by Blain, Guillermo P., M.D. on order for COUMADIN PO (ref #11219725) (POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN) and by Degrange, Diego A., M.D. on order for SIMVASTATIN PO (ref #59315078) (POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & ATORVASTATIN CALCIUM Reason for override: will monitor). He was given teaching regarding nutrition, diabetes, and Coumadin, and instructed to take all medications as directed, and to measure his weight daily. He was also instructed to take a shot with 20 units of insulin every night and to take iron products a minimum of 2 hours before or after a Levofloxacin or Ciprofloxacin dose dose. ADDITIONAL COMMENTS: 1.) Please take your insulin shot (20 units of Lantus) every night at bedtime, 2.) follow an ADA diet, and 3.) take all your medications. He was discharged on ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, FOLATE (FOLIC ACID) 1 MG PO QD Starting Today (9/24), LISINOPRIL 30 MG PO QD, THIAMINE HCL 100 MG PO QD, MVI THERAPEUTIC (THERAPEUTIC MULTIVITAMINS) 1 TAB PO QD, CREON 20 (PANCRELIPASE 20000U) 4 Capsule PO TID, LEVOFLOXACIN 500 MG PO QD, LANTUS (INSULIN GLARGINE) 20 UNITS SC QD, LASIX (FUROSEMIDE) 40 MG PO QD, LIPITOR (ATORVASTATIN) 20 MG PO QD, and COUMADIN (WARFARIN SODIUM) 5 MG PO Q
|
Has this patient ever tried coumadin ( warfarin sodium )
|
{
"answer_end": [
1604
],
"answer_start": [
1565
],
"text": [
"COUMADIN (WARFARIN SODIUM) 5 MG PO QPM,"
]
}
|
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 the patient ever tried lipitor
|
{
"answer_end": [
1173
],
"answer_start": [
1149
],
"text": [
"Lipitor 80 mg p.o. q.d.,"
]
}
|
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 is her current dose of lisinopril
|
{
"answer_end": [
1383
],
"answer_start": [
1335
],
"text": [
"Lisinopril 10 mg q. day, Pravachol 20 mg q. day,"
]
}
|
Mr. Boyles is a 73-year-old man with a past medical history significant for extensive coronary artery disease, diabetes, hypertension, hypercholesterolemia, and smoking, who presents with chest pain and is admitted for rule out myocardial infarction. His vital signs are normal, his lungs are clear, his jugular venous pressure is less than 5.0 centimeters, and his PMI is nonpalpable. His cardiac risk factors include age, diabetes, hypertension, cholesterol, smoking, and family history. On the morning of admission, he experienced chest pain for 1-2 minutes, which dissipated. At 7:00 p.m., he took one sublingual nitroglycerin with a decrease of pain and at 11:00 p.m., he took one sublingual nitroglycerin. His medications include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was placed on Plavix, continued aspirin, and restarted Coumadin after heparin and intravenous TNG. Cozaar 25 milligrams q.d. and amlodipine were added, and he was given normal saline intravenous fluids to equalize his ins and outs. His hematocrit dropped to 28.0, and he was transfused two units with an appropriate bump back to 33.0. His diabetes was managed on NPH 30/10 and 4 regular q.p.m., and Rezulin. His genitourinary issue was managed with Finasteride 5 milligrams q.d. and Levofloxacin 500 milligrams q.d. He developed point tenderness in his right knee, and was managed with Colchicine and a prednisone taper starting at 40 milligrams. His medications on discharge include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was taken back for a left subclavian artery stent and a left brachial artery angioplasty, and further managed with catheterization, finding a saphenous vein graft to the diagonal one was 100 percent occluded, SVG to PDA was open, LMA was 30 percent occluded, LAD was 99 percent occluded, diagonal one was 100 percent occluded, and LCX was 80 percent occluded. He was discharged to home in stable condition, with follow-up appointments with his primary doctor, cardiologist, and the doctor who performed the procedure.
|
Why was nitroglycerin prescribed
|
{
"answer_end": [
1134
],
"answer_start": [
1087
],
"text": [
"Nitroglycerin 0.4 milligrams p.r.n. chest pain,"
]
}
|
This 46-year-old male with a history of Insulin dependent diabetes, currently managed with 32 units of NPH Humulin, presented with pain with motion of the subtalar joint or the mid foot. He had a long history of ankle pain on the right side due to two fractures, one as a child and one due to a fall from a ladder, and was controlling his pain with Darvocet as well as intramuscular Tordal 15 to 30 mg four times a day. He was admitted as a same day surgery candidate and underwent tibiotalar fusion with cross-cannulated AO screws and local bone graft, with a tourniquet time of 1 hour and 57 minutes and received 2500 cc of crystalloid intraoperatively. His current medications include NPH Insulin 32 units every morning, Procardia XL 90 mg q.a.m., Lotensin 40 mg p.o. q.d., Lasix 40 mg p.o. q.d., potassium supplement, Ketorolac 15-30 mg intramuscularly q.i.d., and Darvocet N-100 one to four tablets q.d., with no known drug allergies. He was also prescribed Vicodan one to two p.o. q.3-4h. p.r.n., Naprosyn 500 mg p.o. b.i.d. as a substitute for the Tordal, and Halcion 0.125 to 0.25 mg p.o. q.h.s. p.r.n. Post-operatively, his motor and sensory examinations were intact and he was discharged on post-operative day three with the medications prescribed. He will follow-up with Dr. Norman Dutko in approximately three weeks at which time the cast will be changed and stitches removed.
|
Has a patient had ketorolac
|
{
"answer_end": [
909
],
"answer_start": [
822
],
"text": [
"Ketorolac 15-30 mg intramuscularly q.i.d., and Darvocet N-100 one to four tablets q.d.,"
]
}
|
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.
|
Is there history of use of isordil (isosorbide dinitrate)
|
{
"answer_end": [
506
],
"answer_start": [
439
],
"text": [
"ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID (hold if SBP below 90),"
]
}
|
The patient had been taking Ativan of 3-4 mg q.d. for anxiety for the past two months and abruptly stopped taking it on March 1995 after which she started to have feelings of disorientation, and had been taking chloral hydrate 500 to 1000 mg q.h.s. for five days and Compazine with one dose. CURRENT MEDICATIONS: At home, patient took insulin NPH 25 units in the morning with Regular 10 units in the morning, aspirin 81 mg q.d., Lopressor 25 mg b.i.d., Compazine 5 mg q.6h. p.r.n. anxiety of which she took only one dose, and chloral hydrate 500 to 1000 mg q.h.s. for five days. On admission, her laboratory examination was significant for BUN of 17, creatinine of 1.0, glucose was 364, liver function tests were within normal limits, white count was 7.2, hematocrit was 36, and platelet count was 266. Neurology consultation was obtained who felt that patient's peripheral neuropathy was probably secondary to longstanding diabetes but felt that some of her symptomatology could be consistent with porphyria. Psychiatry felt that this episode was consistent with generalized anxiety disorder separated by post dysthymia and suggested phenothiazines which are proven to be safe in porphyria for treatment. She was started on Trilafon 2 to 4 mg p.o. p.r.n. q.6h. for anxiety and Keflex 500 mg p.o. t.i.d. for treatment. The patient was also seen to be orthostatic which was felt to be secondary to dehydration secondary to poor p.o. intake prior to admission and was treated with normal saline boluses and her orthostasis improved. Her Lopressor was also held with this episode of orthostasis. The Watson-Schwartz test done by Dr. Mohar on patient very early in the admission was negative which made an acute porphyria attack very unlikely. These episodes were felt to be secondary to a combination of anxiety attack and rapid taper of Ativan which she had been taking at moderately high doses for the last two months. Patient also developed urinary tract infection symptoms and her urine culture showed greater than 100,000 colonies of E. coli which were pansensitive. She was discharged to home on August in good condition on medications Aspirin 81 mg p.o. q.d., insulin NPH 25 units subcutaneously q.a.m., insulin regular 10 units subcutaneously q.a.m., Trilafon 2 mg p.o. q.6h., and Keflex 500 mg p.o. t.i.d. Follow-up will be with Dr. Dario Rodriquz.
|
Did the patient receive phenothiazines for generalized anxiety disorder
|
{
"answer_end": [
1205
],
"answer_start": [
1125
],
"text": [
"suggested phenothiazines which are proven to be safe in porphyria for treatment."
]
}
|
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.
|
What medications did the patient take for constipation
|
{
"answer_end": [
726
],
"answer_start": [
661
],
"text": [
"senna tablets one to two tablets p.o. b.i.d. p.r.n. constipation,"
]
}
|
This 60-year-old male presented with a two week history of paroxysmal nocturnal dyspnea and dyspnea on exertion, possibly related to stress from the recent death of the patient's sister-in-law. His past medical history was significant for hypertension of approximately 10 years, non-insulin dependent diabetes mellitus of approximately 12 years, left Bell's palsy in 1985 treated with prednisone, and type IV hypolipoproteinemia. An EKG showed new anterolateral changes since the EKG taken a year earlier, and he was admitted with a diagnosis of Myocardial Infarction, Congestive Heart Failure, and Hypertension. His medications included Micronase 10 mg po bid, Persantine 60 mg po tid, aspirin one po q d, Lisinopril 5 mg po q d, and Atenolol 50 mg po q d. He had a 20 pack year history of smoking and social ethanol consumption. The patient was managed with gentle Lasix diuresis and the beta blocker was held due to concern for wall motion abnormalities. He was anticoagulated on heparin and loaded on Coumadin, and his medications on discharge included Lasix 40 mg po q d, Captopril 37.5 mg po tid, Ecotrin 325 mg po q d, Coumadin 5 mg po q h.s., magnesium oxide two tablets po q d, Isordil 10 mg po tid with meals, and Micronase 10 mg po bid. The patient was stable on discharge and was to follow up with Dr. Luciano Catignani in his office on Tuesday, 15 of October, at 3 p.m.
|
Has the patient ever had coumadin
|
{
"answer_end": [
1150
],
"answer_start": [
1077
],
"text": [
"Captopril 37.5 mg po tid, Ecotrin 325 mg po q d, Coumadin 5 mg po q h.s.,"
]
}
|
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 this patient ever been on antibiotic-containing solution
|
{
"answer_end": [
957
],
"answer_start": [
908
],
"text": [
"copious amounts of antibiotic-containing solution"
]
}
|
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.
|
Previous seretide
|
{
"answer_end": [
251
],
"answer_start": [
193
],
"text": [
"with dobutamine, seretide, and diuretics with good effect,"
]
}
|
This 63 year-old male with a history of peripheral vascular disease, hypertension, non-insulin dependent diabetes mellitus, coronary artery disease, aortic stenosis, and status post bilateral lower extremity bypass grafts presented to the hospital with increasing left lower extremity pain. At which time tPA infusion was commenced and an occlusion of the left lower extremity vein graft was found in the area of the mid-thigh with no passage of contrast and minimal reconstitution of collaterals to his foot. He was managed medically for a few days and underwent catheterization which revealed a right dominant system, a discreet 40% lesion in the proximal left main, a discreet 30% lesion in the proximal left anterior descending artery, 100% lesion in the first marginal branch of the left circumflex artery, as well as 100% lesion in the second marginal branch of the left circumflex artery. He was taken to the operating room on 0/27/02 for an aortic valve replacement with a #23 Carpentier-Edwards pericardial valve and mitral valvuloplasty with an Alfieri suture repair, as well as coronary artery bypass graft times three with left internal mammary artery to the left anterior descending artery, left radial to obtuse marginal one, and left radial to posterior descending artery. During his hospital course he was on MEDICATIONS: Glipizide 5 mg b.i.d., Hydrochlorothiazide 50 mg q.d., Lisinopril 20 mg q.d., Simvastatin 20 mg q.d., Amlodipine 5 mg q.d., Imdur 30 mg q.d., and Toprol 100 mg q.d. and enteric coated aspirin, and he remained on his aspirin and Lopressor, as well as Coumadin. He was placed on the Portland protocol and remained on a full ten-day course of Flagyl and Cefotaxime for his preoperative pneumonia. On his pre-discharge examination he was discharged to rehabilitation with DISCHARGE MEDICATIONS: Coumadin 4 mg p.o. q.hs to maintain INR between 2 and 3, aspirin, Diltiazem 30 mg t.i.d., Simvastatin 20 mg q.d., Colace 100 mg t.i.d., Nexium 20 mg q.d., Niferex-150 b.i.d., Glipizide 5 mg b.i.d., Lasix 40 mg b.i.d., and Lopressor 50 mg b.i.d. with CZI sliding scale.
|
has the patient used diltiazem in the past
|
{
"answer_end": [
1918
],
"answer_start": [
1855
],
"text": [
" maintain INR between 2 and 3, aspirin, Diltiazem 30 mg t.i.d.,"
]
}
|
Dion Scarberry (926-57-39-3) was admitted on 9/0/2005 with a diagnosis of COPD flare and right heart failure and was discharged on 5/28/05 at 02:00 PM with a disposition of Home w/ services. He had a number of medications including Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17), Elavil (Amitriptyline HCL) 10mg PO QHS, Atenolol 25mg PO QD Starting in AM (7/17), Colace (Docusate Sodium) 100mg PO BID, Furosemide 20mg PO QD Starting Today (6/25), Guaifenesin 10ml PO TID Starting Today (6/25) PRN Other:cough, Oxycodone 5mg PO TID Starting Today (6/25) PRN Pain, Quinine Sulfate 325mg PO HS Starting Today (6/25), Senna Tablets (Sennosides) 2 Tab PO BID, MVI Therapeutic (Therapeutic Multivitamins) 1 Tab PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: will monitor, Zocor (Simvastatin) 20mg PO QHS, Morphine Controlled Release 15mg PO Q12H, Felodipine 5mg PO QD Food/Drug Interaction Instruction, Flonase (Fluticasone Nasal Spray) 1 Spray INH QD, Advair Diskus 500/50 (Fluticasone Propionate/...) 1 Puff INH BID, Caltrate+D (Calcium Carbonate 1,500mg (600...) 1 Tab PO BID, Novolog Mix 70/30 (Insulin Aspart 70/30) 35 Units QAM; 22 Units QPM SC 35 Units QAM 22 Units QPM, Prednisone Taper PO Give 60mg q 24 h X 5 dose(s), then Give 50mg q 24 h X 3 dose(s), then Give 40mg q 24 h X 3 dose(s), then Give 30mg q 24 h X 3 dose(s), then Give 20mg q 24 h X 3 dose(s), then Give 10mg q 24 h X 3 dose(s), then Give 5mg q 24 h X 3 dose(s), then Starting Today (6/25), Combivent (Ipratropium and Albuterol Sulfate) 2 Puff INH QID. He was also given a diet of 4 gram Sodium, activity to resume regular exercise, and follow up appointment(s) with primary care doctor at the BCCMC early next week. He had allergies to Erythromycins and was given Azithromycin and supplemental O2 and Levofloxacin and admitted with a diagnosis of COPD flare. Home meds include Atenolol 25mg PO qd, HCTZ 25mg PO qd, Felodipine 5mg PO qd, Zocor 20mg PO qhs, ASA 81mg PO qd, Advair 1 puff bid, Combivent 2 puffs qid, Loratidine 10mg PO qd, Guqifenesin 600mg PO q12h, Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid, Senna 2 tab PO qd, Calcium+Vim D 125 units PO qd, Elavil 10mg PO qhs. He was treated for COPD flare with supplemental O2, DuoNebs, and steroids and received a V/Q scan which reported a low probability of PE, as well as a cardiac MRI which demonstrated normal cardiac anatomy and function, with an LVEF of 73% and no valvular dysfunction. His diabetes was managed with his home regimen of Novolog and chronic pain and insomnia were managed with his out-pt regimen of morphine and oxycodone, and he was given Elavil for sleep. Because of his history of cancer, he was placed on Lovenox for anticoagulation. Additional Comments include the instruction to use his home oxygen when sleeping at night, the addition of Combivent inhalers and a steroid taper to his medicines, and to stop the hydrochlorathiazide (HCTZ) 25mg and take Lasix 20mg once a day. His discharge condition was stable, and he was instructed to continue Lasix 40mg PO QD at home and D/C home HCTZ, to do a slow prednisone
|
Was the patient ever prescribed percocet
|
{
"answer_end": [
2185
],
"answer_start": [
2085
],
"text": [
"Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid,"
]
}
|
The patient was admitted on 4/12/04 with a right plantar surface neurotrophic ulcer, low-grade fevers and chills, and a history of diabetes mellitus, hypertension, distant past of pancreatitis, gout, neuropathy, high cholesterol, and chronic renal insufficiency. Significant labs at the time of admission included a potassium of 4.3, BUN of 38, creatinine of 3.2, and blood glucose of 187. The patient was started on 1. Lantus 100 mg q.p.m., 2. Humalog 20 units q.p.m., 4. Neurontin 300 mg t.i.d., 5. Lisinopril 40 mg q.d., 6. Allopurinol 300 mg q.d., 7. Hydrochlorothiazide 25 mg q.d., 8. Zocor 20 mg q.d., 9. TriCor 50 mg b.i.d., 10. Atenolol 25 mg q.d., 11. Eyedrops prednisolone and atropine, and 12. iron supplementation. The patient underwent an amputation of the third and fourth toe as well as metatarsal heads, and was started on Dr. Tosco's suggested antibiotics, vancomycin, levofloxacin, and Flagyl. To manage temperature greater than 101, the patient was prescribed Tylenol 650 to 1000 mg p.o. q.4h. p.r.n., allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Colace 100 mg p.o. b.i.d., Epogen 10,000 units q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient was seen by Dr. Ulvan in the renal staff and by the diabetes management service by Dr. Clint Holets. Postoperative lab checkup revealed that the patient's creatinine bumped to 4.9 with a BUN of 61, and the renal service was consulted. The patient was given Lopressor 100 mg b.i.d. to control the blood pressure, and was eventually started on PhosLo and Ferrlecit as well as Epogen 10,000 units q. week. Levofloxacin was continued for a one week course, and the patient was discharged to the rehab facility with Tylenol 650 to 1000 mg p.o. q.4h. p.r.n. for temperature greater than 101, allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Lopressor 100 mg p.o. b.i.d., PhosLo 1334 mg p.o. q.a.c., Colace 100 mg p.o. b.i.d., Epogen 10,000 units delivered subcuticularly q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient is to be followed up at the rehab facility at Ing Mansy General Hospital and should follow up with the renal service and Dr. Knaub in two to three weeks and one to two weeks, respectively. The
|
Has the patient ever tried hydrochlorothiazide
|
{
"answer_end": [
586
],
"answer_start": [
555
],
"text": [
"Hydrochlorothiazide 25 mg q.d.,"
]
}
|
A 60 year old Spanish speaking woman with multiple cardiac risk factors and a two to three year history of exertional angina presented complaining of unstable chest pain. Dr. Maximo Bryum in C&O MEDICAL CENTER Clinic initiated an antianginal regimen, however the patient recently stopped taking Aspirin and her symptoms then recurred. The patient was given three sublingual Nitroglycerins after her primary M.D. was called and her pain resolved after approximately 15 minutes. On the 27 of January, 1995, the patient underwent a Dobutamine MIBBE on which she went 6 minutes and 48 seconds reaching a maximal heart rate of 154, a blood pressure of 172/82, with 2 mm ST depressions diffusely and moderate to severe reversible anterior and anteroseptal wall ischemia. Medications on admission included Atenolol 50 mg p.o. q.d., Axid 150 mg p.o. b.i.d., Enteric Coated Aspirin 325 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem 240 mg p.o. q.d., Lisinopril 10 mg p.o. q.d., Lopipd 600 mg p.o. q.d., Lasix 40 mg p.o. q.d., Insulin NPH 75 units sub-q q.a.m., 50 units q.p.m., Insulin Regular 25 units sub-q q.a.m., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, and Omeprazole 20 mg p.o. q.d. The Cardiology Team was consulted and serial CK, MB and EKG's were done, with Heparin initially started given the possibility that this was unstable angina. The patient's Insulin dosages were adjusted in the manner to keep her blood sugars in the approximately 200 range and she was discharged with medications including Enteric Coated Aspirin 325 mg p.o. q.d., Lasix 40 mg p.o. q.d., Lopid 600 mg p.o. q.d., Insulin NPH 100 units sub-q q.a.m., 70 units sub-q q.h.s., Insulin Regular 25 units sub-q q.a.m., Lisinopril 10 mg p.o. q.d., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, Omeprazole 20 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem CD 240 mg p.o. q.d., with follow-up care with her primary M.D., Dr. Jarvis Needy in the RINGBURG RITA'S PROPRES MEMORIAL HOSPITAL Clinic.
|
What medications has the patient been prescribed for her blood sugars
|
{
"answer_end": [
1439
],
"answer_start": [
1382
],
"text": [
"The patient's Insulin dosages were adjusted in the manner"
]
}
|
This is a 46-year-old morbidly obese female with a history of insulin-dependent diabetes mellitus complicated by BKA on two prior occasions, who was admitted to the MICU with BKA, urosepsis, and a non-Q-wave MI. On presentation to the Emergency Department, her vital signs were notable for a blood pressure of 189/92, pulse rate of 120, respiratory rate of 20, and an O2 sat of 90%. She was given insulin, sublingual nitroglycerin x three, 4 mg of morphine, 5 mg of Lopressor, and started on a heparin drip and IV antibiotics, and admitted to the MICU for further management. Her past medical history included insulin-dependent diabetes mellitus for how many years, positive ethanol use, approximately one drink per week, and denied IV drug use or other illicit drug use. She was placed on an insulin drip and hydrated with intravenous fluids, with improvement, and eventually transitioned to NPH with insulin sliding scale coverage. Despite escalating her dose of NPH up to 65 U subcu b.i.d. on the day of discharge, she continued to have elevated blood sugars >200 and required coverage with insulin sliding scale. This issue will need to be addressed as an outpatient. She was also placed on cefotaxime for gram negative coverage, with both her blood cultures and urine cultures growing out E. coli which were sensitive to cefotaxime and gentamycin. As she initially continued to be febrile and continued to have positive blood cultures, one dose of gentamycin was given for synergy, and she was eventually transitioned to p.o. levofloxacin and will take 7 days of p.o. levofloxacin to complete a total 14-day course of antibiotics for urosepsis. She was initially placed on aspirin, heparin, and a beta blocker, and once her creatinine normalized, an ACE inhibitor was also added. Heparin was discontinued once the concern for PE was alleviated, and her beta blocker and ACE inhibitor were titrated up for a goal systolic blood pressure of <140 and a pulse of <70. On admission, the patient was on several pain medicines, including amitriptyline, Flexeril, and Valium for reported history of sciatica and low back pain, which were discontinued and she was placed on Neurontin for likely diabetic neuropathy. She was also placed on GI prophylaxis with Carafate and treated symptomatically with Imodium p.r.n. diarrhea. The patient was discharged with enteric coated aspirin 325 mg p.o. q.d., NPH Humulin insulin 65 U subcu b.i.d., human insulin sliding scale: for blood sugars 151-200 give 4 U, for blood sugars 201-250 give 6 U, for blood sugars 251-300 give 8 U, for blood sugars 301-350 give 10 U, Imodium 2 mg p.o. q. 6 hrs. p.r.n. diarrhea, Niferex 150 mg p.o. b.i.d., nitroglycerin 1/150 one tab sublingual q. 5 min. x 3 p.r.n. chest pain, multivitamin one tab p.o. q.d., simvastatin 10 mg p.o. q.h.s., Neurontin 600 mg p.o. t.i.d., levofloxacin 500 mg p.o. q.d. x 5 days, Toprol XL 400 mg p.o. q.d., lisinopril 40 mg p.o. q.d. The patient was evaluated by the physical therapist, who noted her to walk around the hospital without significant difficulty.
|
What is the reason this patient is on valium
|
{
"answer_end": [
2123
],
"answer_start": [
2026
],
"text": [
"including amitriptyline, Flexeril, and Valium for reported history of sciatica and low back pain,"
]
}
|
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