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This 82-year-old RHM with a history of HTN, DM-2, CAD, and AVR (on Coumadin until 3/29) presented to the WTSMC ER for further work-up after receiving Mannitol. On exam, his VS were T: afebrile, BP: 145/64, P: 60, RR: 18, O2 sat: 97%r.a., HEENT anicteric and MMM without lesions, OP clear, neck supple with no LAD, CV had s1s2 paced, pronounce S2, 3/6 systolic murmur, 2/6 diastolic, resp CTAB, abd +BS Soft/NT/ND, ext no C/C/E, s/p above amputation, MS awake and alert, oriented to date, place, and self, attention DOW backwards, memory registration 3/3, recall 2/3 at 5 min 3/3 with prompting, language fluent, +comprehension, +repetition, +naming intact, nondominant no neglect to DSS, able to salute/brush teeth, CN II, III - pupils 3`2 bilaterally, VFF by confrontation; III, IV, VI - EOMI, no ptosis, no nystagmus; V - sensation intact to LT/PP, corneal reflex intact; VII - mild right facial weakness; VIII - hears finger rub; IX, X - voice dysarthric, palate elevates symmetrically, gag intact; XI - SCM/Trapezii 5/5 B; XII - tongue protrudes midline, motor right pronator drift, no asterixis, normal bulk and tone, no tremor, rigidity or bradykinesia, strength 5/5, DTRs C56, C6, C7, L34, S12, Plantar L2, 2, 2, 1, 0, amputated R1, 1, 1, 1, 0, up, sensory decreased LT, temperature, vibration distally up to knees, coord finger tap rapid & symm, FNF & finger follow intact (for weakness), foot tap rapid & symm, gait deferred. LABS showed Sodium 141 mmol/L, Potassium 4.7 mmol/L, Chloride 103 mmol/L, Total CO2 29 mmol/L, Anion Gap 9 mmol/L, CK 33 U/L, CKMB Quant 1.7 ng/mL, Calcium 9.0 mg/dL, Magnesium 1.6 mg/dL, cTn-I See Result Below ng/mL, and Glucose 130 mg/dL. Medications prescribed were COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN SBP>160mmHg, Insulin Regular Human Sliding Scale (subcutaneously) SC qAC, qHS, Lisinopril 20 mg PO QD, Magnesium Gluconate 500 mg PO BID, Milk of Magnesia (Magnesium Hydroxide) 30 mL PO QD PRN Constipation, Metoprolol Tartrate 25 mg PO TID starting in PM on 0/17, Xalatan (Latanoprost) 1 drop OU QPM, Flomax (Tamsulosin) 0.4 mg PO QD, Nexium (Esomeprazole) 20 mg PO QD, Glipizide 10 mg PO QD, Zocor 20 mg QD, Metformin 1000 mg BID, Niferex 150 BID, ASA 81 PO QD, and BRIMONIDINE 0.2% BID. Neurologic exam was stable with persistent dysarthria, right pronator drift, and mild right leg weakness; patient was evaluated by PT/OT and deemed appropriate candidate for acute rehab. Cardiovascular continued to be in atrial fibrillation, pacemaker was firing, but had an episode of HR 30's x few seconds, and HR 40's-50's for rest of night. EKG unchanged from admission, atrial fibrillation, left anterior fascicular block, some PVCs. Plan was to admit to NICU and transfer to the floor, control BP with home regimen and keep SBP<140, hold ASA and Coumadin, and hold Metformin for now and add insulin sliding scale. Medications included COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN other: SBP>160
|
How often does the patient take colace (docusate sodium)
|
{
"answer_end": [
1743
],
"answer_start": [
1676
],
"text": [
"Medications prescribed were COLACE (Docusate Sodium) 100 mg PO BID,"
]
}
|
An 81-year-old Russian-speaking male with a history of coronary artery disease, multiple strokes, diabetes mellitus type 2, COPD, atrial fibrillation on anticoagulation and a partial pacemaker, congestive heart failure with an ejection fraction of 45-50%, BPH, and hypertension was admitted to Ghampemaw A Hospital for bacteremia with Streptococcus oralis and was treated with a course of IV penicillin through a PICC line, as well as oral Flagyl empirically for an elevated white count. At the rehab facility, he was treated with some sublingual nitroglycerin, and was brought to the Ellwis Medical Center Emergency Room where he was given IV fluid boluses, treated empirically with vancomycin and ceftazidime, and had a CPAP initiated. A head CT was performed which was negative and a right internal jugular line was placed. He was admitted to medicine for further management and a PEG tube placement was done on 4/2/06. His MEDICATIONS ON ADMISSION included Glucotrol 10 mg p.o. b.i.d. and lisinopril 5 mg p.o. q. day, metformin 500 mg p.o. t.i.d., sublingual nitroglycerin p.r.n., nystatin suspension q.i.d., Zyprexa 2.5 mg p.o. q. h.s., Penicillin G 3 million units IV q. 4h x7 days, Milk of Magnesia, Tylenol p.r.n., Dulcolax p.r.n., Colace p.r.n., atenolol 50 mg q. day, Lipitor 20 mg q. day, Senna liquid q. h.s., Flomax 0.4 q. day. He was initially diuresed mildly with Lasix, started on insulin sliding-scale and Lantus, and was kept on potassium and magnesium scales while in hospital. He was given an empiric 7-day course of Ceptaz and Flagyl for aspiration pneumonia, vancomycin, and his vancomycin was switched to IV penicillin and was continued for a full 3-4 week course on 8/14/07. Coumadin was held peri-procedure when he was getting his PEG placed and vitamin K had been administered in view of his supratherapeutic Coumadin. His Coumadin should be restarted on 9/23/07 and Nexium p.o. t.i.d., Flagyl 500 mg p.o. t.i.d. x10 days which was started on 2/5/06. He was oxygenated quickly with 2 liters of oxygen by nasal cannula, restarted on his home doses of aspirin, statin, beta blocker 2 pump, and ACE inhibitor, and his beta blocker and ACE inhibitor were restarted during his hospital stay. He was discharged to rehabilitation where they will focus primarily on his physical therapy and rehab needs.
|
Has the pt. ever been on flomax before
|
{
"answer_end": [
1340
],
"answer_start": [
1300
],
"text": [
"Senna liquid q. h.s., Flomax 0.4 q. day."
]
}
|
Patient SAMU, CURTIS 759-74-53-9 is a 61-year-old female with multiple medical problems including dilated CMP, s/p chemo and XRT for Breast CA, CAD, s/p MI, COPD, and occasional O2 use. On admission, her VS are T97.8, HR73, BP113/71, RR18, and O2Sat 92%. She presents with dry cough associated with SOB x 2 days and increased DOE after 1/2 block, orthopnea and PND, chronic abd pain, increased Alk Phos, increased bloating, and wheezing without increased O2 need at night. She was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, on order for COUMADIN PO (ref #29937145) with POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, DIGOXIN 0.125 MG PO QD, on order for LEVOTHYROXINE SODIUM PO (ref #13700176) with POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, COLACE (DOCUSATE SODIUM) 100 MG PO BID, FERROUS SULFATE 325 MG PO BID, MOTRIN (IBUPROFEN) 600 MG PO Q8H Starting Today (10/7) with PRN Pain Food/Drug Interaction Instruction Take with food, REGLAN (METOCLOPRAMIDE HCL) 5 MG PO AC, SIMETHICONE 80 MG PO QID, VITAMIN B1 (THIAMINE HCL) 100 MG PO QD, TRAZODONE 50 MG PO HS, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: LEVOFLOXACIN & WARFARIN, MVI THERAPEUTIC (THERAPEUTIC MULTIVITAMINS) 1 TAB PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: aware, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 75 MG PO QD, GABAPENTIN 200 MG PO QD, TORSEMIDE 100 MG PO BID, COZAAR (LOSARTAN) 50 MG PO QD, LEVOCARNITINE 1 GM PO QD Starting Today (8/21), CITALOPRAM 20 MG PO QD, ADVAIR DISKUS 250/50 (FLUTICASONE PROPIONATE/...) 1 PUFF INH BID, NEXIUM (ESOMEPRAZOLE) 20 MG PO QD, LANTUS (INSULIN GLARGINE) 60 UNITS SC QHS, NOVOLOG (INSULIN ASPART), LIPITOR (ATORVASTATIN) 10 MG PO QPM, ATORVASTATIN CALCIUM, COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, and Sliding Scale (subcutaneously) SC AC with Food/Drug Interaction Instructions to Avoid milk and antacid, Take with food, Take consistently with meals or on empty stomach, and If BS is less than 125, then give 0 units subcutaneously. The patient was placed on order for COUMADIN PO (ref #29937145) and Adriamycin induced CMP HTN IDDM Sarcoid for DVT on 0/29 (goal 2-3). She was placed on po levofloxacin for 7 days and symptoms resolved. Her weight was 227lbs 7/6/05 (dry weight ~200), and she was on torsemide 100mg bid at baseline, with po lasix increased to 200bid x 2 doses, and zaroxyln 5mg po BID x 6 doses added. Tests included ALK Phos: 627, ALT: 71, AST: 65, Card Enzymes: neg, WBC: 6.4, UA: 1.011, 1+prot, 5-10WBC, 2+bact, CXR: LLL opacity, seen best on lateral view, EKG: prolonged PR, q in AVL, flat Ts laterally, unchanged from 9/5, RUQ US: sludge, gall bladder wall thickened 8mm, neg sonographic Murphy's sign, 2/4 Echo
|
Previous adriamycin
|
{
"answer_end": [
2208
],
"answer_start": [
2141
],
"text": [
"Adriamycin induced CMP HTN IDDM Sarcoid for DVT on 0/29 (goal 2-3)."
]
}
|
Archie BOGUS, an 83-year-old female with afib, HTN, DM, CAD, and MVR, was admitted to rehab placement after sustaining a mechanical fall at home while reaching for grapes with no prodrome, LOC, head trauma, CP, palp, or SOB. Physical exam showed AVSS irreg irreg CTA B L hip ecchymoses with neuro CN intact and strength 5/5. Labs/studies showed hip film negative for fracture and cardiac enzymes negative x 3 with INR 5.2. Hospital course included holding coumadin for goal INR 2.5-3, restarting when appropriate, keeping patient on home meds, having home VNA and home PT to ensure safety, and checking pt's INR on coumadin on Mon 10/18 and forwarding results to Bertram Lenkiewicz. Discharge medications included Trazodone 25 mg PO bedtime PRN insomnia, Potassium Chloride & Lasix (Furosemide) 20 mg PO daily, Isordil (Isosorbide Dinitrate) 20 mg PO TID, Micronase PO, Neurontin (Gabapentin) 300 mg PO TID, Lasix PO, Nexium (Esomeprazole) 20 mg PO daily, Norvasc (Amlodipine) 10 mg PO daily, hold if SBP<100, Lisinopril, Colace (Docusate Sodium) 100 mg PO BID, Glipizide 2.5 mg PO daily, Multivitamin Therapeutic, Tears Naturale (Artificial Tears) 2 drop OU TID, Nitroglycerin 1/150 (0.4 mg) 1 tab SL Q5min x 3 doses PRN chest pain, hold if SBP <100, Plaquenil Sulfate (Hydroxychloroquine) 200 mg PO BID, Amiodarone 100 mg PO daily, Lisinopril 20 mg PO daily, hold if SBP <100, and 1 tab PO daily. Food/Drug Interaction Instructions were also provided, and Alert Overrides were added on 8/15/06 by PRIOLETTI, SCOT GARY, M.D., RASHED, TAD GREGG, M.D., and BELLES, DOMINIC NED, M.D., as well as an Alert Override by CLIFFORD, GUY CHET, M.D. for POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL. The patient's PMH includes HTN, DM, CAD, s/p MVR, h/o heartblock s/p pacemaker, afib on coumadin, RA, h/o DVT/PE, and coumadin was held due to admission. Discharge condition was satisfactory.
|
What was the dosage prescribed of nitroglycerin 1/150 ( 0.4 mg )
|
{
"answer_end": [
1233
],
"answer_start": [
1164
],
"text": [
"Nitroglycerin 1/150 (0.4 mg) 1 tab SL Q5min x 3 doses PRN chest pain,"
]
}
|
Mr. Klaja is an 81-year-old gentleman who presented with abdominal pain and diarrhea, and an abdominal CT revealed an infectious inflammatory bowel process. Stool samples were sent for C. diff toxin and assay, all were negative, while stool cultures did not grow anything out. Empiric treatment with p.o. vancomycin was started, and the patient's abdominal pain resolved and he was afebrile by discharge. A flexible sigmoidoscopy showed colitis consistent with inflammatory etiology, and the patient was discharged with a presumed C. diff colitis diagnosis on a 2-week course of vancomycin. The patient had a DVT followed by bacteremia with multi-resistant Klebsiella pneumoniae, treated with meropenem for 14 days with the course. The patient had no evidence of acute coronary syndrome on admission, and his coronary artery disease, CHF, and chronic kidney disease were managed with MEDICATIONS: aspirin 81 mg, Plavix 75 mg, Coumadin 5 mg, digoxin 0.125 mg, Lasix 49 mg daily, lisinopril 10 mg daily, Lopressor 25 mg b.i.d., Zocor 80 mg daily, Flomax 0.4 mg daily and Flovent 110 mcg b.i.d., lactobacillus p.o. for probiotics and patient also had flex sig 2-week course p.o. vancomycin alone. He was given gentle hydration therapy with 2 liters of IV fluids, and restarted on Lasix 40 mg p.o. daily for diuresis. He was also discharged on a course of lactobacillus p.o. for probiotics, with DISCHARGE MEDICATIONS: Included aspirin 81 mg p.o. daily, Plavix 75 mg p.o. daily, digoxin 0.125 mg p.o. daily, Nexium 20 mg p.o. daily, lactobacillus 2 tabs p.o. t.i.d., metoprolol 25 mg p.o. b.i.d., simvastatin 80 mg p.o. at bed time, Flomax 0.4 mg p.o. every evening, vancomycin 250 mg p.o. every 6 hours x8 days at supertherapeutic, Coumadin 6 mg p.o. daily, Flovent 110 mcg inhale b.i.d., Lasix 40 mg p.o. daily, his daily dose at home.
|
What is the current dose of the patient's coumadin
|
{
"answer_end": [
911
],
"answer_start": [
884
],
"text": [
"MEDICATIONS: aspirin 81 mg,"
]
}
|
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 tried demerol
|
{
"answer_end": [
954
],
"answer_start": [
910
],
"text": [
"initially managed with Demerol and Vistaril,"
]
}
|
The 64-year-old female patient was admitted with atypical chest pain and a history of CAD (NSTEMIs x 2 in 1997/2001, cath 2000 RCA, LCx in 2000, which were complicated by in-stent thrombosis ?3 years ago), HTN, DM (hba1c 6.2), PVD. In the ED, BP 159/69, P 60. No EKG changes new. First set of enzymes negative. D dimer negative. She underwent chemical-MIBI on 6/25 which was negative for any acute or reversible changes (final P). Her pain was only controlled with oxycodone and she was pain-free at discharge. Pt was discharged to home with follow-up already scheduled with Dr. Hassenger, her cardiologist at the end of the month. She was continued on ECASA (Aspirin Enteric Coated) 81 MG PO 3x/Week M-W-F, LISINOPRIL 1.25 MG PO QD (with POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL), PLAVIX (Clopidogrel) 75 MG PO QD, ATENOLOL 50 MG PO QD, LIPITOR (Atorvastatin) 40 MG PO QD, and GLYBURIDE 1.25 MG PO QD. Of note, pt had an elevated WBC (15.2) which seems to be chronic in nature. No fevers, localizing signs/symptoms of infection. Pt has follow-up with cardiology and vascular surgery scheduled. No new medications this admission.
|
Has a patient had lipitor (atorvastatin)
|
{
"answer_end": [
896
],
"answer_start": [
862
],
"text": [
"LIPITOR (Atorvastatin) 40 MG PO QD"
]
}
|
Ms. Christin is an 80-year-old female who presented to an outside hospital with chest pain and shortness of breath. She took one sublingual Nitroglycerin without relief, followed by two more without relief and was then treated with intravenous Lasix, morphine, and Nitroglycerin which resulted in resolution of her pain. Her medical history includes hypertension, hypercholesterolemia, angina, Paget's disease, anemia, and osteoarthritis. An EKG at the hospital showed anterolateral ST depression and her enzymes were negative, ruling out myocardial infarction. Her cardiac symptomatology began in the fall of 1999 and evaluation showed high cholesterol with an LDL 141, EKG with LVH and nonspecific T wave flattening, and a Thallium stress test that was stopped secondary to shortness of breath. Upon admission to Ster Hospital for evaluation of her angina, her laboratory values were consistent with a myocardial infarction and her peak CK was 459 with an MB of 28.7. Her discharge medications include Aspirin 81 mg daily, iron 300 mg three times a day, Hydrochlorothiazide 25 mg daily, Lisinopril 5 mg daily, multivitamin one daily, Relafen 500 mg orally a day, Imdur 60 mg orally a day, Plavix 75 mg daily for 29 days, Lipitor 40 mg daily, Atenolol 25 mg orally a day, and magnesium oxide 420 mg daily. Follow-up with Dr. Porter Luckenbaugh in SH Cardiovascular Group on January at 1:00 p.m. and with Dr. Sammy Kleindienst in the Greenetons Opi Hospital Hematology Clinic.
|
Is there history of use of aspirin
|
{
"answer_end": [
1055
],
"answer_start": [
1004
],
"text": [
"Aspirin 81 mg daily, iron 300 mg three times a day,"
]
}
|
A 42-year-old male was admitted on 4/30 with congestive heart failure exacerbation, hyperhomocysteinemia, chronic renal failure, obesity, hypercholesterolemia, h/o DVT, asthma, OSA, and a worsening of his dyspnea of exertion (DOE) to 3 miles of flat ground with a suspicion of multifocal pneumonia (PNA). He had a D-dimer of 1400, BNP of 2009, and Troponin of 0.84-0.54, which was not considered ischemic, and was not treated. On this admission, his D-dimer was 1207, BNP was 2917, and Troponin was not sent. He had a JVP to earlobe, bibasilar rales, no wheezes, and diffuse pitting edema to his bilateral shins. He had a chest X-ray (CXR) showing increased bilat LL opacities to the periphery with some cephalization of vessels and some opacification. An electrocardiogram (ECG) showed 98 bpm with left anterior fascicular block (LAE) and strain. A chest CT scan from 8/18 (comparing to 4/30) showed per pulm c/w scarring/persistent changes after recent multifocal PNA 4/30, no e/o of new primary lung path, and ground glass c/w pulmonary edema. An echocardiogram showed an ejection fraction (EF) of 25%, moderate right ventricular (RV) dysfunction, and severe tricuspid regurgitation (TR). A follow-up cardiac MRI from 10/16 showed an EF of 23%, global hypokinesis, no wall motion abnormality (WMA), normal RV, and no valve disease. In the ED, he received Duonebs, ASA 325, and Lasix 80mg. His shortness of breath was secondary to CHF exacerbation and fluid overload with no evidence of an infectious pulmonary process contributing to his symptoms. His hypertension was most likely due to taking the wrong dose of Coreg (taking QOD instead of BID). On a BID Coreg regimen, his BP was much better controlled. His renal function remained stable but impaired while he was being evaluated for dialysis as an outpatient but no vascular access was placed yet. He was discharged on 6/7/05 with a full code status and disposition to home with food/drug interaction instruction to take consistently with meals or on empty stomach and activity to walk as tolerated with follow up appointments with Dr. Sackrider at ACH 5/6/05 at 1:30 PM scheduled, Dr. Dauphin at CMC 0/4/05 at 1:40 PM scheduled. He was discharged with ACETYLSALICYLIC ACID 81 MG PO QD, on order for COUMADIN PO (ref #55946845) to address a POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, PHOSLO (CALCIUM ACETATE) 667 MG PO TID, FOLATE (FOLIC ACID) 1 MG PO QD, DIOVAN (VALSARTAN) 160 MG PO QD prescribed by his cardiologist, CARVEDILOL 6.25 MG PO BID HOLD IF: HR < 60, or SBP < 100, NEPHROCAPS (NEPHRO-VIT RX) 1 TAB PO QD, with an alert overridden: Override added on 4/7/05 by ALAMIN, NORMAN B., M.D. POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: MD Aware, LIPITOR (ATORVASTATIN) 20 MG PO QD with an alert overridden: Override added on 6/7/05 by: POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & ATORVASTATIN CALCIUM Reason for override: home med, and LASIX (FUROSEMIDE) 80 MG PO BID, with a d/c JVP 10cm. He had not been taking his Lasix for 2d prior to d/c. Pt was instructed to diurese further at home on Lasix 80 BID and continue on Coumadin for his h/o recent DVT (4/30) and INR 2-3.
|
Has the patient taken any medications for recent dvt management
|
{
"answer_end": [
3193
],
"answer_start": [
3130
],
"text": [
"continue on Coumadin for his h/o recent DVT (4/30) and INR 2-3."
]
}
|
A 60 year old Spanish speaking woman with multiple cardiac risk factors and a two to three year history of exertional angina presented complaining of unstable chest pain. Dr. Maximo Bryum in C&O MEDICAL CENTER Clinic initiated an antianginal regimen, however the patient recently stopped taking Aspirin and her symptoms then recurred. The patient was given three sublingual Nitroglycerins after her primary M.D. was called and her pain resolved after approximately 15 minutes. On the 27 of January, 1995, the patient underwent a Dobutamine MIBBE on which she went 6 minutes and 48 seconds reaching a maximal heart rate of 154, a blood pressure of 172/82, with 2 mm ST depressions diffusely and moderate to severe reversible anterior and anteroseptal wall ischemia. Medications on admission included Atenolol 50 mg p.o. q.d., Axid 150 mg p.o. b.i.d., Enteric Coated Aspirin 325 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem 240 mg p.o. q.d., Lisinopril 10 mg p.o. q.d., Lopipd 600 mg p.o. q.d., Lasix 40 mg p.o. q.d., Insulin NPH 75 units sub-q q.a.m., 50 units q.p.m., Insulin Regular 25 units sub-q q.a.m., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, and Omeprazole 20 mg p.o. q.d. The Cardiology Team was consulted and serial CK, MB and EKG's were done, with Heparin initially started given the possibility that this was unstable angina. The patient's Insulin dosages were adjusted in the manner to keep her blood sugars in the approximately 200 range and she was discharged with medications including Enteric Coated Aspirin 325 mg p.o. q.d., Lasix 40 mg p.o. q.d., Lopid 600 mg p.o. q.d., Insulin NPH 100 units sub-q q.a.m., 70 units sub-q q.h.s., Insulin Regular 25 units sub-q q.a.m., Lisinopril 10 mg p.o. q.d., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, Omeprazole 20 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem CD 240 mg p.o. q.d., with follow-up care with her primary M.D., Dr. Jarvis Needy in the RINGBURG RITA'S PROPRES MEMORIAL HOSPITAL Clinic.
|
Has patient ever been prescribed lopipd
|
{
"answer_end": [
946
],
"answer_start": [
919
],
"text": [
"Diltiazem 240 mg p.o. q.d.,"
]
}
|
This 64-year-old male with a history of coronary artery disease, CHF, EF of 15%, status post AVR, and NSTEMI initially presented to outside hospital with chief complaint of shortness of breath and was found to have a BNP of 747 as well as a troponin I of 0.43. He was diuresed, started on Carvedilol and improved, and placed on a heparin drip. His medications on admission included Aspirin 81, Lisinopril 20, Plavix 75, Verapamil 240 sustained release, Gemfibrozil 600 b.i.d., Nystatin 500 b.i.d., Paxil 20 daily, Glipizide 10 daily, Coumadin 4 prior to admission to outside hospital, Carvedilol 6.25 daily, heparin drip and Spironolactone. During his hospital stay, he was continued on Aspirin, Plavix, beta-blocker and ACE inhibitor, which were titrated to effect, started on a statin and continued on Niaspan, and maintained on a nicotine patch. He was also prescribed Spironolactone 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, and Coumadin 5 mg p.o. at night. The patient's diabetes was controlled with regular insulin and placed back on his oral hypoglycemics, which were discontinued on admission and was encouraged to stop smoking. He had runs of ectopy and SVT, so was placed on a heparin drip. Left heart cath revealed wall defect consistent with a right coronary artery infarct and the patient was continued on Spironolactone. He was discharged in a stable condition on Aspirin 325 p.o. daily, Lisinopril 4 mg p.o. daily, Nicotine patch 14 mg per day topical, Spironolactone 25 mg p.o. daily, Paxil 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, Carvedilol 12.5 mg p.o. twice daily, Plavix 75 mg daily, Gemfibrozil 900 mg p.o. twice daily and Coumadin 5 mg p.o. at night, with instructions to follow up with PCP and Cardiology as well as EP, to check his daily weights and report any increases to his PCP, and to arrange to have his INR drawn on 6/21/06 and follow-up INRs to be drawn every seven days.
|
Has the patient ever been on nicotine patch
|
{
"answer_end": [
848
],
"answer_start": [
817
],
"text": [
"maintained on a nicotine patch."
]
}
|
Mrs. Wetterauer is a 54-year-old female with coronary artery disease status post inferior myocardial infarction in March of 1997, with sick sinus syndrome, status post permanent pacemaker placement, and paroxysmal atrial fibrillation controlled with amiodarone; also with history of diabetes mellitus and hypertension. On 1/11, she experienced severe respiratory distress and was unable to be intubated on the field. She was ultimately intubated at Sirose, and an echocardiogram showed an ejection fraction of 25 to 30 percent with flat CKs. She was diuresed six liters and a right heart catheterization showed a pulmonary artery pressure of 40/15, wedge of 12, and cardiac output of 5.2. Hemodynamics indicated her cardiac output was dependent on her SVR. At the outside hospital, a right upper lobe infiltrate was noted and she was given gentamicin 250 mg times one, and clindamycin 600 mg. She was diagnosed with pneumonia and treated with clindamycin, which caused resolution of her white count. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. Her last admission was on 10/6 for atypical chest pain, and she was placed on Bactrim Double Strength b.i.d. times a total of seven days, as well as Lovenox 60 mg b.i.d., aspirin 325 p.o. q.d., lisinopril 40 mg p.o. b.i.d., digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. Home medications include amiodarone 200 mg p.o. q.d., Glyburide 5 mg p.o. q.d., Lopressor 50 mg p.o. b.i.d., Prempro 0.625/2.5 p.o. q.d., lisinopril 40 mg p.o. q.d., Coumadin, nitroglycerin sublingual, Zantac, beclomethasone, and Ventolin. Medications on transfer, Lovenox 60 mg b.i.d., aspirin 325 p.o. q.8, digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. The patient was also placed on Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Glyburide 5 mg p.o. q.d., Lasix 20 mg p.o. q.d., atenolol 150 mg p.o. q.d., diltiazem CD 240 mg p.o. q.d., and resolved with 20 mg of Lasix p.o. q.d. Mrs. Wetterauer was admitted to the Aley Coness-o Meoak Medical Center for paroxysmal atrial fibrillation controlled with amiodarone, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma. For her anxiety, the patient was treated acutely with Ativan and her problem resolved quite well, and she became more comfortable in the hospital. Diabetes Mellitus was managed with Glyburide held initially on admission, covered with insulin sliding scale, and restarted on discharge. Edema was managed with Lasix 20 mg p.o. q.d. and resolved with 20 mg of Lasix p.o. q.d. Urinary Tract Infection was managed with antibiotics. She was discharged with medications including amiodarone 200 mg p.o. q.d., lisinopril 40 mg p.o. b.i.d., Tapazole 10 mg
|
Was the patient ever given medication for paroxysmal atrial fibrillation
|
{
"answer_end": [
261
],
"answer_start": [
203
],
"text": [
"paroxysmal atrial fibrillation controlled with amiodarone;"
]
}
|
Ms. Fought is a 50-year-old female with a history of bipolar disorder, schizophrenia, obstructive sleep apnea, hypertension, and diabetes who presented with right knee swelling, redness, and pain and was admitted to the Emergency Department. She was given therapeutic doses of heparin because of the concern of pain, as well as IV fluids, Oxycodone 5 mg to 10 mg p.o. q.4h. p.r.n. pain, Tylenol 650 mg p.o. q.4h. p.r.n. pain, Ibuprofen 600 mg q.6h. p.r.n. pain, Klonopin 1 mg p.o. at bedtime, Levofloxacin 500 mg p.o. daily for six days after the day of discharge, and NSAIDs, and was prescribed Lisinopril 10 mg daily, Lipitor 40 mg daily, Klonopin, MetroGel p.o. at bedtime, Lithium 900 mg at bedtime, Acebutolol 200 mg daily, and Risperdal 0.5 mg at bedtime, with no known drug allergies. She responded well to normal saline fluid boluses for a total of 3 liters over her hospital course, and was treated with Unasyn and vancomycin, and then switched to levofloxacin, with six more days after discharge from the hospital. Her bradycardia was resolved either over beta blockade or lithium toxicity, for which her beta-blocker was held and her lithium was also held, resulting in an improved heart rate in the 50s and 60s. Upon discharge, she was given instructions to draw blood for lithium level checks daily until it is below 0.5, at which time, she should be restarted on lithium 300 mg p.o. at bedtime, and to follow up with her primary care physician, Dr. Aurelio Gilberto Hencheck at Li County Hospital.
|
swelling meds on in past
|
{
"answer_end": [
316
],
"answer_start": [
242
],
"text": [
"She was given therapeutic doses of heparin because of the concern of pain,"
]
}
|
Patient Isaac Vanover, Jr., a 44-year-old man with a history of CAD s/p MI x2 4/14 with PCI, in stent thrombosis, and re-stenting, was admitted multiple times for CP with associated fatigue and SOB. He was placed on ECASA (Aspirin Enteric Coated) 325 MG PO QD, COLACE (Docusate Sodium) 100 MG PO BID PRN constipation, ENALAPRIL MALEATE 5 MG PO QAM HOLD IF: SBP<100, POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & ENALAPRIL MALEATE (on order for KCL IMMEDIATE RELEASE PO (ref #56599393)), ATIVAN (Lorazepam) 1 MG PO TID Starting Today March PRN anxiety HOLD IF: RR<12 or pt is lethargic, NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain HOLD IF: SBP < 100, ZOLOFT (Sertraline) 100 MG PO QD, ZOCOR (Simvastatin) 20 MG PO QHS, PLAVIX (Clopidogrel) 75 MG PO QD, VIOXX (Rofecoxib) 25 MG PO QD, ZANTAC (Ranitidine HCl) 150 MG PO BID PRN dyspepsia, and ATENOLOL 25 MG PO QD with Food/Drug Interaction Instruction. Managed on Hep, TNG gtt, Plavix, ACE, B blocker, and Demerol, the pain recurred and he was transferred to BVH for cath. Cardiac catheterization on 8/18/02 showed non-obstructive CAD with LMCA, LAD, LCx, and RCA all OK. Pulmonary level of suspicion for PE is low, so D-dimer is sent and PE ruled out. Mild fluid overload was managed with Lasix to keep I/O's 500-1000cc neg. Pain could represent pericarditis, but psychiatric etiology for CP becomes more likely and psychiatric follow-up and treatment for anxiety and depression is recommended. WBC count increased 4/10 but no other sign/symptom of infection, CXR showed no infiltrates, and the patient was discharged stable with instructions to schedule an appointment with the primary doctor within 2-4 weeks, and if chest pain changes in character or is associated with new symptoms, the patient is to notify their doctor or call 911.
|
Why was the patient prescribed lasix
|
{
"answer_end": [
1300
],
"answer_start": [
1265
],
"text": [
"Lasix to keep I/O's 500-1000cc neg."
]
}
|
Mr. Slunaker is a 56-year-old gentleman who underwent coronary artery bypass grafting x4 and was discharged to home in stable condition on 10/20/06. He presented to see Dr. Emory Bebeau in clinic with a warm and swollen left lower leg with redness and was placed on levofloxacin and vancomycin and had him admitted for left lower leg cellulitis. On admission, he was taking Toprol 25 mg daily, diltiazem 30 mg t.i.d., aspirin 325 mg daily, Lasix 40 mg daily, atorvastatin 40 mg daily, Tricor 145 mg daily, Zetia 10 mg daily, metformin 500 mg daily and potassium chloride slow release 20 mEq daily. Infectious disease was consulted and recommended discontinuing the vancomycin and levofloxacin and changing to Ancef 1 gm IV q.8h. and monitoring his wound. The patient remained afebrile and his white count trended down and leg wound improved on exam. On the day of discharge, he was evaluated by Dr. Manvelyan and cleared for discharge to home with Augmentin 875/125 mg b.i.d. for a total of 10 days, enteric-coated aspirin 325 mg daily, Lipitor 40 mg daily, diltiazem 30 mg t.i.d., Zetia 10 mg daily, Tricor 145 mg nightly, Diflucan 200 mg daily for one dose for a penile yeast infection, due to antibiotic use, Metformin 500 mg q.p.m., Toprol-XL 25 mg daily and oxycodone 5-10 mg q.4h. p.r.n. pain. He was instructed to monitor his leg wound and call if he had any increased weight, temperature greater than 101 degrees, any drainage from the wound, redness, swelling or change of any kind in his leg wound. He was cleared by Infectious Disease Service and discharged to home in stable condition and will follow up with Dr. Noah Schaffhauser on 5/7/06 at 1 o'clock, Dr. Aaron Phung in three-four days, his primary care physician, and his cardiologist, Dr. Jonathon Sopata in one to two weeks.
|
Has this patient ever tried lasix
|
{
"answer_end": [
484
],
"answer_start": [
418
],
"text": [
"aspirin 325 mg daily, Lasix 40 mg daily, atorvastatin 40 mg daily,"
]
}
|
75 yo Spanish speaking F was admitted for pre-syncope and discharged on 9/15/04 with full code status to home with medications including TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, ALBUTEROL INHALER 2 PUFF INH QID Starting Today (2/9), ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, ATENOLOL 25 MG PO BID, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, ZOCOR (SIMVASTATIN) 40 MG PO QHS with food/drug interaction instruction to avoid grapefruit unless MD instructs otherwise and IMDUR (ISOSORBIDE MONONIT.(SR)) 30 MG PO QD with food/drug interaction instruction to give on an empty stomach (give 1hr before or 2hr after food) and ZANTAC (RANITIDINE HCL) 150 MG PO BID and CELEBREX (CELECOXIB) 200 MG PO QD with food/drug interaction instruction to take with food with diet of house/low chol/low sat. fat and activity of walking as tolerated. An EKG showed sinus brady and a TSH test was mildly elevated at 5.3. Labs showed an elevated LDL, cardiac enzymes negative, UA negative, Hct 40 at baseline, and an aMIBI 3/24 showed a small reversible defect of mild intensity in the distal ant wall and apex c/w small area ischemia in the distal LAD. The patient was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, ALBUTEROL INHALER 2 PUFF INH QID Starting Today (2/9), ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, ATENOLOL 25 MG PO BID, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, ZOCOR (SIMVASTATIN) 40 MG PO QHS on order for ZOCOR PO (ref # 63128567), IMDUR (ISOSORBIDE MONONIT.(SR)) 30 MG PO QD, ZANTAC (RANITIDINE HCL) 150 MG PO BID, CELEBREX (CELECOXIB) 200 MG PO QD, NSAIDS, and LOVENOX for DVT ppx. The patient was advised of the benefits of ASA for her and was started on 81mg qd and may benefit from EGD as well as increasing Imdur if persistent hypertension. It is important to call Dr. Mcquade for a follow up appointment within the next 1-2 weeks and to take all medications on the discharge list at the doses specified. The patient presents with pre-syncope, hypothyroidism, asthma, left hip pain, headache and polyarthralgias. The patient was monitored on tele and the atenolol could be a contributing factor to the bradycardia and was switched to bid frequency with 1/2 dose (25mg). GI symptoms include dyspepsia and was started on PPI and checked for H.pylori. Endocrine symptoms included a mildly subtherapeutic levoxyl which was increased to 75mcg qd. Pulmonary symptoms included asthma which was continued on albuterol inhaler PRN and DVT ppx with Lovenox. MSK symptoms included trochanteric bursitis which was treated with Tylenol.
|
Has this patient ever been prescribed levoxyl
|
{
"answer_end": [
2394
],
"answer_start": [
2283
],
"text": [
"Endocrine symptoms included a mildly subtherapeutic levoxyl which was increased to 75mcg qd. Pulmonary symptoms"
]
}
|
This is a 47-year-old female with a history of HIV, diabetes, questionable cerebral aneurysm, and seizure disorder who recently had two syncopal events without prodrome and without postictal state, who presented for evaluation of left arm paresthesias and chest pain, with associated diaphoresis, shortness of breath and nausea. Of note, the patient recently started Flexeril to treat chronic low back pain, was not receiving her Keppra for approximately a year, as her prescription had ran out, and was instead taking Ecotrin 81 mg daily, clonazepam 1 mg q.6 h. p.r.n., Imodium one to two tablets q.i.d. p.r.n. for diarrhea, and low-dose aspirin. The patient was started on low-dose beta-blocker and aspirin, metoprolol 12.5 b.i.d. with occasional bradycardia to the high 40's, and was treated with the Ryo Hospital Medical Center insulin protocol. The patient was restarted on Keppra 250 mg b.i.d. with a goal to increase to 500 mg b.i.d. after 7 days and to 750 mg after another week, and was given Keppra 500 mg b.i.d. for 14 doses and then 750 mg b.i.d., Flexeril 5 mg daily, clonazepam 1 mg q.i.d., Truvada one tablet p.o. daily, Norvir 1400 mg b.i.d., glyburide 5 mg q.a.m. and 2.5 mg q.p.m., Lomotil one tablet q.i.d. p.r.n., methadone 150 mg daily, Zofran 4 mg daily p.r.n., Percocet 325 mg/5 mg tablets one tablet q.6 h. p.r.n., Zantac 150 mg b.i.d., Zoloft 100 mg q.a.m., and trazodone 100 mg nightly. Labs revealed a low reticulocyte index consistent with anemia of chronic disease, and the methadone dose of 155 mg was confirmed with the outpatient clinic. The patient was also given three doses of Klonopin over a six-day period, instructed to take medications as listed, clarify discrepancies with her PCP, return to the ER for evaluation if she faints again, call her PCP and/or return to the ER if her chest pain symptoms recur and persist, make an appointment with the Smill Memorial Hospital to evaluate the cause of her left arm symptoms, and check her blood sugars before meals and at bedtime. Additionally, her PCP was instructed to arrange for a loop monitor, follow up on a 24-hour urine studies assessing for pheochromocytoma, and adjust the patient's diabetes management as needed.
|
What medications has this patient tried for lumbar spine herniations.
|
{
"answer_end": [
1569
],
"answer_start": [
1499
],
"text": [
"the methadone dose of 155 mg was confirmed with the outpatient clinic."
]
}
|
This is a 70-year-old woman with ischemic cardiomyopathy, coronary artery disease status post MI, insulin-dependent diabetes, peripheral vascular disease, and chronic renal insufficiency who presented in volume overload after a previous admission. She had been diuresed with a Lasix drip at 10 mg per hour and Zaroxolyn at 2.5 mg p.o. daily, and her Lopressor was held for a decompensated heart failure. She was then started on amiodarone and Coumadin for a new paroxysmal atrial fibrillation. Her Lasix drip was increased to 20 mg per hour and the Zaroxolyn was increased to b.i.d. After transition from Zaroxolyn to Diuril, which was given 250 mg IV b.i.d., she was prescribed Ativan 0.5 mg p.o. t.i.d. p.r.n. anxiety, Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Lantus 18 units subcutaneously nightly, Lopressor 25 mg p.o. b.i.d., Procrit 40,000 units subcutaneously every other week, Nitroglycerin sublingual p.r.n. chest pain, Aspirin 81 mg p.o. daily, Vitamin B12 subcutaneous injections at clinic, Iron 325 mg p.o. t.i.d., Metolazone p.r.n., Multivitamin one tablet p.o. daily, Torsemide 100 mg q.a.m. and 50 mg q.p.m., Coumadin 1 mg q.p.m., and Amiodarone 200 mg p.o. daily. Despite the dose of Coumadin being decreased from her home dose of 1 mg q.p.m. to a 0.5 mg q.p.m., her INR continued to rise greater than 200. She was started on q.a.c. NovoLog regimen with her Lantus insulin dose decreased from 18 units to 16 units and the NovoLog sliding scale was started. She was monitored on telemetry with no other events and required repletion of both potassium and magnesium despite her renal insufficiency throughout the admission in the setting of injected insulin in the setting of worsening renal failure, so, studies were also normal. She was continued on Aranesp through the admission and was discharged home on a similar regimen to her home regimen simply to Torsemide after the last discharge as her outpatient p.o. Torsemide regimen of 100 mg p.o. q.a.m. and 50 mg q.p.m., Lantus 12 units subcutaneously nightly, Ativan 0.5 mg p.o. t.i.d., Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Multivitamin one tablet p.o. daily, Coumadin 1 mg q.p.m., Metolazone 2.5 mg p.o. daily as needed for fluid retention, Iron 325 mg p.o. t.i.d., and Aspirin 81 mg p.o. daily. She was maintained on a cardiac diet and prophylaxis with Coumadin and Nexium. Potassium and magnesium were repleted as needed and she was maintained on aspirin and Lipitor throughout the admission. She will follow up with her primary care provider, SRRH Cardiology Clinic, and Renal Clinic.
|
has the patient used aranesp in the past
|
{
"answer_end": [
1787
],
"answer_start": [
1759
],
"text": [
"She was continued on Aranesp"
]
}
|
Mr. Legions is a 54 year old professor who presented to Menjack Hospital Medical Center with recurrent substernal chest pain one day after coronary artery bypass graft (5 vessel bypass) 8 years ago. His coronary risk factors include a positive family history and a previous diagnosis of hyperlipidemia. He was given Lovastatin 40 mg q q.m. and 20 mg q p.m., as well as enteric-coated aspirin one tablet q day. At Skaggssin Hospital, he was given IV nitroglycerin, IV heparin, Nifedipine SL, and morphine, in addition to aspirin and Lovastatin. The patient's pain was relieved with four sublingual nitroglycerin and an EKG demonstrated one sublingual nitroglycerin and these EKG changes resolved. He was treated symptomatically with Tylenol and started on Biaxin 500 mg po bid, and also received a five day course of oral Biaxin with Cholestyramine one packet po q hs, Lopressor 50 mg po tid, and Sublingual nitroglycerin 1/150 tablets to be taken prn. The patient had episodes of fever, achieving a maximum temperature of 101.4, and a chest x-ray on 0/26/95 demonstrated evidence of early congestive heart failure. The patient was treated with daily doses of IV Lasix with resolution of his rales. He was admitted to the Cardiac Intensive Care Unit on IV heparin and nitroglycerine as well as continuation of his aspirin and Lovastatin. His pain was treated with morphine sulfate and relieved with four sublingual nitroglycerin. An EKG demonstrated one sublingual nitroglycerin and these EKG changes resolved. After 24 hours pain-free, the patient was transferred to the Cardiac Step-Down floor and the IV nitroglycerin and IV heparin were discontinued. An echocardiogram demonstrated inferior and posterior hypokinesis with an ejection fraction of approximately 46%, and the patient underwent a submax MIBI to assess coronary perfusion of the heart. The exercise component of this examination demonstrated EKG changes consistent with ischemic coronary flow. Nuclear imaging demonstrated a fixed apical lateral defect in the patient's heart consistent with a healed or healing transmural infarct. The patient also complained of progressive anterior and lateral thigh pain, symptoms consistent with an upper respiratory viral infection, and rales 4 to 5 cm above the bases bilaterally. He was discharged to home with followup in MERH under Drs. Dwayne Ariel Bremme with the medications Enteric-coated aspirin 325 mg po q day, Cholestyramine one packet po q hs, Lovastatin 20 mg po q hs, Lopressor 50 mg po tid, and Sublingual nitroglycerin 1/150 tablets to be taken prn with chest pain.
|
has there been a prior aspirin
|
{
"answer_end": [
543
],
"answer_start": [
505
],
"text": [
"in addition to aspirin and Lovastatin."
]
}
|
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 this patient ever been on prilosec
|
{
"answer_end": [
537
],
"answer_start": [
509
],
"text": [
"Prilosec 20 mg p.o. q. day.,"
]
}
|
This is a 59-year-old female with a history of rheumatic heart disease, endocarditis, diabetes mellitus, hypertension, and congestive heart failure who presented with increasing shortness of breath, nausea, vomiting, and abdominal pain. She was given recent Levaquin for an upper respiratory tract infection, then started on Flagyl for a possible C. difficile infection and was diuresed with IV Lasix with good output per report. She complained of 10/10 abdominal pain and was given some Dilaudid. Her hematocrit at one point required two units of packed red blood cells, and she was placed on a heparin drip at 950 units per hour to maintain a PTT between 60 and 80 secondary to atrial fibrillation that has been rate controlled with a beta-blocker. She was discharged on diltiazem 30 mg q.i.d. and a normal dosing of Nexium 40 mg p.o. q.d. while in-house. She was given Darvon and Codeine as needed for pain, and was prescribed Caltrate plus Vitamin D 600 mg, Maalox tablets, Magnesium oxide 400 mg, Multivitamin, Niferex 150 mg, and Lovenox 60 mg subcutaneously b.i.d. with a renal adjustment and NovoLog 15 units subcutaneously with breakfast and dinner. The patient was instructed to call Dr. Mccutchan office to coordinate her appointment for her valve repair in the next one to two weeks pending her surgeon's return and to call Dr. Doug Schlanger on March 2005 to discuss surgical plans and also to follow up. All her blood cultures should be followed up prior to her surgery and if any of her blood cultures become positive in the interim, a long course of antibiotic therapy should be started and surgery should be delayed at the discussion of the Cardiovascular Service. Her medications included Lasix 40 mg p.o. q.o.d. alternating with 80 mg p.o. Lasix q.o.d., Digoxin 0.125 mg q.o.d. alternating with 0.25 q.o.d., Lisinopril 20 mg p.o. q.d., Coumadin 6 mg p.o. q.o.d. alternating with 4 mg q.o.d., Omeprazole 20 mg b.i.d., Metformin 500 mg daily, Insulin 70/30 65 units q.a.m., 35 units q.p.m., Calcium 600 mg p.o. b.i.d., Magnesium 400 mg p.o. b.i.d., Multivitamin, Iron tablets, Actonel every Wednesday, Caltrate plus vitamin D 600 mg one tablet p.o. b.i.d., Maalox tablets quick dissolve, Magnesium oxide 400 mg p.o. b.i.d., Niferex 150 mg p.o. b.i.d., Colace 100 mg p.o. b.i.d., Senokot three tablets p.o. b.i.d., Codeine 15 mg to 30 mg p.o. q.4h. p.r.n. pain. She was required to increase her dosage of Nexium secondary to GERD-like symptoms and was maintained on a stable regimen of NPH 60 units in the morning, NPH 30 units in the evening, and NovoLog of 15 units in the morning with breakfast and 15 at dinner with a sliding scale. She was also transitioned to Lovenox 60 mg b.i.d. with a renal adjustment and was sent to the ED for diuresis where she was given 60 mg of Lasix.
|
Has the pt. ever been on colace before
|
{
"answer_end": [
2295
],
"answer_start": [
2269
],
"text": [
"Colace 100 mg p.o. b.i.d.,"
]
}
|
75 yo Spanish speaking F was admitted for pre-syncope and discharged on 9/15/04 with full code status to home with medications including TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, ALBUTEROL INHALER 2 PUFF INH QID Starting Today (2/9), ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, ATENOLOL 25 MG PO BID, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, ZOCOR (SIMVASTATIN) 40 MG PO QHS with food/drug interaction instruction to avoid grapefruit unless MD instructs otherwise and IMDUR (ISOSORBIDE MONONIT.(SR)) 30 MG PO QD with food/drug interaction instruction to give on an empty stomach (give 1hr before or 2hr after food) and ZANTAC (RANITIDINE HCL) 150 MG PO BID and CELEBREX (CELECOXIB) 200 MG PO QD with food/drug interaction instruction to take with food with diet of house/low chol/low sat. fat and activity of walking as tolerated. An EKG showed sinus brady and a TSH test was mildly elevated at 5.3. Labs showed an elevated LDL, cardiac enzymes negative, UA negative, Hct 40 at baseline, and an aMIBI 3/24 showed a small reversible defect of mild intensity in the distal ant wall and apex c/w small area ischemia in the distal LAD. The patient was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, ALBUTEROL INHALER 2 PUFF INH QID Starting Today (2/9), ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, ATENOLOL 25 MG PO BID, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, ZOCOR (SIMVASTATIN) 40 MG PO QHS on order for ZOCOR PO (ref # 63128567), IMDUR (ISOSORBIDE MONONIT.(SR)) 30 MG PO QD, ZANTAC (RANITIDINE HCL) 150 MG PO BID, CELEBREX (CELECOXIB) 200 MG PO QD, NSAIDS, and LOVENOX for DVT ppx. The patient was advised of the benefits of ASA for her and was started on 81mg qd and may benefit from EGD as well as increasing Imdur if persistent hypertension. It is important to call Dr. Mcquade for a follow up appointment within the next 1-2 weeks and to take all medications on the discharge list at the doses specified. The patient presents with pre-syncope, hypothyroidism, asthma, left hip pain, headache and polyarthralgias. The patient was monitored on tele and the atenolol could be a contributing factor to the bradycardia and was switched to bid frequency with 1/2 dose (25mg). GI symptoms include dyspepsia and was started on PPI and checked for H.pylori. Endocrine symptoms included a mildly subtherapeutic levoxyl which was increased to 75mcg qd. Pulmonary symptoms included asthma which was continued on albuterol inhaler PRN and DVT ppx with Lovenox. MSK symptoms included trochanteric bursitis which was treated with Tylenol.
|
Has a patient had albuterol inhaler
|
{
"answer_end": [
243
],
"answer_start": [
189
],
"text": [
"ALBUTEROL INHALER 2 PUFF INH QID Starting Today (2/9),"
]
}
|
Ms. Elter is an 83-year-old Spanish-speaking female with history of CAD, distant three-vessel CABG, CRI, NSTEMI in 4/20 and type II diabetes who presented to the ED with PND, dyspnea on exertion, and chest heaviness with no fevers or chills and no sick contacts, and EMS had given her Lasix and Nitrospray. She was briefly on a nonrebreather mask and responded to 80 mg of IV Lasix, with her potassium level reaching 5.8 and Kayexalate administered. Her medications included aspirin, metoprolol, allopurinol, valsartan, glipizide, Lipitor, and nifedipine, with her oxygen saturation eventually reaching the high 90s on a couple of liters of oxygen and her chest x-ray full set negative. She was treated with aspirin, beta-blockers, and statin for coronary artery disease, experienced a CHF flare with an elevated BNP which was managed with Lasix and Diuril, and her after load was reduced with ARB and her previous home calcium channel blocker was weaned off. She had a transient new atrial fibrillation and ventricular ectopy which resolved spontaneously, and was placed on humidified room air with nasal saline sprays and Afrin due to her coronary artery disease. She was transfused a total of 3 units to keep her hematocrit greater than 30 and Coumadin was initially started given her new onset of atrial fibrillation, but ultimately only aspirin was given after consideration of risks versus benefits. She had some constipation which was relieved with stool softeners and the patient received a PPI. Her DM-2 was managed with regular sliding scale insulin with good blood sugar control and her glipizide was held given her worsening creatinine clearance, and her allopurinol was changed to q.72h. from q.o.d. due to the creatinine clearance and she had some left heel and foot pain thought to be secondary to gout, which improved at the time of discharge. Her hematocrit dropped from 29 to 25, her guaiac was negative on the 3/20/04, and she was sent home with VNA support to follow up on her weights and fluid status and with home physical therapy. Her medications at the time of discharge included Lasix 20 mg p.o. q.d., Lipitor 80 mg p.o. q.d., Metoprolol sustained release 100 mg p.o. b.i.d., Colace 100 mg p.o. b.i.d. p.r.n. for constipation, Allopurinol 100 mg p.o. q.72h., Aspirin 325 mg p.o. q.d., and Valsartan 160 mg p.o. q.d.
|
Has this patient ever been on kayexalate
|
{
"answer_end": [
449
],
"answer_start": [
351
],
"text": [
"responded to 80 mg of IV Lasix, with her potassium level reaching 5.8 and Kayexalate administered."
]
}
|
This is a 70-year-old woman with ischemic cardiomyopathy, coronary artery disease status post MI, insulin-dependent diabetes, peripheral vascular disease, and chronic renal insufficiency who presented in volume overload after a previous admission. She had been diuresed with a Lasix drip at 10 mg per hour and Zaroxolyn at 2.5 mg p.o. daily, and her Lopressor was held for a decompensated heart failure. She was then started on amiodarone and Coumadin for a new paroxysmal atrial fibrillation. Her Lasix drip was increased to 20 mg per hour and the Zaroxolyn was increased to b.i.d. After transition from Zaroxolyn to Diuril, which was given 250 mg IV b.i.d., she was prescribed Ativan 0.5 mg p.o. t.i.d. p.r.n. anxiety, Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Lantus 18 units subcutaneously nightly, Lopressor 25 mg p.o. b.i.d., Procrit 40,000 units subcutaneously every other week, Nitroglycerin sublingual p.r.n. chest pain, Aspirin 81 mg p.o. daily, Vitamin B12 subcutaneous injections at clinic, Iron 325 mg p.o. t.i.d., Metolazone p.r.n., Multivitamin one tablet p.o. daily, Torsemide 100 mg q.a.m. and 50 mg q.p.m., Coumadin 1 mg q.p.m., and Amiodarone 200 mg p.o. daily. Despite the dose of Coumadin being decreased from her home dose of 1 mg q.p.m. to a 0.5 mg q.p.m., her INR continued to rise greater than 200. She was started on q.a.c. NovoLog regimen with her Lantus insulin dose decreased from 18 units to 16 units and the NovoLog sliding scale was started. She was monitored on telemetry with no other events and required repletion of both potassium and magnesium despite her renal insufficiency throughout the admission in the setting of injected insulin in the setting of worsening renal failure, so, studies were also normal. She was continued on Aranesp through the admission and was discharged home on a similar regimen to her home regimen simply to Torsemide after the last discharge as her outpatient p.o. Torsemide regimen of 100 mg p.o. q.a.m. and 50 mg q.p.m., Lantus 12 units subcutaneously nightly, Ativan 0.5 mg p.o. t.i.d., Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Multivitamin one tablet p.o. daily, Coumadin 1 mg q.p.m., Metolazone 2.5 mg p.o. daily as needed for fluid retention, Iron 325 mg p.o. t.i.d., and Aspirin 81 mg p.o. daily. She was maintained on a cardiac diet and prophylaxis with Coumadin and Nexium. Potassium and magnesium were repleted as needed and she was maintained on aspirin and Lipitor throughout the admission. She will follow up with her primary care provider, SRRH Cardiology Clinic, and Renal Clinic.
|
Why was the patient on nitroglycerin
|
{
"answer_end": [
942
],
"answer_start": [
899
],
"text": [
"Nitroglycerin sublingual p.r.n. chest pain,"
]
}
|
The patient is a 59 year-old right-handed woman admitted for suspected acute stroke with a PMH of hypertension, hypercholesterolemia, prior TIA vs. stroke, recurrent left Bell's palsy, obesity, allergic rhinitis, history of TIA vs. stroke, obstructive sleep apnea, and chronic renal insufficiency. She was put on Acetylsalicylic Acid 325 mg PO QD, Atenolol 50 mg PO QD Starting in AM (2/11), Atorvastatin 40 mg PO QD, Hydrochlorothiazide 25 mg PO QD, Amlodipine 10 mg PO QD Food/Drug Interaction Instruction, and PRN albuterol and loratadine. She was also placed on aspirin 325 mg qd for stroke and heart prophylaxis and should supplement her diet with folic acid, taking a full dose of aspirin (325 mg) and folate supplementation. She should discuss raising her dose of atorvastatin (Lipitor) with her PCP, because her cholesterol and LDL levels were high this admission and she has an outpt appointment for carotid non-invasive studies 4/0/03.
|
What treatments has patient been on for heart prophylaxis. in the past
|
{
"answer_end": [
616
],
"answer_start": [
543
],
"text": [
"She was also placed on aspirin 325 mg qd for stroke and heart prophylaxis"
]
}
|
A 58 year old woman with a history of CABG times three, inferior myocardial infarction, peptic ulcer disease, anemia, and cholelithiasis was admitted with substernal chest pain at rest, dysphagia, light-headedness, coughing, and nocturia. On admission, her blood pressure was 110/68 lying and 90/palp sitting, O2 sat was 97% on room air, JVP was 9 cm with crackles at the right base, and her hematocrit was 20.8. She was given three sublingual nitroglycerins and Maalox, 10 mg of IV Lopressor from which she became hypotensive, two units of packed red blood cells, Lasix, and IV H2 blockers, 20 mEq of Kay Ciel, and IV nitroglycerin 50 units which was increased to 100 units. EKG changes were noted with a flattening in V4 through V6 with no ST depressions and a T wave down in V3. An endoscopy was done which revealed a large hiatal hernia with no evidence of GI bleeding. On discharge, she was given Pepcid 20 mg p.o. b.i.d., metoprolol 50 mg p.o. b.i.d., and nitroglycerin 1/150 0.4 mg sublingual p.r.n. Follow up was recommended with Dr. Pichard and the GI service.
|
has there been a prior nitroglycerins
|
{
"answer_end": [
470
],
"answer_start": [
413
],
"text": [
"She was given three sublingual nitroglycerins and Maalox,"
]
}
|
A 65 year old African-American female with a history of chronic pancreatitis was admitted to the Staho Health 10 of November to 3 of May for her chronic pancreatitis and returned on the 24 of January with recurrent abdominal pain and symptoms consistent with her chronic pancreatitis. On admission, she had a low grade temperature of 100.2, was tachycardic with a heart rate of 131, respiratory rate 20, blood pressure 132/80. Abdominal exam was significant for decreased bowel sounds and abdominal tenderness in the midepigastric region with guarding. Laboratory data showed sodium 128, potassium 4.1, chloride 95, bicarb 26, BUN 23, creatinine 0.8, glucose 433, WBC 17.8, hematocrit 33, platelets 370, alk level of 434, T-bili was 0.6, D-bili was 0.2, lipase was 123, and amylase was 37. An ultrasound showed no gallstones and a 6 cm cyst in the region of the pancreatic head. EKG showed her to be in sinus tachycardia with the rate of 122. Her past medical history was significant for pancreatitis, asthma, insulin dependent diabetes mellitus, history of vascular necrosis of both hips, status post a total hip replacement on the right and left, known coronary artery disease, history of chronic obstructive pulmonary disease, history of GI bleed, status post a Nissen fundoplication with redo, hypertension, alpha thalassemia, history of congestive heart failure, and chronic low back pain secondary to spinal stenosis. Her medications included Metformin, Atrovent, Albuterol, Flovent, Elavil, Cisapride, Flexeril, Axid, NPH insulin, Cardizem CD, lisinopril, Lasix, magnesium oxide, Percocet, Premarin, Provera, Prilosec, Lipitor, Tums and multi-vitamins. She had allergies to Aspirin, Ibuprofen, meperidine, prednisone, penicillin, fophonomide, codeine, morphine, and was not a drinker or smoker. She had developed a urinary tract infection with yeast and was started on fluconazole, and was also begun on H. pylori therapy of Biaxin and bismuth. At the time of discharge, the patient was relatively pain-free, tolerating a p.o. diet, and afebrile and was discharged to the Triadnockum for rehabilitation on her usual medications plus the above-mentioned antibiotics, to complete a seven-day course, and will follow up in the Gug University in the next one to two weeks and will be followed by her primary care physician, Dr. Lorenzo.
|
What types of medications have been tried for a urinary tract infection management
|
{
"answer_end": [
1888
],
"answer_start": [
1802
],
"text": [
"She had developed a urinary tract infection with yeast and was started on fluconazole,"
]
}
|
Patient, a 37 year old male with multiple admissions for atypical chest pain, morbid obesity, restrictive lung disease by PFTs, sleep apnea, and borderline hypertension, came in complaining of SOB and "asthma attack" and anxiety. He responded well to Nebs and Ativan in the ED and was discharged with ECASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO QD with Food/Drug Interaction Instruction to take consistently with meals or on empty stomach, Klonopin (Clonazepam) 1 MG PO TID, Colace (Docusate Sodium) 100 MG PO BID, Prozac (Fluoxetine HCL) 20 MG PO QD, Zestril (Lisinopril) 10 MG PO QD, Niferex-150 150 MG PO BID, Percocet 1 TAB PO Q6H X 7 Days Starting Today (6/1) PRN pain, Azithromycin 250 MG PO QD X 4 Days Starting IN AM (6/1) with Food/Drug Interaction Instruction to take with food, Prednisone Taper PO (60 mg QD X 2 day(s) (0/22/01-09), then 50 mg QD X 2 day(s) (2/26/01-09), then 40 mg QD X 2 day(s) (9/28/01-09), then 30 mg QD X 2 day(s) (4/0/01-09), then 20 mg QD X 2 day(s) (8/26/01-09), then 10 mg QD X 2 day(s) (2/20/01-10), then 5 mg QD X 2 day(s) (3/6/01-10)), on order for Azithromycin PO (ref # 63922816) with Potentially Serious Interaction: Clonazepam & Azithromycin, Prilosec (Omeprazole) 20 MG PO QD, Albuterol Inhaler 2 Puff Inh QID, Atrovent Inhaler (Ipratropium Inhaler) 2 Puff Inh QID, and was instructed to return to work after an appointment with a local physician. He was discharged with a diagnosis of sob of unknown etiology, and other diagnoses included borderline HTN, anxiety disorder, PPD, and morbid obesity.
|
Has the patient ever tried colace ( docusate sodium )
|
{
"answer_end": [
533
],
"answer_start": [
494
],
"text": [
"Colace (Docusate Sodium) 100 MG PO BID,"
]
}
|
The 65-year-old female patient with a history of hypertension, hypercholesterolemia, non-insulin-dependent diabetes mellitus, and no known hx of CAD was admitted with chest pain. On November 1997, an exercise treadmill test revealed a maximal heart rate of 127 and maximal blood pressure of 134/80, with 1 millimeter of ST depression in V5 and T-wave inversions in V4-V6, consistent with, but not diagnostic ischemia. She had a history of sarcoidosis, seizure disorder, pacemaker placement, appendectomy, total abdominal hysterectomy for cervical cancer, adult onset diabetes mellitus, and left calf deep vein thrombosis in 1993. Medications at the time of admission included Linsinopril 5 mg q.d., Pravachol 20 mg q.h.s., aspirin 325 mg q. day, atenolol 0.5 mg b.i.d., Dilantin 200 mg b.i.d., Ventolin inhaler p.r.n., and ferrous gluconate 325 mg t.i.d. Hematocrit on June 1997 was noted to be 29.3 and the patient had been on iron supplements since then. On admission, she was given Nitrol paste and, for her ischemia, she was transfused with one unit of packed red cells. Diagnostic ischemia was present, and she was started on aspirin and atenolol. In the past, she has been treated with prednisone and black secondary to iron supplementation. Two cardiac catheterizations were performed, which showed a 70% residual osteal diagonal stenosis and 0% left anterior descending stenosis. A stent was placed in the diagonal artery with 0% residual stenosis and her left anterior descending was stented. At the time of discharge her medications included Ticlid 250 mg p.o. b.i.d., albuterol inhaler 2 puffs q.i.d. as needed for shortness of breath, enteric-coated aspirin 325 mg p.o. q.d., atenolol 37.5 mg p.o. b.i.d., nitroglycerin 1/150 sublingual one tablet q. 5 minutes times three for chest pain, and Dilantin 200 mg p.o. b.i.d. She was also taking linsinopril 5 mg q.d., Pravachol 20 mg q.h.s., ferrous gluconate 325 mg t.i.d., and Ventolin inhaler p.r.n. She is scheduled to followup with Dr. Doug Millis in her office in one week and will follow up with cardiology as an outpatient.
|
Has the patient ever been on packed red cells
|
{
"answer_end": [
1074
],
"answer_start": [
1003
],
"text": [
"for her ischemia, she was transfused with one unit of packed red cells."
]
}
|
Mr. Notari was admitted to the Orthopaedic Hand Service on 1/18/2006 with a history of increased right shoulder pain following a cellulitis of the right hand. An ESR was checked on admission and was slightly elevated at 18. He was afebrile and non-toxic, therefore was not started on antibiotics. Dilaudid was added to his pain regimen for his increased discomfort. On 9/25/2006 a CT guided right shoulder joint fluid aspiration was performed by Radiology. Analysis of this fluid was not consistent with joint infection. He received Lovenox for DVT prophylaxis during his admission. On HD#4 he was awake, alert, appropriate and afebrile with stable vital signs. His pain was well controlled on oral medications. He was discharged to home with a prescription for COLACE (DOCUSATE SODIUM) 100 MG PO BID, NEXIUM (ESOMEPRAZOLE) 40 MG PO BID, DILAUDID (HYDROMORPHONE HCL) 2-6 MG PO Q4H PRN Pain, ATROVENT HFA INHALER (IPRATROPIUM INHALER) 2 PUFF INH QID PRN Shortness of Breath, LOPRESSOR (METOPROLOL TARTRATE) 12.5 MG PO BID, MS CONTIN (MORPHINE CONTROLLED RELEASE) 45 MG PO QAM, MS CONTIN (MORPHINE CONTROLLED RELEASE) 30 MG PO QPM, SIMVASTATIN 80 MG PO DAILY, TERAZOSIN HCL 10 MG PO DAILY, and Number of Doses Required (approximate): 3, with instructions to do pendulum range of motion exercises regularly, not to drive a motor vehicle, drink any alcohol or operate machinery while taking the medication, drink plenty of water and take a stool softener (Colace) to help prevent constipation, not to drive a car until cleared to do so by a doctor, and to resume home medications unless specifically instructed otherwise. He was also advised to call a doctor or go to a local emergency room if he developed any concerning symptoms. His final joint fluid cultures were pending at the time of discharge, he will be contacted at home if these turn positive.
|
Has the patient ever had atrovent hfa inhaler ( ipratropium inhaler )
|
{
"answer_end": [
973
],
"answer_start": [
891
],
"text": [
"ATROVENT HFA INHALER (IPRATROPIUM INHALER) 2 PUFF INH QID PRN Shortness of Breath,"
]
}
|
Patient Alequin, Garland, a 57-year-old female with a complex medical history including squamous cell lung cancer, cirrhosis, COPD, HTN, PVD, seizure disorder, history of SDH, large abdominal ventral hernia, and chronic back pain, was admitted to the ED obtunded with decreased BP. She had received all her medications as prescribed in the morning at her nursing home and received Thiamine HCL 100 mg PO daily and Narcan in the ED, becoming more responsive and uncomfortable after Narcan with an elevated ammonia level of 233. To manage her mental status, the patient was given Lactulose 30 Milliliters PO QID Starting Today (5/29) and her narcotic dose was avoided. Pain was effectively controlled with MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Celecoxib 100 mg PO daily Starting Today (5/29) PRN Pain, and a Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily. She was prescribed Vitamin C (Ascorbic Acid) 500 mg PO BID, Folate (Folic Acid) 1 mg PO daily, Lasix (Furosemide) 40 mg PO daily, Flagyl (Metronidazole) 500 mg PO q8h, Aldactone (Spironolactone) 75 mg PO BID with food/drug interaction instruction to give with meals, KCL IV (ref #403310506) with serious interaction of Spironolactone & Potassium Chloride with reason for override monitoring, Thiamine HCL 100 mg PO daily, Multivitamin Therapeutic (Therapeutic Multivitamin) 1 tab PO daily, MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Flovent HFA (Fluticasone Propionate) 220 mcg INH BID, Celecoxib 100 mg PO daily, Keppra (Levetiracetam) 1,000 mg PO BID, Caltrate 600 + D (Calcium Carbonate 1,500 mg (...)), Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily, Novolog (Insulin Aspart) sliding scale (subcutaneously) SC AC with instructions to give 0-10 units subcutaneously based on BS, Maalox-Tablets Quick Dissolve/Chewable 1-2 tab PO Q6H PRN Upset Stomach, Vitamin K (Phytonadione) 5 mg PO daily, Protonix (Pantoprazole) 40 mg PO daily, Toprol XL (Metoprolol Succinate Extended Release) 50 mg PO daily with food/drug interaction instruction to take consistently with meals or on empty stomach, Magnesium Oxide 420 mg PO BID, Metronidazol starting on HD 1, and Vancomycin until speciation of blood cultures. Blood cultures were positive for coag negative staph in 2/4. She was also given Flovent for her known COPD and was discharged with instructions to complete a 14-day course of Cipro and Flagyl and a few changes in her medications, including MSIR every 4 hr as needed, Celebrex, and Lidoderm patch. Follow up with Dr. Vargas, Dr. Megeath, Dr. Blandin, and Dr. Pfleider as scheduled, and with PT at nursing home. Blood counts and calcium should be checked on Monday 3/21 and next week respectively.
|
has the patient had lidoderm patch
|
{
"answer_end": [
882
],
"answer_start": [
826
],
"text": [
"Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily."
]
}
|
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 ever tried maalox
|
{
"answer_end": [
988
],
"answer_start": [
948
],
"text": [
"Maalox 1-2 tabs p.o. q.6h. p.r.n. pain. "
]
}
|
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
|
Is there a mention of of tricor usage/prescription in the record
|
{
"answer_end": [
631
],
"answer_start": [
611
],
"text": [
"TriCor 50 mg b.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
|
Has the patient had colace in the past
|
{
"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,"
]
}
|
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
|
Why was the patient on o2
|
{
"answer_end": [
2329
],
"answer_start": [
2256
],
"text": [
"He was treated for COPD flare with supplemental O2, DuoNebs, and steroids"
]
}
|
Logan Czaplinski, an 833-08-42-8 patient, was admitted on 1/27/2001 and discharged on 5/18/2001 to his home with a prescription of ASA (Acetylsalicylic Acid) 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lasix (Furosemide) 80 MG PO BID, Ativan (Lorazepam) 1 MG PO BID PRN anxiety or insomnia, Lopressor (Metoprolol Tartrate) 12.5 MG PO BID, Thiamine (Thiamine HCl) 100 MG PO QD, Coumadin (Warfarin Sodium) 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), Insulin 70/30 (Human) 30 units SC BID, Imdur (Isosorbide Mononit.(SR)) 60 MG PO QD, KCL Slow Rel. 20 mEq x 1 PO BID, Allegra (Fexofenadine HCl) 60 MG PO QD, and Levofloxacin 250 MG PO QD Starting in AM (7/21). An override was added on 10/10/01 by Kent R. Kazee, MD with Potentially Serious Interactions: Aspirin & Warfarin, Simvastatin & Warfarin, and Levofloxacin & Warfarin. Food/Drug Interaction Instructions were also given. This 60-year-old male patient with ischemic CMP and AFib was started on Coumadin 5 weeks ago and was cardioverted via the AICD last Tuesday. He then developed SOB and fever, so he went to the local ED and was given Lasix and Rocephin. His WBC was elevated at 12.2 and he was sent to LMH where he had a low grade fever and required FM O2. He was treated empirically with Levofloxacin, diuresed, and assessed for underlying rhythm. His CXR showed interval improvement and his BCXs from LWMH were negative at 3 days. He was discharged on PO diuretics and a 14-day course of Levofloxacin, with ASA 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lopressor 12.5 MG PO BID, Thiamine 100 MG PO QD, Coumadin 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), and Ativan 1 MG PO BID PRN anxiety or insomnia. He should seek immediate medical attention if he develops chest pain, SOB, lightheadedness, fever, chills, palpitations, or falls.
|
Has the patient had allegra ( fexofenadine hcl ) in the past
|
{
"answer_end": [
689
],
"answer_start": [
650
],
"text": [
"Allegra (Fexofenadine HCl) 60 MG PO QD,"
]
}
|
Logan Czaplinski, an 833-08-42-8 patient, was admitted on 1/27/2001 and discharged on 5/18/2001 to his home with a prescription of ASA (Acetylsalicylic Acid) 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lasix (Furosemide) 80 MG PO BID, Ativan (Lorazepam) 1 MG PO BID PRN anxiety or insomnia, Lopressor (Metoprolol Tartrate) 12.5 MG PO BID, Thiamine (Thiamine HCl) 100 MG PO QD, Coumadin (Warfarin Sodium) 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), Insulin 70/30 (Human) 30 units SC BID, Imdur (Isosorbide Mononit.(SR)) 60 MG PO QD, KCL Slow Rel. 20 mEq x 1 PO BID, Allegra (Fexofenadine HCl) 60 MG PO QD, and Levofloxacin 250 MG PO QD Starting in AM (7/21). An override was added on 10/10/01 by Kent R. Kazee, MD with Potentially Serious Interactions: Aspirin & Warfarin, Simvastatin & Warfarin, and Levofloxacin & Warfarin. Food/Drug Interaction Instructions were also given. This 60-year-old male patient with ischemic CMP and AFib was started on Coumadin 5 weeks ago and was cardioverted via the AICD last Tuesday. He then developed SOB and fever, so he went to the local ED and was given Lasix and Rocephin. His WBC was elevated at 12.2 and he was sent to LMH where he had a low grade fever and required FM O2. He was treated empirically with Levofloxacin, diuresed, and assessed for underlying rhythm. His CXR showed interval improvement and his BCXs from LWMH were negative at 3 days. He was discharged on PO diuretics and a 14-day course of Levofloxacin, with ASA 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lopressor 12.5 MG PO BID, Thiamine 100 MG PO QD, Coumadin 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), and Ativan 1 MG PO BID PRN anxiety or insomnia. He should seek immediate medical attention if he develops chest pain, SOB, lightheadedness, fever, chills, palpitations, or falls.
|
What medications has patient been on for bibasilar infiltrates in the past
|
{
"answer_end": [
1196
],
"answer_start": [
1160
],
"text": [
"ED and was given Lasix and Rocephin."
]
}
|
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.
|
Was the patient on any medication for her chest pain
|
{
"answer_end": [
1497
],
"answer_start": [
1410
],
"text": [
"plus TNG 0.4 mg (Nitroglycerin 1/150 (0.4 mg)) 1 tab SL q5min x 3 doses PRN Chest Pain."
]
}
|
Glen Cooperwood, a 69 year old male with ischemic CMP (EF 25-30%), recent admission for atrial flutter, s/p ablation, and NSVT, was discharged on 6/11/05 at 12:00 PM. The patient was given ACETYLSALICYLIC ACID 81 MG PO QD, INSULIN NPH HUMAN 10 UNITS SC BID, LISINOPRIL 10 MG PO QD, OXYCODONE 5-10 MG PO Q6H PRN Pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, on order for TRICOR PO (ref #76717119), POTENTIALLY SERIOUS INTERACTION: WARFARIN & FENOFIBRATE, MICRONIZED Reason for override: monitoring INR, KEFLEX (CEPHALEXIN) 250 MG PO QID X 12 doses Starting when IV ANTIBIOTICS END, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 25 MG PO QD Food/Drug Interaction Instruction, TRICOR (FENOFIBRATE) 145 MG PO QD, PRILOSEC (OMEPRAZOLE) 20 MG PO QD, DIET: House/Low chol/low sat. fat, ACTIVITY: No heavy lifting and do not lift L elbow above L shoulder x 1 month, Follow up appointment(s) with Dr. Vuckovich on June 10:40am, ALLERGY: NKA, ADMIT DIAGNOSIS: s/p ICD, PRINCIPAL DISCHARGE DIAGNOSIS; Responsible After Study for Causing Admission) s/p ICD, OTHER DIAGNOSIS; Conditions, Infections, Complications, affecting Treatment/Stay CHF (congestive heart failure) CAD (coronary artery disease) s/p CABG (S/P cardiac bypass graft surgery) dm (diabetes mellitus) htn (hypertension) hyperchol (elevated cholesterol) cri (chronic renal dysfunction), OPERATIONS AND PROCEDURES: none, OTHER TREATMENTS/PROCEDURES (NOT IN O.R.): s/p dual chamber ICD, BRIEF RESUME OF HOSPITAL COURSE: 69 y/o man with ischemic CMP (EF 25-30%), recent admit for atrial flutter, s/p ablation, and NSVT. Primary prevention ICD placed without complication. Had short runs of AF during procedure. For coumadin, baby ASA. Also h/o HTN, DM, CRI, CHF. ADDITIONAL COMMENTS: Continue coumadin 5mg each night. Have your INR/coumadin level checked on Monday, March, DISCHARGE CONDITION: Stable, TO DO/PLAN: No dictated summary, ENTERED BY: WEALER, ROYAL R., PA-C (NY43) 6/11/05 @ 10.
|
What medications has the patient ever tried for pain prevention
|
{
"answer_end": [
316
],
"answer_start": [
282
],
"text": [
"OXYCODONE 5-10 MG PO Q6H PRN Pain,"
]
}
|
Ms. Wentz, a 51-year-old female, was found to have an adenomatous polyp at the ileocecal valve, which was not amenable to colonoscopy resection. She has a past history of pulmonary embolism, diabetes mellitus type 2, obesity, hypercholesterolemia, probable COPD, hypertension, and moderate obstructive sleep apnea. The patient also has a long history of smoking, but quit five months before her admission. The patient is allergic to IV erythromycin, which causes rash. She was taking Lipitor 10 mg once a day, Metformin 500 mg in the morning, 100 mg in the afternoon, Coumadin 11 mg, and Tylenol p.r.n. for joint pain. The patient's Coumadin was withheld a week before operation and was placed on heparin. Her Coumadin was restarted on 7/3/05 and on her home dose of 11 mg. Her INR steadily increased over the course of her hospital stay up to 1.7 at her discharge. The patient was on metformin for her diabetes mellitus, which was withheld on the day of her surgery, and was placed on Regular Insulin sliding scale. She also complained of white creamy discharge from her vagina on 9/29/05 and miconazole suppository was prescribed for five days. At the time of discharge, her discharge from her vagina had resolved. The patient was discharged with DuoNeb 3/0.5 mg q.6h, Coumadin 12 mg p.o. nightly, Lipitor 10 mg p.o. once a day, Metformin p.o. 500 mg in the morning, 1000 mg in the afternoon, Colace 100 mg twice a day p.o., and Dilaudid 2-4 mg q.3h. p.o. The patient will arrange to have her INR draw on 1/1/05 with follow-up INRs to be drained every two days and INR will be followed by her primary care physician, Dr. Afonso. The patient is full code.
|
What medications did the patient take for pulmonary embolism
|
{
"answer_end": [
705
],
"answer_start": [
619
],
"text": [
"The patient's Coumadin was withheld a week before operation and was placed on heparin."
]
}
|
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 taken any medications for his congestive heart failure. management
|
{
"answer_end": [
175
],
"answer_start": [
109
],
"text": [
"was initially treated with afterload reduction, digoxin and Lasix."
]
}
|
This is a 47-year-old female with a history of HIV, diabetes, questionable cerebral aneurysm, and seizure disorder who recently had two syncopal events without prodrome and without postictal state, who presented for evaluation of left arm paresthesias and chest pain, with associated diaphoresis, shortness of breath and nausea. Of note, the patient recently started Flexeril to treat chronic low back pain, was not receiving her Keppra for approximately a year, as her prescription had ran out, and was instead taking Ecotrin 81 mg daily, clonazepam 1 mg q.6 h. p.r.n., Imodium one to two tablets q.i.d. p.r.n. for diarrhea, and low-dose aspirin. The patient was started on low-dose beta-blocker and aspirin, metoprolol 12.5 b.i.d. with occasional bradycardia to the high 40's, and was treated with the Ryo Hospital Medical Center insulin protocol. The patient was restarted on Keppra 250 mg b.i.d. with a goal to increase to 500 mg b.i.d. after 7 days and to 750 mg after another week, and was given Keppra 500 mg b.i.d. for 14 doses and then 750 mg b.i.d., Flexeril 5 mg daily, clonazepam 1 mg q.i.d., Truvada one tablet p.o. daily, Norvir 1400 mg b.i.d., glyburide 5 mg q.a.m. and 2.5 mg q.p.m., Lomotil one tablet q.i.d. p.r.n., methadone 150 mg daily, Zofran 4 mg daily p.r.n., Percocet 325 mg/5 mg tablets one tablet q.6 h. p.r.n., Zantac 150 mg b.i.d., Zoloft 100 mg q.a.m., and trazodone 100 mg nightly. Labs revealed a low reticulocyte index consistent with anemia of chronic disease, and the methadone dose of 155 mg was confirmed with the outpatient clinic. The patient was also given three doses of Klonopin over a six-day period, instructed to take medications as listed, clarify discrepancies with her PCP, return to the ER for evaluation if she faints again, call her PCP and/or return to the ER if her chest pain symptoms recur and persist, make an appointment with the Smill Memorial Hospital to evaluate the cause of her left arm symptoms, and check her blood sugars before meals and at bedtime. Additionally, her PCP was instructed to arrange for a loop monitor, follow up on a 24-hour urine studies assessing for pheochromocytoma, and adjust the patient's diabetes management as needed.
|
Previous keppra
|
{
"answer_end": [
462
],
"answer_start": [
408
],
"text": [
"was not receiving her Keppra for approximately a year,"
]
}
|
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.
|
Has a patient had metformin
|
{
"answer_end": [
427
],
"answer_start": [
389
],
"text": [
"ilantin 300/300/250, Glyburide 10 BID,"
]
}
|
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.
|
Was the patient ever prescribed advair diskus 500/50 ( fluticasone propionate/... )
|
{
"answer_end": [
1236
],
"answer_start": [
1160
],
"text": [
"ADVAIR DISKUS 500/50 (FLUTICASONE PROPIONATE/...), ATOVAQUONE 750 mg PO BID,"
]
}
|
A 45-year-old male with morbid obesity presented with chest pain and hypertensive urgency. He was ruled out for MI with negative serial enzymes and EKGs and a cardiac PET showed 2 small areas of reversible ischemia in the mid PDA and distal LAD territory. For CV treatment, he was given Aspirin 81mg PO daily, beta blocker, and HCTZ 25mg PO daily and Atenolol 50mg PO daily for HTN control. For Pulmonary issues, he had very mild asthma exacerbation and a restrictive ventilatory defect from obesity and was given Advair 500/50 BID, Albuterol Nebulizer 2.5 mg neb q2h, Albuterol Inhaler 2 puff inh qid PRN Shortness of Breath and prednisone 60mg QD x 3 doses. For GI issues, he had trace guaiac+ stool and a viral gastroenteritis causing diarrhea and some nausea. For endocrine issues, his A1C was 7.4 and he was educated on low sugar, low carbohydrate diet. For prevention, he was given Lovenox BID. Additional comments included taking HCTZ 25mg daily and Atenolol 50mg daily for blood pressure, eating a low sugar, low carbohydrate diet, and follow-up with cardiology on 11/0. He was discharged in a stable condition with a recommendation for monitor blood sugars and A1C, outpatient colonoscopy, and consider statin therapy, as well as Fluticasone Propionate/Salmeterol 250/50 1 puff inh BID, Albuterol Inhaler 2 puff inh QID, Artificial Tears 2 drop OD TID, Loratadine 10 mg PO QD, Hydrochlorothiazide 25 mg PO QD, Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Albuterol Nebulizer 2.5 mg neb q4h, Acetylsalicylic Acid 81 mg PO daily, and Miconazole Nitrate 2% powder topical TP daily.
|
Has the patient ever tried atenolol
|
{
"answer_end": [
390
],
"answer_start": [
351
],
"text": [
"Atenolol 50mg PO daily for HTN control."
]
}
|
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
|
Previous epogen
|
{
"answer_end": [
1146
],
"answer_start": [
1091
],
"text": [
"Colace 100 mg p.o. b.i.d., Epogen 10,000 units q. week,"
]
}
|
A 58 year old female smoker with a history of Coronary Artery Disease (CAD), Cirrhosis, Diabetes Mellitus Type II (DMII), Hypertension (HTN), and Hyperlipidemia was admitted to the CCU after an elective cardiac catheterization following an abnormal stress test. The cath showed impaired flow in the inferior and posterolateral zones due to obstructive degenerative disease in the SVGs to the RCA and LCF-OM, and a stent was placed in the RCA graft though there was extensive calcification and difficulty obtaining full stent expansion. After the stent deployment there was poor reflow accompanied by mild chest pain and EKG changes, without hemodynamic embarrassment. The patient experienced jaw and chest pain post-procedure which she described as different from previous episodes of angina. The pump-function was preserved, BP low-normal, and rhythm was NSR on telemetry. For pulmonary issues, the patient had a chronic cough due to post nasal drip which was taken off of her antihistamine on admission and CXR was normal with no acute changes. There were no renal issues during the hospital course and the patient was on Lantus, Novolog SS, and FS Glu monitored while in the hospital. Heme-wise, the patient had a cath and subsequent oozing from the site in the groin and was discharged on home meds including Plavix and ASA. Medications prescribed include ENTERIC COATED ASA 325 MG PO DAILY, TESSALON PERLES ( BENZONATATE ) 100 MG PO TID, PLAVIX ( CLOPIDOGREL ) 75 MG PO DAILY, CODEINE PHOSPHATE 15 MG PO Q3H PRN Pain, DEXTROMETHORPHAN HBR 10 MG PO Q6H PRN Other:cough, ZETIA ( EZETIMIBE ) 10 MG PO DAILY, LANTUS ( INSULIN GLARGINE ) 20 UNITS SC BEDTIME, POTASSIUM CHLORIDE IMMED. REL. ( KCL IMMEDIATE... ) 1.Only KCL Immediate Release products may be used for KCL, 4.As per SMH Potassium Chloride Policy: each 20 mEq dose, on order for DIOVAN PO ( ref # 032637277 ), VALSARTAN Reason for override: aware, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, MAGNESIUM GLUCONATE Sliding Scale PO ( orally ) DAILY: -> Mg-scales cannot be used and magnesium doses must be, If Mg level is less than 1 , then give 3 gm Mg Gluconate, NITROGLYCERIN 1/150 ( 0.4 MG ) 1 TAB SL q5min x 3, OXYCODONE 5-10 MG PO Q6H PRN Pain, PINDOLOL 5 MG PO BID HOLD IF: sbp<90 , HR<50, ZOCOR ( SIMVASTATIN ) 80 MG PO BEDTIME, DIOVAN ( VALSARTAN ) 160 MG PO DAILY, Lantus 40u qd Estradiol 0.05, Diltiazem 180 mg qd HCTZ 25 mg qd, Zetia 10mg qd, Plavix 75 mg qd, Zocor 80 mg qd, ASA 325 mg qd, Famotidine 20 mg BID, Lovenox 40 sc qd, nicotine patch MgSO4 qd, Novolog SS Pt as outpt and heparin and Integrelin have been discontinued, insulin, and was stable post cath, with anticoagulation stopped. The patient was prescribed ENTERIC COATED ASA 325 MG PO DAILY, TESSALON PERLES ( BENZONATATE ) 100 MG PO TID, PLAVIX ( CLOPIDOGREL ) 75 MG PO DAILY, CODEINE PHOSPHATE 15 MG PO Q3H PRN Pain, DEXTROMETHORPHAN HBR 10 MG PO Q6H PRN Other:cough, ZETIA ( EZETIMIBE ) 10 MG PO DAILY, LANTUS ( INSULIN GLARGINE ) 20 UNITS SC BEDTIME, POTASSIUM CHLORIDE IMMED. REL. ( KCL IMMEDIATE... ), 1.Only KCL Immediate Release products may be used for KCL, 4.As per SMH Potassium Chloride Policy: each 20 mE
|
What is the current dose of the patient's enteric coated asa
|
{
"answer_end": [
1395
],
"answer_start": [
1360
],
"text": [
"ENTERIC COATED ASA 325 MG PO DAILY,"
]
}
|
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
|
Did the patient ever take any medication for her insomnia in the past
|
{
"answer_end": [
2710
],
"answer_start": [
2641
],
"text": [
"regimen of morphine and oxycodone, and he was given Elavil for sleep."
]
}
|
Patient Alequin, Garland, a 57-year-old female with a complex medical history including squamous cell lung cancer, cirrhosis, COPD, HTN, PVD, seizure disorder, history of SDH, large abdominal ventral hernia, and chronic back pain, was admitted to the ED obtunded with decreased BP. She had received all her medications as prescribed in the morning at her nursing home and received Thiamine HCL 100 mg PO daily and Narcan in the ED, becoming more responsive and uncomfortable after Narcan with an elevated ammonia level of 233. To manage her mental status, the patient was given Lactulose 30 Milliliters PO QID Starting Today (5/29) and her narcotic dose was avoided. Pain was effectively controlled with MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Celecoxib 100 mg PO daily Starting Today (5/29) PRN Pain, and a Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily. She was prescribed Vitamin C (Ascorbic Acid) 500 mg PO BID, Folate (Folic Acid) 1 mg PO daily, Lasix (Furosemide) 40 mg PO daily, Flagyl (Metronidazole) 500 mg PO q8h, Aldactone (Spironolactone) 75 mg PO BID with food/drug interaction instruction to give with meals, KCL IV (ref #403310506) with serious interaction of Spironolactone & Potassium Chloride with reason for override monitoring, Thiamine HCL 100 mg PO daily, Multivitamin Therapeutic (Therapeutic Multivitamin) 1 tab PO daily, MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Flovent HFA (Fluticasone Propionate) 220 mcg INH BID, Celecoxib 100 mg PO daily, Keppra (Levetiracetam) 1,000 mg PO BID, Caltrate 600 + D (Calcium Carbonate 1,500 mg (...)), Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily, Novolog (Insulin Aspart) sliding scale (subcutaneously) SC AC with instructions to give 0-10 units subcutaneously based on BS, Maalox-Tablets Quick Dissolve/Chewable 1-2 tab PO Q6H PRN Upset Stomach, Vitamin K (Phytonadione) 5 mg PO daily, Protonix (Pantoprazole) 40 mg PO daily, Toprol XL (Metoprolol Succinate Extended Release) 50 mg PO daily with food/drug interaction instruction to take consistently with meals or on empty stomach, Magnesium Oxide 420 mg PO BID, Metronidazol starting on HD 1, and Vancomycin until speciation of blood cultures. Blood cultures were positive for coag negative staph in 2/4. She was also given Flovent for her known COPD and was discharged with instructions to complete a 14-day course of Cipro and Flagyl and a few changes in her medications, including MSIR every 4 hr as needed, Celebrex, and Lidoderm patch. Follow up with Dr. Vargas, Dr. Megeath, Dr. Blandin, and Dr. Pfleider as scheduled, and with PT at nursing home. Blood counts and calcium should be checked on Monday 3/21 and next week respectively.
|
has there been a prior lactulose
|
{
"answer_end": [
631
],
"answer_start": [
556
],
"text": [
"the patient was given Lactulose 30 Milliliters PO QID Starting Today (5/29)"
]
}
|
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 this patient ever tried albuterol
|
{
"answer_end": [
2088
],
"answer_start": [
2063
],
"text": [
"Albuterol 2 puffs b.i.d.,"
]
}
|
This 70-year-old woman with a complex medical history, including cerebrovascular accident x two in 1980s without deficits, seizure history probably secondary to ETOH withdrawal, hypertension x 30 years, asthma, gout, and status post repair of subclavian artery stenosis in 1993, presented to the Dagha Medical Center with severe chest pain. A chest CT revealed a 2.3 x 2.8 cm lobulated mass in the right lower lobe involving the pleura, with extensive hilar and mediastinal constitutions consistent with prior granulomatous disease, and tests were positive for multiple precarinal and right peritracheal areas of adenopathy recent from metastatic disease. The patient was admitted to the Thoracic Surgery Service on 3/27/99 and taken to the Operating Room for a video assisted thorascopic right lower lobe lobectomy by Dr. Minick. Postoperatively, the patient did well, with no complications, and was followed by the Internal Medicine Service. The patient went into rapid atrial fibrillation postoperatively, and was successfully converted into a normal sinus rhythm using Diltiazem IV, which was converted to p.o. Diltiazem. The patient's postoperative course was largely unremarkable but for dysrhythmia, and the patient's pain was well controlled with p.o. pain medications, Percocet. Final pathology was read as squamous cell carcinoma, 4.0 cm., moderately differentiated with focal characterization with extensive necrosis. The patient was discharged to home with medications including Adalat 200 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Magnesium Oxide 40 mg t.i.d., Ultram 300 mg q.d., Trazodone 100 mg q.h.s., Azmacort 80 mg p.r.n., aspirin 81 mg q.d., Dyazide 25 mg q.d., nose spray b.i.d., calcium chloride pills q.d., Colchicine 600 mg q.d., cyproheptadine hydrochloride 4 mg b.i.d. q.h.s., anticholesterol med., Albuterol nebulizers 250 mg q.4h., Allopurinol 300 mg q.d., Colchicine 0.6 mg q.d., cyproheptadine hydrochloride by mouth 400 mg q.d., Digoxin 0.125 mg q.d., Diltiazem 30 mg t.i.d., Colace 100 mg t.i.d., Lasix 40 mg p.o. q.d., Percocet 1-2 tablets p.o. q.4h. p.r.n., Dilantin 200 mg p.o. b.i.d., and Trazodone 100 mg p.o. q.h.s., with follow-up with Thoracic Surgery Service as well as with primary care physician and Cardiology as needed.
|
Has the patient had dilantin in the past
|
{
"answer_end": [
2121
],
"answer_start": [
2053
],
"text": [
"Percocet 1-2 tablets p.o. q.4h. p.r.n., Dilantin 200 mg p.o. b.i.d.,"
]
}
|
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.
|
What was the dosage prescribed of azmacort
|
{
"answer_end": [
1456
],
"answer_start": [
1420
],
"text": [
"Azmacort, four puffs inhaled q.i.d.;"
]
}
|
The patient is a 33 year-old woman with diet controlled diabetes mellitus and morbid obesity who presents to the emergency department with periumbilical pain radiating to the right lower quadrant. After an abdominal CT revealing a 5x5 cm cecal thickening with extraluminal air, her white blood count was 19,000 and her urine HCG was negative. She was taken to the operating room by Dr. Jenovese and had a right colectomy due to gangrenous portions of the right colon. During her postoperative course she developed supraventricular tachycardia to a rate of 200 with hypotension, requiring beta blockade and adenosine. An echocardiogram was obtained which was normal and she was ruled out for myocardial infarction. She was kept on Zantac, ampicillin, levofloxacin, and Flagyl, and was weaned off her oxygen and her central line was discontinued. She was discharged to home on November, 2000 with Lopressor 50 mg p.o. t.i.d., Percocet 1-2 tabs p.o. q 3-4 hours p.r.n. pain, Colace 100 mg b.i.d. while on Percocet, and after completing a 5-day course of ampicillin, levofloxacin, and Flagyl. She is tolerating a regular diet, ambulating dependently, and requiring minimal amounts of oral analgesics. She received wet to dry dressing changes b.i.d. to her wounds.
|
Why was percocet originally prescribed
|
{
"answer_end": [
992
],
"answer_start": [
972
],
"text": [
"Colace 100 mg b.i.d."
]
}
|
The patient is a 54-year-old man with nonischemic dilated cardiomyopathy who presents with weight gain, weakness, and azotemia. He was admitted with decompensated heart failure and was treated with dobutamine, seretide, and diuretics with good effect, functioning on ACE inhibitor. Two weeks prior to presentation, Digoxin 0.125 mg q.o.d., Imdur 30 mg q.d., hydralazine 25 mg t.i.d., torsemide was being held, Coumadin 1 mg q.d., carvedilol 3.125 mg b.i.d., allopurinol 100 mg q.d., Glucophage, and glyburide were administered. On 2/19/03, Diuril was added to his regimen and his creatinine was noted to increase from 2.6 to 3.6 and diuretics were subsequently held. The patient was loaded on amiodarone, unfortunately still required low dose dobutamine to maintain his cardiac output and was transferred back to the floor and continued to have decrease urine output on maximal diuretic doses and ionotropes. On 6/8/03, the renal surgery recommended that the dobutamine be stopped in order to enhance renal perfusion and Lasix be increased to 80 mg per hour. He has beyond less invasive measures such as digoxin and ACE inhibitors, and he is now dobutamine dependent dobutamine between 1 and 2.5 mcg/kg/minute to maintain his cardiac output, currently loaded on amiodarone without any further events. He has a chronic osteomyelitis, currently in a six-week course of ceftazidime, vancomycin, Flagyl, and Diflucan for complicated osteomyelitis, end date is on 2/30/03. He has diabetes and was on oral hypoglycemic as an outpatient, however, now this renal function, he has been transitioned over to insulin with his standing doses of Lantus with a lispro sliding scale. The patient was started on TPN for quite severe malnutrition and has increasing albumin with increased appetite. Additionally, he is on maintenance doses of hydrocortisone and was seen by Psychiatry, who suggested starting low dose of Zyprexa in the evening, which has greatly improved his mood. He is planned to be evaluated by Plastic Surgery prior to discharge for final plans whether a flap or healing by secondary retention. The patient currently is stable and would be discharged with home dobutamine and frequent and careful follow up by his primary cardiologist Dr. Mongiovi.
|
Has the patient taken any medications for moderate mr management
|
{
"answer_end": [
251
],
"answer_start": [
193
],
"text": [
"with dobutamine, seretide, and diuretics with good effect,"
]
}
|
EVANKO, BENEDICT 205-94-27-9, a 66-year-old Spanish-speaking male was admitted with chest pressure initially on exertion, most recently at rest, for which he took two nitroglycerin tablets with good resolution and worsening lower extremity edema and a 30-pound weight gain over the past few months due to missing his medications and eating a lot of salt. On examination, he was afebrile with HR in the 60s and BP 110/100% RA. Tests performed revealed pulmonary edema on CXR. He was prescribed Acetylsalicylic Acid 81 mg PO daily, Atorvastatin 80 mg PO daily, Coreg (Carvedilol) 3.125 mg PO BID, Plavix (Clopidogrel) 75 mg PO daily, Lasix (Furosemide) 80 mg PO daily starting in the morning, Insulin 70/30 Human 50 units QAM and 35 units QPM SC, Imdur ER (Isosorbide Mononitrate (SR)) 30 mg PO daily, hold Lisinopril 10 mg PO daily if SBP < 90, Potentially serious interaction: Spironolactone 50 mg PO daily, hold if SBP < 90, Potentially serious interaction: Potassium Chloride &, Metamucil Sugar Free (Psyllium (Metamucil) Sudafed) 1 packet PO daily, KCL Immediate Release PO, Potassium Chloride Immediate Release PO, Captopril PO, Insulin Aspart Sliding Scale (subcutaneously) SC AC, If BS is < 125, then give 0 units subcutaneously, Lipitor 80, Lovenox 100 sq., ACEi started and increased to 10mg QD, NPH 18 BID (increased from home 10), 6U AC and SS, Hgb A1C 10.4 indicating need for tighter glucose control, Diuresed well with weight on DC of 82kg, Sinus with long PR interval, Cardiogenic Pulm Edema, Mild Transaminitis decreased, Alk Phos continues to be elevated at 175, Left Foot Pain, Degenerative Changes. He was started on Lasix 80 IV, Acetylsalicylic Acid 81 mg PO daily, Atorvastatin 80 mg PO daily, Coreg (Carvedilol) 3.125 mg PO BID, Plavix (Clopidogrel) 75 mg PO daily, Lasix (Furosemide) 80 mg PO daily starting in the morning, Insulin 70/30 Human 50 units QAM and 35 units QPM SC, Imdur ER (Isosorbide Mononitrate (SR)) 30 mg PO daily, Lisinopril 10 mg PO daily (hold if SBP<90), and Spironolactone 50 mg PO daily (hold if SBP<90), Potentially Serious Interaction: Potassium Chloride &, Potentially Serious Interaction: Spironolactone &, Insulin Aspart Sliding Scale (subcutaneously) SC AC, and Metamucil Sugar Free (Psyllium (Metamucil) Sugar Free) 1 packet PO daily, Potassium Chloride Immediate Release PO (ref #). He was free of chest pain since Sunday and was discharged with fluid restriction, a low-chol/low-sat fat diet, 2 gram Sodium diet, and walking as tolerated, and was advised to take all his medications as directed, adjust insulin as needed, and check his blood sugars in the morning and with meals, and keep tight control over his blood sugar. He was also scheduled for follow-up appointments with Cardiology Dr. Lelonek 714.815.2497 1-4 weeks and PCP Dr. Hoyt Shimek 556-913-5202 2 weeks.
|
Has this patient ever been prescribed captopril
|
{
"answer_end": [
1132
],
"answer_start": [
1119
],
"text": [
"Captopril PO,"
]
}
|
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.
|
What was the indication for my patient's morphine liquid
|
{
"answer_end": [
1059
],
"answer_start": [
964
],
"text": [
"Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath."
]
}
|
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.
|
has the patient used potassium chloride slow release in the past
|
{
"answer_end": [
1378
],
"answer_start": [
1311
],
"text": [
"three days along with potassium chloride slow release 20 mEq b.i.d."
]
}
|
The patient is a 59 year-old right-handed woman admitted for suspected acute stroke with a PMH of hypertension, hypercholesterolemia, prior TIA vs. stroke, recurrent left Bell's palsy, obesity, allergic rhinitis, history of TIA vs. stroke, obstructive sleep apnea, and chronic renal insufficiency. She was put on Acetylsalicylic Acid 325 mg PO QD, Atenolol 50 mg PO QD Starting in AM (2/11), Atorvastatin 40 mg PO QD, Hydrochlorothiazide 25 mg PO QD, Amlodipine 10 mg PO QD Food/Drug Interaction Instruction, and PRN albuterol and loratadine. She was also placed on aspirin 325 mg qd for stroke and heart prophylaxis and should supplement her diet with folic acid, taking a full dose of aspirin (325 mg) and folate supplementation. She should discuss raising her dose of atorvastatin (Lipitor) with her PCP, because her cholesterol and LDL levels were high this admission and she has an outpt appointment for carotid non-invasive studies 4/0/03.
|
Why is the patient taking atorvastatin ( lipitor )
|
{
"answer_end": [
846
],
"answer_start": [
771
],
"text": [
"atorvastatin (Lipitor) with her PCP, because her cholesterol and LDL levels"
]
}
|
A 58 year old woman with a history of CABG times three, inferior myocardial infarction, peptic ulcer disease, anemia, and cholelithiasis was admitted with substernal chest pain at rest, dysphagia, light-headedness, coughing, and nocturia. On admission, her blood pressure was 110/68 lying and 90/palp sitting, O2 sat was 97% on room air, JVP was 9 cm with crackles at the right base, and her hematocrit was 20.8. She was given three sublingual nitroglycerins and Maalox, 10 mg of IV Lopressor from which she became hypotensive, two units of packed red blood cells, Lasix, and IV H2 blockers, 20 mEq of Kay Ciel, and IV nitroglycerin 50 units which was increased to 100 units. EKG changes were noted with a flattening in V4 through V6 with no ST depressions and a T wave down in V3. An endoscopy was done which revealed a large hiatal hernia with no evidence of GI bleeding. On discharge, she was given Pepcid 20 mg p.o. b.i.d., metoprolol 50 mg p.o. b.i.d., and nitroglycerin 1/150 0.4 mg sublingual p.r.n. Follow up was recommended with Dr. Pichard and the GI service.
|
Has the patient had previous nitroglycerin.
|
{
"answer_end": [
458
],
"answer_start": [
413
],
"text": [
"She was given three sublingual nitroglycerins"
]
}
|
This is a 40 year old, gravida VI para V, black female with an EDC of 3/18/90 at 29 weeks gestation who was admitted for blood sugar control for gestational diabetes and had a fasting blood sugar of 150. She had no other complaints during this pregnancy and had received RhoGAM 4/15/90. She had a past history of hyperthyroidism, status post partial thyroidectomy in 1976 on Synthroid 0.015 mg daily, endometriosis with right salpingo-oophorectomy in 1976, and other previous pregnancies. On admission, she was taking Synthroid and vitamins. On physical examination, her vital signs were stable, HEENT exam was normal, neck was supple, no adenopathy, thyroid full, scar present from partial thyroidectomy, lungs were clear, cardiac exam revealed a normal S1 and S2, no murmurs or gallops, breasts were without masses, abdomen was obese and gravid, cervix was long, thick and closed, extremities were without edema, and deep tendon reflexes were 1-2+. A finger stick blood sugar was 115 with her last meal being at noon. The impression was 29 weeks gestation with gestational diabetes admitted for glucose control, status post partial thyroidectomy and anemia. The plan was to admit her and check q4h blood sugars, begin an ADA diet and possible insulin. The patient was seen by the endocrinology service on admission and begun on a diet. Her blood sugars continued to be high with a fasting in the 120-150 range, so she was begun on insulin and was managed by the endocrinology service and controlled well on the insulin over the next several days, with her fasting blood sugar coming down to eventually 100-95 on 9/30/90. She was discharged home on insulin ten units of regular qAM and 16 units of regular and 16 units NPH qPM with follow-up to be with Dr. Gorneault of the endocrinology service.
|
Why is the patient on insulin
|
{
"answer_end": [
1253
],
"answer_start": [
1161
],
"text": [
"he plan was to admit her and check q4h blood sugars, begin an ADA diet and possible insulin."
]
}
|
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.
|
What medications have been previously used for the treatment of gaseousness
|
{
"answer_end": [
2687
],
"answer_start": [
2612
],
"text": [
"simethicone 80 mg PO q.i.d. PRN gaseousness, trazodone 25 mg PO at bedtime,"
]
}
|
Vance Prunier, a 57 year old patient with diabetes mellitus, hypertension, hyperlipidemia, and known coronary artery disease, was admitted on 5/30/2001 with worsening exercise capacity. A cath today showed severe native TVD, patent LIMA to LAD, occluded SVG-OM, and radial graft to PDA 80% stenosis. PCI of radial graft lesion with Nir 2.5x15mm and S660 2.5x12mm stents resulting in 0% residual was done and Angioseal was applied to RFA. The patient was discharged on 6/17/2001 in a stable condition with medications EC ASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO QPM, Cipro (Ciprofloxacin) 250 MG PO BID, Insulin NPH Human 30 UNITS SC QAM, Insulin Regular (Human) 18 UNITS SC QAM, Levoxyl (Levothyroxine Sodium) 75 MCG PO QD, Lisinopril 20 MG PO QD, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL Q5 MIN X 3 PRN Chest Pain HOLD IF: SBP<[ ], Pravachol (Pravastatin) 20 MG PO QHS, Amlodipine 5 MG PO QD, Imdur (Isosorbide Mononit.( SR )) 60 MG PO QD, Wellbutrin SR (Bupropion Hcl SR) 150 MG PO BID, Clopidogrel 75 MG PO QD, and 16 hours Integrilin and 30 days Plavix. The patient was instructed to call for any further chest pain, groin pain, swelling or bleeding and was to return to work after an appointment with the local physician. Follow up appointments with Dr. Minear in 1-2 weeks and Dr. Givens were scheduled. The patient was discharged to home.
|
has the patient used insulin regular ( human ) in the past
|
{
"answer_end": [
698
],
"answer_start": [
658
],
"text": [
"Insulin Regular (Human) 18 UNITS SC QAM,"
]
}
|
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
|
Why was zofran ( post-op n/v ) ( ondansetron hcl ( post-... ) originally prescribed
|
{
"answer_end": [
1836
],
"answer_start": [
1803
],
"text": [
"1 MG IV Q6H X 2 doses PRN Nausea,"
]
}
|
A 83 year old female with hereditary angioedema was admitted to the hospital with abdominal pain which was not relieved by Stanazolol, and she had diarrhea, nausea/vomiting, sweats, and decreased PO intake. She was given 6 units FFP with premedication of IV Benadryl on the first night of her hospitalization, Stanazolol 4 mg q4h overnight, which was changed to bid on second hospital day, Zantac, and Lovenox. The patient was maintained on Acetylsalicylic Acid 81 mg PO qd, Vit C 500 mg PO bid, Atenolol 75 mg PO qd, hold if sbp <100 or hr <60, Digoxin 0.125 mg PO qod (Sun, Tues, Thurs), Potentially serious interaction: Digoxin & Levothyroxine Sodium, Vit E 400 units PO qd, Pepcid 20 mg PO qd, Colace 100 mg PO bid PRN constipation, Senna Tablets 2 tab PO bid PRN constipation, Lasix 20 mg PO qd, Keflex 500 mg PO qid x 28 doses, and on order for Synthroid PO (ref. #66804792), Lasix PO (ref. #91042032), and Keflex PO (ref. #63524947). She was also continued on her home dose of Synthroid, Rhinocort (Budesonide Nasal Inhaler) 2 spray na bid, and Allegra (Fexofenadine HCl) 60 mg PO bid. She was discharged with instructions to follow up with allergy and to call her doctor if she develops fevers, worsening of her abdominal pain, or other concerning symptoms. Follow up appointments were made with Dr. Morrell and Dr. Guadagnolo or Dr. Yoes for 1-2 weeks.
|
What medications did the patient take for hypothyroid
|
{
"answer_end": [
994
],
"answer_start": [
941
],
"text": [
"She was also continued on her home dose of Synthroid,"
]
}
|
Mr. Heldman is a 69-year-old male with end-stage renal disease on hemodialysis who presented to the emergency department prior to admission with shortness of breath and chest x-ray revealed pulmonary edema. On physical examination, vital signs were temperature 95.8, heart rate 74, and blood pressure in the right arm 134/62, HEENT was dentition without evidence of infection, no carotid bruit, cardiovascular was regular rate and rhythm, peripheral pulses were 2+the carotid, radial, and femoral and dorsalis pedis and posterior tibial were present bilaterally, respiratory rales present bilaterally, and neuro was cool extremities with monophasic pulse. An echocardiogram was done and it showed evidence of dehiscence of the bioprosthetic aortic valve with prolapse into the left ventricular outflow tract and at least moderate perivalvular aortic regurgitation as well as moderate to severe mitral regurgitation. Preoperative labs showed sodium 141, potassium 4.4, chloride 102, carbon dioxide 29, BUN 26, creatinine 5.8, glucose 195, magnesium 1.9, white blood cells 6.11, hematocrit 28, hemoglobin 9.5, and platelets 98,000. He was put on preoperative medications which included Labetalol, 100 mg p.o. t.i.d., amlodipine 10 mg p.o. daily, lisinopril, 20 mg p.o. day, Zocor 40 mg p.o. daily, PhosLo 1334 mg p.o. a.c. The patient underwent a replacement of #24 homograph, MVP with Alfieri suture, bypass time of 355 minutes and crossclamp time of 265 minutes. During the operation, one ventricular wire, one pericardial tube, one retrosternal tube, two left pleural tubes and two right pleural tubes were placed. He was discharged home on the following medications aspirin 325 mg p.o. daily, hydralazine 100 mg p.o. q.i.d., labetalol 100 mg p.o. t.i.d., lisinopril 40 mg p.o. b.i.d., oxycodone 5 mg p.o. q.h.s., losartan 100 mg p.o. daily and he will continue to be on both vancomycin and rifampin until 1/3/04, with the rifampin taken orally and the vancomycin after dialysis three times a week. His postoperative course was complicated by infectious disease and cardiovascular issues and he will follow up with the cardiac surgeon in six weeks, cardiologist in three to four weeks, primary care physician in one to two weeks, and cardiologist in two weeks.
|
Was the patient ever prescribed labetalol
|
{
"answer_end": [
1243
],
"answer_start": [
1215
],
"text": [
"amlodipine 10 mg p.o. daily,"
]
}
|
Mr. Lewter is a 65-year-old gentleman with a history of non-insulin-dependent diabetes mellitus, hypertension, dyslipidemia, and peripheral vascular disease who presented to Tci Prosamp Memorial Hospital on 5/1/06 with unstable angina. EKG revealed sinus tachycardia with a new incomplete left bundle-branch block and downsloping 1-1.5 mm ST depressions in V3 through V6 and 1 mm depression in aVL. Cardiac catheterization revealed an ostial 100% stenosis in the left circumflex coronary artery, a proximal 60% stenosis and a mid 50% stenosis in the left anterior descending coronary artery, a proximal 80% stenosis and a mid 60% stenosis in the right coronary artery, a right dominant circulation, an ejection fraction of 30%, and collateral flow from the second diagonal to the third marginal in the right posterior left ventricular branch to the second marginal, as well as left ventricular hypokinesis and severe inferior and apical. The patient was not heparinized due to the fact that he was on Coumadin for peripheral vascular disease with a therapeutic INR. On 9/18/06, the patient underwent coronary artery bypass graft x3 with left internal mammary artery to left anterior descending coronary artery, a sequential graft and a vein graft connecting from the aorta to the second obtuse marginal coronary artery and then to the left ventricular branch. He was on medications including Lopressor 37.5 mg b.i.d., aspirin 325 mg daily, Colace 100 mg b.i.d., Pepcid 20 mg IV q.12h., insulin sliding scale, atorvastatin 80 mg daily, glipizide, Avandia, Zestril, metformin, meclizine, lactulose, vitamin C, Protonix, Niaspan, Neurontin, Zincate, and Coumadin for peripheral vascular disease. The patient was started on oral medication of glipizide 5 mg and was covered with a NovoLog sliding scale, was transfused 3 units of packed red blood cells, re-started on Coumadin for his reinsertion, and was started on Flomax 0.4 mg once a day. He had some urinary retention postoperatively and did require Foley catheter placement. He was discharged on Enteric-coated aspirin 81 mg QD, Colace 100 mg b.i.d. while taking Dilaudid, Lasix 40 mg QD x3 doses, glipizide 5 mg daily, Dilaudid 2-4 mg every three hours p.r.n. pain, lisinopril 2.5 mg daily, Niferex 150 mg b.i.d., Toprol-XL 150 mg QD, Lipitor 80 mg daily, Flomax 0.4 mg QD, potassium chloride slow release 10 mEq QD x3 doses with Lasix and Coumadin QD per INR result, and the patient will receive 4 mg of Coumadin this evening for his reinsertion and was instructed to remain on his Flomax until that time. Mr. Jana was discharged to rehab in stable condition and will follow up with his cardiologist Dr. Reuben Duttinger in one week, his heart failure cardiologist Dr. Wilton Durkee on 11/10/06 at 1:30 in the afternoon, and Urology Clinic at the Centsson Medical Center for his urinary retention in one week.
|
What is the current dose of lisinopril
|
{
"answer_end": [
2287
],
"answer_start": [
2219
],
"text": [
"lisinopril 2.5 mg daily, Niferex 150 mg b.i.d., Toprol-XL 150 mg QD,"
]
}
|
RECORD #159637 was a 45-year-old male with multiple cardiac risk factors, including known CAD s/p MI (4/14 with PCI to LAD, complicated by instent thrombosis 1 week post-cath->successfully restented), HTN, dyslipidemia, obesity, and positive FHx who was admitted on 4/22/2003 with non-ischemic chest pain. He had an ETT-MIBI in 5/12 which showed large fixed defect in anterior, anteroseptal, anterolateral, inferior, LV apex with EF of 35%. On this occasion, he noted sudden onset of 8/10 chest pain while at rest at 6:30 pm on the evening of admission and was transported to Greena Hospital where his vitals were 98.2, 73, 92/62, 15. He was given IV TNG, heparin, MSO4, ASA with pain down to 4/10 and transferred to ITH. Ruling out ischemia by ensymes and ETT, the patient was discharged on 5/4/2003 with ECASA (Aspirin Enteric Coated) 325 MG PO QD, Folic Acid 1 MG PO QD, Ativan (Lorazepam) 1 MG PO QHS, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain, Darvocet N 100 (Propoxyphene Nap./Acetaminophen) 1 TAB PO Q4H PRN Pain, Zocor (Simvastatin) 80 MG PO QHS, Norvasc (Amlodipine) 2.5 MG PO BID, Toprol XL (Metoprolol (Sust. Rel.)) 50 MG PO QD, Altace (Ramipril) 2.5 MG PO QD, Potassium Chloride IV (ref # 68076838) and Immed. Rel. PO (ref #) with Potentially Serious Interaction: Ramipril & Potassium Chloride, Clopidogrel 75 MG PO QD, Vioxx (Rofecoxib) 25 MG PO BID, Protonex (Pantoprazole) 40 MG PO QD, Diet: House/Low Chol/Low Sat. Fat, Activity: Resume Regular Exercise, Follow Up Appointments with Dr. Damon Krzeczkowski and Dr. Lon Willims, Allergy: Atarax (Hydroxyzine Hcl), Sulfa, Number of Doses Required (approximate): 3, and instructions to consider increasing CCB as patient seems to feel it helps his LH, dizziness and to adjust HTN meds as he was relatively hypotensive (SBP 90-110) in hospital (although asymptomatic) and outpatient cardiac rehabillitation.
|
Has patient ever been prescribed ramipril
|
{
"answer_end": [
1330
],
"answer_start": [
1300
],
"text": [
"Ramipril & Potassium Chloride,"
]
}
|
This 75 year old woman with a history of hypertension, hyperlipidemia, past tobacco use, and angina presented with syncope and was found to be status post non ST elevation myocardial infarction. She was treated with Aspirin, Heparin, Lopressor, Captopril, and Cozaar initially with heart rate and blood pressure secondary to COPD, and was started on Atrovent nebs and given fluids until she had good urine output. Cardiovascular examination revealed ischemia, ST elevation, and myocardial infarction, while Pulmonary examination revealed wheezing and renal examination showed likely dehydration. The patient is currently on Aspirin, Lisinopril, and Atenolol, and was given IV fluids for dehydration. Her neurological examination showed intact PERRL and cranial nerves II-XII, regular rate and rhythm, normal S1, S2, and no murmurs, rubs, or gallops. Respiratory examination revealed wheezing with increased respiratory phase. Abdomen was obese, non-tender, and non-distended with left groin erythematous and scaling. Extremities had no edema and 1+ dorsalis pedis pulses. Neuro examination showed alertness and 4/5 bilateral lower extremity strength with 1+ deep tendon reflexes and normal sensation. Following discharge she requires physical therapy and follow up with Gynecology for incontinence and a possible uterine prolapse.
|
Has this patient ever been on atenolol.
|
{
"answer_end": [
658
],
"answer_start": [
596
],
"text": [
"The patient is currently on Aspirin, Lisinopril, and Atenolol,"
]
}
|
Ms. Hora is a 45 year old woman with hypertensive disease, diabetes, obesity, sleep apnea and peptic ulcer disease who presented with sustained chest pain and shortness of breath. She underwent an exercise tolerance test with MIBI which showed a borderline to minimal anterior reversible defect. The patient was admitted and ruled out for a myocardial infarction with serial CPK and serial troponin, both of which showed 0.0. She was managed by the addition of a gastrointestinal regimen of Prilosec and Cisapride, and the addition of isordil 10mg po tid in the place of Axid. The discharge medications included Proventil 2 puffs inhaler q.i.d., enteric coated aspirin 325 mg p.o. q.day, NPH 40 units q.AM and 55 units subcu q.PM., Lisinopril 20 mg p.o. q.day, Maxide 1 tablet p.o. q.day, nitroglycerin 1/150 1 tablet sublingual q.5 minutes times three p.r.n. chest pain, Prilosec 20 mg p.o. q.day, Azmacort 4 puffs inhaler b.i.d., Cardizem CD 300 mg p.o. q.day, Cisapride 10 mg p.o. q.i.d., and isordil 10 mg po tid.
|
What is the current dose of the patient's cardizem cd
|
{
"answer_end": [
962
],
"answer_start": [
899
],
"text": [
"Azmacort 4 puffs inhaler b.i.d., Cardizem CD 300 mg p.o. q.day,"
]
}
|
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 pain medications have ever been prescribed for pt. in the VA or mentioned in the record
|
{
"answer_end": [
1705
],
"answer_start": [
1628
],
"text": [
"Mycostatin 5 cc p.o. q.i.d., Percocet one or two tabs p.o. q3-4h p.r.n. pain,"
]
}
|
Mr. Lewter is a 65-year-old gentleman with a history of non-insulin-dependent diabetes mellitus, hypertension, dyslipidemia, and peripheral vascular disease who presented to Tci Prosamp Memorial Hospital on 5/1/06 with unstable angina. EKG revealed sinus tachycardia with a new incomplete left bundle-branch block and downsloping 1-1.5 mm ST depressions in V3 through V6 and 1 mm depression in aVL. Cardiac catheterization revealed an ostial 100% stenosis in the left circumflex coronary artery, a proximal 60% stenosis and a mid 50% stenosis in the left anterior descending coronary artery, a proximal 80% stenosis and a mid 60% stenosis in the right coronary artery, a right dominant circulation, an ejection fraction of 30%, and collateral flow from the second diagonal to the third marginal in the right posterior left ventricular branch to the second marginal, as well as left ventricular hypokinesis and severe inferior and apical. The patient was not heparinized due to the fact that he was on Coumadin for peripheral vascular disease with a therapeutic INR. On 9/18/06, the patient underwent coronary artery bypass graft x3 with left internal mammary artery to left anterior descending coronary artery, a sequential graft and a vein graft connecting from the aorta to the second obtuse marginal coronary artery and then to the left ventricular branch. He was on medications including Lopressor 37.5 mg b.i.d., aspirin 325 mg daily, Colace 100 mg b.i.d., Pepcid 20 mg IV q.12h., insulin sliding scale, atorvastatin 80 mg daily, glipizide, Avandia, Zestril, metformin, meclizine, lactulose, vitamin C, Protonix, Niaspan, Neurontin, Zincate, and Coumadin for peripheral vascular disease. The patient was started on oral medication of glipizide 5 mg and was covered with a NovoLog sliding scale, was transfused 3 units of packed red blood cells, re-started on Coumadin for his reinsertion, and was started on Flomax 0.4 mg once a day. He had some urinary retention postoperatively and did require Foley catheter placement. He was discharged on Enteric-coated aspirin 81 mg QD, Colace 100 mg b.i.d. while taking Dilaudid, Lasix 40 mg QD x3 doses, glipizide 5 mg daily, Dilaudid 2-4 mg every three hours p.r.n. pain, lisinopril 2.5 mg daily, Niferex 150 mg b.i.d., Toprol-XL 150 mg QD, Lipitor 80 mg daily, Flomax 0.4 mg QD, potassium chloride slow release 10 mEq QD x3 doses with Lasix and Coumadin QD per INR result, and the patient will receive 4 mg of Coumadin this evening for his reinsertion and was instructed to remain on his Flomax until that time. Mr. Jana was discharged to rehab in stable condition and will follow up with his cardiologist Dr. Reuben Duttinger in one week, his heart failure cardiologist Dr. Wilton Durkee on 11/10/06 at 1:30 in the afternoon, and Urology Clinic at the Centsson Medical Center for his urinary retention in one week.
|
has the patient had insulin
|
{
"answer_end": [
1508
],
"answer_start": [
1462
],
"text": [
"Pepcid 20 mg IV q.12h., insulin sliding scale,"
]
}
|
Ms. Dube is a 58-year-old female with non-insulin dependent diabetes mellitus, hyperlipidemia, hypertension, and a history of a left circumflex coronary artery stent placed three months prior to admission. She presented to the emergency room with left jaw pain, which was relieved with three sublingual nitroglycerin and later with Percocet to which she got some relief. She was started on Lovenox 1 mg per kg subcutaneously b.i.d., beta-blocker, Zocor and ACE inhibitor, t.i.d., glucophage 500 mg b.i.d., Celexa 40 mg p.o. q.d., Zestril 2.5 mg q.d., atenolol 25 mg p.o. q.d., Lipitor 20 mg p.o. q.h.s., Plavix. The patient's Lovenox was reversed with protamine and her hematoma continued to expand overnight, so she received one unit of fresh frozen plasma as well as a third unit of packed red blood cells, resulting in a total of five units of packed red blood cells due to blood loss secondary to her anticoagulation with Lovenox, Plavix, aspirin and a possible STONDE MEDICAL CENTER trial drug. Her headache was treated with Tylenol to which it did not respond and her discharge medications included aspirin 81 mg p.o. q day, Klonopin 0.5 mg p.o. q.h.s., and her home medications of Zocor, Lopressor, captopril, Celexa, Klonopin. Vascular surgery was consulted due to concern for developing compartment syndrome and she was restarted on aspirin. Her head CT was negative for bleeding and she was discharged home on March, 2003 with instructions to follow up with her primary care physician.
|
Has the patient ever been on atenolol
|
{
"answer_end": [
576
],
"answer_start": [
506
],
"text": [
"Celexa 40 mg p.o. q.d., Zestril 2.5 mg q.d., atenolol 25 mg p.o. q.d.,"
]
}
|
Marcelo Walts was admitted to the medical service for a CHF exacerbation and was given ECASA (Aspirin Enteric Coated) 325 mg PO QD, Captopril 12.5 mg PO TID with a potential serious interaction with Potassium Chloride, Lasix (Furosemide) 40 mg PO TID, Levoxyl (Levothyroxine Sodium) 100 mcg PO QD, Nitroglycerin 1/150 (0.4 mg) 1 tab SL Q5 min x 3 PRN Chest Pain HOLD IF: SBP<[ ], Zocor (Simvastatin) 20 mg PO QHS with a potential serious interaction with Niacin, Vit. B-3, Plavix (Clopidogrel) 75 mg PO QD, Atenolol 25 mg PO QD, Nitropatch (Nitroglycerin Patch) 0.2 mg/hr TP QHS, Glyburide 5 mg PO BID, Isordil (Isosorbide Dinitrate) 10 mg PO BID, and a diet of House/Low Chol/Low Sat. Fat and 4 gram Sodium. Activity was limited to Walking as tolerated, and the patient was also given instructions to give ECASA on an empty stomach, and to avoid grapefruit with Zocor unless instructed otherwise. Upon discharge, the patient was given a Full Code status and was sent Home with a follow up appointment with Sandler on 11/28/02. The patient also underwent cardiac catheterization and stent placement of RCA with the medications Heparin, ASA, Plavix, Metoprolol, nitrates, ACE-I, statin, lasix, and nebs for wheezing, and was monitored for lytes. Upon discharge, the patient was stable and advised to follow up with Dr. Lidstone and Dr. Darlin for post-cath management and overall management of CHF and flash pulmonary edema.
|
Is there a mention of of statin usage/prescription in the record
|
{
"answer_end": [
251
],
"answer_start": [
219
],
"text": [
"Lasix (Furosemide) 40 mg PO TID,"
]
}
|
This 82-year-old RHM with a history of HTN, DM-2, CAD, and AVR (on Coumadin until 3/29) presented to the WTSMC ER for further work-up after receiving Mannitol. On exam, his VS were T: afebrile, BP: 145/64, P: 60, RR: 18, O2 sat: 97%r.a., HEENT anicteric and MMM without lesions, OP clear, neck supple with no LAD, CV had s1s2 paced, pronounce S2, 3/6 systolic murmur, 2/6 diastolic, resp CTAB, abd +BS Soft/NT/ND, ext no C/C/E, s/p above amputation, MS awake and alert, oriented to date, place, and self, attention DOW backwards, memory registration 3/3, recall 2/3 at 5 min 3/3 with prompting, language fluent, +comprehension, +repetition, +naming intact, nondominant no neglect to DSS, able to salute/brush teeth, CN II, III - pupils 3`2 bilaterally, VFF by confrontation; III, IV, VI - EOMI, no ptosis, no nystagmus; V - sensation intact to LT/PP, corneal reflex intact; VII - mild right facial weakness; VIII - hears finger rub; IX, X - voice dysarthric, palate elevates symmetrically, gag intact; XI - SCM/Trapezii 5/5 B; XII - tongue protrudes midline, motor right pronator drift, no asterixis, normal bulk and tone, no tremor, rigidity or bradykinesia, strength 5/5, DTRs C56, C6, C7, L34, S12, Plantar L2, 2, 2, 1, 0, amputated R1, 1, 1, 1, 0, up, sensory decreased LT, temperature, vibration distally up to knees, coord finger tap rapid & symm, FNF & finger follow intact (for weakness), foot tap rapid & symm, gait deferred. LABS showed Sodium 141 mmol/L, Potassium 4.7 mmol/L, Chloride 103 mmol/L, Total CO2 29 mmol/L, Anion Gap 9 mmol/L, CK 33 U/L, CKMB Quant 1.7 ng/mL, Calcium 9.0 mg/dL, Magnesium 1.6 mg/dL, cTn-I See Result Below ng/mL, and Glucose 130 mg/dL. Medications prescribed were COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN SBP>160mmHg, Insulin Regular Human Sliding Scale (subcutaneously) SC qAC, qHS, Lisinopril 20 mg PO QD, Magnesium Gluconate 500 mg PO BID, Milk of Magnesia (Magnesium Hydroxide) 30 mL PO QD PRN Constipation, Metoprolol Tartrate 25 mg PO TID starting in PM on 0/17, Xalatan (Latanoprost) 1 drop OU QPM, Flomax (Tamsulosin) 0.4 mg PO QD, Nexium (Esomeprazole) 20 mg PO QD, Glipizide 10 mg PO QD, Zocor 20 mg QD, Metformin 1000 mg BID, Niferex 150 BID, ASA 81 PO QD, and BRIMONIDINE 0.2% BID. Neurologic exam was stable with persistent dysarthria, right pronator drift, and mild right leg weakness; patient was evaluated by PT/OT and deemed appropriate candidate for acute rehab. Cardiovascular continued to be in atrial fibrillation, pacemaker was firing, but had an episode of HR 30's x few seconds, and HR 40's-50's for rest of night. EKG unchanged from admission, atrial fibrillation, left anterior fascicular block, some PVCs. Plan was to admit to NICU and transfer to the floor, control BP with home regimen and keep SBP<140, hold ASA and Coumadin, and hold Metformin for now and add insulin sliding scale. Medications included COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN other: SBP>160
|
Has the patient ever tried xalatan (latanoprost)
|
{
"answer_end": [
2109
],
"answer_start": [
2073
],
"text": [
"Xalatan (Latanoprost) 1 drop OU QPM,"
]
}
|
The patient is a 75-year-old female with a history of 2. Diabetes , on insulin, congestive heart failure, bilateral occipital CVAs, hypertension, chronic renal insufficiency, coronary artery disease, visual impair with tunnel vision, monoclonal gammopathy, and left upper extremity thrombophlebitis. She was found at home with altered mental status and a fingerstick of 37, which increased to 42 with orange juice and normalized her mental status. She was given 1. Lasix 80 mg p.o q.d. in the morning , 40 mg p.o. q.d. in the evening, 2. Atenolol 75 mg p.o. q.d., 3. Lipitor 10 mg p.o. q.d., 4. Amitriptyline 25 to 50 mg p.o. q.h.s. p.r.n., 5. Multivitamins., 6. Aspirin 325 mg p.o. q.d., 7. Folate 100 mg p.o. q.d., 8. Lisinopril 20 mg p.o. q.d., 9. Iron gluconate 325 mg p.o. t.i.d., 10. Novolin 34 to 40 units subcu. q.d., 11. Epogen 5000 units subcu. q. week., 6. Aspirin 325 mg p.o. q.d., 7. Colace 100 mg p.o. b.i.d., and 2. Metoprolol 12.5 mg p.o. b.i.d. Her NPH dose was cut to 20 units subcu. q.d. with lispro sliding scale q.a.c. and q.h.s., and Metoprolol was changed to Toprol as her blood pressure tolerates. Lisinopril was switched to captopril, then discontinued given her bumping which might suggest thalassemia. She is on iron and Epogen with Prophylaxis: Heparin and H2 blocker. Her minimally needed insulin was 5 units a day and her sugars were well controlled otherwise low. Lasix was decreased to 80 mg p.o. b.i.d. and the x-ray on the day of her discharge showed it was unlikely consolidated lobar pneumonia because of the improved forward flow from discontinuation of her ACE inhibitor. She was admitted with hypoglycemic diabetes possibly secondary to infection or logistical and social barriers, and was treated initially with levofloxacin for her right lower lobe pneumonia versus CHF, pleural effusion which decreased only minimally with diuresis of 1 to 2 liters overnight and for diagnostic and therapeutic purposes she underwent a thoracentesis on 2/11/05. Her chronic renal insufficiency was noted with creatinine at baseline of 2.6 and it decreased significantly on this admission possibly because of improved forward flow from discontinuation of her ACE inhibitor. She was on iron and Epogen with an improved hematocrit from the prior admission but no change in her MCV which suggests that she has more than renal disease causing her microcytosis. Her diabetc diet was low sodium, low fat, low cholesterol and prophylaxis included Heparin and H2 blocker. Her discharge medications included 1. Lasix 80 mg p.o. b.i.d., 2. Metoprolol 12.5 mg p.o. b.i.d., 3. Lipitor 10 mg p.o. q.d., 4. Amitriptyline 25 to 50 mg p.o. q.h.s. p.r.n., 5. Multivitamins, 6. Aspirin 325 mg p.o. q.d., 7. Folate 100 mg p.o. q.d., 8. Lisinopril 20 mg p.o. q.d., 9. Iron gluconate 325 mg p.o. t.i.d., and 10. Epogen 5000 units subcu. q. week. She was screened for admission to Jack Nor Medical Center Of where she will go today with intense physical therapy and learning greater independence in her daily functioning. Her pelvic films were negative for fracture. She should be ambulated t.i.d. with follow up with Dr. Rufener when she is able, Lasix dose can be increased as needed for better diuresis, and studies pending include cytology and culture of pleural fluid and follow-up chest x-ray on the day of her discharge.
|
Has the patient ever had insulin
|
{
"answer_end": [
447
],
"answer_start": [
401
],
"text": [
"orange juice and normalized her mental status."
]
}
|
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 this patient ever been prescribed glipizide
|
{
"answer_end": [
776
],
"answer_start": [
723
],
"text": [
"metformin 1000 mg b.i.d., and glipizide 2.5 mg b.i.d."
]
}
|
Patient Mickey Corkill was admitted to the hospital on 5/29/2004 for dizziness and discharged on 7/17/2004. During this time, the patient was given ACETYLSALICYLIC ACID 81 MG PO QD Starting STAT ( 0/17 ), AMIODARONE 200 MG PO QD, DIGOXIN 0.125 MG PO QD, COLACE ( DOCUSATE SODIUM ) 100 MG PO BID, LASIX ( FUROSEMIDE ) 120 MG PO BID, NPH HUMULIN INSULIN ( INSULIN NPH HUMAN ) 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ) 30 MILLILITERS PO QD PRN Constipation, COUMADIN ( WARFARIN SODIUM ) 2 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, NORVASC ( AMLODIPINE ) 10 MG PO QD HOLD IF: SBP < 95, IMDUR ( ISOSORBIDE MONONIT.( SR ) ) 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR ( LOSARTAN ) 100 MG PO QHS Starting STAT ( 4/13 ), PLAVIX ( CLOPIDOGREL ) 75 MG PO QD Starting STAT ( 0/17 ), NEXIUM ( ESOMEPRAZOLE ) 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, Sliding Scale ( subcutaneously ) SC AC+HS, and HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. Due to the potential for serious interactions between WARFARIN and ASPIRIN, WARFARIN and AMIODARONE HCL, DIGOXIN and AMIODARONE HCL, and SIMVASTATIN and WARFARIN, overrides were added on 8/6/04 and 9/23/04 by various physicians, with the MDs being aware that the patient was already on the regimen at home. The patient was also advised to avoid high Vitamin-K containing foods and to avoid grapefruit unless the MD instructed otherwise. The patient's BB was held while in house because of worry about bradyarrhythmia and hypotension. The patient was also continued on home insulin regimen with coverage with insulin sliding scale, and was found to have a TSH of 158 FT4 1.8, FT3 56. The patient was also started on synthroid to be f/u for hypothyroidism and given prophylaxis with Nexium. Treatment included CV, NEURO, ENDO, and Prophylaxis, with the patient to follow-up with various doctors for management of CHF/BP, potential neurovascular etiology of symptoms, and hypothyroidism. The patient was anticoagulated with ACETYLSALICYLIC ACID 81 MG PO QD, AMIODARONE 200 MG PO QD, WARFARIN 2 MG PO QPM, COLACE 100 MG PO BID, LASIX 120 MG PO BID, NPH HUMULIN INSULIN 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA 30 MILLILITERS PO QD PRN Constipation, COUMADIN 2 MG PO QPM, NORVASC 10 MG PO QD HOLD IF: SBP < 95, IMDUR 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR 100 MG PO QHS, PLAVIX 75 MG PO QD, NEXIUM 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, and SIMVASTATIN 80 MG PO QHS HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. The patient was discussed with the cardiologist, and Coreg was held prior to admit for low BP's, with the plan to d/c pt off Coreg and defer to Dr. Doniel for reinstitution of beta blockade. Neuro exam was normal with no focal signs, and no signs of cerebellar dysfunction. The patient was also started on synthroid to be f/u with endocrine for management of hypothyroidism.
|
Previous warfarin
|
{
"answer_end": [
1107
],
"answer_start": [
1086
],
"text": [
"WARFARIN and ASPIRIN,"
]
}
|
An 81-year-old Russian-speaking male with a history of coronary artery disease, multiple strokes, diabetes mellitus type 2, COPD, atrial fibrillation on anticoagulation and a partial pacemaker, congestive heart failure with an ejection fraction of 45-50%, BPH, and hypertension was admitted to Ghampemaw A Hospital for bacteremia with Streptococcus oralis and was treated with a course of IV penicillin through a PICC line, as well as oral Flagyl empirically for an elevated white count. At the rehab facility, he was treated with some sublingual nitroglycerin, and was brought to the Ellwis Medical Center Emergency Room where he was given IV fluid boluses, treated empirically with vancomycin and ceftazidime, and had a CPAP initiated. A head CT was performed which was negative and a right internal jugular line was placed. He was admitted to medicine for further management and a PEG tube placement was done on 4/2/06. His MEDICATIONS ON ADMISSION included Glucotrol 10 mg p.o. b.i.d. and lisinopril 5 mg p.o. q. day, metformin 500 mg p.o. t.i.d., sublingual nitroglycerin p.r.n., nystatin suspension q.i.d., Zyprexa 2.5 mg p.o. q. h.s., Penicillin G 3 million units IV q. 4h x7 days, Milk of Magnesia, Tylenol p.r.n., Dulcolax p.r.n., Colace p.r.n., atenolol 50 mg q. day, Lipitor 20 mg q. day, Senna liquid q. h.s., Flomax 0.4 q. day. He was initially diuresed mildly with Lasix, started on insulin sliding-scale and Lantus, and was kept on potassium and magnesium scales while in hospital. He was given an empiric 7-day course of Ceptaz and Flagyl for aspiration pneumonia, vancomycin, and his vancomycin was switched to IV penicillin and was continued for a full 3-4 week course on 8/14/07. Coumadin was held peri-procedure when he was getting his PEG placed and vitamin K had been administered in view of his supratherapeutic Coumadin. His Coumadin should be restarted on 9/23/07 and Nexium p.o. t.i.d., Flagyl 500 mg p.o. t.i.d. x10 days which was started on 2/5/06. He was oxygenated quickly with 2 liters of oxygen by nasal cannula, restarted on his home doses of aspirin, statin, beta blocker 2 pump, and ACE inhibitor, and his beta blocker and ACE inhibitor were restarted during his hospital stay. He was discharged to rehabilitation where they will focus primarily on his physical therapy and rehab needs.
|
When was flagyl discontinued
|
{
"answer_end": [
1976
],
"answer_start": [
1913
],
"text": [
"Flagyl 500 mg p.o. t.i.d. x10 days which was started on 2/5/06."
]
}
|
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.
|
Was the patient ever prescribed aspirin
|
{
"answer_end": [
1461
],
"answer_start": [
1392
],
"text": [
"Lopressor 37.5 mg b.i.d., aspirin 325 mg daily, Colace 100 mg b.i.d.,"
]
}
|
The 62M with a history of CAD and prior MI leading to CABG in 5/23 was admitted to RCH 6/17 with chest pain and ruled out for MI. A Cath showed non-occlusive disease (70%) and an OM which was stented. The patient experienced frequent chest pain with minimal exertion and experienced an episode of chest pain, SOB, 5/10, no radiation/LH/palpitations, c/o nausea and vomiting, and called EMS to BWSH EW. The patient was given 2 NTG with resolution of symptoms, concerning for increasing frequency of chest pain. The patient was discharged on 8/4/03 with a full code and disposition of home with discharge medications of ACETYLSALICYLIC ACID 325 MG PO BID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, ENALAPRIL MALEATE 5 MG PO QD, ZOCOR (SIMVASTATIN) 20 MG PO QHS, INSULIN 70/30 (HUMAN) 80 UNITS QAM; 60 UNITS QPM SC, PLAVIX (CLOPIDOGREL) 75 MG PO QD, PSYLLIUM 2 TSP PO QD, TOPROL XL (METOPROLOL (SUST. REL.)) 25 MG PO QD, LASIX (FUROSEMIDE) 20 MG PO QD, FAMOTIDINE 20 MG PO BID, and instructions to increased dose for costochondritis as pt. does not wish to take 650 QID dosing. The patient was given instructions to measure weight daily, fluid restriction of 2 liters, house/low chol/low sat. fat, and 2 gram sodium, with advice to resume regular exercise and follow up appointments with Curts 1-2 weeks. The patient also had allergy to codeine, admitting diagnosis of chest pain and CAD, and principal discharge diagnosis of atypical noncardiac chest pain. The patient was also advised to follow up with Dr. Kump and Dr. Sixkiller regarding liver function tests and Dr. Tippen regarding bleeding with bowel movements, respectively.
|
Is there history of use of ntg
|
{
"answer_end": [
509
],
"answer_start": [
414
],
"text": [
"was given 2 NTG with resolution of symptoms, concerning for increasing frequency of chest pain."
]
}
|
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
|
Has this patient ever been prescribed ecasa ( aspirin enteric coated )
|
{
"answer_end": [
1216
],
"answer_start": [
1172
],
"text": [
"ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD,"
]
}
|
Ms. Loften is a 62 year old woman with cardiac risk factors including hypertension, diabetes mellitus, postmenopause, and exertional angina for four months. On admission, her medications included Aspirin q.d., Enalapril 20 mg b.i.d., Cardizem 300 mg q.d., Insulin mixed 70/30 with 60 units in the morning and 30 in the evening, and Atenolol 50 mg q.d., with an additional Simvastatin 10 mg q.h.s. She had a history of Penicillin allergy which gave her edema, and a deep venous thrombosis in 1994, chronic renal insufficiency, cholecystectomy and vitiligo. Her family history is significant for brothers who had myocardial infarctions in their 50's and 60's, and a mother who had a myocardial infarction when she was 69. She was admitted for premedication overnight prior to catheterization due to a previous allergic reaction to contrast dye that caused laryngeal edema. On examination, her chest pain radiates to her left arm, is associated with shortness of breath, but no diaphoresis or nausea or vomiting, and is relieved by rest within two minutes or by a sublingual Nitroglycerin, which she has used in the past week x two. The patient underwent successful balloon angioplasty of the mid left anterior descending artery stenosis from 70 percent to 10 percent and had a mild occurrence of chest pain post catheterization which was relieved with two sublinguals, and showed no electrocardiogram changes. On discharge, she was prescribed Aspirin 325 mg q.d., Enalapril 20 mg b.i.d., Cardizem 300 mg q.d., Insulin mixed 70/30 with 60 units in the morning and 30 in the evening, Atenolol 50 mg q.d., and Simvastatin 10 mg q.h.s. She was discharged in stable condition with an appointment the day after discharge with Dr. Mondone.
|
What treatments if any has the patient tried for the pain in the past
|
{
"answer_end": [
1086
],
"answer_start": [
1014
],
"text": [
"is relieved by rest within two minutes or by a sublingual Nitroglycerin,"
]
}
|
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.
|
Is the patient currently or have they ever taken lantus ( insulin glargine )
|
{
"answer_end": [
486
],
"answer_start": [
444
],
"text": [
"LANTUS (INSULIN GLARGINE) 50 UNITS SC QHS,"
]
}
|
The 43 year old male patient presented with atypical chest pain radiating to the left arm, diaphoresis, nausea, and mild shortness of breath. An EKG with T-wave inversion (TWI) concerning for anterolateral ischemia was also noted, and a Troponin I at ASH was negative (0.04 and 0.05) but the pain persisted, requiring a nitroglycerin (NTG) drip. The patient was admitted to the ward and started on ECASA (Aspirin Enteric Coated) 81 mg PO qd, ferrous sulfate 325 mg PO tid, furosemide (Lasix) 60 mg PO bid, hydralazine HCL 90 mg PO tid, labetalol HCL 600 mg PO tid, nitroglycerin 1/150 (0.4 mg) 1 tab SL q5min x 3 PRN chest pain hold if SBP <100, claritin (loratadine) 10 mg PO qd, losartan (Cozaar) 100 mg PO qd hold if SBP 95, metformin 850 mg PO bid, and Vytorin 10/40 (ezetimibe 10 mg - simvastatin 40 mg) 1 tab PO qd. An Adenosine MIBI showed LV dilation with an ejection fraction of 44%. The patient remained chest pain free overnight and the NTG drip was tapered, with hydralazine and labetalol increased. The patient was discharged with instructions to follow up with Dr. Pulfrey for BP check within 1 week, take discharge medications as prescribed, comply with a low cholesterol, low fat, and <2g sodium diet, and seek medical attention for worsening chest pain, shortness of breath, and marked weight gain, not to resume the Norvasc or Enalapril until instructed to by Dr. Kozola, and to consider further w/u anemia.
|
Has this patient ever been on ferrous sulfate
|
{
"answer_end": [
472
],
"answer_start": [
442
],
"text": [
"ferrous sulfate 325 mg PO tid,"
]
}
|
A 59 year-old woman with metastatic breast cancer and a history of pulmonary embolism presented with symptoms of fatigue, lethargy, tachycardia and fever. CXR showed LLL opacity, LUL opacity and hilar fullness on the right with prominent bronchi (?cuffing) and vertebral fractures. She was admitted with bacteremia on 7/0/2006 and treated with whole brain radiotherapy in March 2006 and with weekly Taxol. Restaging studies showed stable visceral disease but progression of bony metastatic disease, so in January 2006, she initiated a second-line Navelbine therapy. At the ER, she was administered 1UPRBC, 1L NS, Levofloxacin 500 mg IV, and placed CVP~20. Her blood pressure systolic initially 120s but decreased to 90s (MAPS>70), and norepinephrine was administered. She was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q6H PRN Pain, Temperature greater than:101, Other:transfusion premedication, ALBUTEROL NEBULIZER 2.5 MG INH Q4H PRN Wheezing, TESSALON PERLES (BENZONATATE) 100 MG PO TID PRN Other:congestion, BENADRYL (DIPHENHYDRAMINE) 12.5 MG PO x1 PRN Other:pre-transfusion, COLACE (DOCUSATE SODIUM) 100 MG PO BID PRN Constipation, ENOXAPARIN 40 MG SC DAILY, NEXIUM (ESOMEPRAZOLE) 40 MG PO DAILY, FLOVENT HFA (FLUTICASONE PROPIONATE) 110 MCG INH BID, INSULIN ASPART Sliding Scale.
|
What is the dosage of tessalon perles ( benzonatate )
|
{
"answer_end": [
1007
],
"answer_start": [
942
],
"text": [
"TESSALON PERLES (BENZONATATE) 100 MG PO TID PRN Other:congestion,"
]
}
|
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.
|
Did the patient receive dobutamine for enhance renal perfusion
|
{
"answer_end": [
969
],
"answer_start": [
909
],
"text": [
"On 6/8/03, the renal surgery recommended that the dobutamine"
]
}
|
This is a 69 year-old woman with a history of congestive heart failure and hypertension who presented with a productive cough which was worsening over the past 3-4 days and fever to 101 with chills and shakes and increasing shortness of breath. She had a white blood cell count of 9.3 with 54% polys and 9.6 % eosinophils, a glucose of 377, and a chest x-ray without evidence of congestive heart failure or infiltrate. She was treated in the emergency room with Albuterol nebulizer and plans were to discharge her to home, however, her saturations dropped to 89% on room air with exercise in the emergency room and was admitted for further observation. She was started on intravenous Cefuroxime, and initially improved with decrease in cough and shortness of breath; however, the patient continued to desat with exercise. A repeat chest x-ray was performed which showed no change when compared to the admission film. Her sputum culture grew out Pen-sensitive E-coli and she was continued on her intravenous and then PO antibiotics. She continued to desat with exercise, however, and her cough persisted although she remained afebrile with a slightly elevated white count and moderate peripheral eosinophilia. Her chest exam remained rancorous and the reason for this remained unclear. Given the finding of E-coli in the sputum sample, in addition to the elevated eosinophilia and lack of finding on chest x-ray despite significant findings on chest exam, the possibility of a worm or parasitic disease was raised. She had a Persantine MIBI in March of 1996, on which she had no fixed or reversible defects, and was on nitroglycerin for stable angina - "chest heaviness" after climbing one flight of stairs, relieved by rest and one sublingual nitroglycerin. Her medications on admission included Lasix 40 mg. per day, Insulin 70/30 28 units q a.m. and 5 units q p.m., Verapamil SR 120 mg PO b.i.d., Enteric coated aspirin 325 mg q day, KCL 10 mEq PO q day, Premarin 0.625 mg PO q day, Zestril 20 mg b.i.d., Atenolol, recently discontinued, Tofranil 75 mg PO q HS, Albuterol inhaler two puffs inhaled q.i.d., and Potassium slow release 10 mEq PO q day. She was discharged to home with Albuterol inhaler and instructions to follow up with her primary physician in clinic for further evaluation including PFTs and possible chest CT if symptoms did not abate, and to finish a full ten day course of antibiotics for presumed bronchitis. At the time of discharge the patient's saturation was 92 to 93% on room air and dropping slightly to 90 to 91% with exercise, however she was tolerating this well and was getting relief from her Albuterol inhaler.
|
What is the current dose of the patient's kcl
|
{
"answer_end": [
1984
],
"answer_start": [
1936
],
"text": [
"KCL 10 mEq PO q day, Premarin 0.625 mg PO 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.
|
Has the patient had finasteride in the past
|
{
"answer_end": [
1027
],
"answer_start": [
994
],
"text": [
"Colchicine 0.6 milligrams p.r.n.,"
]
}
|
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.
|
Has the patient ever had ciprofloxacin.
|
{
"answer_end": [
355
],
"answer_start": [
298
],
"text": [
"seven-day course of ciprofloxacin and oxycodone for pain,"
]
}
|
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.
|
movement disorder meds on in past
|
{
"answer_end": [
91
],
"answer_start": [
44
],
"text": [
"End stage renal disease thought to be secondary"
]
}
|
GOMEY , REGGIE 802-36-83-4, a 70-year-old female with known CAD, DM, and schzioaffective disorder, presented with intermittent chest pain for 12 hours, with diaphoresis and no nausea/vomiting/fever/cough/shortness of breath. She had a recent cardiac workup with a moderate defect in the circumflex, but decided against medical treatment. Upon discharge, the patient was prescribed ACETYLSALICYLIC ACID 325 MG PO DAILY, ATENOLOL 12.5 MG PO QAM HOLD IF: SBP<100 or HR<50, LIPITOR (ATORVASTATIN) 80 MG PO DAILY, COGENTIN (BENZTROPINE MESYLATE) 1 MG PO QAM, THORAZINE (CHLORPROMAZINE HCL) 400 MG PO QAM (on order, ref # 417100958) with a potentially serious interaction with Benztropine Mesylate and Chlorpromazine HCL, ECASA 325 MG PO DAILY, GLIPIZIDE XL 10 MG PO DAILY, SYNTHROID (LEVOTHYROXINE SODIUM) 100 MCG PO DAILY, LISINOPRIL 20 MG PO DAILY HOLD IF: SBP<100, METFORMIN 1,000 MG PO BID HOLD IF: NPO, and TRAZODONE 50 MG PO BEDTIME PRN Insomnia. CVD ROMI x2 with troponin and ck and CKMB were normal and the patient continued her cardiac medications for BP control and ECG showed early R wave but no ST changes. DM was managed with oral hypoglycemics and the patient was prescribed Heparin for prophylaxis. She was also prescribed a diet of House/Low chol/low sat. fat and 2 gram Sodium and given instructions to walk as tolerated. Follow up appointments were scheduled with Dr. Mike Kalafarski on 10/1/06.
|
Has the patient ever been on atenolol
|
{
"answer_end": [
469
],
"answer_start": [
419
],
"text": [
"ATENOLOL 12.5 MG PO QAM HOLD IF: SBP<100 or HR<50,"
]
}
|
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.
|
Has the pt. ever been on nasal cannula before
|
{
"answer_end": [
646
],
"answer_start": [
552
],
"text": [
"The patient at one point required 5 liters of nasal cannula to get his saturations in the 90s."
]
}
|
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.
|
Has the patient ever tried acei
|
{
"answer_end": [
540
],
"answer_start": [
518
],
"text": [
"ASA, BB, ACEI, statin,"
]
}
|
Vance Prunier, a 57 year old patient with diabetes mellitus, hypertension, hyperlipidemia, and known coronary artery disease, was admitted on 5/30/2001 with worsening exercise capacity. A cath today showed severe native TVD, patent LIMA to LAD, occluded SVG-OM, and radial graft to PDA 80% stenosis. PCI of radial graft lesion with Nir 2.5x15mm and S660 2.5x12mm stents resulting in 0% residual was done and Angioseal was applied to RFA. The patient was discharged on 6/17/2001 in a stable condition with medications EC ASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO QPM, Cipro (Ciprofloxacin) 250 MG PO BID, Insulin NPH Human 30 UNITS SC QAM, Insulin Regular (Human) 18 UNITS SC QAM, Levoxyl (Levothyroxine Sodium) 75 MCG PO QD, Lisinopril 20 MG PO QD, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL Q5 MIN X 3 PRN Chest Pain HOLD IF: SBP<[ ], Pravachol (Pravastatin) 20 MG PO QHS, Amlodipine 5 MG PO QD, Imdur (Isosorbide Mononit.( SR )) 60 MG PO QD, Wellbutrin SR (Bupropion Hcl SR) 150 MG PO BID, Clopidogrel 75 MG PO QD, and 16 hours Integrilin and 30 days Plavix. The patient was instructed to call for any further chest pain, groin pain, swelling or bleeding and was to return to work after an appointment with the local physician. Follow up appointments with Dr. Minear in 1-2 weeks and Dr. Givens were scheduled. The patient was discharged to home.
|
Has the pt. ever been on pravachol ( pravastatin ) before
|
{
"answer_end": [
887
],
"answer_start": [
850
],
"text": [
"Pravachol (Pravastatin) 20 MG PO QHS,"
]
}
|
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.
|
Is there history of use of coumadin
|
{
"answer_end": [
1515
],
"answer_start": [
1449
],
"text": [
"his coumadin dose decreased while being treated with levofloxacin,"
]
}
|
Patient Alequin, Garland, a 57-year-old female with a complex medical history including squamous cell lung cancer, cirrhosis, COPD, HTN, PVD, seizure disorder, history of SDH, large abdominal ventral hernia, and chronic back pain, was admitted to the ED obtunded with decreased BP. She had received all her medications as prescribed in the morning at her nursing home and received Thiamine HCL 100 mg PO daily and Narcan in the ED, becoming more responsive and uncomfortable after Narcan with an elevated ammonia level of 233. To manage her mental status, the patient was given Lactulose 30 Milliliters PO QID Starting Today (5/29) and her narcotic dose was avoided. Pain was effectively controlled with MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Celecoxib 100 mg PO daily Starting Today (5/29) PRN Pain, and a Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily. She was prescribed Vitamin C (Ascorbic Acid) 500 mg PO BID, Folate (Folic Acid) 1 mg PO daily, Lasix (Furosemide) 40 mg PO daily, Flagyl (Metronidazole) 500 mg PO q8h, Aldactone (Spironolactone) 75 mg PO BID with food/drug interaction instruction to give with meals, KCL IV (ref #403310506) with serious interaction of Spironolactone & Potassium Chloride with reason for override monitoring, Thiamine HCL 100 mg PO daily, Multivitamin Therapeutic (Therapeutic Multivitamin) 1 tab PO daily, MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Flovent HFA (Fluticasone Propionate) 220 mcg INH BID, Celecoxib 100 mg PO daily, Keppra (Levetiracetam) 1,000 mg PO BID, Caltrate 600 + D (Calcium Carbonate 1,500 mg (...)), Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily, Novolog (Insulin Aspart) sliding scale (subcutaneously) SC AC with instructions to give 0-10 units subcutaneously based on BS, Maalox-Tablets Quick Dissolve/Chewable 1-2 tab PO Q6H PRN Upset Stomach, Vitamin K (Phytonadione) 5 mg PO daily, Protonix (Pantoprazole) 40 mg PO daily, Toprol XL (Metoprolol Succinate Extended Release) 50 mg PO daily with food/drug interaction instruction to take consistently with meals or on empty stomach, Magnesium Oxide 420 mg PO BID, Metronidazol starting on HD 1, and Vancomycin until speciation of blood cultures. Blood cultures were positive for coag negative staph in 2/4. She was also given Flovent for her known COPD and was discharged with instructions to complete a 14-day course of Cipro and Flagyl and a few changes in her medications, including MSIR every 4 hr as needed, Celebrex, and Lidoderm patch. Follow up with Dr. Vargas, Dr. Megeath, Dr. Blandin, and Dr. Pfleider as scheduled, and with PT at nursing home. Blood counts and calcium should be checked on Monday 3/21 and next week respectively.
|
Was the patient ever prescribed metronidazol
|
{
"answer_end": [
2211
],
"answer_start": [
2130
],
"text": [
"Metronidazol starting on HD 1, and Vancomycin until speciation of blood cultures."
]
}
|
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 this patient tried 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."
]
}
|
Ms. Fought is a 50-year-old female with a history of bipolar disorder, schizophrenia, obstructive sleep apnea, hypertension, and diabetes who presented with right knee swelling, redness, and pain and was admitted to the Emergency Department. She was given therapeutic doses of heparin because of the concern of pain, as well as IV fluids, Oxycodone 5 mg to 10 mg p.o. q.4h. p.r.n. pain, Tylenol 650 mg p.o. q.4h. p.r.n. pain, Ibuprofen 600 mg q.6h. p.r.n. pain, Klonopin 1 mg p.o. at bedtime, Levofloxacin 500 mg p.o. daily for six days after the day of discharge, and NSAIDs, and was prescribed Lisinopril 10 mg daily, Lipitor 40 mg daily, Klonopin, MetroGel p.o. at bedtime, Lithium 900 mg at bedtime, Acebutolol 200 mg daily, and Risperdal 0.5 mg at bedtime, with no known drug allergies. She responded well to normal saline fluid boluses for a total of 3 liters over her hospital course, and was treated with Unasyn and vancomycin, and then switched to levofloxacin, with six more days after discharge from the hospital. Her bradycardia was resolved either over beta blockade or lithium toxicity, for which her beta-blocker was held and her lithium was also held, resulting in an improved heart rate in the 50s and 60s. Upon discharge, she was given instructions to draw blood for lithium level checks daily until it is below 0.5, at which time, she should be restarted on lithium 300 mg p.o. at bedtime, and to follow up with her primary care physician, Dr. Aurelio Gilberto Hencheck at Li County Hospital.
|
Why is the patient on tylenol
|
{
"answer_end": [
425
],
"answer_start": [
387
],
"text": [
"Tylenol 650 mg p.o. q.4h. p.r.n. pain,"
]
}
|
Patient KOMLOS, COLEMAN 223-66-98-9 was admitted on 10/26/2000 and discharged on 9/4 AT 04:00 PM to Home w/ services with a code status of Full code. A 78F with HTN, PAFon amiodarone, MS s/p MVR on coumadin, and ?CAD/IMI with clean coronaries on cath '91, presented with two episodes of ?syncope. The patient had 2.1 CXR showing mild CHF and is on an extensive cardiac regimen including TYLENOL (ACETAMINOPHEN) 650-1,000 MG PO Q4H PRN pain, AMIODARONE 200 MG PO QD, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LASIX (FUROSEMIDE) 80 MG PO BID, MICRONASE (GLYBURIDE) 10 MG PO BID, PLAQUENIL (HYDROXYCHLOROQUINE) 200 MG PO BID, ISORDIL (ISOSORBIDE DINITRATE) 40 MG PO TID, LISINOPRIL 20 MG PO BID, KCL IMMEDIATE REL. PO SCALE QD, LOPRESSOR (METOPROLOL TARTRATE) 25 MG PO BID, NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain HOLD IF: SBP <100, COUMADIN (WARFARIN SODIUM) EVEN days: 5 MG qTTHSat; ODD days: 2.5 MG qMWF PO QD, NORVASC (AMLODIPINE) 10 MG PO QD HOLD IF: sbp <100, LOVENOX (ENOXAPARIN) 70 MG SC Q12H X 4 Days. Override Notices were added on 0/28 by KNIGHTSTEP, HAYDEN S. on order for COUMADIN PO (ref # 03417627) for POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & WARFARIN, POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE Reason for override: tolerates. Cardiology consulted, and recommended an event monitor to assess for specific rhythms while she is symptomatic. Follow up plan: Event monitor to be ordered. Patient to follow up with Dr. Bergerson and Dr. Gamma in 1-2 weeks. Visiting nurse to do home safety eval, and monitor INR/administer Lovenox if needed, and check BP/HR/symptoms. For visiting nurse: Please draw blood qd for 5 days to check INR. If it is less than 2 please give the Lovenox injections for the day. If it remains in 2-3 range, just continue the regular Coumadin dosing. Please check BP and heart rate and call primary doctor Dr. Mickles if it is excessively low or high and patient is complaining of symptoms. Please ensure she is wearing her event monitor.
|
has there been a prior lisinopril
|
{
"answer_end": [
690
],
"answer_start": [
666
],
"text": [
"LISINOPRIL 20 MG PO BID,"
]
}
|
A 74-year-old female with pulmonary sarcoid, CHF, and CRI presented with SOB after stopping Lasix several weeks ago. On admission, she was in mildly decompensated CHF and was started on more aggressive diuresis with Lasix 40 IV BID increased to 80 BID on HD2, with Cardiology Service consulting, then increased to Lasix drip at 15/hr on HD3 with I/O goal 1-2 l neg. She did well on this and by HD5 was near her dry weight of 49kg and her drip was transitioned back to PO Lasix. She was continued on Hydralazine, Lopressol and Isordil on HD3, titrated up to 20 TID. She has history of MI with stents and was continued on ASA, Plavix, Zocor, Coumadin (ref#960263524) PO, MVI Therapeutic 1 TAB PO QD, Iron Sulfate 325 MG PO TID, Folate 1 MG PO QD, Calcium Carbonate 500 MG PO TID, Acetylsalicylic Acid 81 MG PO QD, Colace 100 MG PO BID, Prednisone 10 MG PO QAM, Sodium Bicarbonate 325 MG PO TID, Flovent 220 MCG INH BID, Bactrim DS, Plavix 75 MG PO QD, Esomeprazole 40 MG PO QD, Duoneb, Glipizide XL 2.5 MG PO QD, Vit. B-3, Lipitor 40 MG PO QD, Atorvastatin Calcium, Lovenox 50 MG SC QD, and Insulin Regular Human (Sliding Scale subcutaneously SC AC: if BS is 125-150, then give 2 units; if BS is 151-200, then give 3 units; if BS is 201-250, then give 4 units; if BS is 251-300, then give 6 units; if BS is 301-350, then give 8 units; if BS is 351-400, then give 10 units). She was discharged to Wadesdi Ckgart Community Hospital at a euvolemic state with a dry weight of 49kg, continuing on Lasix 80 PO BID unless Cr rises above new baseline of 3.5 or if she gains weight or shows signs of new overload, and Lovenox should be stopped once her INR is >2. Coumadin dose should be adjusted according to INR goal 2-3, and she should be on a renal diet with low potassium and low glucose but with diabetic caloric supplements like GLUCERNA. She should receive a HOT PACK to her neck 2-3x per day and to her vein before blood draw for comfort, physical therapy daily with the goal of gait stability, home safety, and good O2 sats on 2L O2, and VNA services for meds. She should follow up with PCP, renal, and cardiology, and return to the hospital or call doctor if she experiences worsening SOB, fever over 100.5, chest pain, decreased urine output, weight gain over 5 pounds, or any other concerning symptoms. The patient was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, CALCIUM CARBONATE (500 MG ELEMENTAL CA++) 500 MG PO TID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, IRON SULFATE (FERROUS SULFATE) 325 MG PO TID, FOLATE (FOLIC ACID) 1 MG PO QD, LASIX (FUROSEMIDE) 80 MG PO BID, HYDRALAZINE HCL 25 MG PO TID HOLD IF: SBP<90, INSULIN REGULAR HUMAN Sliding Scale (subcutaneously) SC AC, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, LOPRESSOR (METOPROLOL TARTRATE) 12.5 MG PO TID, DILANTIN (PHENYTOIN) 100 MG PO QID, POTENTIALLY SERIOUS INTERACTION: PHENYTOIN & WARFARIN, PREDNISONE 10 MG PO QAM, SODIUM BICARBONATE 325 MG PO TID, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, SERIOUS INTERACTION: SULFAMETHOXAZOLE & WARFARIN, MVI THERAPEUTIC (THERAPE
|
Has a patient had iron sulfate ( ferrous sulfate )
|
{
"answer_end": [
725
],
"answer_start": [
698
],
"text": [
"Iron Sulfate 325 MG PO TID,"
]
}
|
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