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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
|
Has this patient ever been prescribed insulin
|
{
"answer_end": [
2918
],
"answer_start": [
2883
],
"text": [
"covered with insulin sliding scale,"
]
}
|
Patient Mariano Librizzi was admitted on 4/21/2005 with a viral infection and severe pulmonary hypertension, and discharged on 9/22/2005 to go home. The discharge medications included ECASA (Aspirin Enteric Coated) 81 MG PO QD, with a potentially serious interaction with Warfarin & Aspirin, COLACE (Docusate Sodium) 100 MG PO BID, LASIX (Furosemide) 160 MG PO BID, GLIPIZIDE 10 MG PO BID, OCEAN SPRAY (Sodium Chloride 0.65%) 2 SPRAY NA QID, COUMADIN (Warfarin Sodium) 5 MG PO QPM, JERICH, JOSPEH, M.D. on order for ECASA PO (ref #91585860), ZOLOFT (Sertraline) 150 MG PO QD, AMBIEN (Zolpidem Tartrate) 10 MG PO QHS, KCL SLOW RELEASE 20 MEQ PO BID, ATROVENT NASAL 0.06% (Ipratropium Nasal 0.06%) 2 SPRAY NA TID, NEXIUM (Esomeprazole) 20 MG PO QD, TRACLEER (Bosentan) 125 MG PO BID, VENTAVIS 1 neb NEB Q3H Instructions: during wake hours, ALBUTEROL INHALER 2 PUFF INH Q4H PRN Shortness of Breath, Wheezing, home O2 (8L NC). The patient was also prescribed K-Dur 20 BID, Nexium 20, Lasix 160 BID, Tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft 100, MVI, Oceanspray 2 Spray NA QID, Ambien 10 QHS, Ventavis nebs Q3H, Albuterol Inhaler 2 puff INH Q4H, KCl Slow Release 20 MEQ PO BID, Colace 100 MG PO BID, Atrovent Nasal 0.06%. The diet was House/Low chol/low sat. fat and 4 gram Sodium and they were advised to do walking as tolerated, with serial enzymes/EKG to be continued and Lasix, KCl, ASA 81 also advised. The patient had a history of depression which had been worse of late and was advised to continue Zoloft and Ambien, and to avoid high Vitamin-K containing foods and to give on an empty stomach (give 1hr before or 2hr after food). The patient was followed by the AH service with ACEi, cephalopsporins, GERD nexium prophylaxis and Coumadin for pulmonary microclots on Bx in tracleer 125 BID, Glipizide 80 BID, Coumadin 5/7.5, ECASA 81, Zoloft. The discharge condition was satisfactory.
|
Has a patient had nexium ( esomeprazole )
|
{
"answer_end": [
746
],
"answer_start": [
712
],
"text": [
"NEXIUM (Esomeprazole) 20 MG PO QD,"
]
}
|
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 the patient ever been on neurontin ( gabapentin )
|
{
"answer_end": [
1379
],
"answer_start": [
1342
],
"text": [
"NEURONTIN (GABAPENTIN) 300 MG PO TID,"
]
}
|
The patient is a 54-year-old man with nonischemic dilated cardiomyopathy who presents with weight gain, weakness, and azotemia. He was admitted with decompensated heart failure and was treated with dobutamine, seretide, and diuretics with good effect, functioning on ACE inhibitor. Two weeks prior to presentation, Digoxin 0.125 mg q.o.d., Imdur 30 mg q.d., hydralazine 25 mg t.i.d., torsemide was being held, Coumadin 1 mg q.d., carvedilol 3.125 mg b.i.d., allopurinol 100 mg q.d., Glucophage, and glyburide were administered. On 2/19/03, Diuril was added to his regimen and his creatinine was noted to increase from 2.6 to 3.6 and diuretics were subsequently held. The patient was loaded on amiodarone, unfortunately still required low dose dobutamine to maintain his cardiac output and was transferred back to the floor and continued to have decrease urine output on maximal diuretic doses and ionotropes. On 6/8/03, the renal surgery recommended that the dobutamine be stopped in order to enhance renal perfusion and Lasix be increased to 80 mg per hour. He has beyond less invasive measures such as digoxin and ACE inhibitors, and he is now dobutamine dependent dobutamine between 1 and 2.5 mcg/kg/minute to maintain his cardiac output, currently loaded on amiodarone without any further events. He has a chronic osteomyelitis, currently in a six-week course of ceftazidime, vancomycin, Flagyl, and Diflucan for complicated osteomyelitis, end date is on 2/30/03. He has diabetes and was on oral hypoglycemic as an outpatient, however, now this renal function, he has been transitioned over to insulin with his standing doses of Lantus with a lispro sliding scale. The patient was started on TPN for quite severe malnutrition and has increasing albumin with increased appetite. Additionally, he is on maintenance doses of hydrocortisone and was seen by Psychiatry, who suggested starting low dose of Zyprexa in the evening, which has greatly improved his mood. He is planned to be evaluated by Plastic Surgery prior to discharge for final plans whether a flap or healing by secondary retention. The patient currently is stable and would be discharged with home dobutamine and frequent and careful follow up by his primary cardiologist Dr. Mongiovi.
|
Is there history of use of imdur
|
{
"answer_end": [
375
],
"answer_start": [
315
],
"text": [
"Digoxin 0.125 mg q.o.d., Imdur 30 mg q.d., hydralazine 25 mg"
]
}
|
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.
|
What is has been given for treatment of her his increased discomfort.
|
{
"answer_end": [
365
],
"answer_start": [
297
],
"text": [
"Dilaudid was added to his pain regimen for his increased discomfort."
]
}
|
Mr. Mauras is a 72-year-old man with history of stable angina, type 2 diabetes, peripheral vascular disease, former smoking history, and history of seizure disorder with cataracts. He had occasional anginal symptoms prior to discharge and took about two nitroglycerins per week. Over the past week, he had escalating chest pain requiring one nitroglycerin per day. The pain was relieved by rest and nitroglycerin. One week prior to admission, his digoxin was stopped and his amiodarone was decreased. His Plavix was stopped and his Coumadin was held. On the morning of admission, he had chest pain and received Lopressor, Enalapril, Lovenox treatment dose and a Plavix load in the ED. He was found to have flash pulmonary edema and in atrial fibrillation with rapid ventricular response and was taken back to the catheterization lab and given four stents to his saphenous vein graft, OM1 with good resolution of his symptoms. He was transferred to the floor and was given an amiodarone load given his ejection fraction and increased ectopy on telemetry. His troponin had been trended down to the 0.2s by discharge and his beta-blocker and ACE inhibitor were titrated to heart rate and blood pressure. Prior to anticipated discharge, he re-developed flash pulmonary edema secondary to atrial fibrillation with rapid ventricular response and was re-loaded with digoxin. He was started on Mucomyst precath with good effect, had a difficult-to-place Foley, and was started on Flomax with good effect. His creatinine on discharge was 1.2, his metformin was held, and he was continued on Lantus with sliding scale insulin. He was given three units of packed red blood cells given his history of CAD and was prescribed with Amiodarone 200 mg, Enteric-coated aspirin 325 mg, Librium 10 mg, Colace 200 mg, Ferrous gluconate 324 mg, Lasix 40 mg, Nitroglycerin one tab, Dilantin 100 mg, Senna two tabs, Coumadin 3 mg, Lipitor 80 mg, Flomax 0.4 mg, Plavix 75 mg, Lantus 14 units, Metformin 500 mg, Ranitidine 150 mg, Digoxin 0.125 mg, Enalapril 10 mg, and Atenolol 50 mg, with follow-up appointments with his PCP, Dr. Kelley Hernon of Electrophysiology on 7/8/05, and Dr. Daft on 9/20/05, and INR checked on 8/4/05 or 7/8/05 with Coumadin adjusted accordingly.
|
has there been a prior atenolol
|
{
"answer_end": [
2059
],
"answer_start": [
2044
],
"text": [
"Atenolol 50 mg,"
]
}
|
Mr. Forde has recovered very well following his elective coronary artery bypass graft procedure and is hemodynamically stable with left lower extremity erythema and tenderness significantly improved 24 hours following initiation of Keflex course. White blood cell count was within normal limits and patient continued to remain afebrile. A course of Keflex was administered on postoperative day seven for sinus rhythm in the high 90s with blood pressure mildly hypertensive, additionally with frequent PVCs noted on telemetry. Mr. Notarnicola continued to remain afebrile and his knee pain has significantly improved. Additionally, of note, Mr. Hovenga's Toprol was increased to 150 mg p.o. daily with an extra 2 mg of magnesium. Mr. Neth is discharged to rehabilitation today having recovered well following his elective CABG procedure. Mr. Marcusen is discharged to rehabilitation today, postoperative day eight, hemodynamically stable, to continue a course of Keflex for left lower extremity erythema and additionally to continue one week of diuresis in the form of low dose Lasix for mild persistent postoperative pulmonary effusions. Mr. Brannigan has been instructed to shower and monitor incisions for signs of increasing infection such as fever, drainage, worsening pain or increase in redness. He is to follow up with his primary care physician for continued evaluation and management of hypertension, dyslipidemia, obesity, obstructive sleep apnea, and uncontrolled Type II diabetes mellitus. Additionally, the patient will follow up with his cardiologist for continued evaluation and management of blood pressure, heart rate, heart rhythm, lipid levels, and for possible future adjustment in medication. Mr. Connin will follow up with his cardiac surgeon, Dr. Quinn Dalio, in six to eight weeks. Additionally, he will follow up with his cardiologist, Dr. Octavio Wulffraat, in two to four weeks and with his primary care physician, Dr. Barrett Mittleman, in one to two weeks. The patient is discharged with medications including Tylenol 325 mg p.o. q.6h. p.r.n. pain for temperature greater than 101 degrees Fahrenheit, amlodipine 5 mg p.o. daily, atorvastatin 10 mg p.o. daily, captopril 6.25 mg p.o. t.i.d., Keflex 500 mg p.o. q.i.d. times total of seven days, last dose on 9/15/06, Colace 100 mg p.o. b.i.d. p.r.n. constipation, enteric-coated aspirin 325 mg p.o. daily, Lasix 40 mg p.o. daily x7 days, hydrochlorothiazide 12.5 mg p.o. daily, NovoLog 3 units subcu AC, Lantus 24 units subcu q. 10 p.m., hold if n.p.o., potassium slow release 20 mEq p.o. daily x7 days, Toprol-XL 150 mg p.o. daily, Niferex 150 mg p.o. b.i.d., oxycodone 5 to 10 mg p.o. q.4h. p.r.n. pain, Ambien 5 mg p.o. nightly p.r.n. insomnia, NovoLog 6 units subcu with breakfast, hold if n.p.o., NovoLog 4 units subcu with lunch, hold if n.p.o., NovoLog 4 units subcu with dinner, hold if n.p.o., NovoLog sliding scale subcu AC, blood sugar less than 125, give 0 units subcu, blood sugar 125 to 150, give 2 units subcu, blood sugar 151 to 200, give 3 units subcu, blood sugar 201 to 250, give 4 units subcu, blood sugar 251 to 300, give 6 units subcu, blood sugar 301 to 350, give 8 units subcu, if blood sugar 351 to 400, NovoLog sliding scale subcu q.h.s. Please recheck blood sugar less than 200, give 0 units subcu, if blood sugar 201 to 250, give 2 units subcu, blood sugar 251 to 300, give 3 units subcu, blood sugar 301 to 350, give 4 units subcu, blood sugar 351 to 400, give 10 units subcu, call physician if blood sugar greater than 400.
|
Was the patient ever given magnesium for sinus rhythm...hypertensive...frequent PVCs
|
{
"answer_end": [
727
],
"answer_start": [
665
],
"text": [
"increased to 150 mg p.o. daily with an extra 2 mg of magnesium"
]
}
|
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 this patient ever been treated with asa
|
{
"answer_end": [
639
],
"answer_start": [
592
],
"text": [
"stents and was continued on ASA, Plavix, Zocor,"
]
}
|
Harrison Fullwood was admitted on 4/3/2005 for ICD placement for HCM. On 7/13/05, Medtronic Dual Chamber DDI/ICD was placed under general anesthesia with a CODE STATUS of Full Code and disposition of Home. ECHO 5/13 showed septal thickness 16mm, posterior wall thickness 19mm with preserved EF 65% and LV outflow tract peak gradient 125mmHg. Holter monitoring 0/2 without any arrhythmias. On admission PE, VS 96.4 74 140/90 20 93% RA. Labs/Studies included CBC, BMP, Coags wnl, EKG NSR. TW flat V5/V6 (old), CXR (portable): cardiomegaly, no e/o ptx, PA/lat CXR AM after no ptx, leads in place, no overt failure. The patient was prescribed Albuterol, Advair 250/50 bid, Rhinocort 2 sprays bid, Atrovent 2 puff qid, Singulair 10mg qhs, Nexium 40mg daily, Lasix 20mg daily (inc to 40 or 60 during period), Kcl 20meq daily, Verapamil 120mg daily, Patanol 1-2 OU bid prn, Loratidine 10mg daily, Zocor 20mg qhs, Effexor 75mg daily, Metformin 1250mg bid, Mgoxide 500mg daily, Ambien prn, Amox prior to procedures. On order for Motrin PO (ref# 234611479), the patient had a POSSIBLE allergy to Aspirin; reaction is Unknown. The patient was instructed to take Keflex for a 3 day total course, take all medications with food, and avoid grapefruit unless MD instructs otherwise. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A. ENDO: ISS. restarted Metformin on morning of d/c. NEURO: cont Effexor. On discharge, the patient was prescribed Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Wheezing, Lasix (Furosemide) 20 mg PO QD Starting Today (10/19) with instructions to titrate his dose 20mg/40mg/60mg as he normally does depending on his degree of swelling, Motrin (Ibuprofen) 600 mg PO Q6H PRN Pain, Headache, Magnesium Oxide 560 mg PO QD, Verapamil Sustained Release 120 mg PO QD Starting Today (10/19) with instructions to confirm home dose and resume home dose, Keflex (Cephalexin) 250 mg PO QID X 10 doses, Zocor (Simvastatin) 20 mg PO QHS, Ambien (Zolpidem Tartrate) 10 mg PO QHS PRN Insomnia, Loratadine 10 mg PO QD, Potassium Chloride Slow Rel. (KCl Slow Release) 20 mEq PO QD As per AH Potassium Chloride Policy, each 20 mEq dose to be given with 4 oz of fluid, Metformin 1,250 mg PO BID Starting IN AM (10/19), Rhinocort Aqua (Budesonide Nasal Inhaler) 2 Spray Inh BID, Singulair (Montelukast) 10 mg PO QD, Effexor XR (Venlafaxine Extended Release) 75 mg PO QD Number of Doses Required (approximate): 5, Advair Diskus 250/50 (Fluticasone Propionate/...) 1 Puff Inh BID, Nexium (Esomeprazole) 40 mg PO QD, Oxycodone 10 mg PO Q4H PRN Pain, and Atrovent HFA Inhaler (Ipratropium Inhaler) 2 Puff Inh QID. November of 2004, HF symptoms were controlled on Lasix and at baseline he could work. The patient was also advised to take all medications with food and to avoid grapefruit unless MD instructs otherwise, and to take Keflex for a 3 day total course and to take all other medications as the same. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A.
|
How much potassium chloride slow rel. ( kcl slow release ) does the patient take per day
|
{
"answer_end": [
2218
],
"answer_start": [
2121
],
"text": [
"Potassium Chloride Slow Rel. (KCl Slow Release) 20 mEq PO QD As per AH Potassium Chloride Policy,"
]
}
|
This is a 70-year-old woman with ischemic cardiomyopathy, coronary artery disease status post MI, insulin-dependent diabetes, peripheral vascular disease, and chronic renal insufficiency who presented in volume overload after a previous admission. She had been diuresed with a Lasix drip at 10 mg per hour and Zaroxolyn at 2.5 mg p.o. daily, and her Lopressor was held for a decompensated heart failure. She was then started on amiodarone and Coumadin for a new paroxysmal atrial fibrillation. Her Lasix drip was increased to 20 mg per hour and the Zaroxolyn was increased to b.i.d. After transition from Zaroxolyn to Diuril, which was given 250 mg IV b.i.d., she was prescribed Ativan 0.5 mg p.o. t.i.d. p.r.n. anxiety, Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Lantus 18 units subcutaneously nightly, Lopressor 25 mg p.o. b.i.d., Procrit 40,000 units subcutaneously every other week, Nitroglycerin sublingual p.r.n. chest pain, Aspirin 81 mg p.o. daily, Vitamin B12 subcutaneous injections at clinic, Iron 325 mg p.o. t.i.d., Metolazone p.r.n., Multivitamin one tablet p.o. daily, Torsemide 100 mg q.a.m. and 50 mg q.p.m., Coumadin 1 mg q.p.m., and Amiodarone 200 mg p.o. daily. Despite the dose of Coumadin being decreased from her home dose of 1 mg q.p.m. to a 0.5 mg q.p.m., her INR continued to rise greater than 200. She was started on q.a.c. NovoLog regimen with her Lantus insulin dose decreased from 18 units to 16 units and the NovoLog sliding scale was started. She was monitored on telemetry with no other events and required repletion of both potassium and magnesium despite her renal insufficiency throughout the admission in the setting of injected insulin in the setting of worsening renal failure, so, studies were also normal. She was continued on Aranesp through the admission and was discharged home on a similar regimen to her home regimen simply to Torsemide after the last discharge as her outpatient p.o. Torsemide regimen of 100 mg p.o. q.a.m. and 50 mg q.p.m., Lantus 12 units subcutaneously nightly, Ativan 0.5 mg p.o. t.i.d., Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Multivitamin one tablet p.o. daily, Coumadin 1 mg q.p.m., Metolazone 2.5 mg p.o. daily as needed for fluid retention, Iron 325 mg p.o. t.i.d., and Aspirin 81 mg p.o. daily. She was maintained on a cardiac diet and prophylaxis with Coumadin and Nexium. Potassium and magnesium were repleted as needed and she was maintained on aspirin and Lipitor throughout the admission. She will follow up with her primary care provider, SRRH Cardiology Clinic, and Renal Clinic.
|
Is there history of use of coumadin;
|
{
"answer_end": [
1292
],
"answer_start": [
1194
],
"text": [
"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.,"
]
}
|
Summary: This is a 22 year old gravida V para 0314 at 24 weeks, who presented with a three and a half day history of severe frontal headaches with scintillations and marked polydipsia for four days, with no relief from Tylenol, aspirin or Fioricet. She had a history of preeclampsia with a previous twin gestation, chronic hypertension, seizure disorder following motor vehicle accident for which she is on valproic acid, no clearly documented recent seizures, history of asthma for which she takes medicines p.r.n., history of behavioral disorders with question of organic or psychogenic origin, obesity, multiple drug allergies, cholecystectomy in 1990, appendectomy at age 14, motor vehicle accident with V-P shunt placement in 1980, facial reconstruction times three in 1980, and superficial vascular surgery in 1989 for varicosities of the lower extremities. Symptoms were not completely relieved by Demerol, Percocet or Tylenol, however, she was eventually tried on Fioricet which provided some relief and was at least briefly maintained on hydrochlorothiazide before admission. She was begun on a beta blocker, namely labetolol, with good control and was discharged to home on labetolol. Intravenous hydration was initially provided for nausea and vomiting, however, she declined further IV's and was discharged for a trial of outpatient management. Follow up is in the clinic. She was taking a small dose of valproic acid apparently on her own throughout this pregnancy.
|
medicines
|
{
"answer_end": [
548
],
"answer_start": [
489
],
"text": [
"she takes medicines p.r.n., history of behavioral disorders"
]
}
|
The patient is a 55-year-old man with a history of smoking and a left sided hemisphere stroke, who underwent a right-sided femoral to popliteal bypass graft in February of 1986 for severe claudication. He was readmitted in March of 1988 for increase in pain in the calves and again in February of 1988 for graft stenosis and underwent angioplasty. He presented in July of 1989 with progressive pain and three months of rest pain in the right calf and claudication of the left calf. He also has a history of chest pain, esophageal reflux, anxiety disorder, chronic low back pain, peptic ulcer disease, herniated nucleus pulposus, and cholecystectomy. On admission, medications included Pepcid, 40 mg at h.s.; trazodone, 15 mg at h.s.; Carafate, one q.i.d.; nitroglycerin p.r.n. and Flexeril, 10 mg q eight hours p.r.n. back pain. Allergies include QUESTION OF PENICILLIN AND QUESTION OF DYE. He was taken to the Operating Room in March of 1990 for a right reverse saphenous bypass graft from the in situ vein graft to below the knee popliteal artery, and discharged with excellent palpable pulses.
|
has the patient had flexeril
|
{
"answer_end": [
828
],
"answer_start": [
756
],
"text": [
"nitroglycerin p.r.n. and Flexeril, 10 mg q eight hours p.r.n. back pain."
]
}
|
The patient had been taking Ativan of 3-4 mg q.d. for anxiety for the past two months and abruptly stopped taking it on March 1995 after which she started to have feelings of disorientation, and had been taking chloral hydrate 500 to 1000 mg q.h.s. for five days and Compazine with one dose. CURRENT MEDICATIONS: At home, patient took insulin NPH 25 units in the morning with Regular 10 units in the morning, aspirin 81 mg q.d., Lopressor 25 mg b.i.d., Compazine 5 mg q.6h. p.r.n. anxiety of which she took only one dose, and chloral hydrate 500 to 1000 mg q.h.s. for five days. On admission, her laboratory examination was significant for BUN of 17, creatinine of 1.0, glucose was 364, liver function tests were within normal limits, white count was 7.2, hematocrit was 36, and platelet count was 266. Neurology consultation was obtained who felt that patient's peripheral neuropathy was probably secondary to longstanding diabetes but felt that some of her symptomatology could be consistent with porphyria. Psychiatry felt that this episode was consistent with generalized anxiety disorder separated by post dysthymia and suggested phenothiazines which are proven to be safe in porphyria for treatment. She was started on Trilafon 2 to 4 mg p.o. p.r.n. q.6h. for anxiety and Keflex 500 mg p.o. t.i.d. for treatment. The patient was also seen to be orthostatic which was felt to be secondary to dehydration secondary to poor p.o. intake prior to admission and was treated with normal saline boluses and her orthostasis improved. Her Lopressor was also held with this episode of orthostasis. The Watson-Schwartz test done by Dr. Mohar on patient very early in the admission was negative which made an acute porphyria attack very unlikely. These episodes were felt to be secondary to a combination of anxiety attack and rapid taper of Ativan which she had been taking at moderately high doses for the last two months. Patient also developed urinary tract infection symptoms and her urine culture showed greater than 100,000 colonies of E. coli which were pansensitive. She was discharged to home on August in good condition on medications Aspirin 81 mg p.o. q.d., insulin NPH 25 units subcutaneously q.a.m., insulin regular 10 units subcutaneously q.a.m., Trilafon 2 mg p.o. q.6h., and Keflex 500 mg p.o. t.i.d. Follow-up will be with Dr. Dario Rodriquz.
|
Has the patient taken medication for generalized anxiety disorder
|
{
"answer_end": [
1205
],
"answer_start": [
1125
],
"text": [
"suggested phenothiazines which are proven to be safe in porphyria for treatment."
]
}
|
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
|
simvastatin
|
{
"answer_end": [
773
],
"answer_start": [
752
],
"text": [
"SIMVASTATIN & NIACIN,"
]
}
|
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 prescribed lasix
|
{
"answer_end": [
2265
],
"answer_start": [
2243
],
"text": [
"Lasix 20 mg p.o. q.d.,"
]
}
|
This is a 46-year-old morbidly obese female with a history of insulin-dependent diabetes mellitus complicated by BKA on two prior occasions, who was admitted to the MICU with BKA, urosepsis, and a non-Q-wave MI. On presentation to the Emergency Department, her vital signs were notable for a blood pressure of 189/92, pulse rate of 120, respiratory rate of 20, and an O2 sat of 90%. She was given insulin, sublingual nitroglycerin x three, 4 mg of morphine, 5 mg of Lopressor, and started on a heparin drip and IV antibiotics, and admitted to the MICU for further management. Her past medical history included insulin-dependent diabetes mellitus for how many years, positive ethanol use, approximately one drink per week, and denied IV drug use or other illicit drug use. She was placed on an insulin drip and hydrated with intravenous fluids, with improvement, and eventually transitioned to NPH with insulin sliding scale coverage. Despite escalating her dose of NPH up to 65 U subcu b.i.d. on the day of discharge, she continued to have elevated blood sugars >200 and required coverage with insulin sliding scale. This issue will need to be addressed as an outpatient. She was also placed on cefotaxime for gram negative coverage, with both her blood cultures and urine cultures growing out E. coli which were sensitive to cefotaxime and gentamycin. As she initially continued to be febrile and continued to have positive blood cultures, one dose of gentamycin was given for synergy, and she was eventually transitioned to p.o. levofloxacin and will take 7 days of p.o. levofloxacin to complete a total 14-day course of antibiotics for urosepsis. She was initially placed on aspirin, heparin, and a beta blocker, and once her creatinine normalized, an ACE inhibitor was also added. Heparin was discontinued once the concern for PE was alleviated, and her beta blocker and ACE inhibitor were titrated up for a goal systolic blood pressure of <140 and a pulse of <70. On admission, the patient was on several pain medicines, including amitriptyline, Flexeril, and Valium for reported history of sciatica and low back pain, which were discontinued and she was placed on Neurontin for likely diabetic neuropathy. She was also placed on GI prophylaxis with Carafate and treated symptomatically with Imodium p.r.n. diarrhea. The patient was discharged with enteric coated aspirin 325 mg p.o. q.d., NPH Humulin insulin 65 U subcu b.i.d., human insulin sliding scale: for blood sugars 151-200 give 4 U, for blood sugars 201-250 give 6 U, for blood sugars 251-300 give 8 U, for blood sugars 301-350 give 10 U, Imodium 2 mg p.o. q. 6 hrs. p.r.n. diarrhea, Niferex 150 mg p.o. b.i.d., nitroglycerin 1/150 one tab sublingual q. 5 min. x 3 p.r.n. chest pain, multivitamin one tab p.o. q.d., simvastatin 10 mg p.o. q.h.s., Neurontin 600 mg p.o. t.i.d., levofloxacin 500 mg p.o. q.d. x 5 days, Toprol XL 400 mg p.o. q.d., lisinopril 40 mg p.o. q.d. The patient was evaluated by the physical therapist, who noted her to walk around the hospital without significant difficulty.
|
has there been a prior carafate.
|
{
"answer_end": [
2321
],
"answer_start": [
2238
],
"text": [
"prophylaxis with Carafate and treated symptomatically with Imodium p.r.n. diarrhea."
]
}
|
Ms. Heit is a 67-year-old female who received a heart transplant in March 2006 and was transferred from an outside hospital after sustaining a right hip fracture. On admission, her plain films revealed a nondisplaced right femoral fracture and her EKG showed sinus tachycardia. She was given MEDICATIONS ON ADMISSION: Neoral 150 mg b.i.d., prednisone 8 mg daily, CellCept 1500 mg b.i.d., Protonix 20 mg daily, Pravachol 40 mg daily, diltiazem 360 mg daily, multivitamin one daily, magnesium oxide 400 mg daily, calcium and vitamin D 1800 mg daily, Fosamax weekly on Mondays, Colace 100 mg daily, Zocor 20 mg daily, Dulcolax 10 mg as needed for constipation, vitamin E 400 units daily, and vitamin C 500 mg b.i.d. She had a history of heparin-induced thrombocytopenia, which was treated with fondaparinux daily prior to the procedure and then discharged on aspirin for four weeks postprocedure. She underwent a dynamic hip screw procedure which was uncomplicated and allowed her to begin weightbearing on postoperative day 1, and was transfused with 2 units of packed red blood cells on the day after surgery with appropriate hematocrit rise. She received additional 2 units of packed red blood cells prior to discharge. DISCHARGE MEDICATIONS: Tylenol 650 mg every four hours as needed for pain, Protonix 40 mg daily, Pravachol 40 mg daily, Neoral (cyclosporine) 150 mg b.i.d., diltiazem extended release 360 mg daily, Caltrate plus D one tablet daily, Neoral (cyclosporine) 150 mg b.i.d., diltiazem extended release 360 mg daily, Fosamax 70 mg weekly, Dulcolax p.r. 10 mg as needed for constipation, and oxycodone 5-10 mg every six hours as needed for pain. She will continue her home medication regimen, be maintained on aspirin 325 mg for four weeks to prevent clot formation postsurgery, and take oxycodone as needed for pain. She has a followup appointment with orthopedic surgery, and will also be closely followed by transplant clinic in the Angeles with a walker and should continue aspirin 325 mg daily.
|
How often does the patient take dulcolax
|
{
"answer_end": [
684
],
"answer_start": [
615
],
"text": [
"Dulcolax 10 mg as needed for constipation, vitamin E 400 units daily,"
]
}
|
A 56-year-old morbidly obese female with abdominal skin laxity due to massive weight loss after gastric bypass was admitted to plastics for panniculectomy. The patient tolerated the procedure without difficulty and the post-operative period has been uneventful. At discharge, the patient is afebrile with stable vitals, taking PO's/voiding q shift and has ambulated independently with some difficulty given body habitus. Pain has been well managed and incisions are clean, dry, and intact. JP's with moderate serosanguinous output remain in place. The patient was discharged to rehab in a stable condition, with instructions to continue antibiotics as long as drains are in place, change drain sponges daily, strip drains twice daily, sponge baths only while drains are in place, walking as tolerated, no lifting more than 10 pounds, no jogging, swimming, or aerobics for 4-6 weeks, and to monitor/return for signs of infection. Medications prescribed include TYLENOL (Acetaminophen) 1000 mg PO Q6H, KEFLEX (Cephalexin) 500 mg PO QID, COLACE (Docusate Sodium) 100 mg PO BID, PEPCID (Famotidine) 20 mg PO BID, DILAUDID (Hydromorphone HCL) 2-4 mg PO Q4H PRN Pain, INSULIN REGULAR HUMAN Sliding Scale (subcutaneously) SC Q4H Low Scale, LEVOTHYROXINE SODIUM 75 mcg PO daily, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, MILK OF MAGNESIA (Magnesium Hydroxide) 30 milliliters PO daily PRN Constipation, METOCLOPRAMIDE HCL 10 mg IV Q8H PRN Nausea, QUINAPRIL 20 mg PO daily, SIMETHICONE 40 mg PO QID PRN Upset Stomach, Other:gas, and STYKER PAIN PUMP (Bupivacaine 0.5%) 400 milliliters IV Q24H Instructions: Rate = 4ml/hr. The patient has a probable allergy to Morphine and Code Status is Full Code.
|
What is the dosage of dilaudid ( hydromorphone hcl )
|
{
"answer_end": [
1161
],
"answer_start": [
1109
],
"text": [
"DILAUDID (Hydromorphone HCL) 2-4 mg PO Q4H PRN Pain,"
]
}
|
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.
|
What is the current dose of simvastatin
|
{
"answer_end": [
1157
],
"answer_start": [
1130
],
"text": [
"SIMVASTATIN 80 MG PO DAILY,"
]
}
|
The 68-year-old retired social worker was admitted with atrial flutter and NSTEMI and underwent catheterization which revealed 95% OM1, 70% OM2, and LCX lesions stented with 2.5x13-mm, 2.5x13-mm, and 3.5x13-mm DES respectively, to 0% with TIMI 3 flow. Exam showed faint bibasilar crackles, S1S2 intermittent gallop, no LE edema. Initially rate-controlled on beta-blocker and diltiazem for goal rate in 60s; she was discharged on ATENOLOL 100 MG PO QD, LASIX (FUROSEMIDE) 40 MG PO QD, LISINOPRIL 5 MG PO QD with POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL, NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: ATORVASTATIN CALCIUM & WARFARIN, LOVENOX (ENOXAPARIN) 90 MG SC BID with SERIOUS INTERACTION: HEPARIN & ENOXAPARIN SODIUM, FLOVENT (FLUTICASONE PROPIONATE) 110 MCG INH BID, LIPITOR (ATORVASTATIN) 80 MG PO QD with POTENTIALLY SERIOUS INTERACTION: ATORVASTATIN CALCIUM & WARFARIN, PLAVIX (CLOPIDOGREL) 75 MG PO QD, MAGNESIUM OXIDE (241 MG ELEMENTAL MG) 800 MG PO BID, DIET: Patient should measure weight daily, DIET: Fluid restriction, DIET: House / Low chol/low sat. fat, DIET: 4 gram Sodium, and RETURN TO WORK: Not Applicable. Additionally, CONTINGENT UPON 7pm dose of Lovenox, on order for Coumadin PO (ref# 758570817) and on order for Coumadin PO 5 mg QPM (ref# 370510168) were included with instructions to take all medicines as directed and not to miss a single dose of Plavix, due to potentially serious interactions with Aspirin & Warfarin, Potassium Chloride & Nitroglycerin, and Atorvastatin Calcium & Enoxaparin Sodium; as well as a serious interaction with Heparin & Enoxaparin Sodium.
|
Has this patient ever tried heparin
|
{
"answer_end": [
835
],
"answer_start": [
817
],
"text": [
"ENOXAPARIN SODIUM,"
]
}
|
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.
|
Why is the patient on oxycodone
|
{
"answer_end": [
2611
],
"answer_start": [
2578
],
"text": [
"oxycodone 5 mg PO q. 6h PRN pain,"
]
}
|
A 42-year-old male was admitted on 4/30 with congestive heart failure exacerbation, hyperhomocysteinemia, chronic renal failure, obesity, hypercholesterolemia, h/o DVT, asthma, OSA, and a worsening of his dyspnea of exertion (DOE) to 3 miles of flat ground with a suspicion of multifocal pneumonia (PNA). He had a D-dimer of 1400, BNP of 2009, and Troponin of 0.84-0.54, which was not considered ischemic, and was not treated. On this admission, his D-dimer was 1207, BNP was 2917, and Troponin was not sent. He had a JVP to earlobe, bibasilar rales, no wheezes, and diffuse pitting edema to his bilateral shins. He had a chest X-ray (CXR) showing increased bilat LL opacities to the periphery with some cephalization of vessels and some opacification. An electrocardiogram (ECG) showed 98 bpm with left anterior fascicular block (LAE) and strain. A chest CT scan from 8/18 (comparing to 4/30) showed per pulm c/w scarring/persistent changes after recent multifocal PNA 4/30, no e/o of new primary lung path, and ground glass c/w pulmonary edema. An echocardiogram showed an ejection fraction (EF) of 25%, moderate right ventricular (RV) dysfunction, and severe tricuspid regurgitation (TR). A follow-up cardiac MRI from 10/16 showed an EF of 23%, global hypokinesis, no wall motion abnormality (WMA), normal RV, and no valve disease. In the ED, he received Duonebs, ASA 325, and Lasix 80mg. His shortness of breath was secondary to CHF exacerbation and fluid overload with no evidence of an infectious pulmonary process contributing to his symptoms. His hypertension was most likely due to taking the wrong dose of Coreg (taking QOD instead of BID). On a BID Coreg regimen, his BP was much better controlled. His renal function remained stable but impaired while he was being evaluated for dialysis as an outpatient but no vascular access was placed yet. He was discharged on 6/7/05 with a full code status and disposition to home with food/drug interaction instruction to take consistently with meals or on empty stomach and activity to walk as tolerated with follow up appointments with Dr. Sackrider at ACH 5/6/05 at 1:30 PM scheduled, Dr. Dauphin at CMC 0/4/05 at 1:40 PM scheduled. He was discharged with ACETYLSALICYLIC ACID 81 MG PO QD, on order for COUMADIN PO (ref #55946845) to address a POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, PHOSLO (CALCIUM ACETATE) 667 MG PO TID, FOLATE (FOLIC ACID) 1 MG PO QD, DIOVAN (VALSARTAN) 160 MG PO QD prescribed by his cardiologist, CARVEDILOL 6.25 MG PO BID HOLD IF: HR < 60, or SBP < 100, NEPHROCAPS (NEPHRO-VIT RX) 1 TAB PO QD, with an alert overridden: Override added on 4/7/05 by ALAMIN, NORMAN B., M.D. POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: MD Aware, LIPITOR (ATORVASTATIN) 20 MG PO QD with an alert overridden: Override added on 6/7/05 by: POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & ATORVASTATIN CALCIUM Reason for override: home med, and LASIX (FUROSEMIDE) 80 MG PO BID, with a d/c JVP 10cm. He had not been taking his Lasix for 2d prior to d/c. Pt was instructed to diurese further at home on Lasix 80 BID and continue on Coumadin for his h/o recent DVT (4/30) and INR 2-3.
|
Has the patient had coumadin in the past
|
{
"answer_end": [
2285
],
"answer_start": [
2245
],
"text": [
"on order for COUMADIN PO (ref #55946845)"
]
}
|
The patient is a 70 year old white female with a history of long standing hypertension, hypercholesterolemia, and history of tobacco use who presented upon transfer from Ra Memorial Hospital with chief complaint of post MI unstable angina. She had a history of long standing hypertension and had chest pain in the past including at least one previous episode of rule out MI. She was admitted on 22 of April to Hen Mo Gardensworth Sent Hospital with signs and symptoms consistent with acute MI and apparently received salvage therapy with IV Streptokinase and TPA. On 0 of August, the patient presented to Cooker View Home Hospital with an episode of heavy substernal chest pressure relieved with SL and topical nitrates, and her EKG showed no worrisome ischemic changes. She was transferred to CNMC on IV Heparin, IV Nitroglycerin at 140 micrograms per minute, IV Heparin drip, Lopressor, aspirin one a day, beta blockade and aspirin. She had several episodes of typical substernal chest pain with minimal exertion that were relieved with SL Nitroglycerin, and additional episodes of chest pain that were low in intensity but prolonged, each of these requiring several Nitroglycerins and antacids to be relieved. It was felt that the chest pain was treated by the addition of a calcium channel blocker, and her admission labs showed hematocrit 34.2, WBC 6.7, platelets 159,000, PTT 50.0 on IV Heparin. Postcatheterization, the patient showed mild hypertension which was treated by the addition of a calcium channel blocker, and she was also diuresed for fluid overload. Prior to discharge, she had two additional episodes of chest pain that were low in intensity but prolonged. Each of these required several Nitroglycerins and antacids to be relieved. It was felt that the chest pain was unlikely to be cardiac in origin and more likely represented either GI symptomatology or an anxiety reaction. The patient underwent an exercise treadmill test on the modified Bruce protocol which showed no evidence for ischemia. On discharge, she was prescribed Nifedipine XL 90 mg po q am, Lopressor 50 mg po b.i.d., Zantac 150 mg po q hs, aspirin 81 mg po q d, Serax 15 mg po q 6 h or q hs prn, and Nitroglycerin 1/150 grain q 5 minutes x 3 SL prn chest pain. She was discharged to home and is to follow up with her primary care physician, Dr. Gayle Demeritt, and her cardiologist, Dr. Mark Willians, at ACSH. ALLERGIES: Penicillin which causes anaphylaxis. The patient is a 70 year old white female who had a history of long standing hypertension, hypercholesterolemia, and history of tobacco use and presented upon transfer from Ra Memorial Hospital with chief complaint of post MI unstable angina. She was admitted on 22 of April to Hen Mo Gardensworth Sent Hospital and apparently received salvage therapy with IV Streptokinase and TPA. On 0 of August, she presented to Cooker View Home Hospital with an episode of heavy substernal chest pressure relieved with SL and topical nitrates, and her EKG showed no worrisome ischemic changes. Upon transfer to CNMC, she was without chest pain and was given IV Nitroglycerin at 140 micrograms per minute, IV Heparin drip, Lopressor, aspirin one a day, beta blockade and aspirin. She had several episodes of typical substernal chest pain with minimal exertion that were relieved with SL Nitroglycerin, and additional episodes of chest pain that were low in intensity but prolonged, each of these requiring several Nitroglycerins and antacids to be relieved. Her admission labs showed hematocrit 34.2, WBC 6.7, platelets 159,000, PTT 50.0 on IV Heparin. Postcatheterization, the patient showed mild hypertension which was treated by the addition of a calcium channel blocker, and she was also diuresed for fluid overload. Prior to discharge, she had two additional episodes of chest pain that were low in intensity but prolonged. Each of these required several Nitroglycerins and antacids to be relieved. It was felt that the chest pain was unlikely to be cardiac in origin and more likely represented either GI symptomatology or an anxiety reaction. The patient underwent an exercise treadmill test on the modified Bruce protocol which showed no evidence for ischemia. On discharge, she was prescribed Nifedipine XL 90 mg po q am, Lopressor 50 mg po b.i.d., Zantac 150 mg po q hs, aspirin 81 mg po q d, Serax 15 mg po q 6 h or q hs prn, and Nitroglycer
|
Why is the patient on antacids
|
{
"answer_end": [
1136
],
"answer_start": [
1061
],
"text": [
"additional episodes of chest pain that were low in intensity but prolonged,"
]
}
|
This is a 46-year-old morbidly obese female with a history of insulin-dependent diabetes mellitus complicated by BKA on two prior occasions, who was admitted to the MICU with BKA, urosepsis, and a non-Q-wave MI. On presentation to the Emergency Department, her vital signs were notable for a blood pressure of 189/92, pulse rate of 120, respiratory rate of 20, and an O2 sat of 90%. She was given insulin, sublingual nitroglycerin x three, 4 mg of morphine, 5 mg of Lopressor, and started on a heparin drip and IV antibiotics, and admitted to the MICU for further management. Her past medical history included insulin-dependent diabetes mellitus for how many years, positive ethanol use, approximately one drink per week, and denied IV drug use or other illicit drug use. She was placed on an insulin drip and hydrated with intravenous fluids, with improvement, and eventually transitioned to NPH with insulin sliding scale coverage. Despite escalating her dose of NPH up to 65 U subcu b.i.d. on the day of discharge, she continued to have elevated blood sugars >200 and required coverage with insulin sliding scale. This issue will need to be addressed as an outpatient. She was also placed on cefotaxime for gram negative coverage, with both her blood cultures and urine cultures growing out E. coli which were sensitive to cefotaxime and gentamycin. As she initially continued to be febrile and continued to have positive blood cultures, one dose of gentamycin was given for synergy, and she was eventually transitioned to p.o. levofloxacin and will take 7 days of p.o. levofloxacin to complete a total 14-day course of antibiotics for urosepsis. She was initially placed on aspirin, heparin, and a beta blocker, and once her creatinine normalized, an ACE inhibitor was also added. Heparin was discontinued once the concern for PE was alleviated, and her beta blocker and ACE inhibitor were titrated up for a goal systolic blood pressure of <140 and a pulse of <70. On admission, the patient was on several pain medicines, including amitriptyline, Flexeril, and Valium for reported history of sciatica and low back pain, which were discontinued and she was placed on Neurontin for likely diabetic neuropathy. She was also placed on GI prophylaxis with Carafate and treated symptomatically with Imodium p.r.n. diarrhea. The patient was discharged with enteric coated aspirin 325 mg p.o. q.d., NPH Humulin insulin 65 U subcu b.i.d., human insulin sliding scale: for blood sugars 151-200 give 4 U, for blood sugars 201-250 give 6 U, for blood sugars 251-300 give 8 U, for blood sugars 301-350 give 10 U, Imodium 2 mg p.o. q. 6 hrs. p.r.n. diarrhea, Niferex 150 mg p.o. b.i.d., nitroglycerin 1/150 one tab sublingual q. 5 min. x 3 p.r.n. chest pain, multivitamin one tab p.o. q.d., simvastatin 10 mg p.o. q.h.s., Neurontin 600 mg p.o. t.i.d., levofloxacin 500 mg p.o. q.d. x 5 days, Toprol XL 400 mg p.o. q.d., lisinopril 40 mg p.o. q.d. The patient was evaluated by the physical therapist, who noted her to walk around the hospital without significant difficulty.
|
Was the patient ever given flexeril for low back pain.
|
{
"answer_end": [
2123
],
"answer_start": [
2036
],
"text": [
"amitriptyline, Flexeril, and Valium for reported history of sciatica and low back pain,"
]
}
|
The patient is a 26-year-old female with a past medical history significant for Hodgkin's lymphoma, splenectomy, asthma, and history of tobacco use, who presented to our service with symptoms of congestive heart failure. She underwent an elective mitral valvuloplasty on November, 2003, with size 26 Cosgrove-Edwards ring and vegectomy, where epinephrine was used to maintain proper pressure and subsequently weaned off. On postoperative day #1, diuresis was increased and a low dose beta blocker was started, which she tolerated well. Baby aspirin and Neurontin 300 mg q.d. were also begun. The patient was discharged to home with VNA assistance with follow up recommendations and medications including enteric-coated aspirin 81 mg p.o. q.d., Colace 100 mg p.o. b.i.d. x 7 days, Lasix 60 mg p.o. q.d., ibuprofen 800 mg p.o. q.8h. p.r.n. pain, Lopressor 25 mg p.o. t.i.d., Niferex 150 mg p.o. b.i.d., Atrovent nebulizer 0.5 mg nebulized q.i.d., Neurontin 300 mg p.o. q.d., K-Dur 30 mEq p.o. q.d. to be discontinued or decreased if Lasix dose is changed, and Flovent 44 mcg/inh b.i.d. The patient was also consulted with the Department of Neurology for persistent numbness and tingling of the left lower extremity, for which Neurontin 300 mg q.d. was prescribed. With aggressive diuresis, the patient was able to regain her postoperative weight and by the day of discharge was 1.7 kilograms below her preoperative weight. The patient is anticipated to return to her full preoperative level of independent functioning with continued cardiovascular rehabilitation and VNA assistance.
|
What is the current dose of the patient's k-dur
|
{
"answer_end": [
995
],
"answer_start": [
945
],
"text": [
"Neurontin 300 mg p.o. q.d., K-Dur 30 mEq p.o. q.d."
]
}
|
A 45-year-old female with a history of IDDM, sleep apnea, asthma on chronic prednisone, HTN, and CAD s/p NSTEMI in 6/10 with a stent to the LAD presented with 3 days of worsening dyspnea and chest pressure. She was treated for an asthma exacerbation with Prednisone 40 mg PO QAM x 10 doses, Instructions: Taper: 40mg for 2 days, then 35mg for 2days, then 30mg for 2days, then 25mg for 2days, then 20mg, ECASA (ASPIRIN ENTERIC COATED) 325 mg PO QD, CARDIZEM SR (DILTIAZEM SUSTAINED RELEASE) 120 mg PO QD, Override Notice: Override added on 0/9/05 by DUHART, RANDY M., M.D. on order for LOPRESSOR PO (ref #31219927), POTENTIALLY SERIOUS INTERACTION: DILTIAZEM HCL & METOPROLOL TARTRATE Reason for override: aware, HYDROCHLOROTHIAZIDE 25 MG PO QD, LISINOPRIL 30 MG PO QD, on order for POTASSIUM CHLORIDE IMMED. REL. PO (ref #73021085), POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE Reason for override: aware, LORAZEPAM 0.5 MG PO BID PRN Anxiety, LOPRESSOR (METOPROLOL TARTRATE) 12.5 MG PO BID, on order for CARDIZEM SR PO (ref #76249027), on order for CARDIZEM PO (ref #49626929), COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, ADVAIR DISKUS 500/50 (FLUTICASONE PROPIONATE/...), ATOVAQUONE 750 mg PO BID, NAPROSYN (NAPROXEN) 250-500 mg PO BID PRN Pain, CALCIUM CARB + D (600MG ELEM CA + VIT D/200 IU), ZOLOFT 1 TAB PO QD, Alert overridden: Override added on 4/2/05 by : POTENTIALLY SERIOUS INTERACTION: CLOPIDOGREL BISULFATE & NAPROXEN Reason for override: musculoskeletal pain, diabetes mellitus 2/2 chronic steroid use, Ischemia: continue Zocor, Clopidogrel, ECASA, nitrates as needed., Pump: continue lisinopril, HCTZ, Cardizem, Lopressor 12.5 mg PO BID, presentation. Never hospitalized, chronic prednisone therapy, s/p gentle diuresis, Pred, nebs with improvement of symptoms, D-dimer < 200, admission peak flow 150 (baseline NL 300-350), at discharge 275-300, ambulatory O2 sat WNL., Musculoskeletal workup showed reproducible sternal pain on palpation consistent with costochondritis and Naprosyn PRN pain, Psych: Continue Zoloft for depression and Lorazepam for anxiety, PPx was managed with PPI., Discharge condition was stable. Plan was to assess efficacy of Prednisone 20 mg upon completion of taper, status of dyspnea/asthma symptoms on low dose beta-blocker, chest pain/costochondritis with PRN NSAIDs, and ENDO: Chronic steroid use, Insulin SS in-house. -calcium/vit D supplement, with food/drug interaction instruction to give with meals and take with food, to resume regular exercise, and follow up appointments with Dr. BALVANZ, PCP in 2 weeks and ENDO indefinitely.
|
Has the patient had multiple pred prescriptions
|
{
"answer_end": [
1828
],
"answer_start": [
1763
],
"text": [
"diuresis, Pred, nebs with improvement of symptoms, D-dimer < 200,"
]
}
|
This is a 61-year-old gentleman with severe pulmonary hypertension secondary to chronic PEs, OSA, gout, bilateral hip replacements who presents with two falls in the past two days. He was compliant with his medication regimen and denies dietary indiscretion. He was on his beta-blocker and anticoagulated on Coumadin with an INR goal of 2.5, initially being supertherapeutic with a daily goal of negative 500 to 1 L with IV Lasix once or twice a day as needed, his home dose being 160 mg p.o. His baseline room air oxygen saturation was 90-93% and he should use oxygen as treatment for his pulmonary hypertension and be provided with oxygen at home. He was treated for his hip pain initially with oxycodone which was changed to Dilaudid for better pain control, and he should be changed back to his home dose of oxycodone when discharged. He also has a history of gout which was exacerbated with diuresis and he is on his home doses of allopurinol and colchicine, Indocin being added and he should receive a total of three days of Indocin. Tylenol and narcotics as previously described can be used to help with his gouty pain. His GI regimen includes Nexium at home and Prilosec while an inpatient, and he should be switched back to Nexium when discharged from rehabilitation. His lab results on discharge include a creatinine of 1, hematocrit of 53.1 and INR of 2.3, potassium being 3.9 and magnesium being 2.0. The discharge medications include Coumadin 11 mg on Monday, Wednesday and Friday and 12 mg the other days of the week, Diovan 320 a day, multivitamin 1 tab daily, Toprol-XL 50 once a day, nifedipine extended release 30 once a day, Revatio 20 mg 3 times a day, hydrochlorothiazide 25 once a day, Lasix 160 IV once per day, allopurinol 200 once per day, colchicine 0.6 once per day, Colace, Prilosec 20 once a day, Dilaudid 2 mg q.4 h. p.o. p.r.n. pain, Tylenol 500-1000 mg p.o. q.6 h. p.r.n. pain not to exceed 4 gm total from all sources in a 24-hour period, Ambien 10 mg p.o. nightly p.r.n. insomnia. He is being discharged to rehab with a followup with his cardiologist, Dr. Insco, and an appointment with Endocrinology.
|
has the patient used colace in the past
|
{
"answer_end": [
1864
],
"answer_start": [
1765
],
"text": [
"colchicine 0.6 once per day, Colace, Prilosec 20 once a day, Dilaudid 2 mg q.4 h. p.o. p.r.n. pain,"
]
}
|
The 90+-year-old female patient presented to the Trinmo Rybay Bethmorgreene Burgstern Medical University Of Medical Center Department on 5/1/06 with an intermittently cold and blue right foot, and gangrene was noticed in the second and third right lower extremity toes. She had significant medical issues such as dementia, coronary artery disease, diabetes, and PVOD. She underwent and tolerated a right AKA on 7/8/06 without any complications, and after recovery from anesthesia was admitted to the general care floor. Her diet was advanced as tolerated and the pain was well controlled with oral pain medications and she was evaluated by physical therapy. She was treated with perioperative ancef and switched to one week of p.o. linezolid just prior to discharge. At the time of discharge, the patient was afebrile, vital signs stable, with the right AKA stump well healed and with mild erythema inferior to the incision. Her discharge medications included Trazodone 50 mg nightly, Celexa 20 mg daily, Colace 100 mg b.i.d., Hydrochlorothiazide 25 mg daily, Novolog sliding scale, Lantus 20 units subcutaneously q.a.m., FiberCon one tablet, MVI daily, Synthroid 25 mcg daily, Linezolid 600 mg p.o. q.12h. x10 doses starting today, Zyprexa 2.5 mg p.o. q.p.m., and Tylenol Elixir 1000 mg p.o. q.6h. p.r.n. pain and Lactulose 30 mL p.o. daily p.r.n. constipation. She was discharged to her skilled nursing facility with plans to follow up with her primary care physician and Dr. Wynder in one to two weeks. The patient is DNR/DNI.
|
Previous hydrochlorothiazide
|
{
"answer_end": [
1059
],
"answer_start": [
1027
],
"text": [
"Hydrochlorothiazide 25 mg daily,"
]
}
|
This 54-year-old male with ischemic cardiomyopathy, severe pulmonary hypertension, and chronic kidney disease (Cr 2.5) was admitted to MSCH 3 weeks ago for CHF and diuresis and volume resuscitated with creatinine decreasing to 3.9. He was discharged on 8/27/06 at 2:00 PM with a full code status and disposition to home with medications Aspirin Enteric Coated 81 MG PO DAILY, LIPITOR (ATORVASTATIN) 10 MG PO DAILY, COLESTIPOL HYDROCHLORIDE 10 GM PO DAILY, INSULIN GLARGINE 14 UNITS SC DAILY, HUMALOG INSULIN (INSULIN LISPRO) Sliding Scale (subcutaneous) SC AC, IMDUR ER (ISOSORBIDE MONONITRATE (SR)) 60 MG PO DAILY, KLOR-CON (KCL SLOW RELEASE) 20 MEQ PO DAILY (each 20 mEq dose to be given with 4 oz of fluid), TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 50 MG PO BEDTIME, TORSEMIDE 150 MG PO DAILY, metolazone on an as-needed basis for weight, but presented to ED with Cr 5.1, ZEMPLAR 1MG DAILY, Klorcon slow release 20 mEq daily, Flomax 0.4 qd, colestipol 1g qd, toprol-XL 50 qhs, lantus 14 unit sc, humalog scale, and metolazone 5mg as needed with the instructions to take Torsemide and Klor-Con as per his normal routine and to take Flomax, Colestipol, and Toprol-XL consistently with meals or on an empty stomach, and to continue his home medications otherwise. The patient was also advised to return Monday for his second dialysis run and not take Torsemide on Monday with a Number of Doses Required (approximate): 5.
|
has the patient had insulin glargine
|
{
"answer_end": [
491
],
"answer_start": [
456
],
"text": [
"INSULIN GLARGINE 14 UNITS SC DAILY,"
]
}
|
The patient is a 64-year-old woman with a history of chest pain and an intraventricular conduction delay, QRS interval of 0.10. In February 1988, an exercise tolerance test showed a left bundle branch block with exercise, and a thallium scan showed no evidence of ischemia. In July 1992, an exercise tolerance test with a maximum heart rate of 167 and maximum blood pressure of 138/60 showed a moderate fixed defect in the apicolateral wall. A cardiac catheterization in 1995 showed no coronary disease, but the patient was told she had cardiomyopathy. On the day of admission, the patient was watching television when she suddenly lost consciousness until she awoke with her grandchildren on top of her. Admission medications included Vasotec 10 mg p.o. q.day, Digoxin 0.25 mg p.o. q.day, and Lasix 20 mg q.day. Discharge medications included Enteric coated aspirin 325 mg p.o., Vasotec 15 mg p.o. q.day, Lasix 20 mg p.o. q.day, and Atenolol 12.5 mg p.o. q.day. Laboratory results revealed a CK of 119, magnesium 2.2, digoxin level 0.7, troponin I 0, electrolytes within normal limits, white blood cell count 10.3, hematocrit 36.5, and platelet count 298, urinalysis 0-1 white cells, 0-1 red cells, 1+ bacteria, and 1+ epithelial cells, chest x-ray revealed no evidence of congestive heart failure or infiltrate, EKG showed normal sinus rhythm at a rate of 93 with intervals of 0.183, 0.15, and 0.417, left bundle branch block, no arrhythmias triggered by exercise, carotid noninvasive studies revealed minimal disease bilaterally, tilt table study was entirely normal, no suggestion of a vasovagal response, ejection fraction 30%-35%, anterolateral wall motion abnormalities, right sided heart catheterization revealed coronary arteries completely clean, EP study was entirely normal, and MRA/MRI of her brain and ECG loop recorder were ordered as outpatient follow up.
|
How often does the patient take vasotec
|
{
"answer_end": [
789
],
"answer_start": [
762
],
"text": [
"Digoxin 0.25 mg p.o. q.day,"
]
}
|
The patient is a 76-year-old female with a history of mitral regurgitation, congestive heart failure, recurrent UTIs, and uterine prolapse who presented with chills and hypotension and was admitted to the Medical ICU for treatment of septic shock. Mean arterial pressures were kept above 65 with Levophed and antibiotics were changed to penicillin 3 million units IV q.4h. and gentamicin 50 mg IV q.8h. An ATEE on 10/19 showed severe mitral regurgitation with posterior leaflet calcifications and linear density concerning for endocarditis, for which a PICC line was placed on 1/19 for a six-week course of penicillin 3 million units IV q.4h. and two-week course of gentamicin 50 mg IV q.8h. until 2/25. The patient was initially treated with Levophed for her hypotension until 11/0, and was placed on Levofloxacin and Vancomycin to treat Gram-positive cocci bacteremia and UTI. She was maintained on telemetry and was found to be a normal sinus rhythm with ectopy, including short once of nonsustained ventricular tachycardia. She was started on Lopressor 12.5 mg t.i.d. on 3/18, and this was increased to 25 mg b.i.d. at discharge, with her heart rates continuing to be between the 70s and the 90s, however, with less episodes of ectopy. Aspirin was given, and Lipitor was initially held for an initial transaminitis presumed to be secondary to shock liver. She had guaiac positive stools in the medical ICU, her hematocrit was stable around 33%, and her iron studies suggested anemia of chronic disease with possibly overlying iron deficiency. She had a normal random cortisol level of 35.3, and her Hemoglobin A1c was 6.5, so she was maintained thereafter only on insulin sliding scale and rarely required any coverage. The patient was kept on Lovenox and Protonix and her DISCHARGE MEDICATIONS include Aspirin 81 mg daily, iron sulfate 325 mg daily, gentamicin sulfate 50 mg IV q.8h. until 2/25 for a two-week course, penicillin G potassium 3 million units IV q.4h. until 0/12 for a six-week course, Lopressor 25 mg b.i.d., Caltrate plus D2 tablets p.o. daily, Lipitor 10 mg daily, and Protonix 40 mg daily. She was discharged to rehabilitation at Acanmingpeerra Virg Tantblu Medical Center in order to be able to get her antibiotic therapy, and her physicians will attempt to add the ACE back onto her medical regimen for better afterload reduction as her blood pressure tolerates, and potentially they will add her back on to the Lasix as well. She will require weekly lab draws to check her electrolytes and CBC while she is on the antibiotics.
|
What is the current dose of lipitor
|
{
"answer_end": [
2086
],
"answer_start": [
2029
],
"text": [
"Caltrate plus D2 tablets p.o. daily, Lipitor 10 mg daily,"
]
}
|
This is a 67-year-old male with a history of tremor, hypertension, diabetes, atrial fibrillation, coronary artery disease, benign prostatic hypertrophy, gastroesophageal reflux disease, hiatal hernia, degenerative joint disease, polymyalgia rheumatica, diverticulitis, and osteomyelitis. He was admitted to the hospital with r/o MI and discharged with a diet of House/Low chol/low sat. fat, and instructed to follow up with his primary care doctor one week after d/c from rehab. His medications on admission included Lasix 20 qod, Isordil 40 bid, Prednisone 2 qd, Primidone 50 bid, Norvasc 5 qd, Coreg 25 bid, Flomax 0.4 qd, Prilosec OTC 20 qd, Lipitor 20 qd, ISS, Lantus 7 qd, Novolog 17 qac, Lovenox 30 qd, Vancomycin 1 gm qod, Ceftriaxone 2 gm qd, Digoxin 0.25 qod, Colace 100 bid, and Medications in ED: NS 500 cc, Aspirin. He was anticoagulated with Lovenox and given aspirin. He had a PICC line placed and was discharged with IV abx. At the tail end of his antibiotic regimen he spiked a fever and was admitted to VOWH. His course of antibiotics was extended and he was discharged to rehab on CEFTRIAXONE 2,000 MG IV QD and Vanc. In the ED, his temperature was normal, EKG demonstrated new ST depressions, and his first set of enzymes were negative. For Neuro, he has a history of tremor and is treated with Primidone and for ID, he was continued on his outpatient regimen of Lantus, standing insulin qAC and insulin SS. For GU, he was continued on Flomax for his BPH. He was discharged to rehab on his admission regimen with no dictated summary and advised to follow up with his PCP within 2 weeks.
|
Has the patient ever had isordil ( isosorbide dinitrate )
|
{
"answer_end": [
546
],
"answer_start": [
531
],
"text": [
"Isordil 40 bid,"
]
}
|
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.
|
Why was insulin originally prescribed
|
{
"answer_end": [
1530
],
"answer_start": [
1468
],
"text": [
"He has diabetes and was on oral hypoglycemic as an outpatient,"
]
}
|
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 the patient ever been on lopressor ( metoprolol tartrate )
|
{
"answer_end": [
2772
],
"answer_start": [
2725
],
"text": [
"LOPRESSOR (METOPROLOL TARTRATE) 12.5 MG PO TID,"
]
}
|
Mr. Mauras is a 72-year-old man with history of stable angina, type 2 diabetes, peripheral vascular disease, former smoking history, and history of seizure disorder with cataracts. He had occasional anginal symptoms prior to discharge and took about two nitroglycerins per week. Over the past week, he had escalating chest pain requiring one nitroglycerin per day. The pain was relieved by rest and nitroglycerin. One week prior to admission, his digoxin was stopped and his amiodarone was decreased. His Plavix was stopped and his Coumadin was held. On the morning of admission, he had chest pain and received Lopressor, Enalapril, Lovenox treatment dose and a Plavix load in the ED. He was found to have flash pulmonary edema and in atrial fibrillation with rapid ventricular response and was taken back to the catheterization lab and given four stents to his saphenous vein graft, OM1 with good resolution of his symptoms. He was transferred to the floor and was given an amiodarone load given his ejection fraction and increased ectopy on telemetry. His troponin had been trended down to the 0.2s by discharge and his beta-blocker and ACE inhibitor were titrated to heart rate and blood pressure. Prior to anticipated discharge, he re-developed flash pulmonary edema secondary to atrial fibrillation with rapid ventricular response and was re-loaded with digoxin. He was started on Mucomyst precath with good effect, had a difficult-to-place Foley, and was started on Flomax with good effect. His creatinine on discharge was 1.2, his metformin was held, and he was continued on Lantus with sliding scale insulin. He was given three units of packed red blood cells given his history of CAD and was prescribed with Amiodarone 200 mg, Enteric-coated aspirin 325 mg, Librium 10 mg, Colace 200 mg, Ferrous gluconate 324 mg, Lasix 40 mg, Nitroglycerin one tab, Dilantin 100 mg, Senna two tabs, Coumadin 3 mg, Lipitor 80 mg, Flomax 0.4 mg, Plavix 75 mg, Lantus 14 units, Metformin 500 mg, Ranitidine 150 mg, Digoxin 0.125 mg, Enalapril 10 mg, and Atenolol 50 mg, with follow-up appointments with his PCP, Dr. Kelley Hernon of Electrophysiology on 7/8/05, and Dr. Daft on 9/20/05, and INR checked on 8/4/05 or 7/8/05 with Coumadin adjusted accordingly.
|
What is the reason this patient is on nitroglycerin.
|
{
"answer_end": [
364
],
"answer_start": [
299
],
"text": [
"he had escalating chest pain requiring one nitroglycerin per day."
]
}
|
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.
|
lasix
|
{
"answer_end": [
484
],
"answer_start": [
418
],
"text": [
"aspirin 325 mg daily, Lasix 40 mg daily, atorvastatin 40 mg daily,"
]
}
|
GVERRERO , STAN O 346-21-49-8, a 74 yo woman in remission from Hodgkin's Lymphoma and s/p renal transplant( 11/12 ), was discharged to Home with the attending physician being KERSON , RODNEY S , M.D. and code status being Full code. She was prescribed FESO4 ( FERROUS SULFATE ) 300 MG PO BID, FOLATE ( FOLIC ACID ) 1 MG PO QD, SYNTHROID ( LEVOTHYROXINE SODIUM ) 100 MCG PO QD, PREDNISONE 5 MG PO QAM, ZOCOR ( SIMVASTATIN ) 20 MG PO QHS, NEORAL ( CYCLOSPORINE MICRO ( NEORAL ) ) 100 MG PO BID, LOSARTAN 50 MG PO QD, ATENOLOL 25 MG PO QD, PRILOSEC ( OMEPRAZOLE ) 20 MG PO QD, AMIODARONE 400 MG PO BID, ECASA ( ASPIRIN ENTERIC COATED ) 325 MG PO QD, FLAGYL ( METRONIDAZOLE ) 500 MG PO TID X 2 Days, LEVOFLOXACIN 500 MG PO QD X 2 Days, and DIET: House / Low chol/low sat. fat with instructions for regular exercise and follow up with Dr. Schultheiss ( cardiology ) 5/30/03 scheduled. On order for NEORAL PO ( ref # 55336954 ) with a POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & CYCLOSPORINE override added on 11/0/03 by LIU , HERMAN ANTONIO , M.D., and LOSARTAN PO ( ref # 04133525 ) with a POTENTIALLY SERIOUS INTERACTION: CYCLOSPORINE & LOSARTAN POTASSIUM override added on 11/0/03 by ELVEY , EDMUND LENNY , M.D., Alert overridden: Override added on 5/27/03 by : POTENTIALLY SERIOUS INTERACTION: LEVOFLOXACIN & AMIODARONE HCL Reason for override: aware and POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & LEVOFLOXACIN Reason for override: aware. The patient had a hypoxic episode and EKG changes resolved, requiring 2u PRBCs, and was initially treated with lopressor 5mg IV, eventually rate controlled with dilt drip. PFT's , LFT's and TFT's were completed prior to discharge, and she was instructed to restart ecasa 5d p colonoscopy, as well as to take levofloxacin and flagyl for 5 days, and administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose. Consider anticoagulation for PAF was recommended. On 1/16 she had Afib with RVR to 130s with chest arm pain which is her anginal equivalent. ECG with rate related ischemia ST depression V5-6, L. +Minimal troponin leak to 0.19, which subseq downtrended with nl CK. She was init treated with lopressor 5mg IV but had hypotension to 80's which resolved quickly with IVF. She was eventually rate controlled with dilt drip. She returned to sinus rhythm within the day. Cards c/s'd and recommended amio load. CXR showed no infiltrate/opacity. Levo/Flagyl given empirically x 5days though she remained afeb. Abdominal exam was concerning for focal peritoneal irritation. Her exam improved, and she was tolerating PO well at the time of discharge. She has been afeb and well appearing for several days prior to d/c. Plan to complete 5d abx. As per Dr. Thorburn her colonoscopy was complex, and she had polypectomy of 2.5 cm polyp. Path is pending. If + for cancer, the base looked "clean", so may be feasible to re-scope her for surveillance at a later time, as per GI. Hct after colonoscopy went to 24 ( baseline 30 ); post-transfusion HCt of 30.
|
has there been a prior atenolol
|
{
"answer_end": [
536
],
"answer_start": [
515
],
"text": [
"ATENOLOL 25 MG PO QD,"
]
}
|
The patient, a 77 year old woman, was admitted with complaint of urinary frequency and AMS. She has a possible allergy to Penicillins with a reaction of RASH and cannot tolerate floroquinolones. She was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, LISINOPRIL 10 MG PO QD Starting Today ( 6/25 ), KCL SLOW RELEASE PO ( ref # 761602437 ), TOPROL XL ( METOPROLOL SUCCINATE EXTENDED RELEASE ) 100 MG PO BID HOLD IF: hr<55 , sbp<95, LANTUS ( INSULIN GLARGINE ) 19 UNITS QAM SC QAM Starting Today ( 6/17 ), WARFARIN SODIUM 5 MG PO QPM Starting ROUTINE , 20:00 ( Standard Admin Time ), ROSIGLITAZONE 2 MG PO QD, FUROSEMIDE 20 MG PO BID Starting Today ( 6/25 ) PRN Other:LE edema, SIMVASTATIN 10 MG PO QHS, CEFPODOXIME PROXETIL 200 MG PO BID X 16 doses Starting Today ( 6/25 ) HOLD IF: rash, and DIGOXIN 0.125 MG PO QOD with Food/Drug Interaction Instruction to Give with meals. Her AFIB became tachy to 140's with an elevated troponin to 1.69 which rose to a max of 2.41 with no EKG changes and was rate controlled and started on Levofloxacin. She was given 2 doses of vancomycin to cover potential staph infection and had an adenosine MIBI that showed no perfusion defects. Her INR was increasing due to the levofloxacin effect and was switched to ceftriaxone consistant with blood culture succeptabilities. Follow up blood cultures on 0/27 demostrated gram positive cocci in clusters and antibiotics were d/c'd after repeat cultures were negative. Her cardiac workup included an echocardiogram with RV dialation and wall akinesis with apical sparing , a new finding since last echo in '03. We have altered cardiac medications for better rate control by cancelling the coreg( carvedelol ) and Norvasc( amilodipine ) and replacing them with a blood pressure medication, Toprol XL( Metoprolol XL ) to better control the rate of her atrial fibrillation and the digoxin was also added for heart rate control. The patient was discharged in good condition and was given instructions to take the full course of antibiotics which cover the next 8days, to take medications with meals or on empty stomach and to avoid high Vitamin-K containing foods, to call PCP with any changes in urinary symptoms, or fever >101.0, return to ER if any changes in mental status, chest pain, SOB, or syncope, and follow-up with PCP within the next week with INR and digoxin levels. Do not use lasix unless necessary and contact PCP if using more than 1-2 times per week due to possible toxicity with digoxin use.
|
What is the patient's current dose does the patient take of her cefpodoxime proxetil
|
{
"answer_end": [
750
],
"answer_start": [
705
],
"text": [
"CEFPODOXIME PROXETIL 200 MG PO BID X 16 doses"
]
}
|
Mr. Zack Nieman is a 62-year-old white man with ischemic cardiomyopathy, status post coronary artery bypass graft in 1985 with left internal mammary artery to left anterior descending, saphenous vein graft to posterior descending artery, saphenous vein graft to obtuse marginal branch, and a repeat coronary artery bypass graft done in 1995 with saphenous vein graft to first diagonal, saphenous vein graft to obtuse marginal, and saphenous vein graft to posterior descending artery. He had multiple episodes of pulmonary congestion and was admitted to Rorea Valley Health for IV diuresis. EKG revealed atrial flutter with variable block (2:1 versus 3:1), rate around 120, left bundle branche block, and echocardiogram revealed ejection fraction about 25% with 2+ mitral regurgitation. On admission, his temperature was 97.1, pulse 103, blood pressure 148/94, respirations 18, and O2 saturation 97% on two liters. Because of his rapid ventricular response, Digoxin was started with a loading dose of 0.5 mg, then 0.25 mg times two q. six hours, and the patient was then on a maintenance dose of Digoxin at 0.125 mg p.o. q. day, and his Digoxin level has been maintained around 0.9. For his rate control, the amiodarone was also increased to 400 mg q. day, and the patient was started on anticoagulation with heparin. The patient underwent cardioversion through his AICD by the Electrophysiological Service with successful conversion to normal sinus rhythm, and was loaded with Coumadin and meanwhile on heparin until INR between 2-3. The patient developed hyperthyroidism secondary to amiodarone, treated with PTU, then developed hypothyroidism, treated with Levothyroxine. He was discharged on Amiodarone 400 mg p.o. q.d., Captopril 25 mg p.o. t.i.d., clonazepam 1 mg p.o., Lasix 80 mg p.o. b.i.d., glipizide 5 mg p.o. q.d., levothyroxine sodium 100 mcg p.o. q.d., magnesium oxide 420 mg p.o. q.d., Lopressor 25 mg p.o. b.i.d., nitroglycerin 1/150 (0.4 mg) one tab sublingual q. five minutes times three, Coumadin 5 mg p.o. q. day until INR between 2-3 then the dose needs to be adjusted accordingly to maintain INR between 2-3, Simvastatin 20 mg p.o. q. h.s., Klonopin 0.5 mg p.o. q. a.m., Digoxin 0.125 mg p.o. q.d., isosorbide, mononitrate-SR 30 mg p.o. q.d., and troglipazone 400 mg p.o. q. day.
|
Why did the patient have heparin.
|
{
"answer_end": [
1316
],
"answer_start": [
1260
],
"text": [
"the patient was started on anticoagulation with heparin."
]
}
|
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.
|
Did the patient receive tylenol ( acetaminophen ) for Other:transfusion premedication
|
{
"answer_end": [
829
],
"answer_start": [
768
],
"text": [
"She was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q6H PRN 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
|
Was the patient on any medication for her temperature
|
{
"answer_end": [
1020
],
"answer_start": [
964
],
"text": [
"was prescribed Tylenol 650 to 1000 mg p.o. q.4h. p.r.n.,"
]
}
|
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.
|
Has patient ever been prescribed lasix
|
{
"answer_end": [
1300
],
"answer_start": [
1265
],
"text": [
"Lasix to keep I/O's 500-1000cc neg."
]
}
|
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.
|
What does the patient take tessalon for
|
{
"answer_end": [
930
],
"answer_start": [
888
],
"text": [
"Tessalon 100 mg p.o. t.i.d. p.r.n. cough.,"
]
}
|
Patient was admitted to the Toott Hospital surgery service after undergoing LRYGB and was transferred to the floor from the PACU in stable condition. Pain was controlled and no issues were reported overnight into POD1. The patient had an UGI on POD1 that was negative for obstruction or leak, and was started on a Stage I diet which was tolerated well. The following day the patient was started on a Stage II diet that was tolerated as well, but initially struggled to have adequate intake. The patient was started on ALBUTEROL INHALER 2 PUFF INH QID PRN Shortness of Breath, Wheezing, LANTUS (INSULIN GLARGINE) 60 UNITS SC DAILY, ROXICET ORAL SOLUTION (OXYCODONE+APAP LIQUID) 5-10 MILLILITERS PO Q4H PRN Pain, ZANTAC SYRUP (RANITIDINE HCL SYRUP) 150 MG PO BID, ACTIGALL (URSODIOL) 300 MG PO BID, and LEVAQUIN (LEVOFLOXACIN) 500 MG PO DAILY with instructions to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose, and to cycle (hold 1 hr before to 2 hr after) if on tube feeds, and to take 2 hours before or 2 hours after dairy products. Sugars remained high in 200's during admission and patient was seen by Endocrine service and sugars finally improving with lantus 60 sc hs. The patient also had some difficulties with urination on POD4 and required a foley catheter for about a day, but was d/c'd the AM before she was discharged and urinated without incident. Patient was noted to have a UTI at discharge and was started on three day course of levaquin. The patient was discharged in stable condition, tolerating stage II diet well, ambulating, voiding independently, and with adequate pain control. The patient was given explicit instructions to follow-up in clinic with Dr. Truglia in 1-2 weeks and sent home with VNA for wound checks and close sugar control with instructions to f/u with Leland Bredeson by phone and record fingersticks, and to f/u with her PCP if she has further problems with urination. The patient was also instructed to shower but not bathe, swim or otherwise immerse her incision, not to lift anything heavier than a phone book, not to drive or drink alcohol while taking narcotic pain medication, and to resume all of her home medications, and to call her doctor or go to the nearest emergency room if she has fevers > 101.5 F, vomiting, or increased redness, swelling, or discharge from her incision.
|
How much levaquin ( levofloxacin ) does the patient take per day
|
{
"answer_end": [
840
],
"answer_start": [
801
],
"text": [
"LEVAQUIN (LEVOFLOXACIN) 500 MG PO DAILY"
]
}
|
The patient is a 61-year-old man with a history of ischemic cardiomyopathy and congestive heart failure, who was initially treated with afterload reduction, digoxin and Lasix. A PA line was placed with RA 8, RV 76/4, TA 80/36, pulmonary capillary wedge pressure 34, and cardiac index 1.49. He was then treated with dobutamine, intravenous TNG, and nitroprusside with symptomatic relief and hemodynamic stabilization with wedge pressure falling to 18. TNG and Nipride were successfully weaned, however, the patient remained dobutamine dependent. One week prior to transfer, the patient was admitted to Ment Hospital for management of his congestive heart failure and grew gram positive cocci from two blood cultures. He was then started on vancomycin and defervesced, and subsequently grew gram negative rods in one out of four blood culture specimens. These were gram negative enteric rods, pan-sensitive, for which the patient was started on ampicillin 2 gm IV q. 6. At the time of discharge, the patient was stable, dobutamine dependent, without chest pain, able to ambulate from chair to commode without shortness of breath, palpitations, or light-headedness. His medications at time of discharge included dobutamine at 15 mcg per kilogram per minute; captopril 25 mg p.o. t.i.d.; digoxin 0.125 mg p.o. q.d.; Lasix 160 mg p.o. b.i.d.; potassium chloride 20 mEq p.o. b.i.d.; Coumadin 1 mg p.o. q.d.; Atrovent, two puffs q.i.d.; Azmacort, eight puffs b.i.d.; Pepcid 20 mg p.o. b.i.d.; Colace 100 mg p.o. t.i.d.; vancomycin 1 gm q. 12, discontinued 9-23 a.m. after 14 days; ampicillin 2 gm IV q. 6 (24 of June equals day number five); Halcion 0.125 p.o. q.h.s. prn; Serax 15 mg p.o. q. 6 hours prn. The patient's condition at time of discharge is fair and will be continuing care in the coronary care unit of the hospital inpatient near patient's home under the care of Doctor Daren Swasey.
|
Has the patient had previous atrovent
|
{
"answer_end": [
1429
],
"answer_start": [
1402
],
"text": [
"Atrovent, two puffs q.i.d.;"
]
}
|
The patient had been taking Ativan of 3-4 mg q.d. for anxiety for the past two months and abruptly stopped taking it on March 1995 after which she started to have feelings of disorientation, and had been taking chloral hydrate 500 to 1000 mg q.h.s. for five days and Compazine with one dose. CURRENT MEDICATIONS: At home, patient took insulin NPH 25 units in the morning with Regular 10 units in the morning, aspirin 81 mg q.d., Lopressor 25 mg b.i.d., Compazine 5 mg q.6h. p.r.n. anxiety of which she took only one dose, and chloral hydrate 500 to 1000 mg q.h.s. for five days. On admission, her laboratory examination was significant for BUN of 17, creatinine of 1.0, glucose was 364, liver function tests were within normal limits, white count was 7.2, hematocrit was 36, and platelet count was 266. Neurology consultation was obtained who felt that patient's peripheral neuropathy was probably secondary to longstanding diabetes but felt that some of her symptomatology could be consistent with porphyria. Psychiatry felt that this episode was consistent with generalized anxiety disorder separated by post dysthymia and suggested phenothiazines which are proven to be safe in porphyria for treatment. She was started on Trilafon 2 to 4 mg p.o. p.r.n. q.6h. for anxiety and Keflex 500 mg p.o. t.i.d. for treatment. The patient was also seen to be orthostatic which was felt to be secondary to dehydration secondary to poor p.o. intake prior to admission and was treated with normal saline boluses and her orthostasis improved. Her Lopressor was also held with this episode of orthostasis. The Watson-Schwartz test done by Dr. Mohar on patient very early in the admission was negative which made an acute porphyria attack very unlikely. These episodes were felt to be secondary to a combination of anxiety attack and rapid taper of Ativan which she had been taking at moderately high doses for the last two months. Patient also developed urinary tract infection symptoms and her urine culture showed greater than 100,000 colonies of E. coli which were pansensitive. She was discharged to home on August in good condition on medications Aspirin 81 mg p.o. q.d., insulin NPH 25 units subcutaneously q.a.m., insulin regular 10 units subcutaneously q.a.m., Trilafon 2 mg p.o. q.6h., and Keflex 500 mg p.o. t.i.d. Follow-up will be with Dr. Dario Rodriquz.
|
What medication has the patient take for anxiety
|
{
"answer_end": [
85
],
"answer_start": [
21
],
"text": [
"taking Ativan of 3-4 mg q.d. for anxiety for the past two months"
]
}
|
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.
|
toprol xl ( metoprolol ( sust. rel. ) )
|
{
"answer_end": [
324
],
"answer_start": [
276
],
"text": [
"TOPROL XL (METOPROLOL (SUST. REL.)) 50 MG PO QD,"
]
}
|
This 64-year-old male with a history of coronary artery disease, CHF, EF of 15%, status post AVR, and NSTEMI initially presented to outside hospital with chief complaint of shortness of breath and was found to have a BNP of 747 as well as a troponin I of 0.43. He was diuresed, started on Carvedilol and improved, and placed on a heparin drip. His medications on admission included Aspirin 81, Lisinopril 20, Plavix 75, Verapamil 240 sustained release, Gemfibrozil 600 b.i.d., Nystatin 500 b.i.d., Paxil 20 daily, Glipizide 10 daily, Coumadin 4 prior to admission to outside hospital, Carvedilol 6.25 daily, heparin drip and Spironolactone. During his hospital stay, he was continued on Aspirin, Plavix, beta-blocker and ACE inhibitor, which were titrated to effect, started on a statin and continued on Niaspan, and maintained on a nicotine patch. He was also prescribed Spironolactone 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, and Coumadin 5 mg p.o. at night. The patient's diabetes was controlled with regular insulin and placed back on his oral hypoglycemics, which were discontinued on admission and was encouraged to stop smoking. He had runs of ectopy and SVT, so was placed on a heparin drip. Left heart cath revealed wall defect consistent with a right coronary artery infarct and the patient was continued on Spironolactone. He was discharged in a stable condition on Aspirin 325 p.o. daily, Lisinopril 4 mg p.o. daily, Nicotine patch 14 mg per day topical, Spironolactone 25 mg p.o. daily, Paxil 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, Carvedilol 12.5 mg p.o. twice daily, Plavix 75 mg daily, Gemfibrozil 900 mg p.o. twice daily and Coumadin 5 mg p.o. at night, with instructions to follow up with PCP and Cardiology as well as EP, to check his daily weights and report any increases to his PCP, and to arrange to have his INR drawn on 6/21/06 and follow-up INRs to be drawn every seven days.
|
has the patient had regular insulin
|
{
"answer_end": [
1098
],
"answer_start": [
997
],
"text": [
"The patient's diabetes was controlled with regular insulin and placed back on his oral hypoglycemics,"
]
}
|
This 90+-year-old male with a complex past medical history including CAD, CHF, AF and diabetes mellitus presented to the SICU for removal of chronically MRSA-infected mesh from prior abdominal surgery. He was intubated with etomidate, succinylcholine and kept sedated with Versed and fentanyl. He received intraoperative vancomycin and levofloxacin as well as 2200 mL of lactated Ringer's. In an attempt to reverse anticoagulation, one unit of FFP was begun but then aborted due to hypotension, which resolved with epinephrine injection, likely due to transfusion reaction. Another unit of FFP was administered, with platelets also given at the request of the Plastic Surgery Team in light of aspirin and Plavix, which were continued due to the patient's cardiac stents. Despite bolus Lasix, the patient did develop CHF with symptomatic pulmonary edema and increased oxygen requirement, concomitantly becoming delirious. He developed hypertension refractory to beta-blockade, calcium channel blockers and IV ACE inhibitors, and was thus placed on a nitroglycerin drip, a furosemide drip with ginger blood product resuscitation to address bleeding and an elevated INR, responding well to this regimen and aggressive pulmonary toilet. The patient was advanced to clear liquids, on medications including Amiodarone 200 mg p.o. daily, Calcium, Colace 100 mg by mouth t.i.d., Coumadin alternating doses of 4 mg and 3 mg, Diltiazem CD 360 mg p.o. daily, Aspirin 81 mg p.o. daily, Folate 1 mg p.o. daily, Lisinopril 10 mg p.o. daily, Metamucil p.r.n., Clopidogrel 75 mg p.o. daily, Potassium, Protonix 40 mg p.o. daily, Simvastatin 80 mg p.o. daily, Synthroid 25 mcg p.o. daily, Thiamine 100 mg p.o. daily, Metoprolol SR 100 mg p.o. b.i.d., Zyprexa 2.5 mg at bedtime p.r.n., and Vancomycin for MRSA-infected mesh. He does experience more significant delirium with morphine and less so with sparing Dilaudid p.r.n., and Haldol is written p.r.n. as needed. Weaning off nitroglycerin drip, nitro paste added, hematocrit 25%, one unit of packed red blood cells with Lasix and potassium to be given, RISS, and PICC line consult ordered for anticipated long-term vancomycin. Services following the patient include Medicine, Dr. Harcar, patient's PCP, Cardiology, Dr. Pagliari, and Plastic Surgery, Dr. Dunshie. Patient anticipated to be transferred to the floor on 9/28/06.
|
Has the patient ever tried morphine
|
{
"answer_end": [
1865
],
"answer_start": [
1807
],
"text": [
"He does experience more significant delirium with morphine"
]
}
|
This 54-year-old female with end-stage renal disease on hemodialysis had an apparent VFib arrest at hemodialysis and was admitted to the CCU after being intubated in the Vibay General Hospital ED. She was intubated, received amiodarone and dopamine, as her BP was low. An x-ray revealed diffuse bilateral opacities, possible pulmonary edema versus aspiration pneumonia, and an EKG showed normal sinus rhythm 100 beats per minute with no acute ST changes. Her first set of cardiac enzyme revealed a creatinine kinase of 116 and the MB fraction of 0.7 and troponin T of less than assay and lactate of 1.8. A fistulogram and angioplasty of her right AV fistula was performed on 9/14/06 with prednisone premedication but it was unsuccessful and therefore a left IJ tunneled dialysis catheter was inserted on 10/18/06 with the tip ending in the right atrium. HOME MEDICATIONS at the time of admission included amitriptyline 25 mg p.o. bedtime, enteric-coated aspirin 325 mg p.o. daily, enalapril 20 mg p.o. b.i.d., Lasix 200 mg p.o. b.i.d., Losartan 50 mg p.o. daily, Toprol-XL 200 mg p.o. b.i.d., Advair Diskus 250/50 one puff inhaler b.i.d., insulin NPH 50 units q.a.m. subcu and 25 units q.p.m. subcu, insulin lispro 18 units subcu at dinner time, Protonix 40 mg p.o. daily, sevelamer 1200 mg p.o. t.i.d., tramadol 25 mg p.o. q.6 h. p.r.n. pain. A bronchoscopy was performed on 9/14/06 with prednisone premedication but it was negative for aspiration. The patient had difficulty weaning from vent and was finally extubated on 0/22/06. She had a single set of coag-negative Staph positive blood cultures from Quinton catheter on 8/8/06 and was treated with vancomycin dose by renal levels. An Echo on 8/1/06 showed an EF of 60 to 65% with mild concentric left ventricular hypertrophy and no wall motion abnormalities. The patient was continued on telemetry and treated with her home dose of beta-blocker with good response and was gradually advanced to an oral diet with no signs of aspiration status post extubation. She was also given heparin subcutaneously and Nexium as prophylaxis. The patient is full code and will likely need rehab and is being screened by PT and OT and will likely be discharged to rehab when bed is available.
|
Why does the patient take tramadol
|
{
"answer_end": [
1343
],
"answer_start": [
1304
],
"text": [
"tramadol 25 mg p.o. q.6 h. p.r.n. pain."
]
}
|
This is a 61-year-old gentleman with severe pulmonary hypertension secondary to chronic PEs, OSA, gout, bilateral hip replacements who presents with two falls in the past two days. He was compliant with his medication regimen and denies dietary indiscretion. He was on his beta-blocker and anticoagulated on Coumadin with an INR goal of 2.5, initially being supertherapeutic with a daily goal of negative 500 to 1 L with IV Lasix once or twice a day as needed, his home dose being 160 mg p.o. His baseline room air oxygen saturation was 90-93% and he should use oxygen as treatment for his pulmonary hypertension and be provided with oxygen at home. He was treated for his hip pain initially with oxycodone which was changed to Dilaudid for better pain control, and he should be changed back to his home dose of oxycodone when discharged. He also has a history of gout which was exacerbated with diuresis and he is on his home doses of allopurinol and colchicine, Indocin being added and he should receive a total of three days of Indocin. Tylenol and narcotics as previously described can be used to help with his gouty pain. His GI regimen includes Nexium at home and Prilosec while an inpatient, and he should be switched back to Nexium when discharged from rehabilitation. His lab results on discharge include a creatinine of 1, hematocrit of 53.1 and INR of 2.3, potassium being 3.9 and magnesium being 2.0. The discharge medications include Coumadin 11 mg on Monday, Wednesday and Friday and 12 mg the other days of the week, Diovan 320 a day, multivitamin 1 tab daily, Toprol-XL 50 once a day, nifedipine extended release 30 once a day, Revatio 20 mg 3 times a day, hydrochlorothiazide 25 once a day, Lasix 160 IV once per day, allopurinol 200 once per day, colchicine 0.6 once per day, Colace, Prilosec 20 once a day, Dilaudid 2 mg q.4 h. p.o. p.r.n. pain, Tylenol 500-1000 mg p.o. q.6 h. p.r.n. pain not to exceed 4 gm total from all sources in a 24-hour period, Ambien 10 mg p.o. nightly p.r.n. insomnia. He is being discharged to rehab with a followup with his cardiologist, Dr. Insco, and an appointment with Endocrinology.
|
Previous diovan
|
{
"answer_end": [
1600
],
"answer_start": [
1532
],
"text": [
"Diovan 320 a day, multivitamin 1 tab daily, Toprol-XL 50 once a day,"
]
}
|
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 tried kcl immediate release
|
{
"answer_end": [
1077
],
"answer_start": [
1052
],
"text": [
"KCL Immediate Release PO,"
]
}
|
Mr. Forde has recovered very well following his elective coronary artery bypass graft procedure and is hemodynamically stable with left lower extremity erythema and tenderness significantly improved 24 hours following initiation of Keflex course. White blood cell count was within normal limits and patient continued to remain afebrile. A course of Keflex was administered on postoperative day seven for sinus rhythm in the high 90s with blood pressure mildly hypertensive, additionally with frequent PVCs noted on telemetry. Mr. Notarnicola continued to remain afebrile and his knee pain has significantly improved. Additionally, of note, Mr. Hovenga's Toprol was increased to 150 mg p.o. daily with an extra 2 mg of magnesium. Mr. Neth is discharged to rehabilitation today having recovered well following his elective CABG procedure. Mr. Marcusen is discharged to rehabilitation today, postoperative day eight, hemodynamically stable, to continue a course of Keflex for left lower extremity erythema and additionally to continue one week of diuresis in the form of low dose Lasix for mild persistent postoperative pulmonary effusions. Mr. Brannigan has been instructed to shower and monitor incisions for signs of increasing infection such as fever, drainage, worsening pain or increase in redness. He is to follow up with his primary care physician for continued evaluation and management of hypertension, dyslipidemia, obesity, obstructive sleep apnea, and uncontrolled Type II diabetes mellitus. Additionally, the patient will follow up with his cardiologist for continued evaluation and management of blood pressure, heart rate, heart rhythm, lipid levels, and for possible future adjustment in medication. Mr. Connin will follow up with his cardiac surgeon, Dr. Quinn Dalio, in six to eight weeks. Additionally, he will follow up with his cardiologist, Dr. Octavio Wulffraat, in two to four weeks and with his primary care physician, Dr. Barrett Mittleman, in one to two weeks. The patient is discharged with medications including Tylenol 325 mg p.o. q.6h. p.r.n. pain for temperature greater than 101 degrees Fahrenheit, amlodipine 5 mg p.o. daily, atorvastatin 10 mg p.o. daily, captopril 6.25 mg p.o. t.i.d., Keflex 500 mg p.o. q.i.d. times total of seven days, last dose on 9/15/06, Colace 100 mg p.o. b.i.d. p.r.n. constipation, enteric-coated aspirin 325 mg p.o. daily, Lasix 40 mg p.o. daily x7 days, hydrochlorothiazide 12.5 mg p.o. daily, NovoLog 3 units subcu AC, Lantus 24 units subcu q. 10 p.m., hold if n.p.o., potassium slow release 20 mEq p.o. daily x7 days, Toprol-XL 150 mg p.o. daily, Niferex 150 mg p.o. b.i.d., oxycodone 5 to 10 mg p.o. q.4h. p.r.n. pain, Ambien 5 mg p.o. nightly p.r.n. insomnia, NovoLog 6 units subcu with breakfast, hold if n.p.o., NovoLog 4 units subcu with lunch, hold if n.p.o., NovoLog 4 units subcu with dinner, hold if n.p.o., NovoLog sliding scale subcu AC, blood sugar less than 125, give 0 units subcu, blood sugar 125 to 150, give 2 units subcu, blood sugar 151 to 200, give 3 units subcu, blood sugar 201 to 250, give 4 units subcu, blood sugar 251 to 300, give 6 units subcu, blood sugar 301 to 350, give 8 units subcu, if blood sugar 351 to 400, NovoLog sliding scale subcu q.h.s. Please recheck blood sugar less than 200, give 0 units subcu, if blood sugar 201 to 250, give 2 units subcu, blood sugar 251 to 300, give 3 units subcu, blood sugar 301 to 350, give 4 units subcu, blood sugar 351 to 400, give 10 units subcu, call physician if blood sugar greater than 400.
|
Why is the patient taking colace
|
{
"answer_end": [
2371
],
"answer_start": [
2309
],
"text": [
"p.o. b.i.d. p.r.n. constipation, enteric-coated aspirin 325 mg"
]
}
|
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.
|
What treatments if any has the patient tried for myocardial infarction. in the past
|
{
"answer_end": [
244
],
"answer_start": [
195
],
"text": [
"She was treated with Aspirin, Heparin, Lopressor,"
]
}
|
The patient is a 36-year-old G16, P0-0-15-0, who presented at 6 and 4/7 weeks by LMP consistent with ultrasound of the day of admission, as a transfer from the High-Risk Obstetric Clinic, admitted to the Fuller Antepartum Service for diabetic control. She had a history of pre-gestational diabetes, coronary artery disease, recurrent SABs and Hepatitis B, a fibroid uterus, recurrent miscarriages, cervical dysplasia, a molar pregnancy with subsequent choriocarcinoma, and a history of ST elevation myocardial infarction in 2000, which was treated with TPA and angioplasty, and an ejection fraction of 45% in 2002. On the day of admission, the patient was on a Humalog 7 units b.i.d. and Lantus 12 units in the evening, with her fasting sugars in the 150s before admission. She had previously been on Epivir 150 mg p.o. daily, but this had been stopped prior to pregnancy. During the entire hospital stay, the patient was on a Humalog 7 units b.i.d. and Lantus 12 units in the evening, with her fasting sugars in the 150s before admission and her Lantus was increased to 20 units at nighttime, and she was using 8 units three times a day of insulin lispro, in addition to a lispro sliding scale, in order to determine the additional insulin needs as an outpatient. The patient was also prescribed Vitamin B12 100 mcg p.o. daily, Folate 4 mg p.o. daily, and high-dose folic acid, B12 and B6. Aspirin 81 mg p.o. daily was restarted, and the patient was advised to not take any lamivudine until Gastroenterology followup. Oxycodone as required for pain was also prescribed. Cardiology was consulted and the impression was that the thrombosis was likely a combination of her left ventricular hypokinesia related to the previous infarct, as well as her hypercoagulable state. Therefore, their recommendation was to start the patient on Lovenox for the duration of this pregnancy, which adjusted for her weight was a dose of 90 mg daily, followed by a transition to Coumadin postpartum, to be continued for likely long-term, possibly lifelong duration. The patient had her first trimester labs sent on this admission and was started on prenatal vitamins, as well as high-dose folic acid, B12 and B6. Given the patient's history of hepatitis B, an outpatient appointment was being arranged at the time of discharge, with Dr. Lavy, from the Division of Gastroenterology at the Sasspan Hospital. It was decided that the patient should not take any lamivudine until Gastroenterology followup. She also had an 8-cm fibroid on her ultrasound scan and required rare intermittent doses of oxycodone for fibroid pain. The patient was discharged in a stable condition, with followup appointments arranged for the various specialties, on medications of Aspirin 81 mg p.o. daily, Lovenox subcutaneously 90 mg daily, Vitamin B12 100 mcg p.o. daily, Folate 4 mg p.o. daily, Prenatal vitamins one tablet p.o. daily, Lantus 20 units subcutaneously q.p.m. and Insulin lispro 8 units subcutaneously AC, as well as lispro sliding scale, in addition a AC.
|
Has the patient ever tried coumadin
|
{
"answer_end": [
1980
],
"answer_start": [
1932
],
"text": [
"followed by a transition to Coumadin postpartum,"
]
}
|
This is a 59-year-old female with a history of rheumatic heart disease, endocarditis, diabetes mellitus, hypertension, and congestive heart failure who presented with increasing shortness of breath, nausea, vomiting, and abdominal pain. She was given recent Levaquin for an upper respiratory tract infection, then started on Flagyl for a possible C. difficile infection and was diuresed with IV Lasix with good output per report. She complained of 10/10 abdominal pain and was given some Dilaudid. Her hematocrit at one point required two units of packed red blood cells, and she was placed on a heparin drip at 950 units per hour to maintain a PTT between 60 and 80 secondary to atrial fibrillation that has been rate controlled with a beta-blocker. She was discharged on diltiazem 30 mg q.i.d. and a normal dosing of Nexium 40 mg p.o. q.d. while in-house. She was given Darvon and Codeine as needed for pain, and was prescribed Caltrate plus Vitamin D 600 mg, Maalox tablets, Magnesium oxide 400 mg, Multivitamin, Niferex 150 mg, and Lovenox 60 mg subcutaneously b.i.d. with a renal adjustment and NovoLog 15 units subcutaneously with breakfast and dinner. The patient was instructed to call Dr. Mccutchan office to coordinate her appointment for her valve repair in the next one to two weeks pending her surgeon's return and to call Dr. Doug Schlanger on March 2005 to discuss surgical plans and also to follow up. All her blood cultures should be followed up prior to her surgery and if any of her blood cultures become positive in the interim, a long course of antibiotic therapy should be started and surgery should be delayed at the discussion of the Cardiovascular Service. Her medications included Lasix 40 mg p.o. q.o.d. alternating with 80 mg p.o. Lasix q.o.d., Digoxin 0.125 mg q.o.d. alternating with 0.25 q.o.d., Lisinopril 20 mg p.o. q.d., Coumadin 6 mg p.o. q.o.d. alternating with 4 mg q.o.d., Omeprazole 20 mg b.i.d., Metformin 500 mg daily, Insulin 70/30 65 units q.a.m., 35 units q.p.m., Calcium 600 mg p.o. b.i.d., Magnesium 400 mg p.o. b.i.d., Multivitamin, Iron tablets, Actonel every Wednesday, Caltrate plus vitamin D 600 mg one tablet p.o. b.i.d., Maalox tablets quick dissolve, Magnesium oxide 400 mg p.o. b.i.d., Niferex 150 mg p.o. b.i.d., Colace 100 mg p.o. b.i.d., Senokot three tablets p.o. b.i.d., Codeine 15 mg to 30 mg p.o. q.4h. p.r.n. pain. She was required to increase her dosage of Nexium secondary to GERD-like symptoms and was maintained on a stable regimen of NPH 60 units in the morning, NPH 30 units in the evening, and NovoLog of 15 units in the morning with breakfast and 15 at dinner with a sliding scale. She was also transitioned to Lovenox 60 mg b.i.d. with a renal adjustment and was sent to the ED for diuresis where she was given 60 mg of Lasix.
|
What is the current dose of the patient's insulin 70/30
|
{
"answer_end": [
2007
],
"answer_start": [
1960
],
"text": [
"Insulin 70/30 65 units q.a.m., 35 units q.p.m.,"
]
}
|
This 74-year-old gentleman with insulin-dependent diabetes mellitus, hypertension, and coronary artery disease presented with substernal chest pain on exertion and was admitted with T wave inversions in leads V3 and V4. Cardiac cath showed a 95% ostial LAD lesion, a 60% mid LAD lesion, an 80% distal LAD lesion, a 70% proximal D1 lesion, a 40% proximal circumflex lesion, a 90% ostial OM1 lesion, and a 100% proximal RCA lesion; he underwent CABG x3 with a Y graft, SVG1 connecting SVG2 to the LAD, SVG2 connecting the aorta to OM1, and SVG3 connecting to PDA. The patient is a Spanish-speaking only male who is neurologically intact, moving all extremities, getting in and out of bed, and very independent. He had a ventricular fibrillation arrest in the operating room due to an aprotinin reaction, necessitating open cardiac massage and requiring lidocaine and amiodarone use during the code. Medication on admission included Lopressor 50 mg p.o. t.i.d., Lisinopril 40 mg p.o. daily, Aspirin 325 mg p.o. daily, Hydrochlorothiazide/triamterene one tablet daily, Atorvastatin 80 mg p.o. daily, and Lantus 50 cc daily. The patient developed a deep sternal infection with E. coli and was started on Flagyl and Vancomycin for presumed aspiration pneumonia, Imipenem for ID's recommendation, and Nitrofurantoin and Ceftazidime for UTI. He is on Lopressor 25 mg q.6h, Amlodipine 5 mg b.i.d., Lasix 20 mg p.o. b.i.d., Aspirin, Atorvastatin, Lantus, NovoLog, and Diabetes Management. Imipenem and Vancomycin need to be continued for six weeks. He had a small area of erythema on his chest wound, but it is intact and he is being followed by Plastics. He had one brief episode of atrial fibrillation during a coughing spell, but it resolved and he is on antihypertensive medication. He was deemed fit for transfer back to the Step-Down Unit on postoperative day #18.
|
Was the patient ever prescribed hydrochlorothiazide/triamterene
|
{
"answer_end": [
1064
],
"answer_start": [
1015
],
"text": [
"Hydrochlorothiazide/triamterene one tablet daily,"
]
}
|
Patient was admitted to the All Hospital surgery service on 0/12/2006 after undergoing laparoscopic gastric banding. No concerning intraoperative events occurred; please see dictated operative note for details. The patient was transferred to the floor from the PACU in stable condition and had adequate pain control and no issues overnight into POD1. The patient was started on a Stage I diet which was tolerated and then advanced to clears and discharged to home a Stage II diet. The incision was C/D/I, with no evidence of hematoma collection or infection. The patient was given explicit instructions to follow-up in clinic with Dr. Mcmenamy in two weeks and instructed to take ROXICET ELIXIR (OXYCODONE+APAP LIQUID) 5 MILLILITERS PO Q4H PRN Pain, PHENERGAN (PROMETHAZINE HCL) 25 MG PR Q6H PRN Nausea and MULTIVITAMIN THERAPEUTIC (THERAPEUTIC MULTIVI...) 1 TAB PO DAILY Instructions: chewable. The patient was also instructed not to drive or consume alcohol while taking pain medications and to crush pills, open capsules, or take elixirs. The patient was discharged in stable condition, ambulating and voiding independently, and with adequate pain control.
|
Did the patient receive phenergan ( promethazine hcl ) for nausea
|
{
"answer_end": [
802
],
"answer_start": [
750
],
"text": [
"PHENERGAN (PROMETHAZINE HCL) 25 MG PR Q6H PRN Nausea"
]
}
|
This is a 72 year old black female with a history of hypertension, angina, adult onset diabetes, and recurrent syncopal events who was treated with Dilantin for less than a year in 1970 and her last episode was in 1989. She was given Nitro Paste and 1 amp of D50 when she experienced a syncopal event on the morning of admission and her fingerstick glucose was checked. Her medications on admission include aspirin one tablet q d, Questran one pack q d, Micronase 5 mg po q d, Betaxolol eye drops bid to each eye, Pilocarpine eye drops tid to each eye, and eye drops bid to each eye. She also receives monthly Vitamin B12 injections and takes nitroglycerin with chest pain. Physical examination revealed pinpoint constriction of her pupils secondary to her glaucoma eyedrops, bibasilar, coarse crackles in the chest, no jugular venous distention, and nonfocal neurologic exam. Laboratory data includes sodium of 143, potassium of 4.3, chloride of 109, bicarbonate of 20, BUN of 21, creatinine of 1.0, glucose of 160, hematocrit of 43.4, white count of 6.45, and normal coagulation factors. Chest X ray showed a calcific aorta, C spine X ray and head CT were negative, and EKG showed no changes from her baseline. The patient was started on Isordil and Lopressor empirically but these were discontinued and her chest pain is relieved with nitroglycerin. She was discharged to home with plans for a repeat 24 hour Holter as an outpatient with diagnoses of syncope, borderline type II diabetes, stable exertional angina, and glaucoma. Discharge medications include aspirin one tablet po q d, Questran one package po q d, Pilocarpine eye drops tid per eye, Betaxolol eye drops bid per eye, eye drops bid per eye, sublingual nitroglycerin prn chest pain, and Naprosyn 375 mg tid prn.
|
What medications, if any, has the patient tried for adult onset diabetes in the past
|
{
"answer_end": [
476
],
"answer_start": [
454
],
"text": [
"Micronase 5 mg po q d,"
]
}
|
The patient was admitted on 4/12/04 with a right plantar surface neurotrophic ulcer, low-grade fevers and chills, and a history of diabetes mellitus, hypertension, distant past of pancreatitis, gout, neuropathy, high cholesterol, and chronic renal insufficiency. Significant labs at the time of admission included a potassium of 4.3, BUN of 38, creatinine of 3.2, and blood glucose of 187. The patient was started on 1. Lantus 100 mg q.p.m., 2. Humalog 20 units q.p.m., 4. Neurontin 300 mg t.i.d., 5. Lisinopril 40 mg q.d., 6. Allopurinol 300 mg q.d., 7. Hydrochlorothiazide 25 mg q.d., 8. Zocor 20 mg q.d., 9. TriCor 50 mg b.i.d., 10. Atenolol 25 mg q.d., 11. Eyedrops prednisolone and atropine, and 12. iron supplementation. The patient underwent an amputation of the third and fourth toe as well as metatarsal heads, and was started on Dr. Tosco's suggested antibiotics, vancomycin, levofloxacin, and Flagyl. To manage temperature greater than 101, the patient was prescribed Tylenol 650 to 1000 mg p.o. q.4h. p.r.n., allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Colace 100 mg p.o. b.i.d., Epogen 10,000 units q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient was seen by Dr. Ulvan in the renal staff and by the diabetes management service by Dr. Clint Holets. Postoperative lab checkup revealed that the patient's creatinine bumped to 4.9 with a BUN of 61, and the renal service was consulted. The patient was given Lopressor 100 mg b.i.d. to control the blood pressure, and was eventually started on PhosLo and Ferrlecit as well as Epogen 10,000 units q. week. Levofloxacin was continued for a one week course, and the patient was discharged to the rehab facility with Tylenol 650 to 1000 mg p.o. q.4h. p.r.n. for temperature greater than 101, allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Lopressor 100 mg p.o. b.i.d., PhosLo 1334 mg p.o. q.a.c., Colace 100 mg p.o. b.i.d., Epogen 10,000 units delivered subcuticularly q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient is to be followed up at the rehab facility at Ing Mansy General Hospital and should follow up with the renal service and Dr. Knaub in two to three weeks and one to two weeks, respectively. The
|
What is her current dose of atropine
|
{
"answer_end": [
1371
],
"answer_start": [
1328
],
"text": [
"atropine 1 mg one drop in the affected eye,"
]
}
|
This 60-year-old male presented with a two week history of paroxysmal nocturnal dyspnea and dyspnea on exertion, possibly related to stress from the recent death of the patient's sister-in-law. His past medical history was significant for hypertension of approximately 10 years, non-insulin dependent diabetes mellitus of approximately 12 years, left Bell's palsy in 1985 treated with prednisone, and type IV hypolipoproteinemia. An EKG showed new anterolateral changes since the EKG taken a year earlier, and he was admitted with a diagnosis of Myocardial Infarction, Congestive Heart Failure, and Hypertension. His medications included Micronase 10 mg po bid, Persantine 60 mg po tid, aspirin one po q d, Lisinopril 5 mg po q d, and Atenolol 50 mg po q d. He had a 20 pack year history of smoking and social ethanol consumption. The patient was managed with gentle Lasix diuresis and the beta blocker was held due to concern for wall motion abnormalities. He was anticoagulated on heparin and loaded on Coumadin, and his medications on discharge included Lasix 40 mg po q d, Captopril 37.5 mg po tid, Ecotrin 325 mg po q d, Coumadin 5 mg po q h.s., magnesium oxide two tablets po q d, Isordil 10 mg po tid with meals, and Micronase 10 mg po bid. The patient was stable on discharge and was to follow up with Dr. Luciano Catignani in his office on Tuesday, 15 of October, at 3 p.m.
|
Has the pt. ever been on isordil before
|
{
"answer_end": [
1219
],
"answer_start": [
1151
],
"text": [
"magnesium oxide two tablets po q d, Isordil 10 mg po tid with meals,"
]
}
|
This is a 61-year-old gentleman with severe pulmonary hypertension secondary to chronic PEs, OSA, gout, bilateral hip replacements who presents with two falls in the past two days. He was compliant with his medication regimen and denies dietary indiscretion. He was on his beta-blocker and anticoagulated on Coumadin with an INR goal of 2.5, initially being supertherapeutic with a daily goal of negative 500 to 1 L with IV Lasix once or twice a day as needed, his home dose being 160 mg p.o. His baseline room air oxygen saturation was 90-93% and he should use oxygen as treatment for his pulmonary hypertension and be provided with oxygen at home. He was treated for his hip pain initially with oxycodone which was changed to Dilaudid for better pain control, and he should be changed back to his home dose of oxycodone when discharged. He also has a history of gout which was exacerbated with diuresis and he is on his home doses of allopurinol and colchicine, Indocin being added and he should receive a total of three days of Indocin. Tylenol and narcotics as previously described can be used to help with his gouty pain. His GI regimen includes Nexium at home and Prilosec while an inpatient, and he should be switched back to Nexium when discharged from rehabilitation. His lab results on discharge include a creatinine of 1, hematocrit of 53.1 and INR of 2.3, potassium being 3.9 and magnesium being 2.0. The discharge medications include Coumadin 11 mg on Monday, Wednesday and Friday and 12 mg the other days of the week, Diovan 320 a day, multivitamin 1 tab daily, Toprol-XL 50 once a day, nifedipine extended release 30 once a day, Revatio 20 mg 3 times a day, hydrochlorothiazide 25 once a day, Lasix 160 IV once per day, allopurinol 200 once per day, colchicine 0.6 once per day, Colace, Prilosec 20 once a day, Dilaudid 2 mg q.4 h. p.o. p.r.n. pain, Tylenol 500-1000 mg p.o. q.6 h. p.r.n. pain not to exceed 4 gm total from all sources in a 24-hour period, Ambien 10 mg p.o. nightly p.r.n. insomnia. He is being discharged to rehab with a followup with his cardiologist, Dr. Insco, and an appointment with Endocrinology.
|
What is her current dose of colchicine.
|
{
"answer_end": [
963
],
"answer_start": [
909
],
"text": [
"he is on his home doses of allopurinol and colchicine,"
]
}
|
This 63-year-old male was transferred from LMC with a positive stress test and a history of CABG LIMA-D1, V-OM1, V-OM2, V Y-graft to PDA and PLV. Upon admission, he was diagnosed with CAD and presented with exertional angina. A nuclear stress revealed inferior scar and small area of anterior ischemia, and he was then transferred to CTMC for a cath. His medications on transfer included Dilantin 300/300/250, Glyburide 10 BID, Metformin 850 TID, Toprol 100 Daily, ASA 325 Daily, Isordil 20 TID, Lasix 20 QOD, Lipitor 40 Daily, Neurontin, Celondin 300 TID, Digoxin 0.25 Daily, and Benazepril 10 Daily. His hospital course included CV: Cath LIMA-LAD, DM: holding Metformin and restarting Glyburide and RISS, Neuro: Cont Neurontin 300 TID, Dilantin 200/200/250, and Celondin, and he was switched to Plavix 75 Daily, Atorva to Simva in house, Benazepril to Lisinopril 10, and Digoxin 0.25. He was discharged with instructions to take all medications as prescribed, with a full code status and disposition of Home. Medications at discharge included DIGOXIN 0.25 MG PO DAILY, LASIX (FUROSEMIDE) 20 MG PO EVERY OTHER DAY, GLYBURIDE 10 MG PO BID, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, DILANTIN (PHENYTOIN) 200 MG QAM; 250 MG QPM PO BEDTIME, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 100 MG PO DAILY Food/Drug Interaction Instruction, NEURONTIN (GABAPENTIN) 300 MG PO TID, PLAVIX (CLOPIDOGREL) 75 MG PO DAILY, BENAZEPRIL 10 MG PO DAILY, GLUCOPHAGE (METFORMIN) 850 MG PO TID, and CELONTIN (METHSUXIMIDE) 300 MG PO TID.
|
Is there a mention of of plavix ( clopidogrel ) usage/prescription in the record
|
{
"answer_end": [
1416
],
"answer_start": [
1380
],
"text": [
"PLAVIX (CLOPIDOGREL) 75 MG PO DAILY,"
]
}
|
This 75-year-old female vasculopath was admitted for further evaluation of her peripheral vascular disease which was suspected to be contributing to her new ulcerations and progressively worsening bilateral foot pain, foot mottling and wrist pain as an exacerbating factor to likely atheroembolic phenomenon, status post coronary catheterizations earlier in the year. She was placed on broad-spectrum antibiotics and plan was made for an MRA to evaluate her anatomy, unfortunately, the patient was unable to tolerate the MR and did experience some mental status changes that prevented further noninvasive imaging when she received some narcotic following her hemodialysis round. Over the ensuing days she required rather significant doses of Zyprexa and Haldol to contain agitation and delirium, as the patient would also get physical and violent. This appeared to sedate her sufficiently and over the following days, she did manage to calm significantly and returned to her baseline mental status. Cardiology was consulted during this time to optimize her prior to the OR and her primary cardiologist, Dr. Fugle, did make some recommendations including an echocardiogram that showed preserved ejection fraction and no wall motion abnormalities. Her beta blockade was titrated up and she was instructed to follow up with cardiology. She did tolerate hemodialysis throughout this time without undue difficulty and they offered an angiogram to delineate aortic and bilateral lower extremity runoff anatomy. After extensive discussions with the patient and the patient's family, the patient did agree to a left femoral to dorsalis pedis bypass graft which was performed on 0/25/2006 without complication. By time of discharge, she was tolerating a regular diet and ambulating at baseline with her rolling walker. The pain was well controlled with minimal analgesics that were not narcotic based. Medications on admission included Aspirin 325 mg p.o. daily, Plavix 75 mg p.o. daily, Cardizem 60 mg p.o. t.i.d., Lipitor 80 mg daily, Atrovent 2 puffs four times a day, Albuterol 2 puffs b.i.d., Renagel 806 mg p.o. every meal, Allopurinol 100 mg p.o. daily, Zaroxylyn 2.5 mg p.o. daily p.r.n. overload, Lantus 10 units subcutaneous nightly, Regular insulin sliding scale, Valium 5 mg p.o. b.i.d. p.r.n., Isordil 40 mg p.o. t.i.d., Hydralazine 20 mg p.o. t.i.d., Lopressor 75 mg p.o. t.i.d., Zantac 150 mg p.o. b.i.d., Aciphex 20 mg p.o. daily, Neurontin 300 mg p.o. post-dialysis, Metamucil, Nitroglycerine p.r.n., Procrit 40,000 units subcutaneously every week, Lilly insulin pen, unknown dosage 20 units every morning and 10 units every evening, Loperamide 2 tabs p.o. four times a day, Ambien 10 mg p.o. nightly p.r.n., Tylenol 325 mg p.o. every four hours p.r.n. pain, Albuterol inhaler 2 puffs b.i.d., Calcitriol 1.5 mcg p.o. every Monday and every Friday, Darbepoetin alfa 100 mcg subcutaneous every week, Ferrous sulfate 325 mg p.o. t.i.d., Prozac 40 mg p.o. daily, Motrin 400 mg p.o. every eight hours p.r.n. pain, Insulin regular sliding scale, and Sevelamer 800 mg p.o. t.i.d. Discharge instructions included touchdown weightbearing on the left heel, legs are to be elevated as much as possible while sitting or lying down, all home medications were to be resumed except for Lopressor, VNA was ordered to assist with wound care including Betadine paint to incisions daily, showering only, no bathing or immersion in water for prolonged periods of time, and follow-up visits with Dr. Amorose in one to two weeks and Dr. Morici primary care physician in one week.
|
Has the patient ever had valium
|
{
"answer_end": [
2297
],
"answer_start": [
2266
],
"text": [
"Valium 5 mg p.o. b.i.d. p.r.n.,"
]
}
|
Ms. Leezer is a 50 year-old woman with a history of end stage renal disease, status post renal transplant, and a history of coronary artery disease, status post coronary artery bypass grafting. She had an episode of chest pain which was relieved by Nitroglycerin and passed out while saying goodbye to her husband, as well as several episodes of skipped heart beats during and after which she feels short of breath, and slurred speech for a few minutes. On admission her temperature was 98.8, pulse 96, blood pressure 120/70, and respirations 18. During her stay she was given a 250 cc fluid bolus, transfused two units of blood and her hematocrit went up to 31. Laboratory data revealed a sodium of 137, potassium 4.4, chloride 104, bicarbonate 15, BUN 86, creatinine 3.1, ALT 6, AST 11, alkaline phosphatase 44, bilirubin total 0.4, direct bilirubin 0.1, calcium 9.5, cholesterol 360, and HDL 40. An exercise tolerance test MIBI was performed, which was negative for ischemia, and the patient's ejection fraction was approximated to be 69%. Carotid noninvasives revealed moderate internal carotid plaque on the right and mild stenosis of the other arteries. An echocardiogram revealed concentric left ventricular hypertrophy with an ejection fraction of 65%. The patient was taken to Electrophysiology Study which revealed nonsustained ventricular tachycardia with possible right ventricular outflow tract origin. It was hoped that she could be maintained on Lopressor and Verapamil; however, her blood pressure did not tolerate the medication, so she was already on Atenolol for Beta blockade and Verapamil was tried. Her discharge medications included Aspirin 81 mg p.o. q. day, Vitamin C 100 mg p.o. q. day x14 days, Epogen 2,000 subcu q. week, Lasix 60 mg p.o. q. day, Gemfibrozil 300 mg p.o. b.i.d., Lisinopril 5 mg p.o. q. day, Prilosec 20 mg p.o. q. day, Prednisone 5 mg p.o. on even days, 10 mg p.o. on odd days, MVI with minerals one tablet p.o. q. day, Thiamine 50 mg p.o. b.i.d., Bicitra 15 ml p.o. b.i.d., Nephrocaps one tablet p.o. q. day, Cyclosporine 125 mg p.o. in the morning and 100 mg p.o. in the afternoon, Insulin sliding scale, Cellcept 1,000 mg p.o. b.i.d., and Prempro 0.625/0.25 mg p.o. q. day. Her triglycerides were checked during the hospitalization and found to be very high in the 1,500 range, so she was taken off Simvastatin and started on Gemfibrozil. She was discharged in stable condition the next day.
|
Has the patient ever had prednisone
|
{
"answer_end": [
1922
],
"answer_start": [
1864
],
"text": [
"Prednisone 5 mg p.o. on even days, 10 mg p.o. on odd days,"
]
}
|
Harrison Fullwood was admitted on 4/3/2005 for ICD placement for HCM. On 7/13/05, Medtronic Dual Chamber DDI/ICD was placed under general anesthesia with a CODE STATUS of Full Code and disposition of Home. ECHO 5/13 showed septal thickness 16mm, posterior wall thickness 19mm with preserved EF 65% and LV outflow tract peak gradient 125mmHg. Holter monitoring 0/2 without any arrhythmias. On admission PE, VS 96.4 74 140/90 20 93% RA. Labs/Studies included CBC, BMP, Coags wnl, EKG NSR. TW flat V5/V6 (old), CXR (portable): cardiomegaly, no e/o ptx, PA/lat CXR AM after no ptx, leads in place, no overt failure. The patient was prescribed Albuterol, Advair 250/50 bid, Rhinocort 2 sprays bid, Atrovent 2 puff qid, Singulair 10mg qhs, Nexium 40mg daily, Lasix 20mg daily (inc to 40 or 60 during period), Kcl 20meq daily, Verapamil 120mg daily, Patanol 1-2 OU bid prn, Loratidine 10mg daily, Zocor 20mg qhs, Effexor 75mg daily, Metformin 1250mg bid, Mgoxide 500mg daily, Ambien prn, Amox prior to procedures. On order for Motrin PO (ref# 234611479), the patient had a POSSIBLE allergy to Aspirin; reaction is Unknown. The patient was instructed to take Keflex for a 3 day total course, take all medications with food, and avoid grapefruit unless MD instructs otherwise. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A. ENDO: ISS. restarted Metformin on morning of d/c. NEURO: cont Effexor. On discharge, the patient was prescribed Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Wheezing, Lasix (Furosemide) 20 mg PO QD Starting Today (10/19) with instructions to titrate his dose 20mg/40mg/60mg as he normally does depending on his degree of swelling, Motrin (Ibuprofen) 600 mg PO Q6H PRN Pain, Headache, Magnesium Oxide 560 mg PO QD, Verapamil Sustained Release 120 mg PO QD Starting Today (10/19) with instructions to confirm home dose and resume home dose, Keflex (Cephalexin) 250 mg PO QID X 10 doses, Zocor (Simvastatin) 20 mg PO QHS, Ambien (Zolpidem Tartrate) 10 mg PO QHS PRN Insomnia, Loratadine 10 mg PO QD, Potassium Chloride Slow Rel. (KCl Slow Release) 20 mEq PO QD As per AH Potassium Chloride Policy, each 20 mEq dose to be given with 4 oz of fluid, Metformin 1,250 mg PO BID Starting IN AM (10/19), Rhinocort Aqua (Budesonide Nasal Inhaler) 2 Spray Inh BID, Singulair (Montelukast) 10 mg PO QD, Effexor XR (Venlafaxine Extended Release) 75 mg PO QD Number of Doses Required (approximate): 5, Advair Diskus 250/50 (Fluticasone Propionate/...) 1 Puff Inh BID, Nexium (Esomeprazole) 40 mg PO QD, Oxycodone 10 mg PO Q4H PRN Pain, and Atrovent HFA Inhaler (Ipratropium Inhaler) 2 Puff Inh QID. November of 2004, HF symptoms were controlled on Lasix and at baseline he could work. The patient was also advised to take all medications with food and to avoid grapefruit unless MD instructs otherwise, and to take Keflex for a 3 day total course and to take all other medications as the same. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A.
|
What was the dosage prescribed of keflex ( cephalexin )
|
{
"answer_end": [
2008
],
"answer_start": [
1963
],
"text": [
"Keflex (Cephalexin) 250 mg PO QID X 10 doses,"
]
}
|
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 the patient had multiple colace ( docusate sodium ) prescriptions
|
{
"answer_end": [
2462
],
"answer_start": [
2423
],
"text": [
"COLACE (DOCUSATE SODIUM) 100 MG PO BID,"
]
}
|
Mr. Lumadue is a 68-year-old man with significant cardiac history and vascular disease who came in with a chief complaint of hip pain after a mechanical fall. At that time, his hospital course was complicated by a non-Q wave MI, and Cardiology recommended medical management with Lopressor. An echocardiogram revealed an ejection fraction of 45%, and Dobutamine MIBI revealed a severe fixed perfusion defect in the inferoposterior and inferoseptal left ventricle with an ejection fraction of 26%. His medications included HCTZ 50 mg PO q.d., enteric-coated aspirin 325 mg PO q.d., Zestril 20 mg PO q.d., glyburide 5 mg PO q.d., multivitamins, and cough medicine PRN. Upon admission, his vital signs were afebrile, temperature 97.3, tachycardia, heart rate 106, blood pressure 162/77, oxygenation 94% on room air. X-rays of his left pelvis and femur revealed fracture of the left intertrochanter and subtrochanteric fracture with lesser trochanteric fracture intact by 3 cm, less than five degrees angulation. His femoral head was reduced. During his hospital course, the patient was started on a beta blocker, Ace inhibitor, and continued on an aspirin. He was aggressively diuresed with Lasix for diuresis and was treated with vancomycin, Flagyl, and levofloxacin for presumed aspiration pneumonia. He was continued on Lovenox 60 mg subcu. b.i.d. for prophylaxis against DVT post-hip surgery to continue for six months minimal followed by orthopedic surgery, and restarted on oral hypoglycemics prior to discharge in addition to sliding scale insulin. He was discharged on standing 20 mEq of K-Dur q.d., lisinopril 5 mg PO q.d., hold for systolic blood pressure less than 100, Lasix 100 mg PO q.d., Lovenox 60 mg subcu. b.i.d. x6 months, glipizide 2.5 mg PO q.d., sliding scale insulin, Nexium 20 mg PO q.d., Silvadene wet-to-dry dressing, DuoDerm to left lower leg wound and change q.3 days, and Lopressor 12.5 mg PO t.i.d., hold for systolic blood pressure less than 100. He was maintained on Nexium prophylaxis in the setting of his anticoagulation and on two liters of nasal cannula oxygen at the time of transfer to rehab. Upon discharge, he was instructed to follow up with his primary care physician, orthopedic surgery, cardiology, and pulmonary medicine within two weeks, with labs for a metabolic panel, magnesium, and calcium q.o.d. and physical therapy as needed, with a weightbearing status of non-weightbearing on the left lower extremity and weightbearing as tolerated on the right lower extremity.
|
Why was the patient on ace inhibitor
|
{
"answer_end": [
1153
],
"answer_start": [
1079
],
"text": [
"was started on a beta blocker, Ace inhibitor, and continued on an aspirin."
]
}
|
The patient is a 54 year old white male with cardiac risk factors of diabetes, borderline hypertension, male gender, and a positive family history, who presented to Leyson Memorial Hospital complaining of substernal chest pain. On arrival to Icoson Hospital, the patient's blood pressure was 126/80 and heart rate was 80, and the electrocardiogram showed new ST depressions in V2-V5, T wave inversions in AVL, and flat T's in 1 and V6. The patient was treated with two sublingual nitroglycerins and sent to the Mendwood Hospital. On route to Icoson Hospital, the patient received an aspirin, a sublingual nitroglycerin, nitro paste, Lopressor 5 mg x 1 intravenously, and intravenous heparin. Upon transfer to the CCU, the patient was pain free and was maintained on heparin and intravenous nitroglycerin for 72 hours after admission. The patient was started on Lopressor and Glucotrol 5 mg p.o. q.d., as well as enteric-coated aspirin at admission, and was maintained on his glipizide and atenolol, 50 mg p.o. q.d., and enteric-coated aspirin, as well as nitroglycerins p.r.n. chest pain. Two days after the cardiac catheterization, the patient was pain free and was maintained on heparin overnight. The patient's condition at the time of discharge was stable, and was discharged with diabetic teaching as an outpatient with CH, follow-up with Dr. Kalert, atenolol 50 mg PO q.d., sublingual nitroglycerins PRN chest pain, and Glucotrol 5 mg PO q.d.
|
has there been a prior enteric-coated aspirin
|
{
"answer_end": [
948
],
"answer_start": [
912
],
"text": [
"enteric-coated aspirin at admission,"
]
}
|
The patient is a 57 year-old female with dilated cardiomyopathy who is admitted for transplant evaluation. She initially presented with substernal chest pain in 1991, which was thought to be a myocardial infarction and Streptokinase was given; however details are not known. An echocardiogram showed an ejection fraction of 35-40% with evidence of an anteroseptal myocardial infarction, and an ETT Thallium showed fixed anteroseptal and apical defects. Upon admission, her ejection fraction was 15%, and a bicycle test achieved 5 minutes and 33 seconds with a maximal heart rate of 108 and a VO2 of 6.4 ml per kg per minute. Her past medical history is significant for 1) History of bronchitis, 2) History of cardiomyopathy, 3) Non-insulin dependent diabetes mellitus, 4) Status post hysterectomy at age 40, 5) Status post cholecystectomy, 6) Status post appendectomy, 7) History of panic disorders, 8) History of agoraphobia, and 9) History of alcohol use. Medication on admission included Coumadin 2.5 mg p.o. four times a week and 5 mg p.o. three times a week, Digoxin 0.125 mg p.o. q. day, Enalapril 10 mg p.o. b.i.d., Micronase 2.5 mg p.o. q. day, Multivitamins one tablet p.o. q. day, Lasix 40 mg p.o. b.i.d., and Xanax 0.5 mg p.o. q.i.d. p.r.n. The patient was briefly transferred to the Coronary Care Unit secondary to her elevated pulmonary capillary wedge pressure and the presence of her Swan-Ganz catheter, and was diuresed with good response. As part of the patient's transplant evaluation, she had a PPD with controls placed which showed that her PPD was negative and her controls were positive, and she underwent a Dental consult as well as a Psychiatric consult, and Thyrology showed a cytomegalovirus IgG being positive, a cytomegalovirus IgM being equivocal, and Epstein-Barr virus anti-VCA IgG at 640, an Epstein-Barr virus anti-VCA IgM being less than 10 and a mucal screen being greater than or equal to 32, a varicella zoster titer of 512, a Toxoplasma IgG being positive, and a Toxoplasma IgM being negative. Abdominal ultrasound showed a mildly dilated common bile and pancreatic duct and showed that this patient was status post cholecystectomy. Medication on discharge included Tylenol 650 mg p.o. q.4h. p.r.n. headache, Xanax 0.5 mg p.o. q.i.d., Digoxin 0.125 mg p.o. q. day, Enalapril 12.5 mg p.o. b.i.d., Lasix 40 mg p.o. b.i.d., Micronase 1.25 mg p.o. q. day, Multivitamins one tablet p.o. q. day, and Coumadin 2.5 mg p.o. q. day on even days and 5 mg p.o. q. day on odd days. The patient was instructed that she should increase her diuresis at home if she noticed an increase in her weight and was instructed to see a physician for continued for weight increases due to fluid accumulation. The patient had no known drug allergies and had been on Heparin during this hospitalization, and she did experience some hematuria toward the end of her hospitalization which was felt to be secondary to Foley trauma while she was in the Coronary Care Unit. While the patient maybe a good transplant candidate, it was felt that her weight was a negative factor in her potential for transplant.
|
Has the patient had multiple enalapril prescriptions
|
{
"answer_end": [
1122
],
"answer_start": [
1064
],
"text": [
"Digoxin 0.125 mg p.o. q. day, Enalapril 10 mg p.o. b.i.d.,"
]
}
|
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.
|
How often does the patient take insulin 70/30 ( human )
|
{
"answer_end": [
571
],
"answer_start": [
533
],
"text": [
"Insulin 70/30 (Human) 30 units SC BID,"
]
}
|
Mr. Boyles is a 73-year-old man with a past medical history significant for extensive coronary artery disease, diabetes, hypertension, hypercholesterolemia, and smoking, who presents with chest pain and is admitted for rule out myocardial infarction. His vital signs are normal, his lungs are clear, his jugular venous pressure is less than 5.0 centimeters, and his PMI is nonpalpable. His cardiac risk factors include age, diabetes, hypertension, cholesterol, smoking, and family history. On the morning of admission, he experienced chest pain for 1-2 minutes, which dissipated. At 7:00 p.m., he took one sublingual nitroglycerin with a decrease of pain and at 11:00 p.m., he took one sublingual nitroglycerin. His medications include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was placed on Plavix, continued aspirin, and restarted Coumadin after heparin and intravenous TNG. Cozaar 25 milligrams q.d. and amlodipine were added, and he was given normal saline intravenous fluids to equalize his ins and outs. His hematocrit dropped to 28.0, and he was transfused two units with an appropriate bump back to 33.0. His diabetes was managed on NPH 30/10 and 4 regular q.p.m., and Rezulin. His genitourinary issue was managed with Finasteride 5 milligrams q.d. and Levofloxacin 500 milligrams q.d. He developed point tenderness in his right knee, and was managed with Colchicine and a prednisone taper starting at 40 milligrams. His medications on discharge include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was taken back for a left subclavian artery stent and a left brachial artery angioplasty, and further managed with catheterization, finding a saphenous vein graft to the diagonal one was 100 percent occluded, SVG to PDA was open, LMA was 30 percent occluded, LAD was 99 percent occluded, diagonal one was 100 percent occluded, and LCX was 80 percent occluded. He was discharged to home in stable condition, with follow-up appointments with his primary doctor, cardiologist, and the doctor who performed the procedure.
|
What was the dosage prescribed of nitroglycerin
|
{
"answer_end": [
673
],
"answer_start": [
562
],
"text": [
"which dissipated. At 7:00 p.m., he took one sublingual nitroglycerin with a decrease of pain and at 11:00 p.m.,"
]
}
|
The patient is a 60 year-old woman with adult onset diabetes mellitus, hypertension, and elevated cholesterol admitted with chest pain, bradycardia, and decreased blood pressure. When her blood pressure is elevated, she takes Nifedipine and the pain became three to four out of ten, so she took Cardizem without relief and called EMS. The pain was relieved with the EMTs gave nitroglycerin times two and they found her to have blood pressure of 190/100, heart rate 76, and normal sinus rhythm. They gave two nitrospray, blood pressure decreased to 150/80, heart rate 76, and after two minutes in the vehicle, she had sinus bradycardia at 30-40, blood pressure 120/80. She was given 0.5 mg of Atropine times one without any affect and brought to the hospital with a systolic blood pressure of 100, then suddenly she had bradycardia with heart rate of 30-40 and systolic blood pressure of 75. She was given intravenous fluids and Atropine 0.5 mg times one which increased her blood pressure systolic to 100 and her heart rate increased to 60. On admission, she was given Nifedipine 10 mg p.r.n. for elevated blood pressure, Lasix 20 mg q. day, Glucotrol 15 mg q. day, Cardizem 300 mg q. day, Coumadin 3.75 mg q. day, Colace 100 mg b.i.d., and Iron 325 mg q. day. On discharge, she was given Aspirin 325 mg q. day, Atenolol 50 mg q. day, Lisinopril 10 mg q. day, Pravachol 20 mg q. day, Glucotrol XL 15 mg q. AM, Lasix 20 mg q. day, and Nitroglycerin tablets sublingual p.r.n. chest pain. She underwent exercise tolerance test on a standard Bruce protocol and angiography which showed left main OK, LAD proximal 20%, D2 60%, ostial 90% mid, left circumflex mid 30%, OM2 distal 60-70%, OM1 mild diffuse disease. She underwent PTCA of her diagonal two which went from 90% to 0% stenosis and she received Heparin overnight and the sheaths were pulled on the following day. She is to follow-up in the VERAREA UNIVERSITY HOSPITAL Clinic with Dr. Van Rothenberg.
|
Did the patient receive nifedipine for elevated blood pressure
|
{
"answer_end": [
1092
],
"answer_start": [
1069
],
"text": [
"Nifedipine 10 mg p.r.n."
]
}
|
The patient is a 65-year-old woman with Dilated Cardiomyopathy secondary to Adriamycin, status post recent admission for increased shortness of breath and left pleural effusion. She returns now with increased cough productive of white phlegm and progressive dyspnea on exertion. Her physical examination revealed Temperature 100.6, Blood Pressure 116/65, Heart Rate 100, Respiratory Rate 18, 02 Saturation 90% on room air. She was started on empiric course of antibiotics including cefotaxime and clarithromycin, in addition to Digoxin 0.25 mg q day, Lasix 80 mg q day, Capoten 50 mg t.i.d., Aspirin one per day, Synthroid 2 gr. per day, Tamoxifen 10 mg b.i.d., Elavil 75 mg q day, K-Dur 1 q day, Biaxin 500 mg p.o. b.i.d., Digoxin 0.125 mg alternating with 0.25 mg q day, Thyroid 2 grains p.o. q day, Coumadin 5 mg p.o. q day, and K-Dur 20 mg p.o. b.i.d., Ambien 10 mg p.o. q h.s. A chest x-ray showed a left pleural effusion which is unchanged, a new right pleural effusion +- consolidation, and a large peripheral, red, right lower lobe opacity, highly suggestive of a right lower lobe pulmonary infarction. She underwent ultrasound guided thoracentesis complicated by a pneumothorax requiring chest tube placement and evaluation of the pleural fluid revealed a transudative effusion with all cultures and cytology remaining negative. She was treated with Ancef for approximately 7 days while the chest tube was in place, and then switched to Adriamycin with good result. She was also started on IV Heparin with achievement of therapeutic PTT prior to switching to oral Coumadin without complications, while lower extremity non-invasives and a cardiac echocardiogram remained negative for deep venous thrombosis and right ventricular thrombus. The patient was discharged to home with followup with Dr. Gunsolus at the Leyer Memorial Hospital.
|
What is her current dose of digoxin
|
{
"answer_end": [
591
],
"answer_start": [
528
],
"text": [
"Digoxin 0.25 mg q day, Lasix 80 mg q day, Capoten 50 mg t.i.d.,"
]
}
|
Ms. Kolppa was a 58-year-old woman with a history of non-ischemic cardiomyopathy and ejection fraction of 15% who was initially admitted to the Faharb Medical Center Of following a cardiac arrest. On arrival in the emergency department she was found to have recurrent ventricular tachycardia and was defibrillated, and required pressor medications, an intraaortic balloon pump, and ventilator support to maintain her blood pressure, as her condition affected multiple organ systems. Due to poor neurological status and poor prognosis, and in conjunction with the patient's previously expressed wishes, medical care was withdrawn on 6/14 after many discussions with family, and the intraaortic balloon pump was turned off. Pressure medications were held and the mechanical ventilator was stopped, and the patient passed away on 0/14/07 shortly after removal of mechanical support.
|
has the patient used pressor medications in the past
|
{
"answer_end": [
377
],
"answer_start": [
319
],
"text": [
"required pressor medications, an intraaortic balloon pump,"
]
}
|
A 73-year-old male patient with a history of coronary artery disease, ischemic cardiomyopathy, and valvular heart disease was admitted to the Rose-le Medical Center with a large left foot toe ulcer that was nonhealing, and signs and symptoms of decompensated heart failure and acute on chronic renal failure. During his stay, he was treated with Enteric-coated aspirin 325 mg p.o. daily, Amiodarone 200 mg p.o. daily, Colace 100 mg p.o. b.i.d., insulin NPH 7 units q.a.m. and 3 units q.p.m. subcutaneously, Atrovent HFA inhaler 2 puffs inhaled q.i.d. p.r.n. for wheezing, magnesium gluconate sliding scale p.o. daily, oxycodone 5-10 mg p.o. q. 4h. p.r.n. pain, senna tablets one to two tablets p.o. b.i.d. p.r.n. constipation, spironolactone 25 mg p.o. daily, Coumadin 1 mg p.o. every other day, multivitamin therapeutic one tablet p.o. daily, Zocor 40 mg p.o. daily, torsemide 100 mg p.o. daily, OxyContin 10 mg p.o. b.i.d., Cozaar 25 mg p.o. daily, Remeron 7.5 mg p.o. q.h.s., and aspartate insulin sliding scale, as well as being maintained on subcutaneous heparin and Nexium as DVT and GI prophylaxis, Celexa 20 mg p.o. daily, Coumadin 2.5 mg p.o. daily, Diovan 80 mg p.o. daily, Lantus 25 units every day subcutaneous, Lasix 160 mg p.o. b.i.d., Lipitor 20 mg p.o. q.h.s., Lopressor 50 mg p.o. b.i.d., solsite topical, and 25 mg of hydrochlorothiazide b.i.d. 30 minutes prior to meals, in addition to ciprofloxacin, DuoDERM, BKA site healing with continued aspirin, and inhaled ipratropium. Hyponatremia due to heart failure was improved with diuresis, and the patient was maintained on Coumadin with an INR goal of 2-3, adjusted to 1 mg PO every other day. Diabetes mellitus, insulin-dependent, was covered on NPH QAM and QPM with aspartate sliding scale for duration of hospitalization. The patient was restarted on Celexa per PCP for likely depressive mood response to recent bilateral knee amputation, and later started on Remeron 7.5 mg PO daily in place of Celexa. He was initially treated for urinary tract infection with uncomplicated course with ciprofloxacin, and Wound care nurse consulted for BKA wound and small decubitus on his back, was treated with DuoDERM, BKA site healing well. The patient was maintained on subcutaneous heparin and Nexium as DVT and GI prophylaxis during this hospitalization. He was discharged on Enteric-coated aspirin 325 mg p.o. daily, Amiodarone 200 mg p.o. daily, Atrovent one to two puffs inhaled q.i.d. p.r.n. for wheezing, Celexa 20 mg p.o. daily, Coumadin 2.5 mg p.o. daily, Diovan 80 mg p.o. daily, enteric-coated aspirin 325 mg p.o. daily, Lantus 25 units every day subcutaneous, Lasix 160 mg p.o. b.i.d., Lipitor 20 mg p.o. q.h.s., Lopressor 50 mg p.o. b.i.d., therapeutic multivitamin one tablet p.o. daily, solsite topical, and instructed to follow up with psychiatry to assess depressive disorder/adjustment disorder, start beta-blocker at a low-dose in the outpatient setting, and check creatinine and BUN along with electrolytes to make sure patient is doing well on current maintenance diuretic schedule of 100 mg torsemide PO daily and spironolactone. Code status was full code.
|
What is the reason this patient is on remeron
|
{
"answer_end": [
2874
],
"answer_start": [
2813
],
"text": [
"psychiatry to assess depressive disorder/adjustment disorder,"
]
}
|
Ms. Lofstrom is a 57-year-old female with a past medical history of hypertension, diabetes mellitus, multinodular goiter, arthritis and questionable recurrent bouts of generalized weakness who was admitted for new onset of right sided weakness, right leg numbness and weakness, right arm clumsiness followed by dysarthria. Laboratory tests showed glucose of 353, sodium 138, potassium 4.9, chloride 98, CO2 28, BUN 33, creatinine 1.1, calcium 10.3, magnesium 2.0, troponin 0.09, white count 8.4, hematocrit 39.8, platelet count 367,000, PT 12.1, PTT 19.5, INR 1.0. An echocardiogram revealed evidence of concentric LVH with preserved systolic function, calculated ejection fraction of 55%, one plus tricuspid regurgitation and normal peak doppler flow velocity across the tricuspid valve. Carotid noninvasive studies showed no evidence of hemodynamically significant disease in either carotid artery. MRI showed a focal area of increased T2 signal in the posterior limb of the left internal capsule, close the genu and a similar smaller area of signal abnormality in the left globus pallidus adjacent to the left internal capsule abnormality. The patient had not taken her insulin for several days prior to admission, and was placed on her regular insulin schedule as well as a sliding scale with blood sugar between 150 and high 200s. Her medications included Hydrochlorothiazide 12.5 milligrams once a day, Norvasc 5 milligrams once a day, Taxol 28 milligrams once a day, Premarin 0.625 milligrams once a day, Trazodone, insulin 12 units of regular and 50 units of NPH in the morning and Ansaid 100 milligrams p.o. b.i.d. p.r.n. joint pain. She was also reportedly taking a baby aspirin 81 milligrams once a day, and was placed on subcu heparin and started on full dose aspirin 325 milligrams p.o. q.d. while her antihypertensives were held in order to maintain a systolic blood pressure between 140-160 with a diastolic blood pressure of 85-90. The patient was rehydrated with IV fluids, and close observation was paid to her electrolytes including her potassium. Rheumatology was consulted and recommended checking a urinalysis to check for red blood cells and casts, which showed no protein, no blood, 0-2 red blood cells, and no casts. He therefore suggested to continue aspirin, but in higher doses to alleviate her left shoulder pain. The patient's Norvasc continued to be held with excellent control of her blood pressure between systolic of 140-160, and should not be reinitiated until roughly ten days after her stroke. Social work was consulted due to a history of abuse by her husband, but no further abuse history was elicited since his death. The patient was considered stable and ready for discharge to a rehabilitation facility.
|
What medications did the patient take for her blood pressure
|
{
"answer_end": [
2385
],
"answer_start": [
2343
],
"text": [
"The patient's Norvasc continued to be held"
]
}
|
Patient was admitted to the Toott Hospital surgery service after undergoing LRYGB and was transferred to the floor from the PACU in stable condition. Pain was controlled and no issues were reported overnight into POD1. The patient had an UGI on POD1 that was negative for obstruction or leak, and was started on a Stage I diet which was tolerated well. The following day the patient was started on a Stage II diet that was tolerated as well, but initially struggled to have adequate intake. The patient was started on ALBUTEROL INHALER 2 PUFF INH QID PRN Shortness of Breath, Wheezing, LANTUS (INSULIN GLARGINE) 60 UNITS SC DAILY, ROXICET ORAL SOLUTION (OXYCODONE+APAP LIQUID) 5-10 MILLILITERS PO Q4H PRN Pain, ZANTAC SYRUP (RANITIDINE HCL SYRUP) 150 MG PO BID, ACTIGALL (URSODIOL) 300 MG PO BID, and LEVAQUIN (LEVOFLOXACIN) 500 MG PO DAILY with instructions to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose, and to cycle (hold 1 hr before to 2 hr after) if on tube feeds, and to take 2 hours before or 2 hours after dairy products. Sugars remained high in 200's during admission and patient was seen by Endocrine service and sugars finally improving with lantus 60 sc hs. The patient also had some difficulties with urination on POD4 and required a foley catheter for about a day, but was d/c'd the AM before she was discharged and urinated without incident. Patient was noted to have a UTI at discharge and was started on three day course of levaquin. The patient was discharged in stable condition, tolerating stage II diet well, ambulating, voiding independently, and with adequate pain control. The patient was given explicit instructions to follow-up in clinic with Dr. Truglia in 1-2 weeks and sent home with VNA for wound checks and close sugar control with instructions to f/u with Leland Bredeson by phone and record fingersticks, and to f/u with her PCP if she has further problems with urination. The patient was also instructed to shower but not bathe, swim or otherwise immerse her incision, not to lift anything heavier than a phone book, not to drive or drink alcohol while taking narcotic pain medication, and to resume all of her home medications, and to call her doctor or go to the nearest emergency room if she has fevers > 101.5 F, vomiting, or increased redness, swelling, or discharge from her incision.
|
Was the patient ever prescribed lantus ( insulin glargine )
|
{
"answer_end": [
630
],
"answer_start": [
586
],
"text": [
"LANTUS (INSULIN GLARGINE) 60 UNITS SC DAILY,"
]
}
|
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 the pt. ever been on isordil before
|
{
"answer_end": [
509
],
"answer_start": [
428
],
"text": [
"Metformin 850 TID, Toprol 100 Daily, ASA 325 Daily, Isordil 20 TID, Lasix 20 QOD,"
]
}
|
Mr. Gerache is a 59 yo man with poorly controlled diabetes and asthma who presented with chest pain. He had intermittent chest pain with activity lasting 5 minutes, relieved with rest, as well as shortness of breath when climbing stairs. Cardiac catheterization showed LAD prox 40%, no LCX lesions, no RCA lesions, and R PDA mid 30% lesion. Beta blocker was started, cholesterol was checked (elevated triglycerides 308, total cholesterol 146, HDL 29), statin was started and aspirin was held because of the patient's stated allergy to aspirin (causing asthma type symptoms). He was started on low-dose lisinopril and no prior echo was considered as outpatient. Patient was continued on home regimen of NPH insulin but clearly needs better control of his sugars as outpatient. Hemoglobin A1c is 10.7 and he will need better control of his sugars as outpatient. He has had asthma as a child and no record of PFTs but should obtain as outpatient, with home inhalers continued. Mr. Gaulding currently has good renal function but needs to have his Cr checked after starting the lisinopril. The patient was advised to consider carefully his lifestyle, including diet and exercise plans, and to take medications including VENTOLIN NEBULIZER (ALBUTEROL NEBULIZER) 2.5 MG NEB Q4H PRN Shortness of Breath, ATENOLOL 12.5 MG PO QD Starting IN AM (8/7), NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 60 UNITS QAM; 70 UNITS QPM SC 60 UNITS QAM 70 UNITS QPM, LISINOPRIL 5 MG PO QD, ZOCOR (SIMVASTATIN) 20 MG PO QHS, FLOVENT (FLUTICASONE PROPIONATE) 44 MCG INH BID, COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, and make an appointment with his primary care doctor, take his medications as instructed, and follow up with his cardiologist within 4-6 weeks. He was also placed on a House / Low chol/low sat. fat diet, ADA 2100 cals/dy diet, 2 gram Sodium diet. He was discharged with Full code status and disposition to Home.
|
What is the dosage of flovent ( fluticasone propionate )
|
{
"answer_end": [
1543
],
"answer_start": [
1495
],
"text": [
"FLOVENT (FLUTICASONE PROPIONATE) 44 MCG INH BID,"
]
}
|
A 63 year old male with a history of diabetes mellitus (DM), hypertension (HTN), obesity, and hyperlipidemia presented with chest pain two days ago and a four week history of chronic productive cough, rhinorrhea, and a sensation of nasal discharge down the back of the throat. Labs showed a normal chemical seven, CBC, and cardiac enzymes, and a CXR showed no acute process. The patient was started on ASA and a statin, Lipitor (Atorvastatin) 40 mg PO daily, ECASA 325 mg PO daily, Lantus (Insulin Glargine) 100 units SC daily, Humalog Insulin (Insulin Lispro) 12 units SC AC, Combivent (Ipratropium and Albuterol Sulfate) 2 spray NA daily, Loratadine 10 mg PO daily starting today (5/25), Metformin 1,000 mg PO BID, Prilosec (Omeprazole) 20 mg PO daily, and Azithromycin 250 mg PO daily x 3 doses. Potentially serious interactions were noted for Azithromycin and Atorvastatin Calcium, Simvastatin and Azithromycin, and Valsartan and Potassium Chloride, and the patient was instructed to follow up with his PCP for a possible outpatient stress imaging. In addition, the patient was prescribed Flonase Nasal Spray (Fluticasone Nasal Spray) 2 spray NA daily, Diovan (Valsartan) 160 mg PO daily, and provided with inhalers for wheezing PRN, with diet prophy: lovenox, nexium, 2 gram sodium, house/low chol/low sat. fat, and house/ADA 2100 cals/dy. An override was added on 8/15/06 by NAUMANN, CLAIR L., M.D. on order for Potassium Chloride Immed. Rel. PO (ref # 845941861). The patient was discharged with instructions to follow up with his PCP for a possible outpatient stress imaging and to take his medications as directed.
|
Has the patient had multiple atorvastatin calcium prescriptions
|
{
"answer_end": [
885
],
"answer_start": [
832
],
"text": [
"were noted for Azithromycin and Atorvastatin Calcium,"
]
}
|
The patient was admitted on 4/20/2006 with an Altered Mental Status. A team meeting was held on 3/25/06 and the patient was started on 250 mg b.i.d. of Depakote and Haldol was reduced to just Monday-Wednesday-Friday 1 mg before hemodialysis and 1 mg p.r.n. agitation. On 0/16/06, the patient was diagnosed with pneumonia and started on ceftriaxone IV and Flagyl, which was switched to cefpodoxime and Flagyl for discharge. The patient began to spike fevers on 11/29/06 and was started on antibiotics of ceftriaxone and Flagyl, which was switched to cefpodoxime and Flagyl for discharge, and the cefpodoxime should be dosed after dialysis on Monday-Wednesday-Friday. In terms of endocrine, the patient ultimately discontinued on a regimen of 7 units of Lantus q.a.m. and q.p.m. with 5 units aspart q.a.c. breakfast and lunch and 4 units of aspart q.a.c. dinner. His sliding scale was very light and he is only to be covered with one to two units of aspart during the night as insulin stacks in this patient very easily. At the time of discharge, the patient's fingersticks were well controlled in the 100-200 range and his mental status was A&O x3 and appropriate. Medications on discharge included PhosLo 2001 mg p.o. t.i.d., Depakote 250 mg p.o. b.i.d., folate 1 mg p.o. daily, Haldol 1 mg IV on Monday-Wednesday-Friday given prior to hemodialysis, labetalol 350 mg p.o. b.i.d., lisinopril 80 mg p.o. daily, Flagyl 500 mg p.o. t.i.d. for 14 days, thiamine 100 mg p.o. daily, Norvasc 10 mg p.o. daily, gabapentin 300 mg p.o. q.h.s., cefpodoxime 200 mg p.o. three times a week on Monday-Wednesday-Friday for eight doses given after hemodialysis, Nephrocaps one tablet p.o. daily, sevelamer 2004 mg p.o. t.i.d., Advair diskus 250/50 one puff b.i.d., Nexium 20 mg p.o. daily, Lantus 7 units subcutaneous b.i.d. once in the morning and once evening, aspart 4 units subcutaneous before dinner and 5 units subcutaneous before breakfast and 5 units subcutaneous before lunch, aspart sliding scale starting at blood sugar less than 125 give 0 units, blood sugar 125-300 give 0 units, blood sugar 301-350 give 1 unit, blood sugar 351-400 give 2 units, blood sugar 400-450 give 2 units, albuterol butt paste topical daily, and then p.r.n. Tylenol 650 mg p.r.n. pain, headache, or temperature, albuterol inhaler p.r.n. wheezing, Haldol 1 mg
|
Has the patient had multiple flagyl prescriptions
|
{
"answer_end": [
1479
],
"answer_start": [
1384
],
"text": [
"lisinopril 80 mg p.o. daily, Flagyl 500 mg p.o. t.i.d. for 14 days, thiamine 100 mg p.o. 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.
|
What is the dosage of novalog
|
{
"answer_end": [
947
],
"answer_start": [
931
],
"text": [
"Novalog slides.,"
]
}
|
This is a 70-year-old female with a history of coronary artery disease, hypertension, type II diabetes mellitus, and peripheral vascular disease who presented with increasing chest pain over the past month progressing to pain at rest. On admission, the patient had a blood pressure of 230/90 and was treated with IV Lopressor and Diltiazem drip at 10 mg/hr. The patient underwent cardiac catheterization on 2/25/99, revealing stent restenosis of left circumflex artery, a 60 percent left anterior descending artery stenosis, a 70 percent diagonal ostial stenosis, a 40 percent ostial right coronary artery stenosis, and 95 percent ostial posterior descending artery stenosis. The patient was admitted for rule out myocardial infarction and subsequently underwent a coronary artery bypass graft times three with a left internal mammary artery to the left anterior descending artery and saphenous vein graft to obtuse marginal and saphenous vein graft to posterior descending artery. Postoperatively, the patient was treated with IV Lopressor and Diltiazem drip at 10 mg/hr. for a period of atrial fibrillation with a rapid ventricular response and rates in the 150s. The patient was started on MEDICATIONS including Aspirin 325 mg q.d., Atenolol 125 mg p.o. b.i.d., Captopril 100 mg p.o. t.i.d., Colace, Axid 150 mg p.o. b.i.d., Amlodipine 10 mg p.o. q.d., Imdur 120 mg p.o. b.i.d., and insulin NPH 22 units q.a.m. and regular 10 units q.a.m., and anticoagulation with Coumadin. The patient subsequently converted spontaneously to normal sinus rhythm and was started back on Amlodipine for further blood pressure control and was started on Lopressor and Captopril and gradually increased to preoperative doses. The patient continued to experience brief episodes of atrial fibrillation with spontaneous conversion to normal sinus rhythm. At the time of discharge, the patient was advised to follow-up in six weeks with cardiac surgeon, Dr. Standrew, with primary care physician, Dr. Birdsong, in one to two weeks, and with cardiologist, Dr. Shelko, in one to two weeks, with Discharge Medications: Atenolol 125 mg p.o. b.i.d., Captopril 100 mg p.o. t.i.d., Colace 100 mg p.o. t.i.d., Lasix 40 mg p.o. q.d., insulin 22 units NPH subcu q.a.m. and 10 units regular subcu q.a.m., CZI regular insulin sliding scale, Percocet 1 to 2 tablets p.o. q3 - 4h p.r.n. pain, Zantac 150 mg p.o. b.i.d., Coumadin dosed to INR of 2 to 2.5, and Amlodipine 5 mg p.o. q.d.
|
Has the patient had aspirin in the past
|
{
"answer_end": [
1264
],
"answer_start": [
1215
],
"text": [
"Aspirin 325 mg q.d., Atenolol 125 mg p.o. b.i.d.,"
]
}
|
A 57-year-old female with macromastia and abdominal skin laxity s/p massive weight loss 2/2 gastric bypass was admitted to plastic surgery on 5/8/07. On admission, the patient was prescribed 1. ACETAMINOPHEN 1000 MG PO Q6H, 2. LEVOTHYROXINE SODIUM 75 MCG PO QD, 3. QUINAPRIL 20 MG PO QAM, 4. RANITIDINE HCL 150 MG PO QD, 5. MULTIVITAMINS 1 CAPSULE PO QD, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, VITAMIN C ( ASCORBIC ACID ) 500 MG PO BID, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, KEFLEX ( CEPHALEXIN ) 500 MG PO QID, COLACE ( DOCUSATE SODIUM ) 100 MG PO BID, PEPCID ( FAMOTIDINE ) 20 MG PO BID, DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain (ref #901341233), on order for DILAUDID PO 2-4 MG Q3H (ref #901341233), INSULIN REGULAR HUMAN, supplemental (sliding scale) insulin, If receiving standing regular insulin, please give at same, SYNTHROID ( LEVOTHYROXINE SODIUM ) 75 MCG PO DAILY, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ), REGLAN ( METOCLOPRAMIDE HCL ) 10 MG IV Q6H PRN Nausea, ZOFRAN ( POST-OP N/V ) ( ONDANSETRON HCL ( POST-... ), on order for KCL IV (ref #964491549), POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM CHLORIDE, POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM, SIMETHICONE 80 MG PO QID PRN Upset Stomach, MULTIVITAMIN THERAPEUTIC ( THERAPEUTIC MULTIVI... ) 1 TAB PO DAILY, TIGAN ( TRIMETHOBENZAMIDE HCL ) 200 MG PR Q6H PRN Nausea, ibuprfen. Do not drink/drive/operate machinery with pain medications., Take a stool softener to prevent constipation., 4. Continue your antibiotics as long as you have a drain in place., Sliding Scale (subcutaneously) SC AC+HS Medium Scale, If BS is 125-150, then give 0 units subcutaneously, 30 MILLILITERS PO DAILY PRN Constipation, 1 MG IV Q6H X 2 doses PRN Nausea, Number of Doses Required (approximate): 10, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain. The patient tolerated all procedures without difficulty and post-op period was uneventful, and at discharge, the patient was afebrile with stable vitals, taking po's/voiding q shift, ambulating independently and pain was well-managed with Tigan (Trimethobenzamide HCl) 200 mg PR Q6H PRN Nausea, Tigan (Trimethobenzamide HCl) 300 mg PO Q6H PRN Nausea, Simethicone 80 mg PO QID PRN Upset Stomach, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, 1 mg IV Q6H x 2 doses PRN Nausea, 30 Milliliters PO Daily PRN Constipation and TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, DULCOLAX (Bisacody
|
Has the patient ever tried multivitamins
|
{
"answer_end": [
354
],
"answer_start": [
324
],
"text": [
"MULTIVITAMINS 1 CAPSULE PO QD,"
]
}
|
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.
|
Why is the patient prescribed clindamycin
|
{
"answer_end": [
807
],
"answer_start": [
744
],
"text": [
"gentamicin, and Clindamycin for empiric antimicrobial coverage,"
]
}
|
Ms. Hesby is a 36-year-old woman with very poorly controlled type 1 diabetes, end-stage renal disease, right eye blindness, lower extremity neuropathy, gastroparesis, and a history of extensive infections. She presented to Path Community Hospital with a right thigh burn and infection, and was given a prescription for antibiotics, 20 units of IV insulin, 500 mL normal saline boluses, and several 250 mL boluses, as well as 2 amps of calcium gluconate, Kayexalate, albuterol nebs, and Augmentin and IV vancomycin for her right thigh cellulitis. For long-term management, she was prescribed Lantus 24 units subcu each night, NovoLog sliding scale, PhosLo, Nephrocaps, Vitamin D, Sevelamer 1600 t.i.d., Toprol 100 mg p.o. daily, Lisinopril 5 mg p.o. daily, Plavix 75 mg p.o. daily, Keppra 500 mg p.o. b.i.d., Flovent two puffs b.i.d., Albuterol p.r.n., Baclofen 5 mg p.o. t.i.d., and Ambien 10 mg p.o. at bedtime p.r.n. The patient was admitted with a diagnosis of Diabetic Ketoacidosis (DKA) and was stabilized in the MICU on an insulin waves. She was then transitioned to NPH and finally to Lantus 24 units subcu and her hypertension is being managed on her home dose of Lopressor 25 q.i.d. and switched to Captopril, which is being titrated. Her area of cellulitis has completely resolved, and if she becomes acidotic, the patient can be managed with sodium bicarbonate and D5W in small boluses. The patient is taking her Nephrocaps and sevelamer and is receiving prophylaxis with heparin 5000 units subcu t.i.d., however she has consistently refused her heparin. Of note, on the night of 1/26/06, the patient complained of severe cramping, right lower quadrant pain, which is new. She noted this pain has increased rapidly in the setting of diarrhea. Several C. diff studies, which were sent recently have been negative and the patient has had no blood in her diarrhea. Presumed cause is Augmentin, which has been stopped. The patient has continued to eat freely and is passing diarrhea despite her complaints of 10/10 severe abdominal pain. A CT scan of her abdomen was ordered, but she refused to take oral or IV contrast. The results of this CT scan are pending and will be followed up by the new medical team.
|
Has the patient taken medication for prophylaxis
|
{
"answer_end": [
1515
],
"answer_start": [
1420
],
"text": [
"her Nephrocaps and sevelamer and is receiving prophylaxis with heparin 5000 units subcu t.i.d.,"
]
}
|
This is a 48-year-old female who was admitted to the hospital with pneumonia and Klonopin overdose two days prior to admission, having recently completed an antibiotic course at Dale Skin Sonmu Medical Center for pneumonia. She has not taken her lisinopril or methadone in the past. Upon admission, her respiratory rate was 18, O2 saturation 95% on 8 liters of oxygen and she was aggressively given fluids and was started on Levophed for blood pressure support. Her EKG was notable for low voltage on the precordial leads and her saturations were in the high 80's. She was given vancomycin, Levaquin and gentamicin and 3 liters of normal saline. She had a mild troponin elevation on admission, likely secondary to RV strain, and was given a heparin drip with a goal of 60 to 80. Her second PECT showed a small PE to the right upper lobe, but it was not large enough to explain her dramatic presentation. She had severe hypotension and was on two pressors, which were weaned off of on 4/15/06, but had an episode of hypotension when her BiPAP was started. She was given a little bit of low dose dobutamine and then weaned off of that on 3/6/06. She had an elevated eosinophilia on presentation and it was 4% on admission and increased to 8% on 4/21/06. She was empirically covered on admission with vancomycin, levofloxacin and gentamicin. Her antibiotics were given again on 10/16/06 and on 11/13/06. She did complain of bladder spasms while having the Foley in place and was started on Ditropan. She had multiple negative urinalysis and urine cultures. Once the Foley was discontinued, she was able to void and she stopped having bladder spasms. She was started on Monistat for a yeast infection. She did have a history of severe hypertension and her blood pressures were stable, but not high enough to withstand on additional blood pressure lowering medication. It was discussed with her PCP that she perhaps will need this medication restarted as an outpatient. She also had a normal increase in her cortisol level with ACTH stimulation. Her Coumadin was initially given 10, then a dose of 5 and then 2 dose of 7.5. We are continuing her methadone, which has been switched from 20 mg p.o. daily to 10 mg p.o. b.i.d. She was also given a little bit of Ativan while in-house to help with her agitation and anxiety and was initially given a little bit of Haldol, but that was discontinued on 8/4/06 and there was no additional need for that. She was on unfractionated heparin for her presumed PE until 6/15/06 and then changed to Lovenox in the morning and her methadone has been switched from 20 mg p.o. daily to 10 mg p.o. b.i.d. She was given a little bit of low dose lisinopril while in-house. Her blood pressures were stable, but her weight at that time was 157 kg.
|
Has the patient ever had dobutamine
|
{
"answer_end": [
1143
],
"answer_start": [
1094
],
"text": [
"dobutamine and then weaned off of that on 3/6/06."
]
}
|
This 66-year-old male with a complicated medical history of DM2, CHB with pacer and evidence of clot on pacer wire, and non-compliance with medications and diet was admitted to the ED with symptoms of abdominal pain and SOB with FS of 500-600. On admission, his VS were 99.5, 101/62, 70s, SaO2 96% on room air. His exam was GEN: elderly ill appearing male in NAD; HEENT: Anicteric sclera, PERRL, dry mucous membranes, poor dentition; NECK: Supple, no adenopathy, JVP flat; CHEST: CTA bilaterally; CV: RRR with diffuse PMI, Nl S1, S2 S3 present; ABD: Reducible ventral hernia, NT, ND, bowel sounds present; EXT: No edema or wounds; SKIN: No rashes; EKG: paced; CXR: clear with NAD; ABD CT: small ventral hernia, gallstones, ectasia of the infrarenal aorta, RLL inflammatory changes suggestive of PNA; VQ: Low probability; LABS: Creatinine of 2.2 that dropped to 1.5 with hydration (BL 1.2-1.3). HCT 41.6 with drop after aggressive hydration. Lipase of 132 but has chronic pancreatitis and is now normalizing. UA and ACE negative. The patient received 5 liters of IVF and 36U of insulin in the ED, his blood pressure stabilized with volume, and was transferred to the medical floor. He was started on ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, FOLATE (FOLIC ACID) 1 MG PO QD Starting Today (9/24), LISINOPRIL 30 MG PO QD, THIAMINE HCL 100 MG PO QD, MVI THERAPEUTIC (THERAPEUTIC MULTIVITAMINS) 1 TAB PO QD, LEVOFLOXACIN 500 MG PO QD Starting Today (9/24), LANTUS (INSULIN GLARGINE) 20 UNITS SC QD, LASIX (FUROSEMIDE) 40 MG PO QD, LIPITOR (ATORVASTATIN) 20 MG PO QD, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, and CREON 20 (PANCRELIPASE 20000U) 4 CAPSULE PO TID, with Override Notices added on 4/24/04 by Blain, Guillermo P., M.D. on order for COUMADIN PO (ref #11219725) (POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN) and by Degrange, Diego A., M.D. on order for SIMVASTATIN PO (ref #59315078) (POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & ATORVASTATIN CALCIUM Reason for override: will monitor). He was given teaching regarding nutrition, diabetes, and Coumadin, and instructed to take all medications as directed, and to measure his weight daily. He was also instructed to take a shot with 20 units of insulin every night and to take iron products a minimum of 2 hours before or after a Levofloxacin or Ciprofloxacin dose dose. ADDITIONAL COMMENTS: 1.) Please take your insulin shot (20 units of Lantus) every night at bedtime, 2.) follow an ADA diet, and 3.) take all your medications. He was discharged on ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, FOLATE (FOLIC ACID) 1 MG PO QD Starting Today (9/24), LISINOPRIL 30 MG PO QD, THIAMINE HCL 100 MG PO QD, MVI THERAPEUTIC (THERAPEUTIC MULTIVITAMINS) 1 TAB PO QD, CREON 20 (PANCRELIPASE 20000U) 4 Capsule PO TID, LEVOFLOXACIN 500 MG PO QD, LANTUS (INSULIN GLARGINE) 20 UNITS SC QD, LASIX (FUROSEMIDE) 40 MG PO QD, LIPITOR (ATORVASTATIN) 20 MG PO QD, and COUMADIN (WARFARIN SODIUM) 5 MG PO Q
|
Has the patient had multiple folate ( folic acid ) prescriptions
|
{
"answer_end": [
1296
],
"answer_start": [
1244
],
"text": [
"FOLATE (FOLIC ACID) 1 MG PO QD Starting Today (9/24)"
]
}
|
Ms. Veltin is a 72 year old woman with a PAST MEDICAL HISTORY significant for coronary artery disease, diabetes, and hypertension. On admission, her CURRENT MEDICATIONS included Atenolol 50 b.i.d., hydrochlorothiazide 25 q.d., Lisinopril 40 q.d., simvastatin 10 q.d., metformin 500 q.d., and NPH 43 q.a.m. and 24 q.p.m., while her PAST MEDICAL HISTORY was significant for diabetes for which she took insulin and checked her sugars at home which ran 170 range to 200 range. During admission, she was maintained on metformin, her blood pressure was controlled with Lisinopril at 40 milligrams, she was given nifedipine extended release 120 q.d., and her sugars at home on her regimen of 43 q.a.m. and 24 q.p.m. were in control. She was also maintained on her aspirin and simvastatin, and given Lasix 20 q.d. times seven days and four liters through admission with Lasix at 40 intravenously. Her cardiovascular evaluation showed three vessel disease, diastolic dysfunction, and pulmonary artery systolic pressure of 36 plus RA, but no wall motion abnormalities. Her blood pressure regimen was advanced with the addition of Atenolol 50 b.i.d. and titration up to 120 milligrams q.d. of nifedipine extended release. For congestive heart failure, she diuresed approximately four liters through admission with Lasix at 40 intravenously and would be discharged on a seven day course of Lasix at 20 p.o. q.d. Pulmonary evaluation showed hypoxia on admission to 85% on room air, D-dymer greater than 1000, V/Q scan low probability, negative lower extremity noninvasives, chest CT without interstitial lung disease, and pulmonary function tests consistent with restrictive picture. Endocrine evaluation revealed that she was maintained on metformin during admission and also on half of her dose of NPH given her decreased p.o. intake. She took insulin and checked her sugars at home, which were 170 to 200, and she was discharged on her normal regimen of 43 q.a.m. and 24 q.p.m. of NPH. Discharge medications included Atenolol 50 b.i.d., hydrochlorothiazide 25 q.d., Lisinopril 40 q.d., nifedipine extended release 120 q.d., metformin 500 q.d., NPH 43 q.a.m. and 24 q.p.m., simvastatin 10 q.d., aspirin 325 q.d., and Lasix 20 milligrams p.o. q.d. times seven days. She was discharged in stable condition on March, 2000 and will follow up with Dr. Nakajima, her primary care doctor, and Dr. Klang, her cardiologist.
|
hydrochlorothiazide
|
{
"answer_end": [
226
],
"answer_start": [
178
],
"text": [
"Atenolol 50 b.i.d., hydrochlorothiazide 25 q.d.,"
]
}
|
Dewey Wittie, a 54 year old Hispanic female with morbid obesity, hypertension, non-insulin dependent diabetes mellitus, and sleep apnea on CPAP, was admitted to the MED service on 8/14/2006 for atypical chest pain. An ETT was performed in the ED with an EF of 55%, not in failure, and htn was controlled with BB and ACEI. She presented with one week history of intermittent left arm pain while washing dishes, lasting 15 minutes, sometimes radiating to her left chest, positional, not associated with shortness of breath, nausea, or vomiting. She responded to sublingual nitroglycerin (within 5-10 minutes) and her first set of cardiac enzymes is negative. She received aspirin and heparin gtt was started. Her home medications included Atenolol 50AM/25PM, Avadia 8, Fluoxetine 20, Metformin 1gm BID, Glyburide 10BID, Lisinopril 20, CaCO3 1200QD, and Amitriptyline 50QHS. She completed a ROMI and exercise tolerance test, which she walked for 2 minutes and 33 seconds at 75% maximum predicted heart rate, and stopped due to fatigue with no EKG changes. She was discharged stable with instructions to follow up with an A1C and lipid profile, and to pursue weight reduction. She was advised to resume regular exercise and make a follow up appointment with their primary care provider. The discharge medications included AMITRIPTYLINE HCL 50 MG PO BEDTIME, ENTERIC COATED ASPIRIN (ASPIRIN ENTERIC COATED) 81 MG PO DAILY, ATENOLOL 50 MG QAM; 25 MG QPM PO 50 MG QAM 25 MG QPM, CALTRATE 600 + D (CALCIUM CARBONATE 1,500 MG (...) 2 TAB PO DAILY, FLUOXETINE HCL 20 MG PO DAILY, LISINOPRIL 20 MG PO DAILY HOLD IF: o, METFORMIN 1,000 MG PO BID, AVADIA 8 UNIT DAILY, and GLYBURIDE 10 MG PO BID. The patient was warned about a potentially serious interaction between lisinopril and potassium chloride. The patient's diet was house/low chol/low sat. fat and ADA 1800 cals/dy, with 4 gram sodium.
|
How often does the patient take avadia
|
{
"answer_end": [
1655
],
"answer_start": [
1635
],
"text": [
"AVADIA 8 UNIT DAILY,"
]
}
|
A 45-year-old man with a history of familial cardiomyopathy and status post cardiac transplant in 2002, and chronic renal insufficiency presented with greater than two weeks of polyuria, polydipsia, blurry vision, muscle cramps, and myalgias and reported approximately a 15-pound weight loss over three weeks with decrease in usual lower extremity edema. On admission, notable for a blood glucose of 1064, creatinine 2.2 from a baseline of 1.8, sodium 130, potassium 4.9. Endocrine service was consulted and the patient was controlled with a combination regimen of Lantus, Novolog q. a.c., combined with a Novolog sliding scale. The patient was discharged with followup with Napoleon Mettee, the diabetic teaching nurse and with Dr. Jonson in the diabetes clinic and with VNA services to assist with home medications. The patient had mild acute gout flare during admission for which he was started on colchicine. The patient was discharged with medications including Calcium carbonate 1250 mg t.i.d., Cartia XT 300 mg daily, CellCept 1500 mg b.i.d., colchicine 0.6 mg daily p.r.n., Neoral 150 mg b.i.d., folate 1 mg daily, K-dur 20 mg daily, magnesium oxide 400 mg b.i.d., methotrexate 2.5 mg daily, Pravastatin 20 mg daily, prednisone 7 mg daily, Rocaltrol 0.25 mg daily, Synthroid 150 mcg daily, Torsemide 40 mg daily, Vitamin C, Vitamin E, and cyclosporin 150 mg b.i.d., Vitamin C 500 mg b.i.d., Rocaltrol 0.25 mcg daily, calcium carbonate 500 mg t.i.d., colchicine 0.3 mg p.o. b.i.d., cyclosporin 150 mg b.i.d., folic acid 1 mg daily, Synthroid 150 mcg daily, magnesium oxide 420 mg b.i.d., prednisone 7.5 mg q.a.m., Vitamin E 400 units daily, Pravachol 20 mg at night, Cartia XT that is diltiazem extended release 300 mg daily, CellCept 1500 mg b.i.d., Lantus insulin (Glargine) 40 units subcutaneous q.a.m., Novolog 12 units before breakfast, Novolog 12 units before lunch, Novolog 14 units before dinner, and Novolog sliding scale q. a.c. The patient demonstrated proper understanding of blood glucose testing and insulin administration prior to discharge.
|
Previous synthroid
|
{
"answer_end": [
1297
],
"answer_start": [
1273
],
"text": [
"Synthroid 150 mcg daily,"
]
}
|
The patient is a 60 year old black female presenting with a chief complaint of dizziness and syncope. She was initially seen in 1989, and pacer insertion was performed after an episode of asystole on the monitor. In March 1994, she was seen by the pacer service and found to have a high failure rate necessitating a new pacer insertion. Today, she passed out while walking back to bed and denied any trauma, chest pain, shortness of breath or palpitations. On admission, physical exam was normal and laboratory data showed K 3.9, mag 2.1, Hematocrit 38.9. EKG showed normal sinus rhythm and left ventricular hypertrophy. The patient was admitted and the story was most consistent with an arrhythmia induced syncope. Right upper extremity venogram showed patent vessels and pacemaker insertion was performed without any complications on 4 of October. The patient was discharged to home the following day on Keflex 500 mg q8h for nine doses and Percocet 1-2 p.o. q6h p.r.n. pain, with follow-up in the Pacemaker Clinic.
|
What is the current dose of the patient's keflex
|
{
"answer_end": [
938
],
"answer_start": [
850
],
"text": [
"The patient was discharged to home the following day on Keflex 500 mg q8h for nine doses"
]
}
|
The patient is a 74-year-old male with a history of acute inferior myocardial infarction in February of 1998 and total occlusion of the mid circumflex with fresh thrombus, complicated by postmyocardial infarction atrial fibrillation with Mobitz type I block, now admitted following syncopal episode. At admission, the laboratory data was significant for a creatinine of 1.6 and a potassium of 5.1. Blood count was normal, CK 39, and cardiac Troponin I 0.02. The patient was loaded on procainamide and MEDICATIONS ON ADMISSION included Aspirin 325 mg q.d., Captopril 75 mg t.i.d., NPH insulin 18 q.a.m. and 8 q.p.m., Procainamide 500 mg t.i.d., and Simvastatin 20 mg once a day. The patient underwent evaluation for possible ischemic causes of an arrhythmia and was initially ruled out for myocardial infarction by serial enzymes and electrocardiograms. On standard Bruce protocol exercise tolerance test mibi, the patient went four minutes and thirty seconds, with maximum heart rate 121 and maximum blood pressure 210/85. He had typical chest pain for angina and chest tightness at peak exercise which was relieved with rest. The mibi images showed a mixed MI in basilar half of the inferior wall and mild peri-infarct ischemia in 3/20 segments in the right coronary artery territory. PAST MEDICAL HISTORY included Coronary artery disease, Diabetes mellitus on insulin, Hypertension, Status post bilateral knee replacements, asbestos exposure, and chronic renal insufficiency. The patient underwent cardiac catheterization which revealed a normal left main, left anterior descending artery with minor irregularities, left circumflex with 90 percent in-stent restenosis in proximal segment with a dominant left circumflex, and right coronary artery with a mid 50 percent lesion. He underwent successful percutaneous transluminal coronary angioplasty of the in-stent restenosis and was subsequently continued on aspirin. After the procainamide was held, the patient underwent electrophysiology study revealing normal sinus node recovery time, impaired AV nodal conduction, no inducible sustained ventricular tachycardia, and no inducible supraventricular tachycardia or atrial fibrillation. The patient was discharged to home with plans to follow-up with his primary cardiologist, perhaps with a Holter or event monitor and was prescribed Aspirin 325 mg q.d., Captopril 75 mg t.i.d., NPH Humulin insulin 18 units q.a.m. and 8 units q.p.m., nitroglycerin sublingual tablets, Vitamin E, and Simvastatin 20 mg q.h.s. The patient will be followed up by his primary care doctor, in particular the posterior cervical single lymph node should be followed up by his primary care physician.
|
Did the patient receive procainamide. for atrial fibrillation
|
{
"answer_end": [
496
],
"answer_start": [
458
],
"text": [
"The patient was loaded on procainamide"
]
}
|
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.
|
Has the patient had multiple percocet prescriptions
|
{
"answer_end": [
971
],
"answer_start": [
924
],
"text": [
"Percocet 1-2 tabs p.o. q 3-4 hours p.r.n. pain,"
]
}
|
Ms. Watterson, a 75 year old female with a history of CHF/CAD, A-fib, lung CA s/p R wedge resection, basal cell CA on lip s/p resection, and uterine CA s/p TAH, was admitted to the hospital with increasing SOB, weight gain, orthopnea, fever, chills, decreased UOP x1-2 days, L leg swelling, and a T98.6, P72, BP121/65, RR18. In the ED she was given O2 and 40mg of Lasix IV, and her daily meds included Acetylsalicylic Acid 325mg PO daily, Allopurinol 100mg PO daily, Docusate Sodium 100mg PO BID, Esomeprazole 20mg PO daily, Ferrous Sulfate 325mg PO TID, Glipizide 5mg PO BID, KCL Slow Release 20MEQ PO BID, Levothyroxine Sodium 100mcg PO daily, Lorazepam 0.5mg PO daily PRN Insomnia/Anxiety, Metolazone 2.5mg PO daily, Metoprolol Succinate Extended Release 100mg PO daily, Multivitamins 1tab PO daily, Pravastatin 40mg PO bedtime, Torsemide 20mg PO BID, and Warfarin Sodium 2mg PO QPM. CXR, diuresis with IV medications, EKG, R/O MI, and Abdo CT were performed and the patient improved clinically. Antibiotics such as Azithromycin and Levofloxacin were initiated for PNA, and Cefpodoxime 200mg PO QD x 7 days was added for gram pos coverage. In addition, she was given Tessalon Perels 100mg PO TID PRN cough, Guiatuss 10ml PO Q4H PRN cough, Loperamide 2mg PO Q6H PRN diarrhea, and Metolazone 2.5mg PO daily PRN weight gain. The patient was supertheraputic on Coumadin and it was held throughout her admission, INR remained 3.9 to 4.0 in the setting of hemoptysis, started on 1/2 her home coumadin with VNA/PCP f/u in 2 days, d/ced on Coumadin 1mg qpm, UA and urine CTX were negative, developed diarrhea concerning for c.diff but had only been on azithromycin x1 day, all stool studies were negative, presumed viral gastroenteritis, started on loperamide before discharge to be continued prn diarrhea, pt's po DM rx were held during her admission covered with Lantus and Insulin Asp SS, HgA1c was sent and was in nl range, home po rx were restarted on discharge, kept on her home dose of levoxyl, TSH was rechecked and within nl range, home po rx Allopurinol was also continued, the following antibiotics were added: Levofloxacin 500mg by mouth every 48 hours for 7 days, Cefpodoxime 200mg by mouth once daily for 7 days, Tessalon Perels 100mg by mouth three times daily as needed for cough, Guiatuss 10ml by mouth every 4 hours as needed for cough, Loperamide 2mg by mouth every 6 hours as needed for diarrhea, Coumadin: Were taking 2mg by mouth in the pm, now take 1mg by mouth in the pm, and instructions, pt took Metolazone 2.5mg and Torsamide 40mg x1 which did. During her stay the patient remained in afib with good rate control on her bblocker, rx of betablocker, ASA, statin, was diuresed with IV Lasix in the ED, Metolazone 2.5mg and Torsamide 40mg x1, on 2/22 pt's weight increased to 72.9 kg from 70.6kg, restarted on her home rx of torsemide 20mg po bid, was roughly negative 1.3L, pt's daily weights decreased off diuretics, was found to be supertheraputic on her coumadin which was held throughout admission, PNA was initially treated with azithromycin but as her cough and o2 levels persisted, pt was begun on ceftaz and levo for gram pos coverage (levo) double gram neg coverage, and ceftaz changed to cefpodoxime 200mg po qd x 7 days, however pt had only been on azithromycin x 1 day, all stool studies were negative, presumed viral gastroenteritis
|
Has this patient ever been treated with guiatuss
|
{
"answer_end": [
2349
],
"answer_start": [
2292
],
"text": [
"Guiatuss 10ml by mouth every 4 hours as needed for cough,"
]
}
|
A 79-year-old female with a history of diabetes mellitus, congestive heart failure, coronary artery disease, chronic renal insufficiency, and anemia, status post five years of TAMOXIFEN TREATMENT, was admitted to Darnbo Hospital on 7/29/97 after sudden onset of shortness of breath unrelieved by one sublingual nitroglycerin. This shortness of breath was managed with IV Lasix and IV nitroglycerin, saturating at 99% on 100% oxygen, and IV heparin at 1,300 units per hour. Her blood pressure was stabilized on IV nitroglycerin with TRANSFER MEDICATIONS: Lopressor 25 mg PO BID started three weeks ago, Axid 150 mg PO BID, enteric coated aspirin 325 mg PO QD, Isordil 30 mg PO QID, hydralazine 50 mg PO QID, Lasix 40 mg PO QD, Timoptic 0.25% one GTT OU BID, Serax 30 mg PO QHS PRN insomnia, and nitroglycerin 1/150 one tablet sublingual Q 5 minutes times three PRN chest pain. She underwent cardiac catheterization on 11/4/97 with PTCA plus stent placement to her RCA with a good result and is on Ticlid for two weeks. Her blood pressure was well controlled in her target range of 140-160 systolic blood pressure on hydralazine, Lasix, and Lopressor. She was found to have an iron deficiency anemia treated with Niferex 150 mg PO BID and may benefit from Epogen as an outpatient. She was discharged to home in stable condition to follow up with her cardiologist and primary care physician based on previously scheduled appointments. Discharge medications included enteric coated aspirin 325 mg PO QD, Lasix 40 mg PO QD, hydralazine 50 mg PO QID, Isordil 30 mg PO TID, Lopressor 25 mg PO BID, nitroglycerin 1/150 one tablet sublingual Q 5 minutes times three PRN chest pain, Timoptic 0.25% one drop OU BID, Axid 150 mg PO QD, and Ticlid 250 mg PO BID for two weeks. Also, Niferex tablet 150 mg PO BID. Discharge instructions included that the patient have her CBC checked at two weeks and four weeks given her Ticlid therapy.
|
Has patient ever been prescribed nitroglycerin 1/150
|
{
"answer_end": [
875
],
"answer_start": [
794
],
"text": [
"nitroglycerin 1/150 one tablet sublingual Q 5 minutes times three PRN chest pain."
]
}
|
76 year-old male with significant cardiac history, including NSTEMI and asystole arrest, presented with weakness, dizziness, and chest pain for 3 days, currently chest pain-free. EKG on admission showed subtle changes with <1 mm ST depression in lateral leads. Patient was given Acetylsalicylic Acid 325 mg PO QD, Ativan 0.5 mg x 1, Magnesium Chloride 500 mg x 1, Atenolol 25 mg PO QD, Atorvastatin 80 mg PO QD, Docusate Sodium 100 mg PO BID, Losartan 50 mg PO QD, Amlodipine 10 mg PO QD, Pantoprazole 40 mg PO QD, Lipitor (Atorvastatin) 80 mg PO daily, Colace (Docusate Sodium) 100 mg PO BID, Potassium Chloride IV, Potassium Chloride Immediate Release PO, Magnesium Gluconate (Magnesium Gluconate) 400 mg PO daily, Protonix (Pantoprazole) 40 mg PO daily, ASA 325 mg x 1, and MIBI ordered. Metformin was held and DM protocol was instituted while in house. Patient was at risk for cardiac event and was treated with BB and titrated as tolerated, with Tele monitoring. Nutrition consult was ordered due to recent decrease in appetite and FTT picture. SW was consulted and patient was discussed at length for services at home when discharged. Patient left AMA despite lengthy discussion about his health and risk for MI/death. Number of Doses Required (approximate): 3 for MG GLUCONATE (MAGNESIUM GLUCONATE) and 2 for TERAZOSIN HCL 1 MG PO DAILY. Home meds included ASA 325 mg daily, lipitor 80 mg daily, amlodipine 5 mg daily, protonix 40 mg daily, losartan 50 mg daily, and terazosin 1 mg daily. An override was added on 7/10/07 by KETCHAM, JAKE WALDO, M.D., PH.D. on order for KCL IV (ref # 687673059) with POTENTIALLY SERIOUS INTERACTION: LOSARTAN POTASSIUM & POTASSIUM CHLORIDE Reason for override: md aware, and on 11/8/07 by DERNIER, AUGUSTINE A., P.A.-C. on order for KCL IMMEDIATE RELEASE PO (ref # 856712835) with the same POTENTIALLY SERIOUS INTERACTION. Patient was instructed to resume regular exercise and to avoid grapefruit unless instructed otherwise. He was also given a diet of House/2gm Na/Carbohydrate Controlled/Low saturated fat low cholesterol.
|
has there been a prior acetylsalicylic acid
|
{
"answer_end": [
313
],
"answer_start": [
261
],
"text": [
"Patient was given Acetylsalicylic Acid 325 mg PO QD,"
]
}
|
Patient Emilio R. Strausberg was admitted on 5/26/2004 with atrial fibrillation and calcaneous fracture and was discharged on 7/18/2004 with discharge orders including ECASA (Aspirin Enteric Coated) 325 MG PO QD, with a potentially serious interaction with Warfarin, Vitamin B12 (Cyanocobalamin) 1,000 MCG PO QD, Digoxin 0.25 MG PO QD, Colace (Docusate Sodium) 100 MG PO BID, Lasix (Furosemide) 60 MG PO BID, Oxycodone 5 MG PO Q6H PRN Pain, Coumadin (Warfarin Sodium) 5 MG PO QPM, with a potentially serious interaction with Atorvastatin, Metoprolol (Sust. Rel.) 300 MG PO QD, Accupril (Quinapril) 20 MG PO QD, Tiazac (Diltiazem Extended Release) 240 MG PO QAM, Lipitor (Atorvastatin) 80 MG PO QD, with a potentially serious interaction with Niacin, Vit. B-3 and Calcium, Niaspan (Nicotinic Acid Sustained Release) 1 GM PO QHS, Lantus (Insulin Glargine) 66 UNITS SC QPM, Insulin Lispro Mix 75/25 74 UNITS SC QAM, Glucometer 1 EA SC x1, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM. Override notices were added on 6/9/04 with reasons such as heart, home med, and home emd. The patient was rate controlled with IV metoprolol and diltiazem, instructed to continue ASA, continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->80), continue lasix, 60 bid (was 40po TID at start of hospitalization), and to continue home insulin. Diabetes education was provided. Mr. Schmider was given ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, with a POTENTIALLY SERIOUS INTERACTION: WARFARIN & ASPIRIN, VITAMIN B12 (CYANOCOBALAMIN) 1,000 MCG PO QD, DIGOXIN 0.25 MG PO QD, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LASIX (FUROSEMIDE) 60 MG PO BID, OXYCODONE 5 MG PO Q6H PRN Pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, on order for ECASA PO (ref # 23344198), on order for LIPITOR PO (ref # 90217884), POTENTIALLY SERIOUS INTERACTION: WARFARIN & ATORVASTATIN CALCIUM Reason for override: home 40mg, METOPROLOL (SUST. REL.) 300 MG PO QD, on order for DILTIAZEM PO (ref # 68655693), POTENTIALLY SERIOUS INTERACTION: METOPROLOL TARTRATE & DILTIAZEM HCL Reason for override: home med, on order for TIAZAC PO (ref # 86614276), on order for DILTIAZEM SUSTAINED RELEASE PO (ref #, ACCUPRIL (QUINAPRIL) 20 MG PO QD, TIAZAC (DILTIAZEM EXTENDED RELEASE) 240 MG PO QAM, LIPITOR (ATORVASTATIN) 80 MG PO QD, POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & NIASPAN (NICOTINIC ACID SUSTAINED RELEASE) 1 GM PO QHS, LANTUS (INSULIN GLARGINE) 66 UNITS SC QPM, INSULIN LISPRO MIX 75/25 74 UNITS SC QAM, GLUCOMETER 1 EA SC x1, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM, as well as continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->
|
Has the patient had lipitor/niacin in the past
|
{
"answer_end": [
1325
],
"answer_start": [
1277
],
"text": [
"continue lipitor/niacin (incr lipitor 40--->80),"
]
}
|
The 68-year-old female patient presented with lower extremity swelling and erythema at the lower pole of her sternal wound, and her past medical history includes hypertension, diabetes, hypothyroidism, hypercholesterolemia, COPD, GERD, depression, history of GI bleed on Coumadin therapy, and pulmonary hypertension. On admission, the patient was started on 1. Toprol 25 p.o. daily., 2. Valsartan 40 mg p.o. daily., 3. Aspirin 81 mg p.o. daily., 4. Plavix 75 mg p.o. daily., 6. Lasix 40 mg p.o. b.i.d., 7. Spironolactone 25 mg p.o. daily., 8. Simvastatin 20 mg p.o. daily., 9. Nortriptyline 50 mg p.o. daily., 10. Fluoxetine 20 mg p.o. daily., 11. Synthroid 88 mcg p.o. daily., and a Lasix drip and Diuril with antibiotics for coverage of possible lower extremity cellulitis. After transthoracic echocardiogram revealed an ejection fraction of 40% to 45% and a stable mitral valve, the patient was started on a Lasix drip and Diuril with improvement of symptoms, and the Pulmonary team was consulted and recommended regimen of Advair and steroid taper for her COPD, and she was empirically covered for pneumonia with levofloxacin and Flagyl and continued to diurese well on a Lasix drip. Her preadmission cardiac meds, as well as her Coumadin for atrial fibrillation, were restarted, and the patient required ongoing aggressive diuresis to eventually achieve a fluid balance of is negative 1 liter daily. Liver function tests, as well as amylase and lipase, were checked and noted to be normal, and the patient's nausea and vomiting resolved when her bowels began to move. The patient was discharged to home in good condition on hospital day #8 with medications including Enteric-coated aspirin 81 mg p.o. daily, Zetia 10 mg p.o. daily, Fluoxetine 20 mg p.o. daily, Advair Diskus one puff nebulized b.i.d., Lasix 60 mg p.o. b.i.d., NPH insulin 30 units subcutaneously q.p.m., NPH insulin 20 units subcutaneously q.a.m., Potassium slow release 30 mEq p.o. daily, Levofloxacin 500 mg p.o. q.24 h. x4 doses, Levothyroxine 88 mcg p.o. daily, Toprol-XL 100 mg p.o. daily, Nortriptyline 50 mg p.o. nightly, Prednisone taper 30 mg q.24 h. x3 doses, 20 mg q.24 h. x3 doses followed by a 10 mg q.24 h. x3 doses, then 5 mg q.24 h. x3 doses, Simvastatin 40 mg p.o. nightly, Diovan 20 mg p.o. daily, and Coumadin to be taken as directed to maintain INR 2 to 2.5 for atrial fibrillation, with followup appointments with her cardiologist, Dr. Schwarzkopf in one to two weeks with her cardiac surgeon, Dr. Carlough in four to six weeks, and VNA will monitor her vital signs, weight, and wounds, and the patient's INR and Coumadin dosing will be followed by S Community Hospital Anticoagulation Service at 300-135-5841.
|
levofloxacin
|
{
"answer_end": [
1187
],
"answer_start": [
1112
],
"text": [
"with levofloxacin and Flagyl and continued to diurese well on a Lasix drip."
]
}
|
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