context
stringlengths 762
4.39k
| question
stringlengths 2
220
| answers
dict |
|---|---|---|
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.
|
What was the dosage prescribed of vitamin e
|
{
"answer_end": [
1673
],
"answer_start": [
1648
],
"text": [
"Pravachol 20 mg at night,"
]
}
|
Mr. Lewter is a 65-year-old gentleman with a history of non-insulin-dependent diabetes mellitus, hypertension, dyslipidemia, and peripheral vascular disease who presented to Tci Prosamp Memorial Hospital on 5/1/06 with unstable angina. EKG revealed sinus tachycardia with a new incomplete left bundle-branch block and downsloping 1-1.5 mm ST depressions in V3 through V6 and 1 mm depression in aVL. Cardiac catheterization revealed an ostial 100% stenosis in the left circumflex coronary artery, a proximal 60% stenosis and a mid 50% stenosis in the left anterior descending coronary artery, a proximal 80% stenosis and a mid 60% stenosis in the right coronary artery, a right dominant circulation, an ejection fraction of 30%, and collateral flow from the second diagonal to the third marginal in the right posterior left ventricular branch to the second marginal, as well as left ventricular hypokinesis and severe inferior and apical. The patient was not heparinized due to the fact that he was on Coumadin for peripheral vascular disease with a therapeutic INR. On 9/18/06, the patient underwent coronary artery bypass graft x3 with left internal mammary artery to left anterior descending coronary artery, a sequential graft and a vein graft connecting from the aorta to the second obtuse marginal coronary artery and then to the left ventricular branch. He was on medications including Lopressor 37.5 mg b.i.d., aspirin 325 mg daily, Colace 100 mg b.i.d., Pepcid 20 mg IV q.12h., insulin sliding scale, atorvastatin 80 mg daily, glipizide, Avandia, Zestril, metformin, meclizine, lactulose, vitamin C, Protonix, Niaspan, Neurontin, Zincate, and Coumadin for peripheral vascular disease. The patient was started on oral medication of glipizide 5 mg and was covered with a NovoLog sliding scale, was transfused 3 units of packed red blood cells, re-started on Coumadin for his reinsertion, and was started on Flomax 0.4 mg once a day. He had some urinary retention postoperatively and did require Foley catheter placement. He was discharged on Enteric-coated aspirin 81 mg QD, Colace 100 mg b.i.d. while taking Dilaudid, Lasix 40 mg QD x3 doses, glipizide 5 mg daily, Dilaudid 2-4 mg every three hours p.r.n. pain, lisinopril 2.5 mg daily, Niferex 150 mg b.i.d., Toprol-XL 150 mg QD, Lipitor 80 mg daily, Flomax 0.4 mg QD, potassium chloride slow release 10 mEq QD x3 doses with Lasix and Coumadin QD per INR result, and the patient will receive 4 mg of Coumadin this evening for his reinsertion and was instructed to remain on his Flomax until that time. Mr. Jana was discharged to rehab in stable condition and will follow up with his cardiologist Dr. Reuben Duttinger in one week, his heart failure cardiologist Dr. Wilton Durkee on 11/10/06 at 1:30 in the afternoon, and Urology Clinic at the Centsson Medical Center for his urinary retention in one week.
|
Why is the patient taking coumadin
|
{
"answer_end": [
1077
],
"answer_start": [
1014
],
"text": [
"peripheral vascular disease with a therapeutic INR. On 9/18/06,"
]
}
|
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 this patient ever been on digoxin
|
{
"answer_end": [
500
],
"answer_start": [
443
],
"text": [
"his digoxin was stopped and his amiodarone was decreased."
]
}
|
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.
|
nitroglycerin tablets
|
{
"answer_end": [
1485
],
"answer_start": [
1434
],
"text": [
"Nitroglycerin tablets sublingual p.r.n. chest pain."
]
}
|
The patient had continued to remain stable from an ischemia standpoint and a beta-blocker was added back to his regimen and was titrated to a dose of Lopressor 12.5 mg p.o. t.i.d. He continues on aspirin and statin, and he also continues on Isordil 20 mg p.o. t.i.d. and hydralazine 50 mg p.o. t.i.d. for after load reduction, as well as digoxin at 0.125 mg p.o. q.o.d. The patient was aggressively diuresed with intravenous Lasix and Zaroxolyn followed by conversion to oral diuresis with torsemide at the dose of 100 mg p.o. q.d. He was also found to have atrial clot on transesophageal echocardiogram and thus was started on a heparin drip and transitioned on Coumadin, but after a discussion with the CHF Team, the decision was made not to continue Coumadin anticoagulation and instead he was given aspirin and Plavix at full doses. The patient's medication regimen also includes Colace 100 mg p.o. b.i.d., Folate 1 mg p.o. q.d., Robitussin A-C 5 mL p.o. q.4h. p.r.n. cough, Simethicone 80 mg p.o. q.i.d. p.r.n. upset stomach, Multivitamin one tab p.o. q.d., Compazine 5-10 mg p.o. q.6h. p.r.n. nausea, Tessalon 100 mg p.o. t.i.d. p.r.n. cough, Lipitor 80 mg p.o. q.d., Plavix 75 mg p.o. q.d., Lantus 5 units subcu q.p.m., NovoLog 3 units subcu a.c. and NovoLog sliding scale. The patient is on ACE inhibitor and was restarted on a low-dose beta-blocker at 12.5 mg p.o. t.i.d. as well as his insulin regimen can be adjusted as an outpatient and possibly oral diabetes medications restarted. He is to be discharged to the Com Medical Center for further rehabilitation, with follow-up appointments with Dr. Kyle Yandle in the T Las on 2/28/05 at 08:30 a.m., Dr. Clyde Chatampaya of Elmert Hospital Cardiology 9/26/05 and Raymond Banaag of TRISTONTERN MEDICAL CENTER PCP on 10/3/05 at 01:50 p.m. His sister, Alexis Fernendez, is his health care proxy and is providing substantial social support.
|
Why has the patient been prescribed robitussin a-c
|
{
"answer_end": [
978
],
"answer_start": [
934
],
"text": [
"Robitussin A-C 5 mL p.o. q.4h. p.r.n. cough,"
]
}
|
A 56-year-old morbidly obese female with abdominal skin laxity due to massive weight loss after gastric bypass was admitted to plastics for panniculectomy. The patient tolerated the procedure without difficulty and the post-operative period has been uneventful. At discharge, the patient is afebrile with stable vitals, taking PO's/voiding q shift and has ambulated independently with some difficulty given body habitus. Pain has been well managed and incisions are clean, dry, and intact. JP's with moderate serosanguinous output remain in place. The patient was discharged to rehab in a stable condition, with instructions to continue antibiotics as long as drains are in place, change drain sponges daily, strip drains twice daily, sponge baths only while drains are in place, walking as tolerated, no lifting more than 10 pounds, no jogging, swimming, or aerobics for 4-6 weeks, and to monitor/return for signs of infection. Medications prescribed include TYLENOL (Acetaminophen) 1000 mg PO Q6H, KEFLEX (Cephalexin) 500 mg PO QID, COLACE (Docusate Sodium) 100 mg PO BID, PEPCID (Famotidine) 20 mg PO BID, DILAUDID (Hydromorphone HCL) 2-4 mg PO Q4H PRN Pain, INSULIN REGULAR HUMAN Sliding Scale (subcutaneously) SC Q4H Low Scale, LEVOTHYROXINE SODIUM 75 mcg PO daily, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, MILK OF MAGNESIA (Magnesium Hydroxide) 30 milliliters PO daily PRN Constipation, METOCLOPRAMIDE HCL 10 mg IV Q8H PRN Nausea, QUINAPRIL 20 mg PO daily, SIMETHICONE 40 mg PO QID PRN Upset Stomach, Other:gas, and STYKER PAIN PUMP (Bupivacaine 0.5%) 400 milliliters IV Q24H Instructions: Rate = 4ml/hr. The patient has a probable allergy to Morphine and Code Status is Full Code.
|
Has the pt. ever been on quinapril before
|
{
"answer_end": [
1494
],
"answer_start": [
1469
],
"text": [
"QUINAPRIL 20 mg PO daily,"
]
}
|
Gregory Goodness, a 79-year-old man, was admitted to Sachua Oaks De on 5/18/2003 and discharged on 3/24/2003 with a disposition of home with services. The patient was put on a full code status and the attending physician was Gene R. Kos, M.D. The main diagnoses included Hypercalcemia, Hyperkalemia, CHF, NIDDM, AI/AS, bicuspid aortic valve, LVH, HTN, s/p thyroglossal duct cyst excision, h/o, and CAD. The discharge medications included ECASA (Aspirin Enteric Coated) 325 mg PO QD, Enalapril Maleate 7.5 mg PO BID, hold if b/p<100 systolic, ACE for heart, NPH Humulin Insulin (Insulin NPH Human) 2 units SC QAM, NPH Humulin Insulin (Insulin NPH Human) 3 units SC QPM, Nitroglycerin 1/150 (0.4 mg) 1 tab SL q5min x 3 PRN chest pain, Imdur (Isosorbide Mononit. (SR)) 30 mg PO QD, Nephrocaps (Nephro-Vit Rx) 1 tab PO QD, Nexium (Esomeprazole) 20 mg PO QD, and Toprol XL (Metoprolol (Sust. Rel.)) 200 mg PO QD. The patient was also put on a renal diet with 2000 calories/day, low saturated fat, low cholesterol, and instructions to walk as tolerated. The patient was also instructed to take some medications with meals or on an empty stomach. Hypercalcemia 15 on admission was treated with 50mg of Calcitonin SC and Kayexelate given with Lactulose with good results and repeat K improved with dialysis MWF. SOB with hypoxia on admission from CHF, no clear infiltrates and doing well on NC O2. Pt was also given Nitroglycerin 1/150 (0.4 mg) 1 tab SL q5min x 3 PRN chest pain and adenosine mibi on 9/10 which showed minimal ischemia, and had Hyper PTH and Hyperkalemia without T wave peaking. The patient was switched to Toprol XL 200 QD 7/24 p.anterior wall, and was prescribed ECASA (Aspirin Enteric Coated) 325 mg PO QD, Enalapril Maleate 7.5 mg PO BID, Nitroglycerin 1/150 (0.4 mg) 1 tab SL q5min x 3 PRN chest pain, Imdur (Isosorbide Mononit. (SR)) 30 mg PO QD, Nephrocaps (Nephro-Vit Rx) 1 tab PO QD, Nexium (Esomeprazole) 20 mg PO QD, and Toprol XL (Metoprolol (Sust. Rel.)) 200 mg PO QD. The patient was also on ASA, Lopressor which was increased over 2 days, Nitrates, and ACE-inh, and received Vit D which may have contributed to the hypercalcemia. Pt was put on decreased NPH regimen with BS of 56 on 4/22 and given D50x1 and NPH decreased further to try to maintain tight glycemic control. The patient was discharged in stable condition with follow up chest CT, check SPEP and PTH labs, and call the doctor for any chest pains, dizziness, trouble breathing, fevers >100.4, or any other concerns.
|
Was the patient ever prescribed lactulose
|
{
"answer_end": [
1303
],
"answer_start": [
1213
],
"text": [
"Kayexelate given with Lactulose with good results and repeat K improved with dialysis MWF."
]
}
|
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 patient ever been prescribed lipitor
|
{
"answer_end": [
576
],
"answer_start": [
510
],
"text": [
"Lipitor 40 Daily, Neurontin, Celondin 300 TID, Digoxin 0.25 Daily,"
]
}
|
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.
|
has the patient had beta-blocker
|
{
"answer_end": [
1900
],
"answer_start": [
1841
],
"text": [
"on telemetry and treated with her home dose of beta-blocker"
]
}
|
A 48M with CAD s/p CABG 1997, Type II DM, Hypercholesterolemia, Hypertension and EtOH use was admitted via ED with 2 weeks of dyspnea on exertion and 2 days of severe peripheral oedema. Upon admission, ECASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO BID Starting Today (0/17), Glyburide 10 MG PO BID, Levothyroxine Sodium 75 MCG PO QD, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL Q5MIN X 2 doses PRN Chest Pain HOLD IF: sbp less than 100 mmHg, Plavix (Clopidogrel) 75 MG PO QD, Lipitor (Atorvastatin) 80 MG PO QHS, Lasix (Furosemide) 80 MG PO QD, Benicar 20 MG PO QD, Glucophage (Metformin) 500 MG PO BID, and Metformin added to his home diabetic regimen upon discharge were prescribed. Allergy to Penicillins was noted. The patient was discouraged from drinking and smoking and was discharged with instructions to measure weight daily, fluid restriction of 2 liters, house/low chol/low sat. fat diet and 2 gram sodium diet, and to walk as tolerated. Follow up appointments with Dr Knickrehm on February, 2005 at Bipa Healthcare Center, Dr Gavilanes at Nysi Medical Center and CHF program on Thurs June with Devin Apana at Sadeland Hospital were scheduled.
|
has the patient had lipitor ( atorvastatin )
|
{
"answer_end": [
523
],
"answer_start": [
487
],
"text": [
"Lipitor (Atorvastatin) 80 MG PO QHS,"
]
}
|
This 64-year-old patient had a past medical history of non-small cell lung cancer, status post XRT and chemotherapy, right MC embolic stroke, status post right carotid endarterectomy, Graves’ disease, depression, diabetes, hypertension, asthma, temporal lobe epilepsy, and history of subclavian steal syndrome. On admission, her blood pressure was 66/44, pulse of 100, respiratory rate normal, and blood sugar of 133. She was found to be difficult to arouse and had 1 gm of vancomycin, magnesium and Levaquin 500 mg. Her medication on admission included Mechanical soft diet, aspirin 81 mg, baclofen 5 mg t.i.d., B12 1000 mg daily, iron sulfate 325 mg daily, Cymbalta 20 mg p.o. b.i.d., Neurontin 100 mg b.i.d., Lamictal 200 mg b.i.d., Prilosec 20 daily, levothyroxine, Glucophage 500 once a day, Reglan 10 once a day, niacin 500 once a day, Senna 2 tabs b.i.d., Zocor 20 mg once a day, Nicoderm patch, Colace 100 mg p.o. b.i.d., Lopressor 100 mg p.o. b.i.d., lidoderm 5% patch to the low back, Tylenol, ducolox, Mylanta, lactulose, Seroquel 100 mg, prednisone 50 mg, and Dilaudid 1 mg. She completed a ten-day course of vancomycin for a MRSA urinary tract infection and was treated with tramadol and Tylenol for pain. Her laboratory data showed creatinine of 1, ALT 25, AST 35, hematocrit 33, white count 6.6, and platelets 241,000. She was covered with antibiotics initially, then transitioned over to a ciprofloxacin 700 mg p.o. b.i.d. regime for a total of 12 days for a presumed urinary tract infection. She had a significant polypharmacy and enumerable sedating medications, including baclofen, Dilaudid and trazodone. Her Cymbalta was continued per outpatient follow-up and her Lamictal, as well as her Cymbalta, were maintained for her history of depression. Neurologically, she had a left-sided hemiparesis, as well as agnosia on the left side, and her mental status included intermittent disorientation. She was maintained on Novolog sliding scale for diabetes, QTc monitored with serial EKGs, and prior use of Haldol and other antipsychotics for behavioral modification. She was also continued on a replacement dose levothyroxine for her history of Graves' and a history of radioiodine ablation. For behavioral modification, as well as intermittent agitation and disorientation, the patient was maintained on p.r.n. Seroquel 100 mg p.o. b.i.d., as well as Zydis 5 mg p.o. b.i.d. p.r.n., which was titrated from standing to p.r.n. over the course of her hospitalization in order to try to decrease any sedating medications that may be altering her alertness and orientation.
|
Has the patient ever had prilosec
|
{
"answer_end": [
735
],
"answer_start": [
712
],
"text": [
"Lamictal 200 mg b.i.d.,"
]
}
|
Mary Urbieta, a 56-year-old male with a history of ESRD, CAD, and CHF (EF 20-25%), was admitted to the hospital with Hypotension and NSTEMI. Upon discharge he was placed on a Full Code status, a renal diet (FDI), and walking as tolerated, and was instructed to avoid grapefruit unless MD instructs otherwise. His BP was 66/30 after 5.5 liters were removed, and rose to 73/40 after 1 liter of NS was given. Labs showed WBC 5, TnI 0.37, CK 153, CKMB 8.2, and EKG NSR, 1st deg AVB, LAE, LVH, old TWI in 1, L, V5, V6, more pronounced ST dep in V5 than 6/4, and CXR R pl effusion, CMG. Ischemia was managed with medical management with Asa, Beta Blocker, Imdur, Zocor, NTG PRN, and a PET scan was ordered to assess for viable myocardium and ischemia. The results showed a small region of myocardial scar/hibernation along with mild residual stress induced peri-infarct ischemia in the distal LAD distribution and moderate global LV systolic dysfunction, essentially unchanged from his prior study of February 2003. A BNP was sent and pending, and an echo revealed EF 30% and mod AI. He was placed on Acetysalicylic Acid 325 mg PO QD, Colace (Docusate Sodium) 100 mg PO BID, Enalapril Maleate 10 mg PO BID, NPH Humulin Insulin 2 units QAM; 3 units QPM SC 2 units QAM 3 units QPM, NTG 1/150 (Nitroglycerin 1/150 (0.4 mg)) 1 tab SL q5min x 3 PRN chest pain, Zocor (Simvastatin) 40 mg PO QHS, on order for Nephrocaps PO (ref #12327843), Potentially Serious Interaction Simvastatin & Niacin, Vit. B-3 Reason for override: home regimen, Imdur (Isosorbide Mononit.(SR)) 30 mg PO QD, Nephrocaps (Nephro-Vit RX) 2 tab PO QD, Nexium (Esomeprazole) 20 mg PO QD, Toprol XL (Metoprolol (Sust. Rel.)) 200 mg PO QHS, Persantine and viability cardiac PET scan 5/19/04, and SQ heparin for DVT prophylaxis. He was alerted to the Definite Allergy (or Sensitivity) to ACE Inhibitors. Follow-up appointments were made with the cardiologist, primary care physician, and Dr Alan Mcratt, and the family was called to stress the importance of follow up with the cardiologist, Dr Ivrin, and to adhere to dietary restrictions, fluid intake, and medications.
|
Why did the patient have imdur
|
{
"answer_end": [
649
],
"answer_start": [
581
],
"text": [
"Ischemia was managed with medical management with Asa, Beta Blocker,"
]
}
|
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 a patient had halcion
|
{
"answer_end": [
1665
],
"answer_start": [
1635
],
"text": [
"Halcion 0.125 p.o. q.h.s. prn;"
]
}
|
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.
|
Why was the patient on tylenol
|
{
"answer_end": [
248
],
"answer_start": [
117
],
"text": [
"severe frontal headaches with scintillations and marked polydipsia for four days, with no relief from Tylenol, aspirin or Fioricet."
]
}
|
MAZINGO, THOMAS 281-40-01-4 was admitted for CHF and discharged on 7/14/04. The patient, a 63 year old female with a history of resistant diabetes, morbid obesity, coronary artery disease, and hypertension, presented with one week of shortness of Breath. Examination revealed a respiratory rate of 22, oxygen saturation of 98% on 2L, bibasilar crackles, decreased breath sounds, scattered wheezes, and a normal heart exam. Labs and studies were notable for cardiac enzymes negative x3, BNP marginally elevated at 191, glucose of 286, A1c elevated at 10.3, and TSH of 3.847. An elevated PTT of 64.9 of uncertain significance was also found. The patient was ruled out for ischemia and given low-salt and ADA 1800 diets. She was prescribed Tylenol (Acetaminophen) 650 mg PO Q4H PRN Headache, ECASA (Aspirin Enteric Coated) 325 mg PO QD, Colace (Docusate Sodium) 100 mg PO BID, Lasix (Furosemide) 80 mg PO BID starting today, Insulin NPH Human 110 units SC QAM, NTG 1/150 (Nitroglycerin 1/150 (0.4 mg)) 1 Tab SL Q5min x 3 PRN Chest Pain, Verapamil Sustained Release 240 mg PO BID, Flovent (Fluticasone Propionate) 220 mcg Inh BID, Diovan (Valsartan) 160 mg PO QD, Vioxx (Rofecoxib) 12.5 mg PO QD, Duoneb (Albuterol and Ipratropium Nebulizer) QID with Q2H Albuterol O/N, Lipitor (Atorvastatin) 10 mg PO QD, Prilosec (Omeprazole) 20 mg PO QD, Albuterol Nebulizer 2.5 mg Neb Q2H PRN Shortness of Breath, 3/0.5 mg Inh Q6H PRN Shortness of Breath, and Heparin 5000 SC TID for DVT prophylaxis, as well as 80 IV Lasix in the ED and put out 1200 cc. She was instructed to follow-up with Dr. Ross Ogston on Friday 6/8/04, take Lasix pills twice a day until she sees Dr. Nicoll, and call her doctor if she has fever, chills, shortness of breath, or chest pain.
|
Was the patient ever prescribed vioxx ( rofecoxib )
|
{
"answer_end": [
1192
],
"answer_start": [
1160
],
"text": [
"Vioxx (Rofecoxib) 12.5 mg PO QD,"
]
}
|
This 90+-year-old male with a complex past medical history including CAD, CHF, AF and diabetes mellitus presented to the SICU for removal of chronically MRSA-infected mesh from prior abdominal surgery. He was intubated with etomidate, succinylcholine and kept sedated with Versed and fentanyl. He received intraoperative vancomycin and levofloxacin as well as 2200 mL of lactated Ringer's. In an attempt to reverse anticoagulation, one unit of FFP was begun but then aborted due to hypotension, which resolved with epinephrine injection, likely due to transfusion reaction. Another unit of FFP was administered, with platelets also given at the request of the Plastic Surgery Team in light of aspirin and Plavix, which were continued due to the patient's cardiac stents. Despite bolus Lasix, the patient did develop CHF with symptomatic pulmonary edema and increased oxygen requirement, concomitantly becoming delirious. He developed hypertension refractory to beta-blockade, calcium channel blockers and IV ACE inhibitors, and was thus placed on a nitroglycerin drip, a furosemide drip with ginger blood product resuscitation to address bleeding and an elevated INR, responding well to this regimen and aggressive pulmonary toilet. The patient was advanced to clear liquids, on medications including Amiodarone 200 mg p.o. daily, Calcium, Colace 100 mg by mouth t.i.d., Coumadin alternating doses of 4 mg and 3 mg, Diltiazem CD 360 mg p.o. daily, Aspirin 81 mg p.o. daily, Folate 1 mg p.o. daily, Lisinopril 10 mg p.o. daily, Metamucil p.r.n., Clopidogrel 75 mg p.o. daily, Potassium, Protonix 40 mg p.o. daily, Simvastatin 80 mg p.o. daily, Synthroid 25 mcg p.o. daily, Thiamine 100 mg p.o. daily, Metoprolol SR 100 mg p.o. b.i.d., Zyprexa 2.5 mg at bedtime p.r.n., and Vancomycin for MRSA-infected mesh. He does experience more significant delirium with morphine and less so with sparing Dilaudid p.r.n., and Haldol is written p.r.n. as needed. Weaning off nitroglycerin drip, nitro paste added, hematocrit 25%, one unit of packed red blood cells with Lasix and potassium to be given, RISS, and PICC line consult ordered for anticipated long-term vancomycin. Services following the patient include Medicine, Dr. Harcar, patient's PCP, Cardiology, Dr. Pagliari, and Plastic Surgery, Dr. Dunshie. Patient anticipated to be transferred to the floor on 9/28/06.
|
has the patient had ginger blood product
|
{
"answer_end": [
1167
],
"answer_start": [
1082
],
"text": [
"drip with ginger blood product resuscitation to address bleeding and an elevated INR,"
]
}
|
This is a 63-year-old female who presented with bilateral lower extremity edema, increasing shortness of breath, 3+ edema in the extremities, areas of erythematous and shiny shallow ulcerations, significant laboratory data of sodium 147, potassium 3.4, chloride 110, CO2 26, BUN 23, creatinine 1.6, and glucose 69, CBC significant for white count of 6.7, hematocrit 39.4, and platelets of 258, CK 432, troponin less than assay, BNP greater than assay, and D-dimer 50 and 69, chest x-ray showed decreased lung volumes with moderate cardiac enlargement, EKG showed sinus bradycardia with a rate of 59, axis of -36 and no acute changes. The patient has a history of congestive heart failure, deep venous thrombosis bilaterally with PE, acute renal failure, nephrotic syndrome, pneumonia, iron and folate deficiency anemia, paroxysmal atrial fibrillation with rapid ventricular response, nonsustained ventricular tachycardia, insulin-dependent diabetes mellitus, hypertension, cholesterol, chronic knee and back pain, arthroscopic knee surgery bilaterally, gastritis, benign colon polyps greater than 10, cataracts, and glaucoma. She was prescribed Lasix 120 mg p.o. b.i.d., Atenolol 50 mg p.o. q.d., Iron sulfate 300 b.i.d., Folate 1 mg q.d., NPH insulin 20 units q.d., Oxycodone 5 mg to 10 mg q.4-6h. p.r.n. pain., Senna, Multivitamins, Zocor 40 mg p.o. q.d., Norvasc 10 mg p.o. q.d., Accupril 80 mg p.o. q.d., Miconazole 2% topical b.i.d., Celexa 20 mg p.o. q.d., Avandia 8 mg p.o. q.d., Nexium 20 mg p.o. q.d., Albuterol p.r.n., aspirin as well as statin, a low-dose short-acting beta-blocker (Lopressor), an ACE inhibitor with this switched to captopril as a short-acting ACE inhibitor for a goal blood pressure of systolic of 120, an adenosine MIBI, runs of NSVT and Coumadin 5 mg p.o. q.h.s., folate and iron replacement, NPH 20 units for her known diabetes, Bactrim one tablet p.o. b.i.d. for 7 days, Celebrex and other antiinflammatory medications, Colace 100 mg p.o. b.i.d., Prozac 20 mg p.o. q.d., NPH human insulin 20 units subcu q.p.m., Zestril 30 mg p.o. q.d., Senna tablets 2 mg p.o. b.i.d., Aldactone 25 mg p.o. q.d., Multivitamins with minerals one tablet p.o. q.d., Toprol XL p.o. q.d., Imdur 30 mg p.o. q.d., Prednisolone acetate 0.125% one drop OU q.i.d., Albuterol inhaler 2 puffs inhaler q.i.d. p.r.n. wheezing., Miconazole nitrate powder topical b.i.d. p.r.n., Aspirin 81 mg p.o. q.d., and her creatinine continued to rise until 8/3/03, when it reached 2.7, diuresis was put on hold on 3/15/03 and 10/5/03, and her ACE inhibitor dose was halved on 10/5/03, in order to monitor her creatinine function, she was found to have a UTI with E. Coli that was sensitive to Bactrim and she was treated with Bactrim with resolution, for her chronic pain and arthritis, her Celebrex was held given her increased creatinine and she was given oxycodone p.r.n. for pain, joint exam revealed swollen PIP joints of both hands as well as marked swelling over both wrists, and an ANA test came back negative, she was continued on Celexa for depression, a goal INR of 2 to 3 was set for her Coumadin, which was restarted on 4/12/03 for known paroxys
|
has the patient had accupril
|
{
"answer_end": [
1408
],
"answer_start": [
1383
],
"text": [
"Accupril 80 mg p.o. q.d.,"
]
}
|
This 70-year-old woman with a complex medical history, including cerebrovascular accident x two in 1980s without deficits, seizure history probably secondary to ETOH withdrawal, hypertension x 30 years, asthma, gout, and status post repair of subclavian artery stenosis in 1993, presented to the Dagha Medical Center with severe chest pain. A chest CT revealed a 2.3 x 2.8 cm lobulated mass in the right lower lobe involving the pleura, with extensive hilar and mediastinal constitutions consistent with prior granulomatous disease, and tests were positive for multiple precarinal and right peritracheal areas of adenopathy recent from metastatic disease. The patient was admitted to the Thoracic Surgery Service on 3/27/99 and taken to the Operating Room for a video assisted thorascopic right lower lobe lobectomy by Dr. Minick. Postoperatively, the patient did well, with no complications, and was followed by the Internal Medicine Service. The patient went into rapid atrial fibrillation postoperatively, and was successfully converted into a normal sinus rhythm using Diltiazem IV, which was converted to p.o. Diltiazem. The patient's postoperative course was largely unremarkable but for dysrhythmia, and the patient's pain was well controlled with p.o. pain medications, Percocet. Final pathology was read as squamous cell carcinoma, 4.0 cm., moderately differentiated with focal characterization with extensive necrosis. The patient was discharged to home with medications including Adalat 200 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Magnesium Oxide 40 mg t.i.d., Ultram 300 mg q.d., Trazodone 100 mg q.h.s., Azmacort 80 mg p.r.n., aspirin 81 mg q.d., Dyazide 25 mg q.d., nose spray b.i.d., calcium chloride pills q.d., Colchicine 600 mg q.d., cyproheptadine hydrochloride 4 mg b.i.d. q.h.s., anticholesterol med., Albuterol nebulizers 250 mg q.4h., Allopurinol 300 mg q.d., Colchicine 0.6 mg q.d., cyproheptadine hydrochloride by mouth 400 mg q.d., Digoxin 0.125 mg q.d., Diltiazem 30 mg t.i.d., Colace 100 mg t.i.d., Lasix 40 mg p.o. q.d., Percocet 1-2 tablets p.o. q.4h. p.r.n., Dilantin 200 mg p.o. b.i.d., and Trazodone 100 mg p.o. q.h.s., with follow-up with Thoracic Surgery Service as well as with primary care physician and Cardiology as needed.
|
Has this patient ever been on magnesium oxide
|
{
"answer_end": [
1594
],
"answer_start": [
1545
],
"text": [
"Magnesium Oxide 40 mg t.i.d., Ultram 300 mg q.d.,"
]
}
|
The patient is a 46 year old male with left hip pain, now worsening over the past year, unrelieved with conservative therapy. He had a history of congenital dysplasia of the hip, which was treated with osteotomy of the right hip in 1988, with good improvement. PAST MEDICAL HISTORY was also remarkable for sleep apnea and ALLERGIES included intravenous pyelogram dye and shrimp. MEDICATIONS ON ADMISSION were none. On 0 of May, the patient underwent left total hip replacement which he tolerated well with 400 cc of estimated blood loss. The patient was in stable condition for the entire hospital stay with postoperative hematocrit of 36.3, but dropped to 29 and the patient received 2 units of autologous blood. The patient was anticoagulated with Coumadin for a prothrombin time in the range of 14 to 16, and stabilized at a dose of 8 milligrams per night. At the last dose, his prothrombin time had gone up over 16 and he was changed to Coumadin 5 milligrams by mouth at hour of sleep. The patient started physical therapy on postoperative day #1 and made rapid progress. MEDICATIONS ON DISCHARGE included Coumadin for a full 6-week course, Percocet as needed. The patient will FOLLOW-UP with the Coumadin Program through this hospital and with Dr. Mcfadden in 5 weeks. CONDITION ON DISCHARGE was good.
|
Has the patient taken any medications for prothrombin time management
|
{
"answer_end": [
807
],
"answer_start": [
714
],
"text": [
"The patient was anticoagulated with Coumadin for a prothrombin time in the range of 14 to 16,"
]
}
|
Mr. Kanaan is a 68-year-old gentleman with stage IV esophageal cancer who presented with progressive shortness of breath over the three days prior to admission and had a known ejection fraction of 20%. His medical regimen was maximized with an ACE inhibitor or statin and baby aspirin was started on him. He was admitted with diarrhea related to chemotherapy, pulmonary edema secondary to decompensated heart failure, and gout in his right great toe. He was diuresed with Lasix and torsemide in addition to his spironolactone dose with a goal of 1.5 liters a day and received Atrovent nebulizers to help with his shortness of breath, with the combination of dopamine, nesiritide, and Lasix drips being most effective. His medications included amiodarone, digoxin, colchicine, Atrovent, lisinopril, spironolactone, torsemide, Ativan, Zocor, and Prilosec, with instructions to follow up with his primary care doctor with DVT prophylaxis with Lovenox. He also received ferrous sulfate 325 mg daily, trazodone 50 mg at night, multivitamins one tablet daily, and simvastatin 80 mg at night. He was discharged home with oxygen to use overnight and when symptomatic.
|
has there been a prior spironolactone
|
{
"answer_end": [
853
],
"answer_start": [
798
],
"text": [
"spironolactone, torsemide, Ativan, Zocor, and Prilosec,"
]
}
|
This 70-year-old woman with a complex medical history, including cerebrovascular accident x two in 1980s without deficits, seizure history probably secondary to ETOH withdrawal, hypertension x 30 years, asthma, gout, and status post repair of subclavian artery stenosis in 1993, presented to the Dagha Medical Center with severe chest pain. A chest CT revealed a 2.3 x 2.8 cm lobulated mass in the right lower lobe involving the pleura, with extensive hilar and mediastinal constitutions consistent with prior granulomatous disease, and tests were positive for multiple precarinal and right peritracheal areas of adenopathy recent from metastatic disease. The patient was admitted to the Thoracic Surgery Service on 3/27/99 and taken to the Operating Room for a video assisted thorascopic right lower lobe lobectomy by Dr. Minick. Postoperatively, the patient did well, with no complications, and was followed by the Internal Medicine Service. The patient went into rapid atrial fibrillation postoperatively, and was successfully converted into a normal sinus rhythm using Diltiazem IV, which was converted to p.o. Diltiazem. The patient's postoperative course was largely unremarkable but for dysrhythmia, and the patient's pain was well controlled with p.o. pain medications, Percocet. Final pathology was read as squamous cell carcinoma, 4.0 cm., moderately differentiated with focal characterization with extensive necrosis. The patient was discharged to home with medications including Adalat 200 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Magnesium Oxide 40 mg t.i.d., Ultram 300 mg q.d., Trazodone 100 mg q.h.s., Azmacort 80 mg p.r.n., aspirin 81 mg q.d., Dyazide 25 mg q.d., nose spray b.i.d., calcium chloride pills q.d., Colchicine 600 mg q.d., cyproheptadine hydrochloride 4 mg b.i.d. q.h.s., anticholesterol med., Albuterol nebulizers 250 mg q.4h., Allopurinol 300 mg q.d., Colchicine 0.6 mg q.d., cyproheptadine hydrochloride by mouth 400 mg q.d., Digoxin 0.125 mg q.d., Diltiazem 30 mg t.i.d., Colace 100 mg t.i.d., Lasix 40 mg p.o. q.d., Percocet 1-2 tablets p.o. q.4h. p.r.n., Dilantin 200 mg p.o. b.i.d., and Trazodone 100 mg p.o. q.h.s., with follow-up with Thoracic Surgery Service as well as with primary care physician and Cardiology as needed.
|
Has a patient had zantac
|
{
"answer_end": [
1544
],
"answer_start": [
1469
],
"text": [
"medications including Adalat 200 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d.,"
]
}
|
This is a 47-year-old female with a history of HIV, diabetes, questionable cerebral aneurysm, and seizure disorder who recently had two syncopal events without prodrome and without postictal state, who presented for evaluation of left arm paresthesias and chest pain, with associated diaphoresis, shortness of breath and nausea. Of note, the patient recently started Flexeril to treat chronic low back pain, was not receiving her Keppra for approximately a year, as her prescription had ran out, and was instead taking Ecotrin 81 mg daily, clonazepam 1 mg q.6 h. p.r.n., Imodium one to two tablets q.i.d. p.r.n. for diarrhea, and low-dose aspirin. The patient was started on low-dose beta-blocker and aspirin, metoprolol 12.5 b.i.d. with occasional bradycardia to the high 40's, and was treated with the Ryo Hospital Medical Center insulin protocol. The patient was restarted on Keppra 250 mg b.i.d. with a goal to increase to 500 mg b.i.d. after 7 days and to 750 mg after another week, and was given Keppra 500 mg b.i.d. for 14 doses and then 750 mg b.i.d., Flexeril 5 mg daily, clonazepam 1 mg q.i.d., Truvada one tablet p.o. daily, Norvir 1400 mg b.i.d., glyburide 5 mg q.a.m. and 2.5 mg q.p.m., Lomotil one tablet q.i.d. p.r.n., methadone 150 mg daily, Zofran 4 mg daily p.r.n., Percocet 325 mg/5 mg tablets one tablet q.6 h. p.r.n., Zantac 150 mg b.i.d., Zoloft 100 mg q.a.m., and trazodone 100 mg nightly. Labs revealed a low reticulocyte index consistent with anemia of chronic disease, and the methadone dose of 155 mg was confirmed with the outpatient clinic. The patient was also given three doses of Klonopin over a six-day period, instructed to take medications as listed, clarify discrepancies with her PCP, return to the ER for evaluation if she faints again, call her PCP and/or return to the ER if her chest pain symptoms recur and persist, make an appointment with the Smill Memorial Hospital to evaluate the cause of her left arm symptoms, and check her blood sugars before meals and at bedtime. Additionally, her PCP was instructed to arrange for a loop monitor, follow up on a 24-hour urine studies assessing for pheochromocytoma, and adjust the patient's diabetes management as needed.
|
Has this patient ever been treated with clonazepam
|
{
"answer_end": [
1104
],
"answer_start": [
992
],
"text": [
"was given Keppra 500 mg b.i.d. for 14 doses and then 750 mg b.i.d., Flexeril 5 mg daily, clonazepam 1 mg q.i.d.,"
]
}
|
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.
|
Has the patient ever had metformin
|
{
"answer_end": [
320
],
"answer_start": [
268
],
"text": [
"metformin 500 q.d., and NPH 43 q.a.m. and 24 q.p.m.,"
]
}
|
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.
|
What is the patient's current dose does the patient take of her calcium carbonate
|
{
"answer_end": [
1000
],
"answer_start": [
957
],
"text": [
"including Calcium carbonate 1250 mg t.i.d.,"
]
}
|
Lupe Rumble, a 42 year old female with a history of asthma, hypertension, obesity, hyperlipidemia, hyperglycemia, hirsutism, chiari malformation, spinal stenosis, and spinal syrinx, was admitted to the hospital with a recent asthma flare, productive cough, low grade fevers, shortness of breath, and wheezing. Her chest x-ray showed a linear opacity in the right lower lobe most consistent with platelike atelectasis, but could not rule out resolving or new pneumonia. Treatment included ALBUTEROL INHALER 2 PUFF INH QID, ALBUTEROL NEBULIZER 2.5 MG NEB Q4H, Advair Diskus 500/50 (Fluticasone Propionate/...), Combivent (Ipratropium and Albuterol Sulfate) 2 PUFF INH TID, LISINOPRIL 20 MG PO DAILY, Singulair (Montelukast) 10 MG PO DAILY, and a prednisone taper starting at 60 mg q 24 h x 2 doses, then 50 mg daily x 3 days, then 40 mg daily x 3 days, then 30 mg daily x 3 days, then 20 mg daily x 3 days, and then 10 mg daily x 2 days and stop. The peak flow had improved to 250 and ambulating oxygen saturation was 92-94% at discharge. The patient was also advised to try a nicotine patch and was given Lovenox as a prophylaxis. Her lisinopril was increased to 20mg due to hypertension, and she was discharged on order for KCL IMMEDIATE RELEASE PO (ref #) with instructions to continue all home medications, a prednisone taper, nebs, and advair, singulair, albuterol, and combivent. Smoking cessation was encouraged and she was interested in trying a nicotine patch.
|
Has the patient ever been on lisinopril
|
{
"answer_end": [
697
],
"answer_start": [
671
],
"text": [
"LISINOPRIL 20 MG PO 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.
|
Has the patient ever had digoxin
|
{
"answer_end": [
789
],
"answer_start": [
762
],
"text": [
"Digoxin 0.25 mg p.o. q.day,"
]
}
|
A 66-year-old gentleman with a medical history significant for coronary artery disease and two prior MIs presented with substernal chest pain while walking that lasted 2-3 hours and was relieved by rest and sublingual nitroglycerin. He was admitted and cardiac catheterization revealed 90% proximal LAD stenosis, 90% mid LAD and 100% distal LAD stenosis, 100% mid LVB1, 80% mid circumflex, 70% proximal D1, 70% proximal PDA, and a right dominant circulation, with diffuse coronary calcification and extensive diffuse disease with small distal vessels. LAD in stent restenosis and collateral flow diffusely small left main. On 4/15/05, the patient underwent CABG x4 with SVG1 to RCA, and sequential graft of SVG2 to D1 and then OM1, with LIMA to LAD and an LAD endarterectomy. On arrival to the hospital, he was given 150 mg of Plavix, heparin 500 units for 48 hours, and aspirin that same night. He was also started on Enteric-coated aspirin 325 mg p.o. daily, atenolol 75 mg p.o. daily, Colace 100 mg p.o. t.i.d., oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n. pain, Plavix 75 mg p.o. daily, Lantus 38 units subcutaneously at bedtime, NovoLog 18 units subcutaneous q.a.m., and Lasix with good effect. He required the transfusion of a unit of packed red blood cells and neosynephrine transiently, which was weaned off on postoperative day #2. He was also noted to have a preoperative urinary tract infection of E. coli for which he was started on levofloxacin on 0/5/05 and treated for five days. The patient was followed by the Diabetes Management Service for blood sugar control and was transitioned from IV insulin to subcutaneous insulin postoperatively. He was discharged to home in good condition on postoperative day #7 on the following medications and is to have a follow-up appointment with his cardiologist, Dr. Abusufait, in one to two weeks, and with his cardiac surgeon, Dr. Cederberg, in four to six weeks.
|
Why was the patient prescribed insulin
|
{
"answer_end": [
1653
],
"answer_start": [
1520
],
"text": [
"the Diabetes Management Service for blood sugar control and was transitioned from IV insulin to subcutaneous insulin postoperatively."
]
}
|
A 60 year old Spanish speaking woman with multiple cardiac risk factors and a two to three year history of exertional angina presented complaining of unstable chest pain. Dr. Maximo Bryum in C&O MEDICAL CENTER Clinic initiated an antianginal regimen, however the patient recently stopped taking Aspirin and her symptoms then recurred. The patient was given three sublingual Nitroglycerins after her primary M.D. was called and her pain resolved after approximately 15 minutes. On the 27 of January, 1995, the patient underwent a Dobutamine MIBBE on which she went 6 minutes and 48 seconds reaching a maximal heart rate of 154, a blood pressure of 172/82, with 2 mm ST depressions diffusely and moderate to severe reversible anterior and anteroseptal wall ischemia. Medications on admission included Atenolol 50 mg p.o. q.d., Axid 150 mg p.o. b.i.d., Enteric Coated Aspirin 325 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem 240 mg p.o. q.d., Lisinopril 10 mg p.o. q.d., Lopipd 600 mg p.o. q.d., Lasix 40 mg p.o. q.d., Insulin NPH 75 units sub-q q.a.m., 50 units q.p.m., Insulin Regular 25 units sub-q q.a.m., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, and Omeprazole 20 mg p.o. q.d. The Cardiology Team was consulted and serial CK, MB and EKG's were done, with Heparin initially started given the possibility that this was unstable angina. The patient's Insulin dosages were adjusted in the manner to keep her blood sugars in the approximately 200 range and she was discharged with medications including Enteric Coated Aspirin 325 mg p.o. q.d., Lasix 40 mg p.o. q.d., Lopid 600 mg p.o. q.d., Insulin NPH 100 units sub-q q.a.m., 70 units sub-q q.h.s., Insulin Regular 25 units sub-q q.a.m., Lisinopril 10 mg p.o. q.d., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, Omeprazole 20 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem CD 240 mg p.o. q.d., with follow-up care with her primary M.D., Dr. Jarvis Needy in the RINGBURG RITA'S PROPRES MEMORIAL HOSPITAL Clinic.
|
Why was the patient prescribed nitroglycerins
|
{
"answer_end": [
1193
],
"answer_start": [
1114
],
"text": [
"Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain,"
]
}
|
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.
|
What was the dosage prescribed of toprol
|
{
"answer_end": [
383
],
"answer_start": [
361
],
"text": [
"Toprol 25 p.o. daily.,"
]
}
|
The patient is an elderly woman with known coronary artery disease status post coronary artery bypass graft who had her Beta blocker, Pendalol decreased from 5 mg to 2.5 mg prior to this trip to Glension Street. On return to the hospital she developed substernal chest pain that radiated down both arms, which was treated with Amoxicillin given to her by her son who is a physician. At this visit, he did start her on Prinivil and she took a sublingual nitroglycerin that completely relieved her symptoms. Laboratory studies were significant for a white blood cell count of 5.46, hematocrit 40.1, platelets 190, Cardiac Troponin I was 0.0, CK was 102, and Urinalysis was negative. Chest x-ray was clear with no infiltrates, and EKG was normal sinus rhythm with normal intervals and normal axis with a left bundle branch block pattern and first degree atrioventricular block with no change compared to an EKG done on January, 1997. MEDICATIONS ON ADMISSION: 1) Zocor 5 mg p.o. q.h.s., 2) Prinivil 5 mg p.o. q. day., 3) Pendalol 2.5 mg p.o. q. day., 4) Aspirin 325 mg p.o. q. day., 5) Synthroid 0.100 mg p.o. q. Monday, Wednesday and Friday and 0.12 mg p.o. Tuesday, Thursday, Saturday and Sunday., 6) Pepcid p.r.n. From here, she was managed medically with increases in her ACE inhibitor, Statin and the addition of nitrates. After the cardiac catheterization, she developed a large right groin hematoma at the puncture site and a bruit was noted. An ultrasound was done that revealed a pseudoaneurysm of the common femoral artery, which was later surgically repaired. MEDICATIONS ON DISCHARGE: 1) Aspirin 325 mg p.o. q. day., 2) Colace 100 mg p.o. b.i.d., 3) Synthroid 100 mcg p.o. q. Monday, Wednesday and Friday, 112 mcg p.o. q. Tuesday, Thursday, Saturday and Sunday., 4) Lisinopril 10 mg p.o. q. day., 5) Beclomethasone diproprionate double strength spray to each nostril b.i.d., 6) Zocor 20 mg p.o. q.h.s., 7) Toprol XL 75 mg p.o. q. day., 8) Imdur 30 mg p.o. q. day., 9) Augmentin one tablet p.o. q. day for seven additional days. The patient had been having low grade fevers and a cough productive of a green sputum, and experienced diaphoretic episodes, both at rest and exertion, which was relieved by a sublingual nitroglycerin. The latest echocardiogram in May of 1997 showed an ejection fraction of 35% with mid to distal septal and apical akinesis and inferior akinesis with mild mitral regurgitation, and she went 4 minutes and 18 seconds on an exercise tolerance test with Thallium which showed only fixed defects, no reversible defects.
|
Is the patient currently or have they ever taken prinivil
|
{
"answer_end": [
426
],
"answer_start": [
383
],
"text": [
"At this visit, he did start her on Prinivil"
]
}
|
A 66-year-old gentleman with a medical history significant for coronary artery disease and two prior MIs presented with substernal chest pain while walking that lasted 2-3 hours and was relieved by rest and sublingual nitroglycerin. He was admitted and cardiac catheterization revealed 90% proximal LAD stenosis, 90% mid LAD and 100% distal LAD stenosis, 100% mid LVB1, 80% mid circumflex, 70% proximal D1, 70% proximal PDA, and a right dominant circulation, with diffuse coronary calcification and extensive diffuse disease with small distal vessels. LAD in stent restenosis and collateral flow diffusely small left main. On 4/15/05, the patient underwent CABG x4 with SVG1 to RCA, and sequential graft of SVG2 to D1 and then OM1, with LIMA to LAD and an LAD endarterectomy. On arrival to the hospital, he was given 150 mg of Plavix, heparin 500 units for 48 hours, and aspirin that same night. He was also started on Enteric-coated aspirin 325 mg p.o. daily, atenolol 75 mg p.o. daily, Colace 100 mg p.o. t.i.d., oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n. pain, Plavix 75 mg p.o. daily, Lantus 38 units subcutaneously at bedtime, NovoLog 18 units subcutaneous q.a.m., and Lasix with good effect. He required the transfusion of a unit of packed red blood cells and neosynephrine transiently, which was weaned off on postoperative day #2. He was also noted to have a preoperative urinary tract infection of E. coli for which he was started on levofloxacin on 0/5/05 and treated for five days. The patient was followed by the Diabetes Management Service for blood sugar control and was transitioned from IV insulin to subcutaneous insulin postoperatively. He was discharged to home in good condition on postoperative day #7 on the following medications and is to have a follow-up appointment with his cardiologist, Dr. Abusufait, in one to two weeks, and with his cardiac surgeon, Dr. Cederberg, in four to six weeks.
|
Is there a mention of of atenolol usage/prescription in the record
|
{
"answer_end": [
987
],
"answer_start": [
919
],
"text": [
"Enteric-coated aspirin 325 mg p.o. daily, atenolol 75 mg p.o. daily,"
]
}
|
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.
|
Was the patient ever given dilaudid for pain
|
{
"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,"
]
}
|
A 45-year-old male with morbid obesity presented with chest pain and hypertensive urgency. He was ruled out for MI with negative serial enzymes and EKGs and a cardiac PET showed 2 small areas of reversible ischemia in the mid PDA and distal LAD territory. For CV treatment, he was given Aspirin 81mg PO daily, beta blocker, and HCTZ 25mg PO daily and Atenolol 50mg PO daily for HTN control. For Pulmonary issues, he had very mild asthma exacerbation and a restrictive ventilatory defect from obesity and was given Advair 500/50 BID, Albuterol Nebulizer 2.5 mg neb q2h, Albuterol Inhaler 2 puff inh qid PRN Shortness of Breath and prednisone 60mg QD x 3 doses. For GI issues, he had trace guaiac+ stool and a viral gastroenteritis causing diarrhea and some nausea. For endocrine issues, his A1C was 7.4 and he was educated on low sugar, low carbohydrate diet. For prevention, he was given Lovenox BID. Additional comments included taking HCTZ 25mg daily and Atenolol 50mg daily for blood pressure, eating a low sugar, low carbohydrate diet, and follow-up with cardiology on 11/0. He was discharged in a stable condition with a recommendation for monitor blood sugars and A1C, outpatient colonoscopy, and consider statin therapy, as well as Fluticasone Propionate/Salmeterol 250/50 1 puff inh BID, Albuterol Inhaler 2 puff inh QID, Artificial Tears 2 drop OD TID, Loratadine 10 mg PO QD, Hydrochlorothiazide 25 mg PO QD, Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Albuterol Nebulizer 2.5 mg neb q4h, Acetylsalicylic Acid 81 mg PO daily, and Miconazole Nitrate 2% powder topical TP daily.
|
Has this patient ever tried aspirin
|
{
"answer_end": [
309
],
"answer_start": [
274
],
"text": [
"he was given Aspirin 81mg PO daily,"
]
}
|
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 this patient ever been treated with lipitor
|
{
"answer_end": [
419
],
"answer_start": [
375
],
"text": [
"The patient was started on ASA and a statin,"
]
}
|
This is a 55-year-old female with a history of diabetes mellitus type 2 (DMII) who was admitted for recurrent left lower extremity (LE) ulcerations and cellulitis of the right foot. She was treated with IV Unasyn for 5 days and switched to Linezolid 600MG PO BID as an outpatient medication. COUMADIN (WARFARIN SODIUM) 5MG PO QPM, NEXIUM (ESOMEPRAZOLE) 20MG PO QD, ACETYLSALICYLIC ACID 325MG PO QD, SIMVASTATIN 20MG PO QHS, GLYBURIDE 2.5MG PO QD HOLD IF: NPO, LISINOPRIL 10MG PO QD HOLD IF: SBP<95, SARNA TOPICAL TP QD, MICONAZOLE NITRATE 2% POWDER TOPICAL TP BID were prescribed. POTENTIALLY SERIOUS INTERACTIONS: WARFARIN & CIPROFLOXACIN, WARFARIN & SIMVASTATIN, WARFARIN & ASPIRIN, LISINOPRIL & POTASSIUM CHLORIDE Reason for override: as needed were noted. Bone scan and plain films from prior hospitalizations were consulted and Instructions for bilateral lower extremity rash were given. She was discharged on 7/15/05 with disposition home and diet with no restrictions, told to resume regular exercise and arrange INR to be drawn on 10/13/05 with follow-up INR's to be drawn every 7 days.
|
Is there history of use of acetylsalicylic acid
|
{
"answer_end": [
398
],
"answer_start": [
365
],
"text": [
"ACETYLSALICYLIC ACID 325MG PO QD,"
]
}
|
This 82-year-old RHM with a history of HTN, DM-2, CAD, and AVR (on Coumadin until 3/29) presented to the WTSMC ER for further work-up after receiving Mannitol. On exam, his VS were T: afebrile, BP: 145/64, P: 60, RR: 18, O2 sat: 97%r.a., HEENT anicteric and MMM without lesions, OP clear, neck supple with no LAD, CV had s1s2 paced, pronounce S2, 3/6 systolic murmur, 2/6 diastolic, resp CTAB, abd +BS Soft/NT/ND, ext no C/C/E, s/p above amputation, MS awake and alert, oriented to date, place, and self, attention DOW backwards, memory registration 3/3, recall 2/3 at 5 min 3/3 with prompting, language fluent, +comprehension, +repetition, +naming intact, nondominant no neglect to DSS, able to salute/brush teeth, CN II, III - pupils 3`2 bilaterally, VFF by confrontation; III, IV, VI - EOMI, no ptosis, no nystagmus; V - sensation intact to LT/PP, corneal reflex intact; VII - mild right facial weakness; VIII - hears finger rub; IX, X - voice dysarthric, palate elevates symmetrically, gag intact; XI - SCM/Trapezii 5/5 B; XII - tongue protrudes midline, motor right pronator drift, no asterixis, normal bulk and tone, no tremor, rigidity or bradykinesia, strength 5/5, DTRs C56, C6, C7, L34, S12, Plantar L2, 2, 2, 1, 0, amputated R1, 1, 1, 1, 0, up, sensory decreased LT, temperature, vibration distally up to knees, coord finger tap rapid & symm, FNF & finger follow intact (for weakness), foot tap rapid & symm, gait deferred. LABS showed Sodium 141 mmol/L, Potassium 4.7 mmol/L, Chloride 103 mmol/L, Total CO2 29 mmol/L, Anion Gap 9 mmol/L, CK 33 U/L, CKMB Quant 1.7 ng/mL, Calcium 9.0 mg/dL, Magnesium 1.6 mg/dL, cTn-I See Result Below ng/mL, and Glucose 130 mg/dL. Medications prescribed were COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN SBP>160mmHg, Insulin Regular Human Sliding Scale (subcutaneously) SC qAC, qHS, Lisinopril 20 mg PO QD, Magnesium Gluconate 500 mg PO BID, Milk of Magnesia (Magnesium Hydroxide) 30 mL PO QD PRN Constipation, Metoprolol Tartrate 25 mg PO TID starting in PM on 0/17, Xalatan (Latanoprost) 1 drop OU QPM, Flomax (Tamsulosin) 0.4 mg PO QD, Nexium (Esomeprazole) 20 mg PO QD, Glipizide 10 mg PO QD, Zocor 20 mg QD, Metformin 1000 mg BID, Niferex 150 BID, ASA 81 PO QD, and BRIMONIDINE 0.2% BID. Neurologic exam was stable with persistent dysarthria, right pronator drift, and mild right leg weakness; patient was evaluated by PT/OT and deemed appropriate candidate for acute rehab. Cardiovascular continued to be in atrial fibrillation, pacemaker was firing, but had an episode of HR 30's x few seconds, and HR 40's-50's for rest of night. EKG unchanged from admission, atrial fibrillation, left anterior fascicular block, some PVCs. Plan was to admit to NICU and transfer to the floor, control BP with home regimen and keep SBP<140, hold ASA and Coumadin, and hold Metformin for now and add insulin sliding scale. Medications included COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN other: SBP>160
|
Has this patient ever been treated with coumadin
|
{
"answer_end": [
159
],
"answer_start": [
59
],
"text": [
"AVR (on Coumadin until 3/29) presented to the WTSMC ER for further work-up after receiving Mannitol."
]
}
|
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 ever taken ativan for their anxiety
|
{
"answer_end": [
85
],
"answer_start": [
21
],
"text": [
"taking Ativan of 3-4 mg q.d. for anxiety for the past two months"
]
}
|
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.
|
Was the patient ever given medication for her presumed pe
|
{
"answer_end": [
2509
],
"answer_start": [
2442
],
"text": [
"She was on unfractionated heparin for her presumed PE until 6/15/06"
]
}
|
Patient SAMU, CURTIS 759-74-53-9 is a 61-year-old female with multiple medical problems including dilated CMP, s/p chemo and XRT for Breast CA, CAD, s/p MI, COPD, and occasional O2 use. On admission, her VS are T97.8, HR73, BP113/71, RR18, and O2Sat 92%. She presents with dry cough associated with SOB x 2 days and increased DOE after 1/2 block, orthopnea and PND, chronic abd pain, increased Alk Phos, increased bloating, and wheezing without increased O2 need at night. She was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, on order for COUMADIN PO (ref #29937145) with POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, DIGOXIN 0.125 MG PO QD, on order for LEVOTHYROXINE SODIUM PO (ref #13700176) with POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, COLACE (DOCUSATE SODIUM) 100 MG PO BID, FERROUS SULFATE 325 MG PO BID, MOTRIN (IBUPROFEN) 600 MG PO Q8H Starting Today (10/7) with PRN Pain Food/Drug Interaction Instruction Take with food, REGLAN (METOCLOPRAMIDE HCL) 5 MG PO AC, SIMETHICONE 80 MG PO QID, VITAMIN B1 (THIAMINE HCL) 100 MG PO QD, TRAZODONE 50 MG PO HS, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: LEVOFLOXACIN & WARFARIN, MVI THERAPEUTIC (THERAPEUTIC MULTIVITAMINS) 1 TAB PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: aware, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 75 MG PO QD, GABAPENTIN 200 MG PO QD, TORSEMIDE 100 MG PO BID, COZAAR (LOSARTAN) 50 MG PO QD, LEVOCARNITINE 1 GM PO QD Starting Today (8/21), CITALOPRAM 20 MG PO QD, ADVAIR DISKUS 250/50 (FLUTICASONE PROPIONATE/...) 1 PUFF INH BID, NEXIUM (ESOMEPRAZOLE) 20 MG PO QD, LANTUS (INSULIN GLARGINE) 60 UNITS SC QHS, NOVOLOG (INSULIN ASPART), LIPITOR (ATORVASTATIN) 10 MG PO QPM, ATORVASTATIN CALCIUM, COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, and Sliding Scale (subcutaneously) SC AC with Food/Drug Interaction Instructions to Avoid milk and antacid, Take with food, Take consistently with meals or on empty stomach, and If BS is less than 125, then give 0 units subcutaneously. The patient was placed on order for COUMADIN PO (ref #29937145) and Adriamycin induced CMP HTN IDDM Sarcoid for DVT on 0/29 (goal 2-3). She was placed on po levofloxacin for 7 days and symptoms resolved. Her weight was 227lbs 7/6/05 (dry weight ~200), and she was on torsemide 100mg bid at baseline, with po lasix increased to 200bid x 2 doses, and zaroxyln 5mg po BID x 6 doses added. Tests included ALK Phos: 627, ALT: 71, AST: 65, Card Enzymes: neg, WBC: 6.4, UA: 1.011, 1+prot, 5-10WBC, 2+bact, CXR: LLL opacity, seen best on lateral view, EKG: prolonged PR, q in AVL, flat Ts laterally, unchanged from 9/5, RUQ US: sludge, gall bladder wall thickened 8mm, neg sonographic Murphy's sign, 2/4 Echo
|
Has the pt. ever been on colace ( docusate sodium ) before
|
{
"answer_end": [
803
],
"answer_start": [
764
],
"text": [
"COLACE (DOCUSATE SODIUM) 100 MG PO BID,"
]
}
|
MAZINGO, THOMAS 281-40-01-4 was admitted for CHF and discharged on 7/14/04. The patient, a 63 year old female with a history of resistant diabetes, morbid obesity, coronary artery disease, and hypertension, presented with one week of shortness of Breath. Examination revealed a respiratory rate of 22, oxygen saturation of 98% on 2L, bibasilar crackles, decreased breath sounds, scattered wheezes, and a normal heart exam. Labs and studies were notable for cardiac enzymes negative x3, BNP marginally elevated at 191, glucose of 286, A1c elevated at 10.3, and TSH of 3.847. An elevated PTT of 64.9 of uncertain significance was also found. The patient was ruled out for ischemia and given low-salt and ADA 1800 diets. She was prescribed Tylenol (Acetaminophen) 650 mg PO Q4H PRN Headache, ECASA (Aspirin Enteric Coated) 325 mg PO QD, Colace (Docusate Sodium) 100 mg PO BID, Lasix (Furosemide) 80 mg PO BID starting today, Insulin NPH Human 110 units SC QAM, NTG 1/150 (Nitroglycerin 1/150 (0.4 mg)) 1 Tab SL Q5min x 3 PRN Chest Pain, Verapamil Sustained Release 240 mg PO BID, Flovent (Fluticasone Propionate) 220 mcg Inh BID, Diovan (Valsartan) 160 mg PO QD, Vioxx (Rofecoxib) 12.5 mg PO QD, Duoneb (Albuterol and Ipratropium Nebulizer) QID with Q2H Albuterol O/N, Lipitor (Atorvastatin) 10 mg PO QD, Prilosec (Omeprazole) 20 mg PO QD, Albuterol Nebulizer 2.5 mg Neb Q2H PRN Shortness of Breath, 3/0.5 mg Inh Q6H PRN Shortness of Breath, and Heparin 5000 SC TID for DVT prophylaxis, as well as 80 IV Lasix in the ED and put out 1200 cc. She was instructed to follow-up with Dr. Ross Ogston on Friday 6/8/04, take Lasix pills twice a day until she sees Dr. Nicoll, and call her doctor if she has fever, chills, shortness of breath, or chest pain.
|
Why is the patient taking albuterol nebulizer
|
{
"answer_end": [
1438
],
"answer_start": [
1337
],
"text": [
"Albuterol Nebulizer 2.5 mg Neb Q2H PRN Shortness of Breath, 3/0.5 mg Inh Q6H PRN Shortness of Breath,"
]
}
|
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
|
Previous diltiazem cd
|
{
"answer_end": [
2323
],
"answer_start": [
2293
],
"text": [
"diltiazem CD 240 mg p.o. q.d.,"
]
}
|
This is a 66-year-old man with spinal sarcoidosis and secondary paraplegia who presented with altered mental status, hypoxemic respiratory failure, and hypotension. He became hypotensive with intubation despite using etomidate with Levophed, and was started on vancomycin, gentamicin, Flagyl, and stress dose steroids with 1 liter of IV fluid. His urine was found to have Proteus, resistant to Macrobid, and Klebsiella, resistant to ampicillin, so he was started on Levophed with a systolic blood pressure in the 130's on 7 to 10 of Levophed and Levofloxacin was continued at 500 mg per day for a total 10-day course on in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, to end on 10/16/2006 for a total course of 10 days. Urology replaced the suprapubic catheter and he was started on maintenance IV fluids until cleared to eat by Speech and Swallow. His home medications included Regular Insulin sliding scale a.c. and at bedtime, NPH 54 units in the morning and 68 units in the night, baclofen 10 mg t.i.d., amitriptyline 25 mg at bedtime, oxybutynin 5 mg t.i.d., gabapentin 300 mg t.i.d., iron sulfate 325 mg t.i.d., vitamin C 500 mg daily, magnesium 420 mg t.i.d., Coumadin 5 mg daily, ranitidine 150 mg b.i.d., and calcium 950 mg daily. He was given a head CT without contrast and a chest x-ray that showed no obvious infiltrate. His INR was found to be elevated and he had a suprapubic catheter obstruction with bilateral hydronephrosis and distended bladder. He was given Nexium and Coumadin for prophylaxis and was started on a low dose of captopril on 8/14/2006 for diabetes, and was started on 12.5 mg b.i.d. metoprolol on 0/14/2006 with good results. He was given NPH 20 b.i.d. through his hospitalization and Regular Insulin sliding scale. His creatinine came down to 1.2 and he was given the new beta-blocker and the ACE inhibitor as well as baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate 325 mg p.o. t.i.d., gabapentin 300 mg p.o. t.i.d., NPH human insulin 54 units in the morning, 68 units in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, magnesium oxide 420 mg p.o. t.i.d., metoprolol 12.5 mg p.o. b.i.d., oxybutynin 5 mg p.o. t.i.d., Panafil ointment t.i.d., and ranitidine 500 mg p.o. b.i.d. He was admitted with severe sepsis due to UTI, suprapubic catheter/ostomy for 12 years, diabetes type II, right DVT, on Coumadin, status post chronic UTI, and CPAP at night for pneumonia with ceftazidime, levofloxacin, and vancomycin. His sugars were controlled with no complications and was able to maintain blood pressures in the 130's. His creatinine was initially 2.7, and after receiving IV fluids, it came down to 1.2. He likely had acute renal failure secondary to postrenal obstructive etiology. His INR was found to be therapeutic and he had half of his home Coumadin dose while he was on levofloxacin, so he was given half of dose and his INRs came down to a nadir of 1.7. At discharge, his hematocrit was 27.2, down from 29, which was closed to his baseline of 34, and his INR was 2.1. He was placed on maintenance IV fluids until cleared to eat by Speech and Swallow, and was given amitriptyline 25 mg p.o. at bedtime, vitamin C 500 mg p.o. daily, baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate
|
Has the patient had panafil in the past
|
{
"answer_end": [
2275
],
"answer_start": [
2251
],
"text": [
"Panafil ointment t.i.d.,"
]
}
|
Mr. Gramby is a 43-year-old man with morbid obesity, type II diabetes, hypertension, hyperlipidemia, chronic renal insufficiency, and severe peripheral arterial disease status post femoral popliteal bypass in July which was complicated by repeated return of cellulitis x 2 who was admitted with cellulitis and volume overload. He was initially treated with courses of intravenous nafcillin and vancomycin for four weeks, having been seen by Vascular Surgery five days prior to admission and had been started on dicloxacillin for a third episode of cellulitis. He had also presented with fluid overload and spironolactone was added to his diuretic regimen. The patient was prescribed Atenolol 100 mg q.d., spironolactone, torsemide 160 mg b.i.d., Hyzaar 50/12.5 q. day, lisinopril 60 mg q. day, Neurontin 1200 mg t.i.d., Norvasc 10 mg q.a.m. and 5 mg q.p.m., Coumadin 8 mg, aspirin, Humalog sliding scale, Percocet, Pletal 100 mg b.i.d., Procrit, Zantac, nitroglycerin p.r.n., and NPH 80 q.a.m. and q.p.m. His torsemide was changed to IV and metolazone was added on the first day of admission and his electrolytes were replaced as needed. He was hypertensive on arrival, which was treated with Hydralazine initially and transitioned to his p.o. home medicines, with Hydralazine p.o. added on hospital day #9 to lower his systolic blood pressure to the range of the 120s-130s. His Coumadin was restarted when his INR was 2.2 and he his now in the therapeutic range and will need to be followed. The patient is on NPH and Humalog, with NPH doses increased to 90 units in the morning and 85 units at night, and the goal for this patient is below 150 particularly given the need for wound healing. Additional antibiotic coverage was added specifically of fluoroquinolone for anti-psuedomonal coverage for his diabetic foot ulcers, with surgical debridement done in the operating room with drainage of pus, but the metal showed could not be located even with fluoroscopy. The patient will complete a 14-day course of levofloxacin and clindamycin for these foot ulcers, and will be discharged home with visiting nursing care for b.i.d. wet-to-dry dressing changes. He will follow up with Jerold Cristopher Blazon, M.D. in one to two weeks, go home with visiting nurse care, and will need to see his nephrologist, vascular surgeons, primary care provider, and Bariatric Surgery following discharge.
|
Has this patient ever been on atenolol
|
{
"answer_end": [
745
],
"answer_start": [
656
],
"text": [
"The patient was prescribed Atenolol 100 mg q.d., spironolactone, torsemide 160 mg b.i.d.,"
]
}
|
Arron Umbaugh was admitted on 4/30/2001 and discharged on 7/10/2001 with a code status of full code and disposition of home w/ services. The discharge medications included ASA (Acetylsalicylic Acid) 325 mg PO QD, Atenolol 25 mg PO QD Starting Today (1/24) HOLD IF, Colace (Docusate Sodium) 100 mg PO BID, Lasix (Furosemide) 60 mg PO QD Starting Today (1/24) Instructions: Take 60mg per day for 3 days and then change, Zestril (Lisinopril) 7.5 mg PO QD, on order for KCL IMMEDIATE REL. PO (ref # 85723815) POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE Reason for override: will follow, on order for KCL SLOW REL. PO (ref # 68279429), COUMADIN (Warfarin Sodium) 6 mg PO QD, on order for ZOCOR PO (ref # 88249805) POTENTIALLY SERIOUS INTERACTION: WARFARIN & SIMVASTATIN, ZOCOR (Simvastatin) 20 mg PO QHS, on order for ERYTHROMYCIN TP (ref # 53201344) POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & ERYTHROMYCIN, TOPICAL OR OPHTHALMIC, Metformin 1,000 mg PO BID Starting Today (1/24), Prilosec (Omeprazole) 20 mg PO QD, with instructions to take consistently with meals or on empty stomach, and a warning for a potentially serious interaction: Furosemide & Omeprazole, Valacyclovir 1,000 mg PO Q8H X 7 Days, with Tylenol. Please page Dr. Blouir about your eye pain and come to the ED, lasix qd and see Dr. boeshore on wed. as well as daily weights, and to call Dr. Pradel if they can't control their pain due to zoster on your back. The patient was admitted with CHF exacerbation, increased SOB over past few days, orthopnea and PND, with left sided failure and diastolic dysfunction, and IV lasix 40 in ED, which decreased SOB. The patient was also prescribed Metformin 1000 mg PO BID, Prilosec (Omeprazole) 20 mg PO QD, and Valacyclovir 1000 mg PO Q8H X 7 Days with instructions to take consistently with meals or on empty stomach, and a warning for a potentially serious interaction: Furosemide & Omeprazole. Override Notices were added for COUMADIN PO (ref # 29560859), KCL IMMEDIATE REL. PO (ref # 85723815), KCL SLOW REL. PO (ref # 68279429), and ZOCOR PO (ref # 88249805) due to potentially serious interactions: Aspirin & Warfarin, Lisinopril & Potassium Chloride, Warfarin & Simvastatin, respectively. The patient was also instructed to take lasix qd and see Dr. boeshore on wed. as well as daily weights, and to call Dr. Pradel if they can't control their pain due to zoster on their back. The patient was discharged with discharge medications including ASA (Acetylsalicylic Acid) 325 mg PO QD, Atenolol 25 mg PO QD Starting Today (1/24) HOLD IF, Colace (Docusate Sodium) 100 mg PO BID, Lasix (Furosemide) 60 mg PO QD Starting Today (1/24) Instructions: Take 60mg per day for 3 days and then change, Zestril (Lisinopril) 7.5 mg PO QD, COUMADIN (Warfarin Sodium) 6 mg PO QD with instructions to avoid high Vitamin-K containing foods, and ZOCOR (Simvastatin) 20 mg PO QHS with instructions to avoid grapefruit unless MD instructs otherwise.
|
Has the patient had previous zocor ( simvastatin )
|
{
"answer_end": [
820
],
"answer_start": [
787
],
"text": [
"ZOCOR (Simvastatin) 20 mg PO QHS,"
]
}
|
Ms. Christin is an 80-year-old female who presented to an outside hospital with chest pain and shortness of breath. She took one sublingual Nitroglycerin without relief, followed by two more without relief and was then treated with intravenous Lasix, morphine, and Nitroglycerin which resulted in resolution of her pain. Her medical history includes hypertension, hypercholesterolemia, angina, Paget's disease, anemia, and osteoarthritis. An EKG at the hospital showed anterolateral ST depression and her enzymes were negative, ruling out myocardial infarction. Her cardiac symptomatology began in the fall of 1999 and evaluation showed high cholesterol with an LDL 141, EKG with LVH and nonspecific T wave flattening, and a Thallium stress test that was stopped secondary to shortness of breath. Upon admission to Ster Hospital for evaluation of her angina, her laboratory values were consistent with a myocardial infarction and her peak CK was 459 with an MB of 28.7. Her discharge medications include Aspirin 81 mg daily, iron 300 mg three times a day, Hydrochlorothiazide 25 mg daily, Lisinopril 5 mg daily, multivitamin one daily, Relafen 500 mg orally a day, Imdur 60 mg orally a day, Plavix 75 mg daily for 29 days, Lipitor 40 mg daily, Atenolol 25 mg orally a day, and magnesium oxide 420 mg daily. Follow-up with Dr. Porter Luckenbaugh in SH Cardiovascular Group on January at 1:00 p.m. and with Dr. Sammy Kleindienst in the Greenetons Opi Hospital Hematology Clinic.
|
Has the patient had previous lasix
|
{
"answer_end": [
260
],
"answer_start": [
210
],
"text": [
"was then treated with intravenous Lasix, morphine,"
]
}
|
Mr. Mauras is a 72-year-old man with history of stable angina, type 2 diabetes, peripheral vascular disease, former smoking history, and history of seizure disorder with cataracts. He had occasional anginal symptoms prior to discharge and took about two nitroglycerins per week. Over the past week, he had escalating chest pain requiring one nitroglycerin per day. The pain was relieved by rest and nitroglycerin. One week prior to admission, his digoxin was stopped and his amiodarone was decreased. His Plavix was stopped and his Coumadin was held. On the morning of admission, he had chest pain and received Lopressor, Enalapril, Lovenox treatment dose and a Plavix load in the ED. He was found to have flash pulmonary edema and in atrial fibrillation with rapid ventricular response and was taken back to the catheterization lab and given four stents to his saphenous vein graft, OM1 with good resolution of his symptoms. He was transferred to the floor and was given an amiodarone load given his ejection fraction and increased ectopy on telemetry. His troponin had been trended down to the 0.2s by discharge and his beta-blocker and ACE inhibitor were titrated to heart rate and blood pressure. Prior to anticipated discharge, he re-developed flash pulmonary edema secondary to atrial fibrillation with rapid ventricular response and was re-loaded with digoxin. He was started on Mucomyst precath with good effect, had a difficult-to-place Foley, and was started on Flomax with good effect. His creatinine on discharge was 1.2, his metformin was held, and he was continued on Lantus with sliding scale insulin. He was given three units of packed red blood cells given his history of CAD and was prescribed with Amiodarone 200 mg, Enteric-coated aspirin 325 mg, Librium 10 mg, Colace 200 mg, Ferrous gluconate 324 mg, Lasix 40 mg, Nitroglycerin one tab, Dilantin 100 mg, Senna two tabs, Coumadin 3 mg, Lipitor 80 mg, Flomax 0.4 mg, Plavix 75 mg, Lantus 14 units, Metformin 500 mg, Ranitidine 150 mg, Digoxin 0.125 mg, Enalapril 10 mg, and Atenolol 50 mg, with follow-up appointments with his PCP, Dr. Kelley Hernon of Electrophysiology on 7/8/05, and Dr. Daft on 9/20/05, and INR checked on 8/4/05 or 7/8/05 with Coumadin adjusted accordingly.
|
What is the current dose of enteric-coated aspirin
|
{
"answer_end": [
1766
],
"answer_start": [
1736
],
"text": [
"Enteric-coated aspirin 325 mg,"
]
}
|
The patient was admitted on 4/12/04 with a right plantar surface neurotrophic ulcer, low-grade fevers and chills, and a history of diabetes mellitus, hypertension, distant past of pancreatitis, gout, neuropathy, high cholesterol, and chronic renal insufficiency. Significant labs at the time of admission included a potassium of 4.3, BUN of 38, creatinine of 3.2, and blood glucose of 187. The patient was started on 1. Lantus 100 mg q.p.m., 2. Humalog 20 units q.p.m., 4. Neurontin 300 mg t.i.d., 5. Lisinopril 40 mg q.d., 6. Allopurinol 300 mg q.d., 7. Hydrochlorothiazide 25 mg q.d., 8. Zocor 20 mg q.d., 9. TriCor 50 mg b.i.d., 10. Atenolol 25 mg q.d., 11. Eyedrops prednisolone and atropine, and 12. iron supplementation. The patient underwent an amputation of the third and fourth toe as well as metatarsal heads, and was started on Dr. Tosco's suggested antibiotics, vancomycin, levofloxacin, and Flagyl. To manage temperature greater than 101, the patient was prescribed Tylenol 650 to 1000 mg p.o. q.4h. p.r.n., allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Colace 100 mg p.o. b.i.d., Epogen 10,000 units q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient was seen by Dr. Ulvan in the renal staff and by the diabetes management service by Dr. Clint Holets. Postoperative lab checkup revealed that the patient's creatinine bumped to 4.9 with a BUN of 61, and the renal service was consulted. The patient was given Lopressor 100 mg b.i.d. to control the blood pressure, and was eventually started on PhosLo and Ferrlecit as well as Epogen 10,000 units q. week. Levofloxacin was continued for a one week course, and the patient was discharged to the rehab facility with Tylenol 650 to 1000 mg p.o. q.4h. p.r.n. for temperature greater than 101, allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Lopressor 100 mg p.o. b.i.d., PhosLo 1334 mg p.o. q.a.c., Colace 100 mg p.o. b.i.d., Epogen 10,000 units delivered subcuticularly q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient is to be followed up at the rehab facility at Ing Mansy General Hospital and should follow up with the renal service and Dr. Knaub in two to three weeks and one to two weeks, respectively. The
|
Has the pt. ever been on atropine before
|
{
"answer_end": [
1371
],
"answer_start": [
1328
],
"text": [
"atropine 1 mg one drop in the affected eye,"
]
}
|
Mr. Klaja is an 81-year-old gentleman who presented with abdominal pain and diarrhea, and an abdominal CT revealed an infectious inflammatory bowel process. Stool samples were sent for C. diff toxin and assay, all were negative, while stool cultures did not grow anything out. Empiric treatment with p.o. vancomycin was started, and the patient's abdominal pain resolved and he was afebrile by discharge. A flexible sigmoidoscopy showed colitis consistent with inflammatory etiology, and the patient was discharged with a presumed C. diff colitis diagnosis on a 2-week course of vancomycin. The patient had a DVT followed by bacteremia with multi-resistant Klebsiella pneumoniae, treated with meropenem for 14 days with the course. The patient had no evidence of acute coronary syndrome on admission, and his coronary artery disease, CHF, and chronic kidney disease were managed with MEDICATIONS: aspirin 81 mg, Plavix 75 mg, Coumadin 5 mg, digoxin 0.125 mg, Lasix 49 mg daily, lisinopril 10 mg daily, Lopressor 25 mg b.i.d., Zocor 80 mg daily, Flomax 0.4 mg daily and Flovent 110 mcg b.i.d., lactobacillus p.o. for probiotics and patient also had flex sig 2-week course p.o. vancomycin alone. He was given gentle hydration therapy with 2 liters of IV fluids, and restarted on Lasix 40 mg p.o. daily for diuresis. He was also discharged on a course of lactobacillus p.o. for probiotics, with DISCHARGE MEDICATIONS: Included aspirin 81 mg p.o. daily, Plavix 75 mg p.o. daily, digoxin 0.125 mg p.o. daily, Nexium 20 mg p.o. daily, lactobacillus 2 tabs p.o. t.i.d., metoprolol 25 mg p.o. b.i.d., simvastatin 80 mg p.o. at bed time, Flomax 0.4 mg p.o. every evening, vancomycin 250 mg p.o. every 6 hours x8 days at supertherapeutic, Coumadin 6 mg p.o. daily, Flovent 110 mcg inhale b.i.d., Lasix 40 mg p.o. daily, his daily dose at home.
|
Previous fluids
|
{
"answer_end": [
1259
],
"answer_start": [
1194
],
"text": [
"He was given gentle hydration therapy with 2 liters of IV fluids,"
]
}
|
Lupe Rumble, a 42 year old female with a history of asthma, hypertension, obesity, hyperlipidemia, hyperglycemia, hirsutism, chiari malformation, spinal stenosis, and spinal syrinx, was admitted to the hospital with a recent asthma flare, productive cough, low grade fevers, shortness of breath, and wheezing. Her chest x-ray showed a linear opacity in the right lower lobe most consistent with platelike atelectasis, but could not rule out resolving or new pneumonia. Treatment included ALBUTEROL INHALER 2 PUFF INH QID, ALBUTEROL NEBULIZER 2.5 MG NEB Q4H, Advair Diskus 500/50 (Fluticasone Propionate/...), Combivent (Ipratropium and Albuterol Sulfate) 2 PUFF INH TID, LISINOPRIL 20 MG PO DAILY, Singulair (Montelukast) 10 MG PO DAILY, and a prednisone taper starting at 60 mg q 24 h x 2 doses, then 50 mg daily x 3 days, then 40 mg daily x 3 days, then 30 mg daily x 3 days, then 20 mg daily x 3 days, and then 10 mg daily x 2 days and stop. The peak flow had improved to 250 and ambulating oxygen saturation was 92-94% at discharge. The patient was also advised to try a nicotine patch and was given Lovenox as a prophylaxis. Her lisinopril was increased to 20mg due to hypertension, and she was discharged on order for KCL IMMEDIATE RELEASE PO (ref #) with instructions to continue all home medications, a prednisone taper, nebs, and advair, singulair, albuterol, and combivent. Smoking cessation was encouraged and she was interested in trying a nicotine patch.
|
When the the patient last receive prednisone taper
|
{
"answer_end": [
796
],
"answer_start": [
744
],
"text": [
"prednisone taper starting at 60 mg q 24 h x 2 doses,"
]
}
|
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 used humalog in the past
|
{
"answer_end": [
576
],
"answer_start": [
528
],
"text": [
"Humalog Insulin (Insulin Lispro) 12 units SC AC,"
]
}
|
This 79-year-old male was admitted for coronary artery disease and aortic stenosis with a history of hypertension, dyslipidemia, chest radiation, prostate cancer, osteoporosis, and urinary incontinence. A CABG x3 with a LIMA to the LAD, a saphenous vein graft to the PDA, and a saphenous vein graft to the obtuse marginal was done on 10/3/06, while the aortic valve was only found to be mildly stenotic. Postoperatively, he was transferred to the Intensive Care Unit in a stable fashion, and was found to have an inferior lateral ischemia on EKG, which was resolved after cardiac catheterization. He was weaned off pressors and extubated, and started on Lopressor and gentle diuresis. On postoperative day #3, his Norvasc was started and he was transferred to the Step-Down Unit. On postoperative day #4, he was slightly tachycardic with ambulation and his beta-blockers were titrated up, with PA and chest x-ray looking good. He was started on empiric levofloxacin for questionable pneumonia and found suitable for discharge on postoperative day #5, however, he had isolated temperature and his white count was found to be trending and he was hypertensive. A positive blood culture was found from when he had been in the Intensive Care Unit and he was continued on levofloxacin, while he was also started on vancomycin due to left leg cellulitis at the knee. On postoperative day #10, a fluid collection was found above the knee to the mid calf, and he underwent a drainage and irrigation of his left lower extremity saphenous vein donor site. After this procedure, he was transferred back to the Step-Down Unit and was discharged on postoperative day #5.
|
What medications did the patient take for left leg cellulitis
|
{
"answer_end": [
1359
],
"answer_start": [
1286
],
"text": [
"he was also started on vancomycin due to left leg cellulitis at the knee."
]
}
|
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.
|
antibiotics
|
{
"answer_end": [
466
],
"answer_start": [
368
],
"text": [
"She was placed on broad-spectrum antibiotics and plan was made for an MRA to evaluate her anatomy,"
]
}
|
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.
|
Is there a mention of of dulcolax usage/prescription in the record
|
{
"answer_end": [
684
],
"answer_start": [
615
],
"text": [
"Dulcolax 10 mg as needed for constipation, vitamin E 400 units daily,"
]
}
|
Mr. Wolfinbarger is a 55 year old male with Coronary Artery Disease who was admitted to Enreen Dallout Medical Center for cardiac catheterization. His Past Medical History includes non-Hodgkin's lymphoma, status bone marrow transplant and chemotherapy in 1992 and 1993; history of hypercholesterolemia, hypertension, insulin dependent diabetes, gastroesophageal reflux disorder and chronic renal insufficiency. He is allergic to Benadryl. His medications on admission included Toprol XL 200 mg q.d. Procardia XL 90 mg q.d, Lipitor 20 mg q.d., aspirin 325 mg q.d., Zantac 150 mg b.i.d., NPH humulin insulin 32 units each morning and 18 units each evening subcutaneously, Valium 5 mg q.d., Minipress 1 mg b.i.d. His physical examination was within normal limits, no varicosities. He underwent harvesting of the left radial artery for graft and a coronary artery bypass grafting x three with a left internal mammary artery to the left anterior descending coronary artery, saphenous vein graft from the posterior descending coronary artery to the aorta and a radial artery from the saphenous vein graft to the obtuse marginal coronary artery. Postoperatively, he had an episode of rapid atrial flutter and was chemically converted to sinus rhythm with Corvert and has remained in sinus rhythm on Lopressor and diltiazem for 24 hours. His saphenous vein harvest site showed some slight erythema to be treated with antibiotics by mouth. He is discharged on Axid 150 mg b.i.d, Lipitor 20 mg q.d., NPH Humulin insulin 32 Units every morning, 18 Units every evening; Diltiazem 60 mg t.i.d., Lopressor 150 mg b.i.d., enteric coated aspirin 125 mg once a day, Valium 5 mg once a day, Keflex 500 mg four times a day for 7 days, Percocet 1 to 2 tablets every four hours as needed for pain.
|
What medications did the patient take for erythema
|
{
"answer_end": [
1430
],
"answer_start": [
1390
],
"text": [
"to be treated with antibiotics by mouth."
]
}
|
This is a 66-year-old man with spinal sarcoidosis and secondary paraplegia who presented with altered mental status, hypoxemic respiratory failure, and hypotension. He became hypotensive with intubation despite using etomidate with Levophed, and was started on vancomycin, gentamicin, Flagyl, and stress dose steroids with 1 liter of IV fluid. His urine was found to have Proteus, resistant to Macrobid, and Klebsiella, resistant to ampicillin, so he was started on Levophed with a systolic blood pressure in the 130's on 7 to 10 of Levophed and Levofloxacin was continued at 500 mg per day for a total 10-day course on in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, to end on 10/16/2006 for a total course of 10 days. Urology replaced the suprapubic catheter and he was started on maintenance IV fluids until cleared to eat by Speech and Swallow. His home medications included Regular Insulin sliding scale a.c. and at bedtime, NPH 54 units in the morning and 68 units in the night, baclofen 10 mg t.i.d., amitriptyline 25 mg at bedtime, oxybutynin 5 mg t.i.d., gabapentin 300 mg t.i.d., iron sulfate 325 mg t.i.d., vitamin C 500 mg daily, magnesium 420 mg t.i.d., Coumadin 5 mg daily, ranitidine 150 mg b.i.d., and calcium 950 mg daily. He was given a head CT without contrast and a chest x-ray that showed no obvious infiltrate. His INR was found to be elevated and he had a suprapubic catheter obstruction with bilateral hydronephrosis and distended bladder. He was given Nexium and Coumadin for prophylaxis and was started on a low dose of captopril on 8/14/2006 for diabetes, and was started on 12.5 mg b.i.d. metoprolol on 0/14/2006 with good results. He was given NPH 20 b.i.d. through his hospitalization and Regular Insulin sliding scale. His creatinine came down to 1.2 and he was given the new beta-blocker and the ACE inhibitor as well as baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate 325 mg p.o. t.i.d., gabapentin 300 mg p.o. t.i.d., NPH human insulin 54 units in the morning, 68 units in the evening, Regular Insulin sliding scale, levofloxacin 500 mg p.o. daily, magnesium oxide 420 mg p.o. t.i.d., metoprolol 12.5 mg p.o. b.i.d., oxybutynin 5 mg p.o. t.i.d., Panafil ointment t.i.d., and ranitidine 500 mg p.o. b.i.d. He was admitted with severe sepsis due to UTI, suprapubic catheter/ostomy for 12 years, diabetes type II, right DVT, on Coumadin, status post chronic UTI, and CPAP at night for pneumonia with ceftazidime, levofloxacin, and vancomycin. His sugars were controlled with no complications and was able to maintain blood pressures in the 130's. His creatinine was initially 2.7, and after receiving IV fluids, it came down to 1.2. He likely had acute renal failure secondary to postrenal obstructive etiology. His INR was found to be therapeutic and he had half of his home Coumadin dose while he was on levofloxacin, so he was given half of dose and his INRs came down to a nadir of 1.7. At discharge, his hematocrit was 27.2, down from 29, which was closed to his baseline of 34, and his INR was 2.1. He was placed on maintenance IV fluids until cleared to eat by Speech and Swallow, and was given amitriptyline 25 mg p.o. at bedtime, vitamin C 500 mg p.o. daily, baclofen 10 mg p.o. t.i.d., Caltrate 600 Plus D one tablet p.o. b.i.d., ferrous sulfate
|
Has the patient taken any medications for the presumed pneumonia management
|
{
"answer_end": [
2514
],
"answer_start": [
2465
],
"text": [
"and CPAP at night for pneumonia with ceftazidime,"
]
}
|
This 64-year-old patient had a past medical history of non-small cell lung cancer, status post XRT and chemotherapy, right MC embolic stroke, status post right carotid endarterectomy, Graves’ disease, depression, diabetes, hypertension, asthma, temporal lobe epilepsy, and history of subclavian steal syndrome. On admission, her blood pressure was 66/44, pulse of 100, respiratory rate normal, and blood sugar of 133. She was found to be difficult to arouse and had 1 gm of vancomycin, magnesium and Levaquin 500 mg. Her medication on admission included Mechanical soft diet, aspirin 81 mg, baclofen 5 mg t.i.d., B12 1000 mg daily, iron sulfate 325 mg daily, Cymbalta 20 mg p.o. b.i.d., Neurontin 100 mg b.i.d., Lamictal 200 mg b.i.d., Prilosec 20 daily, levothyroxine, Glucophage 500 once a day, Reglan 10 once a day, niacin 500 once a day, Senna 2 tabs b.i.d., Zocor 20 mg once a day, Nicoderm patch, Colace 100 mg p.o. b.i.d., Lopressor 100 mg p.o. b.i.d., lidoderm 5% patch to the low back, Tylenol, ducolox, Mylanta, lactulose, Seroquel 100 mg, prednisone 50 mg, and Dilaudid 1 mg. She completed a ten-day course of vancomycin for a MRSA urinary tract infection and was treated with tramadol and Tylenol for pain. Her laboratory data showed creatinine of 1, ALT 25, AST 35, hematocrit 33, white count 6.6, and platelets 241,000. She was covered with antibiotics initially, then transitioned over to a ciprofloxacin 700 mg p.o. b.i.d. regime for a total of 12 days for a presumed urinary tract infection. She had a significant polypharmacy and enumerable sedating medications, including baclofen, Dilaudid and trazodone. Her Cymbalta was continued per outpatient follow-up and her Lamictal, as well as her Cymbalta, were maintained for her history of depression. Neurologically, she had a left-sided hemiparesis, as well as agnosia on the left side, and her mental status included intermittent disorientation. She was maintained on Novolog sliding scale for diabetes, QTc monitored with serial EKGs, and prior use of Haldol and other antipsychotics for behavioral modification. She was also continued on a replacement dose levothyroxine for her history of Graves' and a history of radioiodine ablation. For behavioral modification, as well as intermittent agitation and disorientation, the patient was maintained on p.r.n. Seroquel 100 mg p.o. b.i.d., as well as Zydis 5 mg p.o. b.i.d. p.r.n., which was titrated from standing to p.r.n. over the course of her hospitalization in order to try to decrease any sedating medications that may be altering her alertness and orientation.
|
Is there a mention of of chemotherapy usage/prescription in the record
|
{
"answer_end": [
116
],
"answer_start": [
83
],
"text": [
"status post XRT and chemotherapy,"
]
}
|
Vance Prunier, a 57 year old patient with diabetes mellitus, hypertension, hyperlipidemia, and known coronary artery disease, was admitted on 5/30/2001 with worsening exercise capacity. A cath today showed severe native TVD, patent LIMA to LAD, occluded SVG-OM, and radial graft to PDA 80% stenosis. PCI of radial graft lesion with Nir 2.5x15mm and S660 2.5x12mm stents resulting in 0% residual was done and Angioseal was applied to RFA. The patient was discharged on 6/17/2001 in a stable condition with medications EC ASA (Aspirin Enteric Coated) 325 MG PO QD, Atenolol 50 MG PO QPM, Cipro (Ciprofloxacin) 250 MG PO BID, Insulin NPH Human 30 UNITS SC QAM, Insulin Regular (Human) 18 UNITS SC QAM, Levoxyl (Levothyroxine Sodium) 75 MCG PO QD, Lisinopril 20 MG PO QD, Nitroglycerin 1/150 (0.4 MG) 1 TAB SL Q5 MIN X 3 PRN Chest Pain HOLD IF: SBP<[ ], Pravachol (Pravastatin) 20 MG PO QHS, Amlodipine 5 MG PO QD, Imdur (Isosorbide Mononit.( SR )) 60 MG PO QD, Wellbutrin SR (Bupropion Hcl SR) 150 MG PO BID, Clopidogrel 75 MG PO QD, and 16 hours Integrilin and 30 days Plavix. The patient was instructed to call for any further chest pain, groin pain, swelling or bleeding and was to return to work after an appointment with the local physician. Follow up appointments with Dr. Minear in 1-2 weeks and Dr. Givens were scheduled. The patient was discharged to home.
|
What medication has the patient take for chest pain
|
{
"answer_end": [
849
],
"answer_start": [
768
],
"text": [
"Nitroglycerin 1/150 (0.4 MG) 1 TAB SL Q5 MIN X 3 PRN Chest Pain HOLD IF: SBP<[ ],"
]
}
|
The patient is a 50 year old man with unstable angina who was referred to the Rhalca Medical Center for cardiac catheterization and coronary artery bypass grafting. He had a four-year history of coronary artery disease and described episodes of chest pain occurring approximately q. two months as well as evidence of shortness of breath due to chronic obstructive pulmonary disease. On admission, he was taking NTG on a twice daily basis for exertional angina and was given intravenous NTG, heparin, and Diltiazem by an EMT. His cardiac risk factors included an 80-pack year smoking history, family history of heart disease, hypercholesterolemia, and non-insulin-dependent diabetes mellitus. His past medical history was notable for interstitial lung disease, hyperlipidemia, GERD, chronic bronchitis, and obstructive sleep apnea. Medications on admission included Cardizem 120mg p.o.b.i.d., Mevacor 20mg p.o.b.i.d., Pepcid 40mg p.o.q.d., Ventolin and Seldane taken on a prn basis. Allergies were NKDA. An ETT Thallium demonstrated reperfusion abnormalities in the inferior and anterior walls. He underwent cardiac catheterization demonstrating 80% distal stenosis of the left main as well as the origin of the LAD with additional occlusion of the midportion of the LAD and distal carotid, 80% stenosis of midportion of left circumflex and proximal occlusion of the right coronary. On the 26th of May, he received double coronary artery bypass graft including pedicle LIMA bypass to the LAD and LAD patch angioplasty with a single aortocoronary saphenous vein bypass graft to the obtuse marginal. He had a low-grade fever and leukocytosis up to 20,000 for which he was started on an empiric course of cefuroxime and clindamycin 300mg p.o.q.i.d. He was evaluated by the Dental Service and prescribed a course of penicillin for a possible periodontal abscess of tooth #32. He was encouraged to see his cardiologist for follow-up and return to Dr. Donnie Daidone office for completion of his antibiotics. Discharge medications included Aspirin 325mg q.d., Diltiazem 120mg p.o.t.i.d., Colace 100mg t.i.d., iron sulfate 300mg t.i.d., Lasix 80mg p.o.b.i.d., Mevacor 20mg p.o.b.i.d., MVI one p.o.q.d., Percocet one to two tabs. q. 4 prn, KCl 40mil/eq p.o.b.i.d., and ciprofloxacin 500mg p.o.b.i.d. X 10 days taken with clindamycin 300mg p.o.q.i.d.
|
Has the patient had previous ciprofloxacin
|
{
"answer_end": [
2300
],
"answer_start": [
2260
],
"text": [
"ciprofloxacin 500mg p.o.b.i.d. X 10 days"
]
}
|
This 39-year-old female with a history of discoid lupus and pericarditis presented with severe substernal chest pain after having prednisone and Plaquenil discontinued. She first developed arthralgias of various joints, which were treated with aspirin, Motrin and steroids. In 1985, she developed pleuritic substernal chest pain and was diagnosed at Westten Hospital with pericarditis. In 1988, she was seen at the Arthritis Clinic by Dr. Goerlitz and was treated with Plaquenil 200 bid, plus aspirin and Naprosyn. In 22 of May, she was diagnosed with a lupus flare and was put on prednisone 30 q am and in 23 of March, the steroids were tapered off and discontinued. However, she presented with increasing joint pain and had her prednisone restarted with Plaquenil 200 bid, Motrin 80 tid, prednisone 10 q am, Dilantin 200 bid, and prednisone 30 q day. Laboratory examination showed electrolytes within normal limits, CK of 76, white count of 4.7, hematocrit of 30, platelets of 352,000, mean corpuscular volume of 83, ESR of 88, oxygen saturation of 99% on room air, and urinalysis showed specific gravity of 1.026, 2+ protein, 10 to 15 white cells, 8 to 10 red blood cells and a few granular casts. Chest x-ray showed increased heart size, multiple thoracic compression fractures and osteopenia, and electrocardiogram showed sinus rhythm with frequent premature ventricular contractions at a rate of approximately 70. She was ruled out for a myocardial infarction, had an echocardiogram which showed a small amount of pericardial fluid, and was placed back on her Plaquenil 200 bid and prednisone 30 q day. The hematocrit remained stable between 27 and 30 without transfusions or further intervention, and she was discharged on medications including Plaquenil 200 bid, prednisone 20 q day, Dilantin 400 q day, L-thyroxine 0.2 q am, Motrin 800 tid, Carafate, iron and folate for follow-up in Rheumatology Clinic with Dr. Grondin.
|
How often does the patient take plaquenil
|
{
"answer_end": [
528
],
"answer_start": [
469
],
"text": [
"Plaquenil 200 bid, plus aspirin and Naprosyn. In 22 of May,"
]
}
|
This is a 69 year-old woman with a history of congestive heart failure and hypertension who presented with a productive cough which was worsening over the past 3-4 days and fever to 101 with chills and shakes and increasing shortness of breath. She had a white blood cell count of 9.3 with 54% polys and 9.6 % eosinophils, a glucose of 377, and a chest x-ray without evidence of congestive heart failure or infiltrate. She was treated in the emergency room with Albuterol nebulizer and plans were to discharge her to home, however, her saturations dropped to 89% on room air with exercise in the emergency room and was admitted for further observation. She was started on intravenous Cefuroxime, and initially improved with decrease in cough and shortness of breath; however, the patient continued to desat with exercise. A repeat chest x-ray was performed which showed no change when compared to the admission film. Her sputum culture grew out Pen-sensitive E-coli and she was continued on her intravenous and then PO antibiotics. She continued to desat with exercise, however, and her cough persisted although she remained afebrile with a slightly elevated white count and moderate peripheral eosinophilia. Her chest exam remained rancorous and the reason for this remained unclear. Given the finding of E-coli in the sputum sample, in addition to the elevated eosinophilia and lack of finding on chest x-ray despite significant findings on chest exam, the possibility of a worm or parasitic disease was raised. She had a Persantine MIBI in March of 1996, on which she had no fixed or reversible defects, and was on nitroglycerin for stable angina - "chest heaviness" after climbing one flight of stairs, relieved by rest and one sublingual nitroglycerin. Her medications on admission included Lasix 40 mg. per day, Insulin 70/30 28 units q a.m. and 5 units q p.m., Verapamil SR 120 mg PO b.i.d., Enteric coated aspirin 325 mg q day, KCL 10 mEq PO q day, Premarin 0.625 mg PO q day, Zestril 20 mg b.i.d., Atenolol, recently discontinued, Tofranil 75 mg PO q HS, Albuterol inhaler two puffs inhaled q.i.d., and Potassium slow release 10 mEq PO q day. She was discharged to home with Albuterol inhaler and instructions to follow up with her primary physician in clinic for further evaluation including PFTs and possible chest CT if symptoms did not abate, and to finish a full ten day course of antibiotics for presumed bronchitis. At the time of discharge the patient's saturation was 92 to 93% on room air and dropping slightly to 90 to 91% with exercise, however she was tolerating this well and was getting relief from her Albuterol inhaler.
|
Is the patient currently or have they ever taken antibiotics.
|
{
"answer_end": [
1031
],
"answer_start": [
970
],
"text": [
"she was continued on her intravenous and then PO antibiotics."
]
}
|
A 45-year-old man with a history of familial cardiomyopathy and status post cardiac transplant in 2002, and chronic renal insufficiency presented with greater than two weeks of polyuria, polydipsia, blurry vision, muscle cramps, and myalgias and reported approximately a 15-pound weight loss over three weeks with decrease in usual lower extremity edema. On admission, notable for a blood glucose of 1064, creatinine 2.2 from a baseline of 1.8, sodium 130, potassium 4.9. Endocrine service was consulted and the patient was controlled with a combination regimen of Lantus, Novolog q. a.c., combined with a Novolog sliding scale. The patient was discharged with followup with Napoleon Mettee, the diabetic teaching nurse and with Dr. Jonson in the diabetes clinic and with VNA services to assist with home medications. The patient had mild acute gout flare during admission for which he was started on colchicine. The patient was discharged with medications including Calcium carbonate 1250 mg t.i.d., Cartia XT 300 mg daily, CellCept 1500 mg b.i.d., colchicine 0.6 mg daily p.r.n., Neoral 150 mg b.i.d., folate 1 mg daily, K-dur 20 mg daily, magnesium oxide 400 mg b.i.d., methotrexate 2.5 mg daily, Pravastatin 20 mg daily, prednisone 7 mg daily, Rocaltrol 0.25 mg daily, Synthroid 150 mcg daily, Torsemide 40 mg daily, Vitamin C, Vitamin E, and cyclosporin 150 mg b.i.d., Vitamin C 500 mg b.i.d., Rocaltrol 0.25 mcg daily, calcium carbonate 500 mg t.i.d., colchicine 0.3 mg p.o. b.i.d., cyclosporin 150 mg b.i.d., folic acid 1 mg daily, Synthroid 150 mcg daily, magnesium oxide 420 mg b.i.d., prednisone 7.5 mg q.a.m., Vitamin E 400 units daily, Pravachol 20 mg at night, Cartia XT that is diltiazem extended release 300 mg daily, CellCept 1500 mg b.i.d., Lantus insulin (Glargine) 40 units subcutaneous q.a.m., Novolog 12 units before breakfast, Novolog 12 units before lunch, Novolog 14 units before dinner, and Novolog sliding scale q. a.c. The patient demonstrated proper understanding of blood glucose testing and insulin administration prior to discharge.
|
Is the patient currently or have they ever taken k-dur
|
{
"answer_end": [
1122
],
"answer_start": [
1104
],
"text": [
"folate 1 mg daily,"
]
}
|
Patient TEWA, GERMAN M, a 74-year-old African American female with a history of NYHA III CHF (EF 45%), PHT, HTN-CMP, and obesity, was admitted to CAR service on 1/20/2005 for CHF exacerbation and UTI and was discharged on 4/28/2005 with Full Code status. She was prescribed ALLOPURINOL 100 MG PO BID, FERROUS SULFATE 325 MG PO QD, LASIX (FUROSEMIDE) 60 MG PO BID starting today (8/27), HYDRALAZINE HCL 10 MG PO TID (hold if SBP below 90), ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID (hold if SBP below 90), LISINOPRIL 20 MG PO QD (hold if SBP below 90), LIPITOR (ATORVASTATIN) 10 MG PO QD, PROTONIX (PANTOPRAZOLE) 40 MG PO QD, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 75 MG PO QD, LEVAQUIN (LEVOFLOXACIN) 250 MG PO QD, and ACETYLSALICYLIC ACID 325 MG PO QD. Override notices were added on 5/12/05, 10/29/05, and 10/29/05 on order for KCL IMMEDIATE RELEASE PO (ref #03030471, 01642329, 91907761, 15927551) and KCL IV (ref #78178294) for POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE. Food/Drug Interaction Instruction to avoid milk and antacid, take consistently with meals or on empty stomach, and administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose (if on tube feeds, please cycle (hold 1 hr before to 2 hr after) and take 2 hours before or 2 hours after dairy products) was provided, as well as fluid restriction and diurese aggressively with lasix 100 bid, replete lytes, keeping in mind CRI, cont BB, ACEI, and added hydralazine/isordil for CAD, hyperlipidemia: BB, ACEI, statin, ASA; RENAL: CRI with anemia; HEME: Anemia - Given aranesp, FeSO4; HTN: BB, ACEI; ID: UTI, E coli in Ucx, sensitivities pending; and empirically tx with Keflex, changed empirically on HD4 to levo. RHEUM: Gout - allopurinol. The patient was discharged in a satisfactory condition.
|
has there been a prior kcl immediate release
|
{
"answer_end": [
940
],
"answer_start": [
830
],
"text": [
"on order for KCL IMMEDIATE RELEASE PO (ref #03030471, 01642329, 91907761, 15927551) and KCL IV (ref #78178294)"
]
}
|
The patient, Emile Daron 493-31-10-1, was admitted on 3/17/2003 for pancreatitis with a Discharge Date of 2/1/2003 and was placed on a Full Code status and discharged to Home. She had a definite allergy (or sensitivity) to muscle relaxants, skeletal, and possible allergy (or sensitivity) to sulfa. The patient is a 64-year-old with known CAD, atherosclerotic peripheral vascular disease, and type 2 diabetes who presented with 8/10 stabbing back pain 4 days ago without a clear precipitant, which was non-raditating and partially relieved with analgesics. She denied any bowel or bladder incontinence or saddle anesthes ia, fevers, chills, nausea, vomiting, or diarrhea, however she did complain of urinary frequency (on lasix) in the last few days with out any dysuria or urgency. The patient also has increasing shortness of breath over the past month and abdominal distension over the last month, as well as intermittent left sided chest pain that radiates to her left arm. In the ED the patient was ruled out for an aortic dissection, MI, and had a negative D-Dimer, however lipase levels were elevated with normal LFTs. The patient had poor glucose control and her LDL was 151 and her triglycerides were very high, which could be a cause of her pancreatitis. The patient was placed on a House/Adv. as tol. / ADA 1800 cals/day / Very low fat (20gms/day) diet and was encouraged to resume regular exercise. Discharge medications included ACETYLSALICYLIC ACID 81 MG PO QD, AMITRIPTYLINE HCL 30 MG PO QHS, PREMARIN (CONJUGATED ESTROGENS) 0.625 MG PO QD, FLEXERIL (CYCLOBENZAPRINE HCL) 10 MG PO TID PRN Pain, COLACE (DOCUSATE SODIUM) 100 MG PO BID, FLUOXETINE (FLUOXETINE HCL) 40 MG PO QD, GEMFIBROZIL 600 MG PO BID with SERIOUS INTERACTION: SIMVASTATIN & GEMFIBROZIL, NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 10 UNITS SC QAM and NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 50 UNITS SC QHS, LORAZEPAM 1 MG PO QD, AMLODIPINE 10 MG PO QD Food/Drug Interaction Instruction, TOPROL XL (METOPROLOL (SUST. REL.)) 100 MG PO QD, IRBESARTAN 300 MG PO QD, LASIX (FUROSEMIDE) 40 MG PO QD, and LIPITOR (ATORVASTATIN) 80 MG PO QD with SERIOUS INTERACTION: GEMFIBROZIL & ATORVASTATIN CALCIUM, and was instructed to take consistently with meals or on empty stomach and to avoid grapefruit unless MD instructs otherwise. Follow up appointments included Dr. Bouy, vascular surgery, U Daylis Ont, 12:50 pm, Dr. Blaine Wehrley, 11:30 AM 5/14/03, MRI/A of abdomen, SHS Re Na, New Hampshire 59460, 11:20 AM, and Dr. Colleen on 10/2. We changed ATENOLOL to TOPROL XL 100 MG PO QD and AMLODIPINE 10 MG PO QD with Food/Drug Interaction Instruction. Endocrine- Has had poor glucose control. HbA1c 13. We continued NPH HUMULIN INSULIN 10 UNITS SC QAM and started AM NPH as well. Number of Doses Required (approximate): 5. Please take insulin in the morning as well as the night, and ask Dr. Colleen to help with your insulin regimen.
|
Has the patient had amlodipine in the past
|
{
"answer_end": [
1966
],
"answer_start": [
1909
],
"text": [
"AMLODIPINE 10 MG PO QD Food/Drug Interaction Instruction,"
]
}
|
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 pt. ever been on bactrim ds ( trimethoprim/sulfamethoxazole dou... ) before
|
{
"answer_end": [
929
],
"answer_start": [
918
],
"text": [
"Bactrim DS,"
]
}
|
This 64-year-old patient had a past medical history of non-small cell lung cancer, status post XRT and chemotherapy, right MC embolic stroke, status post right carotid endarterectomy, Graves’ disease, depression, diabetes, hypertension, asthma, temporal lobe epilepsy, and history of subclavian steal syndrome. On admission, her blood pressure was 66/44, pulse of 100, respiratory rate normal, and blood sugar of 133. She was found to be difficult to arouse and had 1 gm of vancomycin, magnesium and Levaquin 500 mg. Her medication on admission included Mechanical soft diet, aspirin 81 mg, baclofen 5 mg t.i.d., B12 1000 mg daily, iron sulfate 325 mg daily, Cymbalta 20 mg p.o. b.i.d., Neurontin 100 mg b.i.d., Lamictal 200 mg b.i.d., Prilosec 20 daily, levothyroxine, Glucophage 500 once a day, Reglan 10 once a day, niacin 500 once a day, Senna 2 tabs b.i.d., Zocor 20 mg once a day, Nicoderm patch, Colace 100 mg p.o. b.i.d., Lopressor 100 mg p.o. b.i.d., lidoderm 5% patch to the low back, Tylenol, ducolox, Mylanta, lactulose, Seroquel 100 mg, prednisone 50 mg, and Dilaudid 1 mg. She completed a ten-day course of vancomycin for a MRSA urinary tract infection and was treated with tramadol and Tylenol for pain. Her laboratory data showed creatinine of 1, ALT 25, AST 35, hematocrit 33, white count 6.6, and platelets 241,000. She was covered with antibiotics initially, then transitioned over to a ciprofloxacin 700 mg p.o. b.i.d. regime for a total of 12 days for a presumed urinary tract infection. She had a significant polypharmacy and enumerable sedating medications, including baclofen, Dilaudid and trazodone. Her Cymbalta was continued per outpatient follow-up and her Lamictal, as well as her Cymbalta, were maintained for her history of depression. Neurologically, she had a left-sided hemiparesis, as well as agnosia on the left side, and her mental status included intermittent disorientation. She was maintained on Novolog sliding scale for diabetes, QTc monitored with serial EKGs, and prior use of Haldol and other antipsychotics for behavioral modification. She was also continued on a replacement dose levothyroxine for her history of Graves' and a history of radioiodine ablation. For behavioral modification, as well as intermittent agitation and disorientation, the patient was maintained on p.r.n. Seroquel 100 mg p.o. b.i.d., as well as Zydis 5 mg p.o. b.i.d. p.r.n., which was titrated from standing to p.r.n. over the course of her hospitalization in order to try to decrease any sedating medications that may be altering her alertness and orientation.
|
has the patient had neurontin
|
{
"answer_end": [
686
],
"answer_start": [
659
],
"text": [
"Cymbalta 20 mg p.o. b.i.d.,"
]
}
|
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 on any medication for her left lower extremity erythema
|
{
"answer_end": [
263
],
"answer_start": [
199
],
"text": [
"24 hours following initiation of Keflex course. White blood cell"
]
}
|
A 73-year-old male patient with a history of coronary artery disease, ischemic cardiomyopathy, and valvular heart disease was admitted to the Rose-le Medical Center with a large left foot toe ulcer that was nonhealing, and signs and symptoms of decompensated heart failure and acute on chronic renal failure. During his stay, he was treated with Enteric-coated aspirin 325 mg p.o. daily, Amiodarone 200 mg p.o. daily, Colace 100 mg p.o. b.i.d., insulin NPH 7 units q.a.m. and 3 units q.p.m. subcutaneously, Atrovent HFA inhaler 2 puffs inhaled q.i.d. p.r.n. for wheezing, magnesium gluconate sliding scale p.o. daily, oxycodone 5-10 mg p.o. q. 4h. p.r.n. pain, senna tablets one to two tablets p.o. b.i.d. p.r.n. constipation, spironolactone 25 mg p.o. daily, Coumadin 1 mg p.o. every other day, multivitamin therapeutic one tablet p.o. daily, Zocor 40 mg p.o. daily, torsemide 100 mg p.o. daily, OxyContin 10 mg p.o. b.i.d., Cozaar 25 mg p.o. daily, Remeron 7.5 mg p.o. q.h.s., and aspartate insulin sliding scale, as well as being maintained on subcutaneous heparin and Nexium as DVT and GI prophylaxis, Celexa 20 mg p.o. daily, Coumadin 2.5 mg p.o. daily, Diovan 80 mg p.o. daily, Lantus 25 units every day subcutaneous, Lasix 160 mg p.o. b.i.d., Lipitor 20 mg p.o. q.h.s., Lopressor 50 mg p.o. b.i.d., solsite topical, and 25 mg of hydrochlorothiazide b.i.d. 30 minutes prior to meals, in addition to ciprofloxacin, DuoDERM, BKA site healing with continued aspirin, and inhaled ipratropium. Hyponatremia due to heart failure was improved with diuresis, and the patient was maintained on Coumadin with an INR goal of 2-3, adjusted to 1 mg PO every other day. Diabetes mellitus, insulin-dependent, was covered on NPH QAM and QPM with aspartate sliding scale for duration of hospitalization. The patient was restarted on Celexa per PCP for likely depressive mood response to recent bilateral knee amputation, and later started on Remeron 7.5 mg PO daily in place of Celexa. He was initially treated for urinary tract infection with uncomplicated course with ciprofloxacin, and Wound care nurse consulted for BKA wound and small decubitus on his back, was treated with DuoDERM, BKA site healing well. The patient was maintained on subcutaneous heparin and Nexium as DVT and GI prophylaxis during this hospitalization. He was discharged on Enteric-coated aspirin 325 mg p.o. daily, Amiodarone 200 mg p.o. daily, Atrovent one to two puffs inhaled q.i.d. p.r.n. for wheezing, Celexa 20 mg p.o. daily, Coumadin 2.5 mg p.o. daily, Diovan 80 mg p.o. daily, enteric-coated aspirin 325 mg p.o. daily, Lantus 25 units every day subcutaneous, Lasix 160 mg p.o. b.i.d., Lipitor 20 mg p.o. q.h.s., Lopressor 50 mg p.o. b.i.d., therapeutic multivitamin one tablet p.o. daily, solsite topical, and instructed to follow up with psychiatry to assess depressive disorder/adjustment disorder, start beta-blocker at a low-dose in the outpatient setting, and check creatinine and BUN along with electrolytes to make sure patient is doing well on current maintenance diuretic schedule of 100 mg torsemide PO daily and spironolactone. Code status was full code.
|
What medications has patient been on for dvt...prophylaxis in the past
|
{
"answer_end": [
2251
],
"answer_start": [
2201
],
"text": [
"The patient was maintained on subcutaneous heparin"
]
}
|
A 83 year old female with hereditary angioedema was admitted to the hospital with abdominal pain which was not relieved by Stanazolol, and she had diarrhea, nausea/vomiting, sweats, and decreased PO intake. She was given 6 units FFP with premedication of IV Benadryl on the first night of her hospitalization, Stanazolol 4 mg q4h overnight, which was changed to bid on second hospital day, Zantac, and Lovenox. The patient was maintained on Acetylsalicylic Acid 81 mg PO qd, Vit C 500 mg PO bid, Atenolol 75 mg PO qd, hold if sbp <100 or hr <60, Digoxin 0.125 mg PO qod (Sun, Tues, Thurs), Potentially serious interaction: Digoxin & Levothyroxine Sodium, Vit E 400 units PO qd, Pepcid 20 mg PO qd, Colace 100 mg PO bid PRN constipation, Senna Tablets 2 tab PO bid PRN constipation, Lasix 20 mg PO qd, Keflex 500 mg PO qid x 28 doses, and on order for Synthroid PO (ref. #66804792), Lasix PO (ref. #91042032), and Keflex PO (ref. #63524947). She was also continued on her home dose of Synthroid, Rhinocort (Budesonide Nasal Inhaler) 2 spray na bid, and Allegra (Fexofenadine HCl) 60 mg PO bid. She was discharged with instructions to follow up with allergy and to call her doctor if she develops fevers, worsening of her abdominal pain, or other concerning symptoms. Follow up appointments were made with Dr. Morrell and Dr. Guadagnolo or Dr. Yoes for 1-2 weeks.
|
Has the pt. ever been on benadryl before
|
{
"answer_end": [
266
],
"answer_start": [
207
],
"text": [
"She was given 6 units FFP with premedication of IV Benadryl"
]
}
|
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
|
What is the current dose of the patient's acetaminophen
|
{
"answer_end": [
223
],
"answer_start": [
194
],
"text": [
"ACETAMINOPHEN 1000 MG PO Q6H,"
]
}
|
Rufus Leanard, a 55-year-old female, was admitted to Hend Ratal/creek Hospital with chest pain on exertion and underwent NSTEMI by enzymes peaking on 8/21/04 with CK 381 and TNI 0.18. She was transferred to Woduatesit General Hospital for catheterization and possible CABG, with her medical history including hypertension, diabetes mellitus, insulin therapy, dyslipidemia, COPD, bronchodilator therapy, asthma, class II angina, class II heart failure, and family history of coronary artery disease. Her physical exam showed carotid 2+ bilaterally, femoral 2+ bilaterally, radial 2+ bilaterally, and dorsalis pedis present by Doppler bilaterally. Laboratory data showed WBC 9.58, hematocrit 30.9, hemoglobin 10.7, platelets 287, PT 13.6, INR 1.0, PTT 36.9, sodium 138, potassium 3.9, chloride 103, CO2 26, BUN 16, creatinine 0.7, glucose 164. Cardiac catheterization data from 3/0/04 showed coronary anatomy, 95% osteo LAD, 40% proximal LAD, 60% proximal ramus, 90% mid circumflex, 90% mid OM1, and right dominant circulation. Preoperative medications included Verapamil 80 mg b.i.d., Avapro 150 mg q.d., aspirin 325 mg q.d. IV heparin, hydrochlorothiazide 50 mg q.d., albuterol 2 puffs b.i.d., fluticasone 2 puffs q.i.d., atorvastatin 10 mg q.d., Celexa 20 mg q.d., ibuprofen 800 mg b.i.d., and NPH insulin 30 units b.i.d. Rufus Leanard underwent an AVR with a 21 Carpentier-Edwards pericardial valve and a CABG x3 LIMA to LAD, SVG1 to PDA, SVG2-OM2 with a Robichek closure, with a bypass time of 201 minutes and a crossclamp time of 156 minutes. On CPB, the patient had severe calcification and adhesions between heart and pericardium, with no complications. Postoperatively, Rufus Leanard was extubated without difficulty and had reasonable saturations on nasal cannula, with chest x-ray appearing wet and diuresis increased. The history of COPD and preoperative COPD medications were restarted, she was in sinus rhythm with a systolic blood pressure of 110 and started on beta-blocker, and given Toradol initially for pain and Percocet for break through pain, with oxygen delivered via nasal cannula at 96% saturation with 3 liters. Postoperative echocardiogram showed an ejection fraction of 55-60%, trace MR, trace TR, no AI, and no regional wall motion abnormalities. Discharge medications included Enteric-coated aspirin 325 mg q.d., Lasix 600 mg q.6h p.r.n. pain, Lopressor 50 mg t.i.d., niferex 150 150 mg b.i.d., simvastatin 20 mg q.h.s., K-Dur 30 mEq b.i.d. and then 20 mEq b.i.d., fluticasone 44 mcg inhaled b.i.d., levofloxacin 500 mg q.d. for 2 days to complete course for UTI, Humalog, insulin on sliding scale, Humalog insulin 12 units subq with breakfast, Humalog insulin 16 units subcutaneous with lunch and dinner, Humalog insulin 62 units subcutaneous q.h.s., and Combivent 2 puffs inhaled q.i.d., Nexium 20 mg q.d., and Lantus insulin 60 mg b.i.d. for 3 days then 40 mg b.i.d. for 3 days, ibuprofen 600 mg q.6h p.r.n. pain. Follow-up appointments were made with Dr. Feder, Dr. Burkhead, and Dr. Saltmarsh, with instructions to make all follow up appointments, wash all wounds daily with soap and water, and watch for signs of infection.
|
Was the patient ever given levofloxacin for uti
|
{
"answer_end": [
2552
],
"answer_start": [
2478
],
"text": [
"20 mEq b.i.d., fluticasone 44 mcg inhaled b.i.d., levofloxacin 500 mg q.d."
]
}
|
The patient is an 83-year-old man with a history of CAD, s/p MI in 1973, s/p CABG x3, T2DM, and hypertension who was admitted with chest pressure and feeling numb in his arms and legs and around his head. He took some SL nitro but does not remember if it helped and denies shortness of breath. His EKG was A-paced and unchanged from March, his CXR had no acute process, and his cardiac enzymes were negative. His stress test from March 2005 revealed a small to medium sized region of myocardial scar/hibernation in the distribution of the PDA coronary artery and no evidence of stress induced ischemia at a low cardiac workload. He went into V-paced rhythm when given dobutamine and the test was submaximal with max HR 98 (77% predicted). No reversible ischemia was seen. He was continued on B-blocker, statin, and persantine, with no aspirin since history of GIB with it, and monitored on telemetry without any events. He also had an adenosine MIBI on 2/8/05 with results as above. Held oral hypoglycemic while in house. Covered with SSI regular qac. His PM was evaluated by EP to r/o pAF and EP interrogation revealed no mode shifts. He was weaned O2 to sat>93%, his creatinine remained at baseline, he avoided aspirin and was continued on PPI, was covered with SSI regular qac, and was given a PT consult. He was discharged with a full code status, home with services, and on a House/Low chol/low sat. fat and House/ADA 1800 cals/dy diet, and instructed to take medication consistently with meals or on an empty stomach, and to avoid grapefruit unless instructed otherwise and to walk as tolerated. Follow up appointments were scheduled with Dr. Widowski March at 3:30 PM and Dr. Caris 11/10/06. Allergies included Penicillins, Aspirin, DILTIAZEM, and ATORVASTATIN. The discharge medications included TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, PERSANTINE (DIPYRIDAMOLE) 50 MG PO BID, LASIX (FUROSEMIDE) 10 MG PO QD, ATIVAN (LORAZEPAM) 3.5 MG PO QHS, NTG 1/150 (NITROGLYCERIN 1/150 (0.4 MG)), NITROGLYCERIN PASTE 2% 1 INCHES TP BID, INDERAL (PROPRANOLOL HCL) 10 MG PO QID, SUCRALFATE 1 GM PO QID Food/Drug Interaction Instruction, PAXIL (PAROXETINE) 10 MG PO QD, NORVASC (AMLODIPINE) 2.5 MG PO QD, on order for NORVASC PO 5 MG QD (ref #913242331), IMDUR ER (ISOSORBIDE MONONITRATE (SR)) 30 MG PO BID, COZAAR (LOSARTAN) 50 MG PO QD, PROTONIX (PANTOPRAZOLE) 40 MG PO QD, GLYBURIDE 2.5 MG PO QD, ZETIA (EZETIMIBE) 10 MG PO QD, ATIVAN (LORAZEPAM) 2 MG PO QID PRN Anxiety, Lescol 20 mg po qd, and 1 TAB SL Q5MIN X 3 doses PRN Chest Pain. Number of Doses Required (approximate): 3. He was also given instructions to take medication consistently with meals or on an empty stomach, and to avoid grapefruit unless instructed otherwise and to walk as tolerated. Follow up appointments were scheduled with Dr. Widowski March at 3:30 PM and Dr. Caris 11/10/06. Allergies included Penicillins, Aspirin, DILTIAZEM, and ATORVASTATIN. The discharge medications included TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, PERSANTINE (DIPYRIDAMOLE) 50 MG PO BID, LASIX (FUROSEMIDE) 10 MG PO QD, ATIVAN (LORAZEPAM) 3.5 MG PO QHS, NTG 1/150 (NITROGLYCERIN 1/150 (0.4 MG)), NITROGLYCERIN
|
has the patient had ppi
|
{
"answer_end": [
1246
],
"answer_start": [
1202
],
"text": [
"he avoided aspirin and was continued on PPI,"
]
}
|
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.
|
Is there history of use of toprol.
|
{
"answer_end": [
1707
],
"answer_start": [
1576
],
"text": [
"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,"
]
}
|
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.
|
Was the patient ever prescribed axid
|
{
"answer_end": [
1327
],
"answer_start": [
1265
],
"text": [
"Captopril 100 mg p.o. t.i.d., Colace, Axid 150 mg p.o. b.i.d.,"
]
}
|
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.
|
Is there history of use of nexium
|
{
"answer_end": [
2813
],
"answer_start": [
2688
],
"text": [
"miconazole nitrate 2% powder topical BID to areas between skin folds including under the right breast, Nexium 20 mg PO daily,"
]
}
|
Ms. Veltin is a 72 year old woman with a PAST MEDICAL HISTORY significant for coronary artery disease, diabetes, and hypertension. On admission, her CURRENT MEDICATIONS included Atenolol 50 b.i.d., hydrochlorothiazide 25 q.d., Lisinopril 40 q.d., simvastatin 10 q.d., metformin 500 q.d., and NPH 43 q.a.m. and 24 q.p.m., while her PAST MEDICAL HISTORY was significant for diabetes for which she took insulin and checked her sugars at home which ran 170 range to 200 range. During admission, she was maintained on metformin, her blood pressure was controlled with Lisinopril at 40 milligrams, she was given nifedipine extended release 120 q.d., and her sugars at home on her regimen of 43 q.a.m. and 24 q.p.m. were in control. She was also maintained on her aspirin and simvastatin, and given Lasix 20 q.d. times seven days and four liters through admission with Lasix at 40 intravenously. Her cardiovascular evaluation showed three vessel disease, diastolic dysfunction, and pulmonary artery systolic pressure of 36 plus RA, but no wall motion abnormalities. Her blood pressure regimen was advanced with the addition of Atenolol 50 b.i.d. and titration up to 120 milligrams q.d. of nifedipine extended release. For congestive heart failure, she diuresed approximately four liters through admission with Lasix at 40 intravenously and would be discharged on a seven day course of Lasix at 20 p.o. q.d. Pulmonary evaluation showed hypoxia on admission to 85% on room air, D-dymer greater than 1000, V/Q scan low probability, negative lower extremity noninvasives, chest CT without interstitial lung disease, and pulmonary function tests consistent with restrictive picture. Endocrine evaluation revealed that she was maintained on metformin during admission and also on half of her dose of NPH given her decreased p.o. intake. She took insulin and checked her sugars at home, which were 170 to 200, and she was discharged on her normal regimen of 43 q.a.m. and 24 q.p.m. of NPH. Discharge medications included Atenolol 50 b.i.d., hydrochlorothiazide 25 q.d., Lisinopril 40 q.d., nifedipine extended release 120 q.d., metformin 500 q.d., NPH 43 q.a.m. and 24 q.p.m., simvastatin 10 q.d., aspirin 325 q.d., and Lasix 20 milligrams p.o. q.d. times seven days. She was discharged in stable condition on March, 2000 and will follow up with Dr. Nakajima, her primary care doctor, and Dr. Klang, her cardiologist.
|
What is the patient's current dose does the patient take of her aspirin
|
{
"answer_end": [
2235
],
"answer_start": [
2163
],
"text": [
"simvastatin 10 q.d., aspirin 325 q.d., and Lasix 20 milligrams p.o. q.d."
]
}
|
This 66 year old African American woman presented with an acute stroke and was brought in by her daughter. She had a CTA done which showed questionable luminal narrowing of the distal left middle cerebral artery, and was given a 9 mg bolus dose of intravenous TPA over two minutes and 81 mg given over the following hour. Her past medical history includes diet controlled diabetes, obesity, hypertension, ulcerative colitis, a prior MI in 1988, and a possible old stroke. Her medications are aspirin 325 mg and Asacol, although she was unsure of the dose. Blood pressure was 138/76, heart rate was 80 and paced, and she had a right field compromise difficulty crossing the midline with a right upper motor neuron seventh weakness and decreased power on the right side of the face. After the TPA, her language returned completely to normal. Protocol for the stroke was followed, including blood pressure monitoring, nasal oxygen, and no antiplatelet therapy for 24 hours. Head of bed was raised to 30 degrees and a head CT was repeated the following morning. An echocardiogram showed normal ventricular size and systolic function, trace aortic insufficiency, trace mitral regurgitation, and persistent atrial flutter. She was coumadinized and discharged without rehabilitation on 0/21/99 on Coumadin with a plan for complete cardioversion within one month.
|
Has the patient had previous tpa
|
{
"answer_end": [
280
],
"answer_start": [
248
],
"text": [
"intravenous TPA over two minutes"
]
}
|
A 43-year-old morbidly obese female with a history of obstructive sleep apnea (OSA) presented with fatigue, shortness of breath, orthopnea, cough, and lower extremity edema (LEE), thought to be congestive heart failure (CHF). The patient was admitted on 6/19/2000 and was prescribed a diet of House/Low chol/low sat. fat, and was given instructions to follow up with Dr. Schak one week, Dr. Hartis next week, and Dr. Chionchio nest available. She had definite iron deficiency anemia (IDA) and was treated with iron intravenously. A gyn appointment was recommended with Flagyl for bacterial vaginosis (BV). The patient was treated with TYLENOL (ACETAMINOPHEN) 650-1,000 MG PO Q4-6H PRN headache, TYLENOL LIQUID (ACETAMINOPHEN ELIXER) 650-1,300 MG PO Q4-6H PRN headache, TYLENOL #3 (ACETAMINOPHEN W/CODEINE 30MG) 1-2 TAB PO Q4H PRN pain with instructions to not exceed a max dose of tylenol of 4gram/day, LAC-HYDRIN 12% (AMMONIUM LACTATE 12%) TOPICAL TP BID with instructions to lower extremities, CEPACOL 1 LOZENGE PO Q4H PRN sore throat, FLAGYL (METRONIDAZOLE) 500 MG PO BID X 5 Days with instructions to take with food, METAMUCIL SUGAR FREE (PSYLLIUM (METAMUCIL) SUGAR FREE) 1 PACKET PO QD PRN CONSTIPATION, DICLOXACILLIN 500 MG PO QID X 12 Days with instructions to give on an empty stomach and LISINOPRIL 20 MG PO QD. The patient was also instructed to inhale steroids or claritin, and was consented for iv treatment, with a tolerance for iron iv, and was prescribed Flagyl for BV. The patient was also given a flu shot and pneumovax. The patient has allergies to Aspirin, Iron (ferrous sulfate), and Nsaid's. The patient was not compliant with CPAP at night due to feeling of suffocating and was also refusing inpatient rehabilitation despite assistance from social work and care coordinators with home and bills issues. An EKG with possible lateral strain was also done. The patient was refusing BP medication because she claimed she did not have high BP, and was treated with Dicloxacillin for cellulitis. She was recommended to follow-up with Dr. Fridal and Dr. Trezza in one week and to see Dr. Knipple at the next available appointment. She was also to get a VNA for every other day to do a respiratory evaluation and assistance with medical care, as well as physical therapy/occupational therapy twice weekly. The patient was to use CPAP at 18-19 cm H2O for 8 hours a night with oxygen at 4-5L and with ambulation, and to do sitz baths to vagina twice a day. She was instructed to call her doctor if she was short of breath, had chest pain, nausea/vomiting, worsening leg pain, headaches, or other worrisome symptoms. She was discharged on 9/10/2000 with a code status of Full code and disposition of Home w/ services in a stable condition.
|
Has this patient ever been prescribed tylenol #3 ( acetaminophen w/codeine 30mg)
|
{
"answer_end": [
834
],
"answer_start": [
769
],
"text": [
"TYLENOL #3 (ACETAMINOPHEN W/CODEINE 30MG) 1-2 TAB PO Q4H PRN pain"
]
}
|
Patient Mickey Corkill was admitted to the hospital on 5/29/2004 for dizziness and discharged on 7/17/2004. During this time, the patient was given ACETYLSALICYLIC ACID 81 MG PO QD Starting STAT ( 0/17 ), AMIODARONE 200 MG PO QD, DIGOXIN 0.125 MG PO QD, COLACE ( DOCUSATE SODIUM ) 100 MG PO BID, LASIX ( FUROSEMIDE ) 120 MG PO BID, NPH HUMULIN INSULIN ( INSULIN NPH HUMAN ) 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ) 30 MILLILITERS PO QD PRN Constipation, COUMADIN ( WARFARIN SODIUM ) 2 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, NORVASC ( AMLODIPINE ) 10 MG PO QD HOLD IF: SBP < 95, IMDUR ( ISOSORBIDE MONONIT.( SR ) ) 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR ( LOSARTAN ) 100 MG PO QHS Starting STAT ( 4/13 ), PLAVIX ( CLOPIDOGREL ) 75 MG PO QD Starting STAT ( 0/17 ), NEXIUM ( ESOMEPRAZOLE ) 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, Sliding Scale ( subcutaneously ) SC AC+HS, and HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. Due to the potential for serious interactions between WARFARIN and ASPIRIN, WARFARIN and AMIODARONE HCL, DIGOXIN and AMIODARONE HCL, and SIMVASTATIN and WARFARIN, overrides were added on 8/6/04 and 9/23/04 by various physicians, with the MDs being aware that the patient was already on the regimen at home. The patient was also advised to avoid high Vitamin-K containing foods and to avoid grapefruit unless the MD instructed otherwise. The patient's BB was held while in house because of worry about bradyarrhythmia and hypotension. The patient was also continued on home insulin regimen with coverage with insulin sliding scale, and was found to have a TSH of 158 FT4 1.8, FT3 56. The patient was also started on synthroid to be f/u for hypothyroidism and given prophylaxis with Nexium. Treatment included CV, NEURO, ENDO, and Prophylaxis, with the patient to follow-up with various doctors for management of CHF/BP, potential neurovascular etiology of symptoms, and hypothyroidism. The patient was anticoagulated with ACETYLSALICYLIC ACID 81 MG PO QD, AMIODARONE 200 MG PO QD, WARFARIN 2 MG PO QPM, COLACE 100 MG PO BID, LASIX 120 MG PO BID, NPH HUMULIN INSULIN 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA 30 MILLILITERS PO QD PRN Constipation, COUMADIN 2 MG PO QPM, NORVASC 10 MG PO QD HOLD IF: SBP < 95, IMDUR 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR 100 MG PO QHS, PLAVIX 75 MG PO QD, NEXIUM 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, and SIMVASTATIN 80 MG PO QHS HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. The patient was discussed with the cardiologist, and Coreg was held prior to admit for low BP's, with the plan to d/c pt off Coreg and defer to Dr. Doniel for reinstitution of beta blockade. Neuro exam was normal with no focal signs, and no signs of cerebellar dysfunction. The patient was also started on synthroid to be f/u with endocrine for management of hypothyroidism.
|
Why is the patient prescribed levothyroxine
|
{
"answer_end": [
921
],
"answer_start": [
887
],
"text": [
"LEVOTHYROXINE SODIUM 50 MCG PO QD,"
]
}
|
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 ever prescribed atropine
|
{
"answer_end": [
1371
],
"answer_start": [
1328
],
"text": [
"atropine 1 mg one drop in the affected eye,"
]
}
|
Mr. Wizar is a 51-year-old man who was admitted for repair of left pseudoaneurysm in his groin and was given wet-to-dry dressing changes t.i.d. On 6/3/2003, he was taken to the operating room for left groin closure with flap by Plastic Surgery and Vascular Surgery. He was injected with heparin solution and received serial needle pricks, which improved the appearance of the flap. He was given vancomycin, levofloxacin, and Flagyl for empiric treatment for C. diff, with C. diff cultures being negative on 0/7/2003 and drain cultures showing rare Staphylococcus aureus on 10/6/2003. His Zestril was held secondary to an elevation in creatinine, which gradually resolved. He was also seen by Cardiology and Nutrition and was given supplements, vitamin C, and Zinc for wound healing, with the flap being stable, pink, and viable at the time of discharge. His discharge medications included Aspirin 325 mg once a day; digoxin 0.125 once a day; Ultralente 16 units q.a.m. , 4 units q.p.m.; Zocor 10 mg once a day; Toprol 25 mg once a day; Imdur 30 mg once a day; torsemide 100 mg once a day; lisinopril 2.5 mg once a day; colace; and Percocet.
|
Has the patient ever had zocor
|
{
"answer_end": [
1059
],
"answer_start": [
1036
],
"text": [
"Imdur 30 mg once a day;"
]
}
|
This 64-year-old patient had a past medical history of non-small cell lung cancer, status post XRT and chemotherapy, right MC embolic stroke, status post right carotid endarterectomy, Graves’ disease, depression, diabetes, hypertension, asthma, temporal lobe epilepsy, and history of subclavian steal syndrome. On admission, her blood pressure was 66/44, pulse of 100, respiratory rate normal, and blood sugar of 133. She was found to be difficult to arouse and had 1 gm of vancomycin, magnesium and Levaquin 500 mg. Her medication on admission included Mechanical soft diet, aspirin 81 mg, baclofen 5 mg t.i.d., B12 1000 mg daily, iron sulfate 325 mg daily, Cymbalta 20 mg p.o. b.i.d., Neurontin 100 mg b.i.d., Lamictal 200 mg b.i.d., Prilosec 20 daily, levothyroxine, Glucophage 500 once a day, Reglan 10 once a day, niacin 500 once a day, Senna 2 tabs b.i.d., Zocor 20 mg once a day, Nicoderm patch, Colace 100 mg p.o. b.i.d., Lopressor 100 mg p.o. b.i.d., lidoderm 5% patch to the low back, Tylenol, ducolox, Mylanta, lactulose, Seroquel 100 mg, prednisone 50 mg, and Dilaudid 1 mg. She completed a ten-day course of vancomycin for a MRSA urinary tract infection and was treated with tramadol and Tylenol for pain. Her laboratory data showed creatinine of 1, ALT 25, AST 35, hematocrit 33, white count 6.6, and platelets 241,000. She was covered with antibiotics initially, then transitioned over to a ciprofloxacin 700 mg p.o. b.i.d. regime for a total of 12 days for a presumed urinary tract infection. She had a significant polypharmacy and enumerable sedating medications, including baclofen, Dilaudid and trazodone. Her Cymbalta was continued per outpatient follow-up and her Lamictal, as well as her Cymbalta, were maintained for her history of depression. Neurologically, she had a left-sided hemiparesis, as well as agnosia on the left side, and her mental status included intermittent disorientation. She was maintained on Novolog sliding scale for diabetes, QTc monitored with serial EKGs, and prior use of Haldol and other antipsychotics for behavioral modification. She was also continued on a replacement dose levothyroxine for her history of Graves' and a history of radioiodine ablation. For behavioral modification, as well as intermittent agitation and disorientation, the patient was maintained on p.r.n. Seroquel 100 mg p.o. b.i.d., as well as Zydis 5 mg p.o. b.i.d. p.r.n., which was titrated from standing to p.r.n. over the course of her hospitalization in order to try to decrease any sedating medications that may be altering her alertness and orientation.
|
Has the pt. ever been on antipsychotics before
|
{
"answer_end": [
2081
],
"answer_start": [
2032
],
"text": [
"other antipsychotics for behavioral modification."
]
}
|
Rufus Leanard, a 55-year-old female, was admitted to Hend Ratal/creek Hospital with chest pain on exertion and underwent NSTEMI by enzymes peaking on 8/21/04 with CK 381 and TNI 0.18. She was transferred to Woduatesit General Hospital for catheterization and possible CABG, with her medical history including hypertension, diabetes mellitus, insulin therapy, dyslipidemia, COPD, bronchodilator therapy, asthma, class II angina, class II heart failure, and family history of coronary artery disease. Her physical exam showed carotid 2+ bilaterally, femoral 2+ bilaterally, radial 2+ bilaterally, and dorsalis pedis present by Doppler bilaterally. Laboratory data showed WBC 9.58, hematocrit 30.9, hemoglobin 10.7, platelets 287, PT 13.6, INR 1.0, PTT 36.9, sodium 138, potassium 3.9, chloride 103, CO2 26, BUN 16, creatinine 0.7, glucose 164. Cardiac catheterization data from 3/0/04 showed coronary anatomy, 95% osteo LAD, 40% proximal LAD, 60% proximal ramus, 90% mid circumflex, 90% mid OM1, and right dominant circulation. Preoperative medications included Verapamil 80 mg b.i.d., Avapro 150 mg q.d., aspirin 325 mg q.d. IV heparin, hydrochlorothiazide 50 mg q.d., albuterol 2 puffs b.i.d., fluticasone 2 puffs q.i.d., atorvastatin 10 mg q.d., Celexa 20 mg q.d., ibuprofen 800 mg b.i.d., and NPH insulin 30 units b.i.d. Rufus Leanard underwent an AVR with a 21 Carpentier-Edwards pericardial valve and a CABG x3 LIMA to LAD, SVG1 to PDA, SVG2-OM2 with a Robichek closure, with a bypass time of 201 minutes and a crossclamp time of 156 minutes. On CPB, the patient had severe calcification and adhesions between heart and pericardium, with no complications. Postoperatively, Rufus Leanard was extubated without difficulty and had reasonable saturations on nasal cannula, with chest x-ray appearing wet and diuresis increased. The history of COPD and preoperative COPD medications were restarted, she was in sinus rhythm with a systolic blood pressure of 110 and started on beta-blocker, and given Toradol initially for pain and Percocet for break through pain, with oxygen delivered via nasal cannula at 96% saturation with 3 liters. Postoperative echocardiogram showed an ejection fraction of 55-60%, trace MR, trace TR, no AI, and no regional wall motion abnormalities. Discharge medications included Enteric-coated aspirin 325 mg q.d., Lasix 600 mg q.6h p.r.n. pain, Lopressor 50 mg t.i.d., niferex 150 150 mg b.i.d., simvastatin 20 mg q.h.s., K-Dur 30 mEq b.i.d. and then 20 mEq b.i.d., fluticasone 44 mcg inhaled b.i.d., levofloxacin 500 mg q.d. for 2 days to complete course for UTI, Humalog, insulin on sliding scale, Humalog insulin 12 units subq with breakfast, Humalog insulin 16 units subcutaneous with lunch and dinner, Humalog insulin 62 units subcutaneous q.h.s., and Combivent 2 puffs inhaled q.i.d., Nexium 20 mg q.d., and Lantus insulin 60 mg b.i.d. for 3 days then 40 mg b.i.d. for 3 days, ibuprofen 600 mg q.6h p.r.n. pain. Follow-up appointments were made with Dr. Feder, Dr. Burkhead, and Dr. Saltmarsh, with instructions to make all follow up appointments, wash all wounds daily with soap and water, and watch for signs of infection.
|
What is the current dose of the patient's hydrochlorothiazide
|
{
"answer_end": [
1167
],
"answer_start": [
1104
],
"text": [
"aspirin 325 mg q.d. IV heparin, hydrochlorothiazide 50 mg q.d.,"
]
}
|
A 56-year-old morbidly obese female with abdominal skin laxity due to massive weight loss after gastric bypass was admitted to plastics for panniculectomy. The patient tolerated the procedure without difficulty and the post-operative period has been uneventful. At discharge, the patient is afebrile with stable vitals, taking PO's/voiding q shift and has ambulated independently with some difficulty given body habitus. Pain has been well managed and incisions are clean, dry, and intact. JP's with moderate serosanguinous output remain in place. The patient was discharged to rehab in a stable condition, with instructions to continue antibiotics as long as drains are in place, change drain sponges daily, strip drains twice daily, sponge baths only while drains are in place, walking as tolerated, no lifting more than 10 pounds, no jogging, swimming, or aerobics for 4-6 weeks, and to monitor/return for signs of infection. Medications prescribed include TYLENOL (Acetaminophen) 1000 mg PO Q6H, KEFLEX (Cephalexin) 500 mg PO QID, COLACE (Docusate Sodium) 100 mg PO BID, PEPCID (Famotidine) 20 mg PO BID, DILAUDID (Hydromorphone HCL) 2-4 mg PO Q4H PRN Pain, INSULIN REGULAR HUMAN Sliding Scale (subcutaneously) SC Q4H Low Scale, LEVOTHYROXINE SODIUM 75 mcg PO daily, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, MILK OF MAGNESIA (Magnesium Hydroxide) 30 milliliters PO daily PRN Constipation, METOCLOPRAMIDE HCL 10 mg IV Q8H PRN Nausea, QUINAPRIL 20 mg PO daily, SIMETHICONE 40 mg PO QID PRN Upset Stomach, Other:gas, and STYKER PAIN PUMP (Bupivacaine 0.5%) 400 milliliters IV Q24H Instructions: Rate = 4ml/hr. The patient has a probable allergy to Morphine and Code Status is Full Code.
|
Why is the patient prescribed milk of magnesia ( magnesium hydroxide )
|
{
"answer_end": [
1424
],
"answer_start": [
1344
],
"text": [
"MILK OF MAGNESIA (Magnesium Hydroxide) 30 milliliters PO daily PRN Constipation,"
]
}
|
This 82-year-old RHM with a history of HTN, DM-2, CAD, and AVR (on Coumadin until 3/29) presented to the WTSMC ER for further work-up after receiving Mannitol. On exam, his VS were T: afebrile, BP: 145/64, P: 60, RR: 18, O2 sat: 97%r.a., HEENT anicteric and MMM without lesions, OP clear, neck supple with no LAD, CV had s1s2 paced, pronounce S2, 3/6 systolic murmur, 2/6 diastolic, resp CTAB, abd +BS Soft/NT/ND, ext no C/C/E, s/p above amputation, MS awake and alert, oriented to date, place, and self, attention DOW backwards, memory registration 3/3, recall 2/3 at 5 min 3/3 with prompting, language fluent, +comprehension, +repetition, +naming intact, nondominant no neglect to DSS, able to salute/brush teeth, CN II, III - pupils 3`2 bilaterally, VFF by confrontation; III, IV, VI - EOMI, no ptosis, no nystagmus; V - sensation intact to LT/PP, corneal reflex intact; VII - mild right facial weakness; VIII - hears finger rub; IX, X - voice dysarthric, palate elevates symmetrically, gag intact; XI - SCM/Trapezii 5/5 B; XII - tongue protrudes midline, motor right pronator drift, no asterixis, normal bulk and tone, no tremor, rigidity or bradykinesia, strength 5/5, DTRs C56, C6, C7, L34, S12, Plantar L2, 2, 2, 1, 0, amputated R1, 1, 1, 1, 0, up, sensory decreased LT, temperature, vibration distally up to knees, coord finger tap rapid & symm, FNF & finger follow intact (for weakness), foot tap rapid & symm, gait deferred. LABS showed Sodium 141 mmol/L, Potassium 4.7 mmol/L, Chloride 103 mmol/L, Total CO2 29 mmol/L, Anion Gap 9 mmol/L, CK 33 U/L, CKMB Quant 1.7 ng/mL, Calcium 9.0 mg/dL, Magnesium 1.6 mg/dL, cTn-I See Result Below ng/mL, and Glucose 130 mg/dL. Medications prescribed were COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN SBP>160mmHg, Insulin Regular Human Sliding Scale (subcutaneously) SC qAC, qHS, Lisinopril 20 mg PO QD, Magnesium Gluconate 500 mg PO BID, Milk of Magnesia (Magnesium Hydroxide) 30 mL PO QD PRN Constipation, Metoprolol Tartrate 25 mg PO TID starting in PM on 0/17, Xalatan (Latanoprost) 1 drop OU QPM, Flomax (Tamsulosin) 0.4 mg PO QD, Nexium (Esomeprazole) 20 mg PO QD, Glipizide 10 mg PO QD, Zocor 20 mg QD, Metformin 1000 mg BID, Niferex 150 BID, ASA 81 PO QD, and BRIMONIDINE 0.2% BID. Neurologic exam was stable with persistent dysarthria, right pronator drift, and mild right leg weakness; patient was evaluated by PT/OT and deemed appropriate candidate for acute rehab. Cardiovascular continued to be in atrial fibrillation, pacemaker was firing, but had an episode of HR 30's x few seconds, and HR 40's-50's for rest of night. EKG unchanged from admission, atrial fibrillation, left anterior fascicular block, some PVCs. Plan was to admit to NICU and transfer to the floor, control BP with home regimen and keep SBP<140, hold ASA and Coumadin, and hold Metformin for now and add insulin sliding scale. Medications included COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN other: SBP>160
|
Has the pt. ever been on lasix (furosemide) before
|
{
"answer_end": [
1775
],
"answer_start": [
1744
],
"text": [
"LASIX (Furosemide) 20 mg PO QD,"
]
}
|
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 ever take any medication for her bs is 301-350 in the past
|
{
"answer_end": [
1280
],
"answer_start": [
1252
],
"text": [
"INSULIN ASPART Sliding Scale"
]
}
|
Shaull Darin was admitted on 8/12/2007 and discharged on 7/17/2007 with a full code status and disposition to home. During his stay, he was prescribed ACETYLSALICYLIC ACID 325 MG PO DAILY, with an Override Notice added on 10/30/07 by LAUB , STERLING B M. , M.D. on order for COUMADIN PO ( ref # 853955570 ) due to a POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN, ATENOLOL 37.5 MG PO DAILY, CAPTOPRIL 12.5 MG PO BID, on order for KCL IMMEDIATE RELEASE PO ( ref # 545368405 ) due to a POTENTIALLY SERIOUS INTERACTION: CAPTOPRIL & POTASSIUM CHLORIDE, CELEXA ( CITALOPRAM ) 40 MG PO DAILY, PLAVIX ( CLOPIDOGREL ) 75 MG PO DAILY, DIGOXIN 0.125 MG PO DAILY, EPLERENONE 25 MG PO DAILY, FOLATE ( FOLIC ACID ) 1 MG PO DAILY, LASIX ( FUROSEMIDE ) 60 MG PO BID, Alert overridden: Override added on 10/30/07 by GOODWINE , BUFORD H B. , M.D. on order for LASIX PO ( ref # 145213873 ), NEURONTIN ( GABAPENTIN ) 100 MG PO TID, LORAZEPAM 0.5 MG PO DAILY PRN Anxiety, LOVASTATIN 40 MG PO DAILY, with an Override Notice added on 10/30/07 by PERAULT , SHELBY H M. , M.D. on order for COUMADIN PO ( ref # 853955570 ) due to a POTENTIALLY SERIOUS INTERACTION: LOVASTATIN & WARFARIN, POTENTIALLY SERIOUS INTERACTION: NIACIN , VIT. B-3 & LOVASTATIN, OMEPRAZOLE 20 MG PO DAILY, TEMAZEPAM 15-30 MG PO BEDTIME PRN Insomnia, MULTIVITAMIN THERAPEUTIC ( THERAPEUTIC MULTIVI... ) 1 TAB PO DAILY, COSOPT ( TIMOLOL/DORZOLAMIDE ) 1 DROP OU BID, Alert overridden: Override added on 11/14/07 by LUTHY , LANNY D E. , M.D. on order for COSOPT OU ( ref # 517414331 ), COUMADIN ( WARFARIN SODIUM ) 1 MG PO QPM, TRAVATAN 1 DROP OU BEDTIME Instructions: OU. thanks., amiodarone toxicity, Peripheral neuropathy, restless legs, Spinal, ASA/Plavix, BB. Some concern for ischemia causing his, to 60 bid. Cont Dig/nitrate/BB, ACEi. Checked echo, no change., Rhythym: Tele. Lyte replete78M with significant CAD, iCM EF 15-20%, presenting with SOB, underwent Adenosine MIBI with no focal defects, LHC with no new disease and no interventions, RHC with wedge of 16, PFTs 1992 with no COPD, CR 1.4-1.8, Barrett's on PPI, neuropathy, neurontin, celexa, glaucoma on eye drops, CV, NAS, 2L fluid restrict diet, held coumadin for cath then restarted it with 2mg on 8/1, 1mg on 6/10, INR of 1.7 on d/c, additional comments included measuring daily weights and calling MD if weight increases by more than 5 lbs in one week or 2-3 lbs in one day, continuing coumadin and checking INR on Monday, taking lasix 60 twice a day, and resuming all home medications. Patient discharged in stable condition with instructions to follow up volume status and check INR on 2/21/07. Number of Doses Required ( approximate ): 7. Override Notice: Override added on 10/30/07 by LAUB, STERLING B M. , M.D. on order for COUMADIN PO ( ref # 853955570 ) and Alert overridden: Override added on 11/14/07 by LUTHY , LANNY D E. , M.D. on order for
|
Has the patient ever been on acei
|
{
"answer_end": [
1817
],
"answer_start": [
1754
],
"text": [
"to 60 bid. Cont Dig/nitrate/BB, ACEi. Checked echo, no change.,"
]
}
|
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 previous warfarin
|
{
"answer_end": [
2351
],
"answer_start": [
2299
],
"text": [
"POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN,"
]
}
|
An 81-year-old woman with Atrial Fibrillation (AF) on Fondaparinux, no Coumadin secondary to prior epistaxis, Non-small Cell Lung Cancer (NSC Lung Ca), and Pernicious Anemia (Pernicious Anemia) presents with three days of constant chest pain, pleuritic, not exertional, and mostly related to arm movement. Treatment included ACEBUTOLOL HCL 400 MG PO DAILY Starting IN AM ( 8/10 ), ALLOPURINOL 100 MG PO DAILY, VITAMIN C (ASCORBIC ACID) 500 MG PO BID, CALCIUM CARBONATE (500 MG ELEMENTAL CA++) 500 MG PO BID, CIPROFLOXACIN 250 MG PO Q12H X 4 doses (Administer iron products a minimum of 2 hours before or after a Levofloxacin or Ciprofloxacin dose dose), DIGOXIN 0.125 MG PO DAILY, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LOVENOX (ENOXAPARIN) 120 MG SC BEDTIME, TARCEVA (ERLOTINIB) 100 mg PO DAILY, FOLIC ACID 1 MG PO DAILY, FUROSEMIDE 40 MG PO DAILY Starting IN AM ( 4/9 ), DILAUDID (HYDROMORPHONE HCL) 0.5 MG PO Q4H PRN Pain (on order for DILAUDID PO, ref# 925975305, POTENTIALLY SERIOUS INTERACTION: TRAMADOL HCL & HYDROMORPHONE HCL, Reason for override: aware), LIDODERM 5% PATCH (LIDOCAINE 5% PATCH) 1 EA TP DAILY, PRAVACHOL (PRAVASTATIN) 20 MG PO BEDTIME, VITAMIN B6 (PYRIDOXINE HCL) 50 MG PO DAILY, ULTRAM (TRAMADOL) 50 MG PO Q6H PRN Pain (on order for ULTRAM PO, ref# 417339527, POTENTIALLY SERIOUS INTERACTION: MORPHINE & TRAMADOL HCL). CT-PE showed no evidence of PE or Deep Venous Thrombosis (DVT) and post Right Lower Lobe Resection changes, with interval resolution of Left Upper Lobe Nodule without new nodules, and possible chronic subsegmental PE. CXR showed no acute process. Factor Xa level was checked to insure Lovenox dosing was therapeutic. Discharge plan included mammogram next week for evaluation, continue pain control with Lidoderm patch, Ultram and low dose Dilaudid as needed for severe pain, continue Tarceva as per outpatient oncologist, continue Lovenox as outpt, continue Lasix at 40mg daily, complete course of Cipro 250mg BID x 3 days, follow up with cardiologist for continued management of heart conditions, and follow up with rehabilitation specialists to try to regain strength and function. Discharge condition was stable.
|
Why did the patient need fondaparinux
|
{
"answer_end": [
109
],
"answer_start": [
0
],
"text": [
"An 81-year-old woman with Atrial Fibrillation (AF) on Fondaparinux, no Coumadin secondary to prior epistaxis,"
]
}
|
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.
|
Why was the patient on beta-blockade
|
{
"answer_end": [
1023
],
"answer_start": [
921
],
"text": [
"He developed hypertension refractory to beta-blockade, calcium channel blockers and IV ACE inhibitors,"
]
}
|
Ms. Fought is a 50-year-old female with a history of bipolar disorder, schizophrenia, obstructive sleep apnea, hypertension, and diabetes who presented with right knee swelling, redness, and pain and was admitted to the Emergency Department. She was given therapeutic doses of heparin because of the concern of pain, as well as IV fluids, Oxycodone 5 mg to 10 mg p.o. q.4h. p.r.n. pain, Tylenol 650 mg p.o. q.4h. p.r.n. pain, Ibuprofen 600 mg q.6h. p.r.n. pain, Klonopin 1 mg p.o. at bedtime, Levofloxacin 500 mg p.o. daily for six days after the day of discharge, and NSAIDs, and was prescribed Lisinopril 10 mg daily, Lipitor 40 mg daily, Klonopin, MetroGel p.o. at bedtime, Lithium 900 mg at bedtime, Acebutolol 200 mg daily, and Risperdal 0.5 mg at bedtime, with no known drug allergies. She responded well to normal saline fluid boluses for a total of 3 liters over her hospital course, and was treated with Unasyn and vancomycin, and then switched to levofloxacin, with six more days after discharge from the hospital. Her bradycardia was resolved either over beta blockade or lithium toxicity, for which her beta-blocker was held and her lithium was also held, resulting in an improved heart rate in the 50s and 60s. Upon discharge, she was given instructions to draw blood for lithium level checks daily until it is below 0.5, at which time, she should be restarted on lithium 300 mg p.o. at bedtime, and to follow up with her primary care physician, Dr. Aurelio Gilberto Hencheck at Li County Hospital.
|
Has the pt. ever been on unasyn before
|
{
"answer_end": [
970
],
"answer_start": [
896
],
"text": [
"was treated with Unasyn and vancomycin, and then switched to levofloxacin,"
]
}
|
This 81-year-old Italian-speaking gentleman was admitted to M Valley Medical Center with rising chest pain. Upon admission, his vital signs were normal and his physical examination was unremarkable. Cardiac catheterization revealed 30% mid RCA occlusion, 40% distal RCA, 90% ostial OM1, 90% mid CX, 80% proximal LAD, 99% mid LAD and 60% mid LM. EKG showed normal sinus rhythm and an incomplete right bundle-branch block. During his hospital stay, he was started on beta-blockers, statins, fluid resuscitation and vasopressor administration, subcu insulin, prednisone, Plavix, and antibiotics. He experienced agitation and delirium, for which he was on alcohol drip due to preop history of alcohol use and Haldol was used p.r.n. Later during the hospital stay, he became hypotensive, requiring Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath. He was also on Lopressor 25 orally every 6 hours, Diltiazem 125 mg orally daily, Furosemide 20 mg orally daily, Methylprednisolone 30 mg IV every 8 hours, Atorvastatin 80 mg orally daily, Allopurinol 100 mg orally daily, Ativan 0.5 mg orally at bedtime, Nexium 20 mg orally daily, and Proscar 5 mg orally every night. Tight glycemic control was maintained with Portland protocol in the immediate postop period and subsequently with subcu insulin. Incidental radiologic finding of a renal mass consistent with renal cell carcinoma was also found. Support for the patient's family was provided throughout the hospital course, and the patient was discharged with Tylenol suppository 650 mg every 6 hours, Toradol orally 10 mg every 4 hours as needed for pain, Haldol liquid 1 to 3 mg orally every 4 hours as needed for agitation, Nexium 20 mg everyday, and Morphine liquid 5 to 20 mg orally every 2 hours as needed for pain and for shortness of breath.
|
has the patient used proscar in the past
|
{
"answer_end": [
1377
],
"answer_start": [
1345
],
"text": [
"Proscar 5 mg orally every night."
]
}
|
Patient Alequin, Garland, a 57-year-old female with a complex medical history including squamous cell lung cancer, cirrhosis, COPD, HTN, PVD, seizure disorder, history of SDH, large abdominal ventral hernia, and chronic back pain, was admitted to the ED obtunded with decreased BP. She had received all her medications as prescribed in the morning at her nursing home and received Thiamine HCL 100 mg PO daily and Narcan in the ED, becoming more responsive and uncomfortable after Narcan with an elevated ammonia level of 233. To manage her mental status, the patient was given Lactulose 30 Milliliters PO QID Starting Today (5/29) and her narcotic dose was avoided. Pain was effectively controlled with MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Celecoxib 100 mg PO daily Starting Today (5/29) PRN Pain, and a Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily. She was prescribed Vitamin C (Ascorbic Acid) 500 mg PO BID, Folate (Folic Acid) 1 mg PO daily, Lasix (Furosemide) 40 mg PO daily, Flagyl (Metronidazole) 500 mg PO q8h, Aldactone (Spironolactone) 75 mg PO BID with food/drug interaction instruction to give with meals, KCL IV (ref #403310506) with serious interaction of Spironolactone & Potassium Chloride with reason for override monitoring, Thiamine HCL 100 mg PO daily, Multivitamin Therapeutic (Therapeutic Multivitamin) 1 tab PO daily, MSIR (Morphine Immediate Release) 7.5 mg PO Q4H PRN Pain, Flovent HFA (Fluticasone Propionate) 220 mcg INH BID, Celecoxib 100 mg PO daily, Keppra (Levetiracetam) 1,000 mg PO BID, Caltrate 600 + D (Calcium Carbonate 1,500 mg (...)), Lidoderm 5% Patch (Lidocaine 5% Patch) topical TP daily, Novolog (Insulin Aspart) sliding scale (subcutaneously) SC AC with instructions to give 0-10 units subcutaneously based on BS, Maalox-Tablets Quick Dissolve/Chewable 1-2 tab PO Q6H PRN Upset Stomach, Vitamin K (Phytonadione) 5 mg PO daily, Protonix (Pantoprazole) 40 mg PO daily, Toprol XL (Metoprolol Succinate Extended Release) 50 mg PO daily with food/drug interaction instruction to take consistently with meals or on empty stomach, Magnesium Oxide 420 mg PO BID, Metronidazol starting on HD 1, and Vancomycin until speciation of blood cultures. Blood cultures were positive for coag negative staph in 2/4. She was also given Flovent for her known COPD and was discharged with instructions to complete a 14-day course of Cipro and Flagyl and a few changes in her medications, including MSIR every 4 hr as needed, Celebrex, and Lidoderm patch. Follow up with Dr. Vargas, Dr. Megeath, Dr. Blandin, and Dr. Pfleider as scheduled, and with PT at nursing home. Blood counts and calcium should be checked on Monday 3/21 and next week respectively.
|
Has the patient ever taken novolog ( insulin aspart ) for their bs
|
{
"answer_end": [
1686
],
"answer_start": [
1662
],
"text": [
"Novolog (Insulin Aspart)"
]
}
|
A 57-year-old female with macromastia and abdominal skin laxity s/p massive weight loss 2/2 gastric bypass was admitted to plastic surgery on 5/8/07. On admission, the patient was prescribed 1. ACETAMINOPHEN 1000 MG PO Q6H, 2. LEVOTHYROXINE SODIUM 75 MCG PO QD, 3. QUINAPRIL 20 MG PO QAM, 4. RANITIDINE HCL 150 MG PO QD, 5. MULTIVITAMINS 1 CAPSULE PO QD, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, VITAMIN C ( ASCORBIC ACID ) 500 MG PO BID, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, KEFLEX ( CEPHALEXIN ) 500 MG PO QID, COLACE ( DOCUSATE SODIUM ) 100 MG PO BID, PEPCID ( FAMOTIDINE ) 20 MG PO BID, DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain (ref #901341233), on order for DILAUDID PO 2-4 MG Q3H (ref #901341233), INSULIN REGULAR HUMAN, supplemental (sliding scale) insulin, If receiving standing regular insulin, please give at same, SYNTHROID ( LEVOTHYROXINE SODIUM ) 75 MCG PO DAILY, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ), REGLAN ( METOCLOPRAMIDE HCL ) 10 MG IV Q6H PRN Nausea, ZOFRAN ( POST-OP N/V ) ( ONDANSETRON HCL ( POST-... ), on order for KCL IV (ref #964491549), POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM CHLORIDE, POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM, SIMETHICONE 80 MG PO QID PRN Upset Stomach, MULTIVITAMIN THERAPEUTIC ( THERAPEUTIC MULTIVI... ) 1 TAB PO DAILY, TIGAN ( TRIMETHOBENZAMIDE HCL ) 200 MG PR Q6H PRN Nausea, ibuprfen. Do not drink/drive/operate machinery with pain medications., Take a stool softener to prevent constipation., 4. Continue your antibiotics as long as you have a drain in place., Sliding Scale (subcutaneously) SC AC+HS Medium Scale, If BS is 125-150, then give 0 units subcutaneously, 30 MILLILITERS PO DAILY PRN Constipation, 1 MG IV Q6H X 2 doses PRN Nausea, Number of Doses Required (approximate): 10, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain. The patient tolerated all procedures without difficulty and post-op period was uneventful, and at discharge, the patient was afebrile with stable vitals, taking po's/voiding q shift, ambulating independently and pain was well-managed with Tigan (Trimethobenzamide HCl) 200 mg PR Q6H PRN Nausea, Tigan (Trimethobenzamide HCl) 300 mg PO Q6H PRN Nausea, Simethicone 80 mg PO QID PRN Upset Stomach, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, 1 mg IV Q6H x 2 doses PRN Nausea, 30 Milliliters PO Daily PRN Constipation and TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, DULCOLAX (Bisacody
|
Why is the patient prescribed zofran ( post-op n/v ) ( ondansetron hcl ( post-... )
|
{
"answer_end": [
1836
],
"answer_start": [
1803
],
"text": [
"1 MG IV Q6H X 2 doses PRN Nausea,"
]
}
|
The 62M with a history of CAD and prior MI leading to CABG in 5/23 was admitted to RCH 6/17 with chest pain and ruled out for MI. A Cath showed non-occlusive disease (70%) and an OM which was stented. The patient experienced frequent chest pain with minimal exertion and experienced an episode of chest pain, SOB, 5/10, no radiation/LH/palpitations, c/o nausea and vomiting, and called EMS to BWSH EW. The patient was given 2 NTG with resolution of symptoms, concerning for increasing frequency of chest pain. The patient was discharged on 8/4/03 with a full code and disposition of home with discharge medications of ACETYLSALICYLIC ACID 325 MG PO BID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, ENALAPRIL MALEATE 5 MG PO QD, ZOCOR (SIMVASTATIN) 20 MG PO QHS, INSULIN 70/30 (HUMAN) 80 UNITS QAM; 60 UNITS QPM SC, PLAVIX (CLOPIDOGREL) 75 MG PO QD, PSYLLIUM 2 TSP PO QD, TOPROL XL (METOPROLOL (SUST. REL.)) 25 MG PO QD, LASIX (FUROSEMIDE) 20 MG PO QD, FAMOTIDINE 20 MG PO BID, and instructions to increased dose for costochondritis as pt. does not wish to take 650 QID dosing. The patient was given instructions to measure weight daily, fluid restriction of 2 liters, house/low chol/low sat. fat, and 2 gram sodium, with advice to resume regular exercise and follow up appointments with Curts 1-2 weeks. The patient also had allergy to codeine, admitting diagnosis of chest pain and CAD, and principal discharge diagnosis of atypical noncardiac chest pain. The patient was also advised to follow up with Dr. Kump and Dr. Sixkiller regarding liver function tests and Dr. Tippen regarding bleeding with bowel movements, respectively.
|
Has a patient had 325/insulin 70/30/
|
{
"answer_end": [
810
],
"answer_start": [
758
],
"text": [
"INSULIN 70/30 (HUMAN) 80 UNITS QAM; 60 UNITS QPM SC,"
]
}
|
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 prescribed nitroglycerins
|
{
"answer_end": [
1136
],
"answer_start": [
1061
],
"text": [
"additional episodes of chest pain that were low in intensity but prolonged,"
]
}
|
The 62M with a history of CAD and prior MI leading to CABG in 5/23 was admitted to RCH 6/17 with chest pain and ruled out for MI. A Cath showed non-occlusive disease (70%) and an OM which was stented. The patient experienced frequent chest pain with minimal exertion and experienced an episode of chest pain, SOB, 5/10, no radiation/LH/palpitations, c/o nausea and vomiting, and called EMS to BWSH EW. The patient was given 2 NTG with resolution of symptoms, concerning for increasing frequency of chest pain. The patient was discharged on 8/4/03 with a full code and disposition of home with discharge medications of ACETYLSALICYLIC ACID 325 MG PO BID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, ENALAPRIL MALEATE 5 MG PO QD, ZOCOR (SIMVASTATIN) 20 MG PO QHS, INSULIN 70/30 (HUMAN) 80 UNITS QAM; 60 UNITS QPM SC, PLAVIX (CLOPIDOGREL) 75 MG PO QD, PSYLLIUM 2 TSP PO QD, TOPROL XL (METOPROLOL (SUST. REL.)) 25 MG PO QD, LASIX (FUROSEMIDE) 20 MG PO QD, FAMOTIDINE 20 MG PO BID, and instructions to increased dose for costochondritis as pt. does not wish to take 650 QID dosing. The patient was given instructions to measure weight daily, fluid restriction of 2 liters, house/low chol/low sat. fat, and 2 gram sodium, with advice to resume regular exercise and follow up appointments with Curts 1-2 weeks. The patient also had allergy to codeine, admitting diagnosis of chest pain and CAD, and principal discharge diagnosis of atypical noncardiac chest pain. The patient was also advised to follow up with Dr. Kump and Dr. Sixkiller regarding liver function tests and Dr. Tippen regarding bleeding with bowel movements, respectively.
|
What is her current dose of toprol xl ( metoprolol ( sust. rel. ) )
|
{
"answer_end": [
915
],
"answer_start": [
867
],
"text": [
"TOPROL XL (METOPROLOL (SUST. REL.)) 25 MG PO QD,"
]
}
|
The patient is a 64 year-old gentleman with a history of chest discomfort, dyspnea on exertion and fatigue who was scheduled for a coronary artery bypass grafting. He had cardiac catheterization at Ryhoagberg Spisus Community Hospital on November, 1999 which demonstrated a 30% tapering lesion of the left main coronary artery, 70% proximal lesion of the left anterior descending coronary artery, 80% lesion distal to D1, 100% occlusion of his left circumflex and a 100% occlusion of his right coronary artery. On March, 1999, he underwent coronary artery bypass grafting times three with a left internal mammary artery to the left anterior coronary artery, saphenous vein graft to the aorta and a saphenous vein graft from the obtuse marginal to the aorta. His intraoperative course was uncomplicated and he was weaned to extubation and he was treated with stress steroids to prevent steroid withdrawal. He was taken back to the operating room for bleeding and was reintubated and was returned in good and stable condition to the intensive care unit on renal Dopamine. He was again extubated and was seen in consultation by the Gastrointestinal Service for a question of gastrointestinal bleed since there was a clot seen on the transesophageal echocardiogram probe at its withdrawal from his first surgery. The Gastrointestinal Service saw any evidence of any upper gastrointestinal bleed and he was maintained on H2 blockers. He was sent to the step down unit on routine postoperative day number two and his Captopril was increased for afterload reduction. He continued to improve and continued to have care for his respiratory situation with continued diuresis and nebulizer treatments and ambulation. He was discharged to the care of Dr. Lou Pineault at Potmend Rehabilitation Hospital, Moorlberl Street with medications including Prednisone 5 mg p.o. twice a day, Enteric coated aspirin 325 mg p.o. q. day, Zantac 150 mg p.o. twice a day, Niferex 150 mg p.o. twice a day, Atrovent nebulizer 0.5 mg four times a day, Timolol eye drops 0.5% one drop in both eyes twice a day, Atenolol 25 mg p.o. twice a day, Captopril 12.5 mg p.o. three times a day, Lasix 40 mg p.o. q. day, Potassium SR 20 mEq p.o. q. day, Simvastatin 40 mg p.o. q. day, and Ibuprofen 200-800 mg as needed for pain q.4-6h.
|
Why was the patient prescribed steroids
|
{
"answer_end": [
904
],
"answer_start": [
838
],
"text": [
"he was treated with stress steroids to prevent steroid withdrawal."
]
}
|
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 beta blockade
|
{
"answer_end": [
616
],
"answer_start": [
578
],
"text": [
"requiring beta blockade and adenosine."
]
}
|
Mr. Plagmann was admitted to the hospital for management of his decompensated heart failure and prescribed Aldactone 25 mg once a day, K-Dur 40 mEq once a day, lisinopril 2.5 mg once a day, Isordil 20 mg three times a day, digoxin 0.125 once a day, torsemide 200 mg twice, and metolazone p.r.n. for volume overload. To improve his urine output, we started a low-dose dopamine drip at 2 mcg per hour and increased the Lasix drip from 10 mg an hour to 20 mg an hour after 200 mg IV Lasix bolus, with good effectiveness reflected in his total weight. We monitored strict I's and O's, checked daily weight, and monitored the b.i.d. lytes. Eventually, his blood pressures remained stable, his JVP decreased from 18 to 20 on admission to about 10 to 12, and his creatinine was stable at 1.7. Given his potassium, which was always borderline low in the 33 or 35 range, we decided to increase his Aldactone dose to 25 mg b.i.d., but given his underlying renal insufficiency, we have decreased his standing K-Dur from 40 mEq a day to 20 mEq a day. We re-added his Isordil at 10 mg t.i.d. for the last 24 hours and his blood pressures were stable in the 90s. We also added folate 5 mg to his regimen because he had an elevated homocystine level and he also takes Ambien at night p.r.n. for insomnia. He is being discharged to home with plan to follow up with Dr. Grassi in her Thyroid Clinic on 2/11/05. Mr. Plagmann states that his symptoms have drastically improved and he is able to exert himself much more without symptoms of shortness of breath or lightheadedness.
|
Was the patient ever given medication for his potassium
|
{
"answer_end": [
134
],
"answer_start": [
96
],
"text": [
"prescribed Aldactone 25 mg once a day,"
]
}
|
GVERRERO , STAN O 346-21-49-8, a 74 yo woman in remission from Hodgkin's Lymphoma and s/p renal transplant( 11/12 ), was discharged to Home with the attending physician being KERSON , RODNEY S , M.D. and code status being Full code. She was prescribed FESO4 ( FERROUS SULFATE ) 300 MG PO BID, FOLATE ( FOLIC ACID ) 1 MG PO QD, SYNTHROID ( LEVOTHYROXINE SODIUM ) 100 MCG PO QD, PREDNISONE 5 MG PO QAM, ZOCOR ( SIMVASTATIN ) 20 MG PO QHS, NEORAL ( CYCLOSPORINE MICRO ( NEORAL ) ) 100 MG PO BID, LOSARTAN 50 MG PO QD, ATENOLOL 25 MG PO QD, PRILOSEC ( OMEPRAZOLE ) 20 MG PO QD, AMIODARONE 400 MG PO BID, ECASA ( ASPIRIN ENTERIC COATED ) 325 MG PO QD, FLAGYL ( METRONIDAZOLE ) 500 MG PO TID X 2 Days, LEVOFLOXACIN 500 MG PO QD X 2 Days, and DIET: House / Low chol/low sat. fat with instructions for regular exercise and follow up with Dr. Schultheiss ( cardiology ) 5/30/03 scheduled. On order for NEORAL PO ( ref # 55336954 ) with a POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & CYCLOSPORINE override added on 11/0/03 by LIU , HERMAN ANTONIO , M.D., and LOSARTAN PO ( ref # 04133525 ) with a POTENTIALLY SERIOUS INTERACTION: CYCLOSPORINE & LOSARTAN POTASSIUM override added on 11/0/03 by ELVEY , EDMUND LENNY , M.D., Alert overridden: Override added on 5/27/03 by : POTENTIALLY SERIOUS INTERACTION: LEVOFLOXACIN & AMIODARONE HCL Reason for override: aware and POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & LEVOFLOXACIN Reason for override: aware. The patient had a hypoxic episode and EKG changes resolved, requiring 2u PRBCs, and was initially treated with lopressor 5mg IV, eventually rate controlled with dilt drip. PFT's , LFT's and TFT's were completed prior to discharge, and she was instructed to restart ecasa 5d p colonoscopy, as well as to take levofloxacin and flagyl for 5 days, and administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose. Consider anticoagulation for PAF was recommended. On 1/16 she had Afib with RVR to 130s with chest arm pain which is her anginal equivalent. ECG with rate related ischemia ST depression V5-6, L. +Minimal troponin leak to 0.19, which subseq downtrended with nl CK. She was init treated with lopressor 5mg IV but had hypotension to 80's which resolved quickly with IVF. She was eventually rate controlled with dilt drip. She returned to sinus rhythm within the day. Cards c/s'd and recommended amio load. CXR showed no infiltrate/opacity. Levo/Flagyl given empirically x 5days though she remained afeb. Abdominal exam was concerning for focal peritoneal irritation. Her exam improved, and she was tolerating PO well at the time of discharge. She has been afeb and well appearing for several days prior to d/c. Plan to complete 5d abx. As per Dr. Thorburn her colonoscopy was complex, and she had polypectomy of 2.5 cm polyp. Path is pending. If + for cancer, the base looked "clean", so may be feasible to re-scope her for surveillance at a later time, as per GI. Hct after colonoscopy went to 24 ( baseline 30 ); post-transfusion HCt of 30.
|
Is the patient currently or have they ever taken synthroid ( levothyroxine sodium )
|
{
"answer_end": [
376
],
"answer_start": [
327
],
"text": [
"SYNTHROID ( LEVOTHYROXINE SODIUM ) 100 MCG PO QD,"
]
}
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.