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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. | zaroxolyn | {
"answer_end": [
444
],
"answer_start": [
370
],
"text": [
"The patient was aggressively diuresed with intravenous Lasix and Zaroxolyn"
]
} |
This 70-year-old woman with no known CAD, cardiac RF: HTN, DM, hyperchol., current tob., H/O PAF on no anticoag 2/2 distant h/o LGIB, a/w palpitations followed by 10 hrs of chest pain was admitted on 1/10/2001 and treated medically with lovenox/integrilin (refused cath) for NSTE MI. In the ED, pain was relieved with NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 and SLNG, and 2" NTP. EKG with TWflattening v5-6 but no ST elevations, and CK160, TnI 0.3. During her stay, she was on heparin, integrelin for NSTE MI, ASA, BB, ACEI, statin, nexium, colace, and levofloxacin for UTI, and lovenox for DVT proph. Her blood pressure was titrated to 130-160 and HCTZ was added for better control because her HR was in the 50's, and a repeat echo was done to check for any changes in function. Upon discharge, she will be on ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, MICRONASE (GLYBURIDE) 5 MG PO QD, HCTZ (HYDROCHLOROTHIAZIDE) 25 MG PO QD, NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3, ZOCOR (SIMVASTATIN) 20 MG PO QHS, LEVOFLOXACIN 250 MG PO QD X 4 Days, ZESTRIL (LISINOPRIL) 20 MG PO QD, ATENOLOL 50 MG PO QD Food/Drug Interaction Instruction, PRILOSEC (OMEPRAZOLE) 20 MG PO QD, and POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL, POTENTIALLY SERIOUS INTERACTION: HYDROCHLOROTHIAZIDE & OMEPRAZOLE, and SLNG PRN. She was also instructed to take atenolol consistently with meals or on empty stomach and to avoid grapefruit unless MD instructs otherwise. Follow up appointments were scheduled with Dr. Truman Thro 1-2 wks, Dr. Stevie Gilani, cardiology, Mon, 1/2/02 1:00 pm, and Bock 0/12/02. | Why is the patient prescribed integrelin | {
"answer_end": [
492
],
"answer_start": [
485
],
"text": [
"heparin"
]
} |
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 this patient ever tried haldol | {
"answer_end": [
727
],
"answer_start": [
705
],
"text": [
"Haldol was used p.r.n."
]
} |
The 43 year old male patient presented with atypical chest pain radiating to the left arm, diaphoresis, nausea, and mild shortness of breath. An EKG with T-wave inversion (TWI) concerning for anterolateral ischemia was also noted, and a Troponin I at ASH was negative (0.04 and 0.05) but the pain persisted, requiring a nitroglycerin (NTG) drip. The patient was admitted to the ward and started on ECASA (Aspirin Enteric Coated) 81 mg PO qd, ferrous sulfate 325 mg PO tid, furosemide (Lasix) 60 mg PO bid, hydralazine HCL 90 mg PO tid, labetalol HCL 600 mg PO tid, nitroglycerin 1/150 (0.4 mg) 1 tab SL q5min x 3 PRN chest pain hold if SBP <100, claritin (loratadine) 10 mg PO qd, losartan (Cozaar) 100 mg PO qd hold if SBP 95, metformin 850 mg PO bid, and Vytorin 10/40 (ezetimibe 10 mg - simvastatin 40 mg) 1 tab PO qd. An Adenosine MIBI showed LV dilation with an ejection fraction of 44%. The patient remained chest pain free overnight and the NTG drip was tapered, with hydralazine and labetalol increased. The patient was discharged with instructions to follow up with Dr. Pulfrey for BP check within 1 week, take discharge medications as prescribed, comply with a low cholesterol, low fat, and <2g sodium diet, and seek medical attention for worsening chest pain, shortness of breath, and marked weight gain, not to resume the Norvasc or Enalapril until instructed to by Dr. Kozola, and to consider further w/u anemia. | Was the patient ever given medication for continued pain | {
"answer_end": [
345
],
"answer_start": [
251
],
"text": [
"ASH was negative (0.04 and 0.05) but the pain persisted, requiring a nitroglycerin (NTG) drip."
]
} |
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 a patient had percocet | {
"answer_end": [
1164
],
"answer_start": [
1145
],
"text": [
"Percocet as needed."
]
} |
The patient, Jacob M. Pobre, was admitted on 1/18/2005 for PPM placement. Discharge was on 1/7/2005. The code status was Full Code and disposition was Home. The patient was discharged on 7/7/05 at 01:00 PM contingent upon attending evaluation. The discharge medications included ECASA (Aspirin Enteric Coated) 325 MG PO QD, ZESTRIL (Lisinopril) 2.5 MG PO QD, ZOLOFT (Sertraline) 50 MG PO QD, KEFLEX (Cephalexin) 250 MG PO QID X 12 doses starting when IV antibiotics end, ARICEPT (Donepezil HCL) 10 MG PO QPM with number of doses required (approximate) 1, PLAVIX (Clopidogrel) 75 MG PO QD, TOPROL XL (Metoprolol (Sust. Rel.)) 50 MG PO QD, LIPITOR (Atorvastatin) 80 MG PO QD, GLUCOPHAGE (Metformin) 500 MG PO QD, GLYBURIDE 1.25 MG PO QD, diet of house/low chol/low sat. fat, 2 gram sodium, and activity of walking as tolerated. The admit diagnosis was CHB and the principal discharge diagnosis was PPM placement. The patient had 3VD, DM, HTN, CAD, and CRI. PPM was placed on 0/7/05 without complications and no other treatments/procedures were done. The patient was stable at discharge and was to follow up as arranged by cardiology. | Is there a mention of of toprol xl ( metoprolol ( sust. rel. ) ) usage/prescription in the record | {
"answer_end": [
637
],
"answer_start": [
589
],
"text": [
"TOPROL XL (Metoprolol (Sust. Rel.)) 50 MG PO QD,"
]
} |
Mr. Barriger is a 73-year-old gentleman who was admitted to the Cardiac Step-Down Floor after being a restrained driver in a motor vehicle collision. His past medical history includes myocardial infarction, hypertension, hypercholesterolemia, diabetes, renal cyst, and cataract, and a past surgical history of coronary stenting and cataract removal. He was prescribed Glyburide 100 mg p.o. b.i.d., Metformin 500 mg p.o. b.i.d., Aspirin 81 mg p.o. q. day., Zocor 80 mg p.o. q. day., Plavix 75 mg p.o. q. day., Prilosec 20 mg p.o. q. day., Isosorbide dinitrate 40 mg p.o. t.i.d., Atenolol 100 mg p.o. q. day., Tylenol 650 mg p.o. q.4h. p.r.n. pain., Colace 100 mg p.o. b.i.d., Ativan 1-2 mg IV p.r.n. anxiety., Oxycodone 5-10 mg p.o. q.6h. p.r.n. pain., Senna tablets 2 p.o. b.i.d., Keflex 250 mg p.o. q.i.d. x12 doses. Keflex should be completed on Monday night., Ambien 5 mg p.o. q.h.s., Tessalon 100 mg p.o. t.i.d. p.r.n. cough., Novalog slides., Maalox 1-2 tabs p.o. q.6h. p.r.n. pain. and Dilaudid 1-2 mg IV q.4h. p.r.n. pain. for pain control. He was also put on Lovenox 40 mg sub-Q. q. day for DVT prophylaxis and aspirin and Plavix for secondary cardiac and neurological prophylaxis. He was also started on Ancef 1 gm q.8h. with a PICC line which was placed later on the day. His pain was well controlled with the combination of Dilaudid and oxycodone and he was encouraged to take several deep breaths per hour to reduce the risk of atelectasis or pneumonia. He was seen by numerous consultants, and his white count improved dramatically and he was afebrile for more than 48 hours while on the Ancef. He was discharged to rehab with appointments with the mentioned doctors. | What medications, if any, has the patient tried for secondary cardiac and neurological prophylaxis in the past | {
"answer_end": [
1189
],
"answer_start": [
1103
],
"text": [
"prophylaxis and aspirin and Plavix for secondary cardiac and neurological prophylaxis."
]
} |
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. | Previous aspirin | {
"answer_end": [
1953
],
"answer_start": [
1927
],
"text": [
"Aspirin 325 mg p.o. daily,"
]
} |
This 66-year-old male with a complicated medical history of DM2, CHB with pacer and evidence of clot on pacer wire, and non-compliance with medications and diet was admitted to the ED with symptoms of abdominal pain and SOB with FS of 500-600. On admission, his VS were 99.5, 101/62, 70s, SaO2 96% on room air. His exam was GEN: elderly ill appearing male in NAD; HEENT: Anicteric sclera, PERRL, dry mucous membranes, poor dentition; NECK: Supple, no adenopathy, JVP flat; CHEST: CTA bilaterally; CV: RRR with diffuse PMI, Nl S1, S2 S3 present; ABD: Reducible ventral hernia, NT, ND, bowel sounds present; EXT: No edema or wounds; SKIN: No rashes; EKG: paced; CXR: clear with NAD; ABD CT: small ventral hernia, gallstones, ectasia of the infrarenal aorta, RLL inflammatory changes suggestive of PNA; VQ: Low probability; LABS: Creatinine of 2.2 that dropped to 1.5 with hydration (BL 1.2-1.3). HCT 41.6 with drop after aggressive hydration. Lipase of 132 but has chronic pancreatitis and is now normalizing. UA and ACE negative. The patient received 5 liters of IVF and 36U of insulin in the ED, his blood pressure stabilized with volume, and was transferred to the medical floor. He was started on ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, FOLATE (FOLIC ACID) 1 MG PO QD Starting Today (9/24), LISINOPRIL 30 MG PO QD, THIAMINE HCL 100 MG PO QD, MVI THERAPEUTIC (THERAPEUTIC MULTIVITAMINS) 1 TAB PO QD, LEVOFLOXACIN 500 MG PO QD Starting Today (9/24), LANTUS (INSULIN GLARGINE) 20 UNITS SC QD, LASIX (FUROSEMIDE) 40 MG PO QD, LIPITOR (ATORVASTATIN) 20 MG PO QD, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, and CREON 20 (PANCRELIPASE 20000U) 4 CAPSULE PO TID, with Override Notices added on 4/24/04 by Blain, Guillermo P., M.D. on order for COUMADIN PO (ref #11219725) (POTENTIALLY SERIOUS INTERACTION: ASPIRIN & WARFARIN) and by Degrange, Diego A., M.D. on order for SIMVASTATIN PO (ref #59315078) (POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & ATORVASTATIN CALCIUM Reason for override: will monitor). He was given teaching regarding nutrition, diabetes, and Coumadin, and instructed to take all medications as directed, and to measure his weight daily. He was also instructed to take a shot with 20 units of insulin every night and to take iron products a minimum of 2 hours before or after a Levofloxacin or Ciprofloxacin dose dose. ADDITIONAL COMMENTS: 1.) Please take your insulin shot (20 units of Lantus) every night at bedtime, 2.) follow an ADA diet, and 3.) take all your medications. He was discharged on ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, FOLATE (FOLIC ACID) 1 MG PO QD Starting Today (9/24), LISINOPRIL 30 MG PO QD, THIAMINE HCL 100 MG PO QD, MVI THERAPEUTIC (THERAPEUTIC MULTIVITAMINS) 1 TAB PO QD, CREON 20 (PANCRELIPASE 20000U) 4 Capsule PO TID, LEVOFLOXACIN 500 MG PO QD, LANTUS (INSULIN GLARGINE) 20 UNITS SC QD, LASIX (FUROSEMIDE) 40 MG PO QD, LIPITOR (ATORVASTATIN) 20 MG PO QD, and COUMADIN (WARFARIN SODIUM) 5 MG PO Q | Has patient ever been prescribed lisinopril | {
"answer_end": [
1320
],
"answer_start": [
1298
],
"text": [
"LISINOPRIL 30 MG PO QD"
]
} |
Patient Omar J. Coolbaugh, a 71-year-old female post cardiac transplant with allograft coronary artery disease, bilateral carotid disease, TIA, diabetes, and obesity, was admitted on 11/8/2007 and discharged on 4/14/2007 with s/p angioplasty and stenting. The medications on admission included Mycophenolate Mofetil 1000 mg PO BID, Oxybutynin Chloride XL 10 mg PO QD, Insulin Glargine 20 units SC QAM, Furosemide PO QD, Clopidogrel 75 mg PO QD, Pravastatin 40 mg PO QHS, Prednisone 5 mg PO QD, Cyclosporine (Sandimmune) 75 mg PO BID, Metoprolol Succinate Extended Release 50 mg PO QD, and Fenofibrate (Tricor) 48 mg PO QD. Elective cardiac catheterization was performed, revealing double vessel disease and successful PTCA/Stenting of LAD was done using XB3.5 guide, BMW, with no residual stenosis. The patient was advised to take Enteric Coated ASA 325 mg PO Daily, Plavix (Clopidogrel) 75 mg PO Daily, Cyclosporine (Sandimmune) 75 mg PO BID, Tricor (Fenofibrate (Tricor)) 48 mg PO Daily, Lasix (Furosemide) 40 mg PO Daily, Insulin Glargine 20 units SC Daily, Toprol XL (Metoprolol Succinate Extended Release) 50 mg PO Daily, CellCept (Mycophenolate Mofetil) 1,000 mg PO BID, Ditropan XL (Oxybutynin Chloride XL) 10 mg PO Daily, Pravachol (Pravastatin) 40 mg PO Bedtime, Prednisolone Sodium Phosphate 5mg/5ml 5 mg PO Daily, and vitamins, with ASA 325 and Plavix for life and other medications at usual doses, plus TNG 0.4 mg (Nitroglycerin 1/150 (0.4 mg)) 1 tab SL q5min x 3 doses PRN Chest Pain. The importance of both aspirin and taking medications consistently was stressed and the patient understands, with diet house/low chol/low sat. fat and activity light activity with no heavy lifting or driving x 2 days, ok to shower, no swimming or bathing x 5 days and lift restrictions of not lifting greater then 10-15 pounds. Follow up appointments were scheduled for Heart Failure Clinic 2-4 weeks and patient was discharged in stable condition and advised to drink plenty of fluids over the next several days, and to call with any questions or concerns. | Has the patient had fenofibrate ( tricor ) in the past | {
"answer_end": [
622
],
"answer_start": [
589
],
"text": [
"Fenofibrate (Tricor) 48 mg PO QD."
]
} |
Logan Czaplinski, an 833-08-42-8 patient, was admitted on 1/27/2001 and discharged on 5/18/2001 to his home with a prescription of ASA (Acetylsalicylic Acid) 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lasix (Furosemide) 80 MG PO BID, Ativan (Lorazepam) 1 MG PO BID PRN anxiety or insomnia, Lopressor (Metoprolol Tartrate) 12.5 MG PO BID, Thiamine (Thiamine HCl) 100 MG PO QD, Coumadin (Warfarin Sodium) 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), Insulin 70/30 (Human) 30 units SC BID, Imdur (Isosorbide Mononit.(SR)) 60 MG PO QD, KCL Slow Rel. 20 mEq x 1 PO BID, Allegra (Fexofenadine HCl) 60 MG PO QD, and Levofloxacin 250 MG PO QD Starting in AM (7/21). An override was added on 10/10/01 by Kent R. Kazee, MD with Potentially Serious Interactions: Aspirin & Warfarin, Simvastatin & Warfarin, and Levofloxacin & Warfarin. Food/Drug Interaction Instructions were also given. This 60-year-old male patient with ischemic CMP and AFib was started on Coumadin 5 weeks ago and was cardioverted via the AICD last Tuesday. He then developed SOB and fever, so he went to the local ED and was given Lasix and Rocephin. His WBC was elevated at 12.2 and he was sent to LMH where he had a low grade fever and required FM O2. He was treated empirically with Levofloxacin, diuresed, and assessed for underlying rhythm. His CXR showed interval improvement and his BCXs from LWMH were negative at 3 days. He was discharged on PO diuretics and a 14-day course of Levofloxacin, with ASA 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lopressor 12.5 MG PO BID, Thiamine 100 MG PO QD, Coumadin 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), and Ativan 1 MG PO BID PRN anxiety or insomnia. He should seek immediate medical attention if he develops chest pain, SOB, lightheadedness, fever, chills, palpitations, or falls. | Was the patient ever given ativan ( lorazepam ) for anxiety | {
"answer_end": [
331
],
"answer_start": [
276
],
"text": [
"Ativan (Lorazepam) 1 MG PO BID PRN anxiety or insomnia,"
]
} |
The patient is a 42-year-old woman admitted for treatment of two pulmonary embolisms and a urinary tract infection. Twenty years ago she suffered a pulmonary embolism which was poorly documented after a tubal ligation. She was treated with heparin and Coumadin and had been well since that time. On 1 of October she underwent elective total abdominal hysterectomy secondary to fibroids and menorrhagia. Before admission, she noted shortness of breath and a temperature to 101, as well as pleuritic chest pain. Upon physical examination, her temperature was 102.5, blood pressure 110/80, heart rate 120, and O2 saturation on room air was 99%. Labs showed electrolytes within normal limits, BUN 6, creatinine 0.8, glucose 114, white count 12.2, hematocrit 26, platelets 508,000, PT 13.4, PTT 25.6. Chest x-ray showed bilateral basilar atelectasis and EKG showed sinus tachycardia at 104 with normal interval and axis. The patient was admitted and started on heparin and the PTT was quickly therapeutic. She had ultrasound of the thighs which failed to show deep venous thrombosis and underwent pulmonary angiography which showed two small pulmonary embolisms on the left side. The patient developed a UTI and was treated with ceftizoxime and converted to p.o. Bactrim. Upon discharge, the patient's condition was good and she was transferred to the Critmi Ganstown Community Medical Center under the care of Dr. Jamie Perman with a PT that was likely in the range of 18 to 20 and was discharged on Bactrim one double strength tablet p.o. b.i.d., iron sulfate 325 mg p.o. q.d., Motrin 800 mg p.o. t.i.d., Colace 100 mg p.o. t.i.d., and Coumadin 1 mg p.o. q. h.s. | What medications has this patient tried for pulmonary embolism | {
"answer_end": [
247
],
"answer_start": [
184
],
"text": [
"documented after a tubal ligation. She was treated with heparin"
]
} |
This is a 65-year-old female with a history of coronary artery disease, hypertension, diabetes, IPF diagnosed in 1986, osteoarthritis, and obesity who presented with five days of chest pain/SOB. She was initially put on aspirin, Lopressor 37.5 t.i.d., heparin, oxygen and hooked up to a cardiac monitor and EKG q.d. and was ruled out for unstable angina. Cardiac catheterization revealed LAD ostial 90%, proximal 80%, diag ostial 90%, left circ 90%, 80% lesions, marginal 1, TUB 90%, RCA 50%. The patient underwent PTCA and stent x 2 with good results and remained chest pain free. On admission she was on medications Captopril 50 mg b.i.d., Lasix 40 mg q.d., Lopid 600 mg b.i.d., Axid 150 mg b.i.d., and insulin 70/30 90 q. a.m. and 40 q. p.m. The patient was hypokalemic on 10/23 with a curious whitening on EKG and peak T waves and was treated with insulin, calcium, and Kayexalate x 3. She had a history of colonic polyps but tolerated the aspirin and was put on Nexium prophylaxis. She was then treated with prednisone overnight for IV contrast dye allergy and treated with digoxin and prednisone. The patient was treated with levofloxacin 500 mg q.d. for fourteen days and discharged on medications ASA 325 mg p.o.q.d., atenolol 75 mg p.o. b.i.d., Lasix 40 mg p.o. q.d., Lopid 600 mg p.o. b.i.d., nitroglycerin 1/150 one tab q. 5 minutes x 3 p.r.n. chest pain, Zocor 10 mg p.o. q.h.s., Norvasc 5 mg p.o.q.d., xalatan one drop OU q.h.s., Alphagan one drop OU b.i.d., levofloxacin 500 mg p.o.q.d., clopidogrel 75 mg p.o.q.d., insulin 70/30 90 units q.a.m., 40 units q.p.m. subcu, and Axid 150 mg p.o. b.i.d. | Has patient ever been prescribed lasix | {
"answer_end": [
659
],
"answer_start": [
596
],
"text": [
"he was on medications Captopril 50 mg b.i.d., Lasix 40 mg q.d.,"
]
} |
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 the patient ever had lisinopril | {
"answer_end": [
1320
],
"answer_start": [
1297
],
"text": [
"LISINOPRIL 20 MG PO QD."
]
} |
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 atorvastatin calcium before | {
"answer_end": [
1774
],
"answer_start": [
1753
],
"text": [
"ATORVASTATIN CALCIUM,"
]
} |
A 58-year-old woman with multiple cardiac risk factors (uncontrolled DM2 10.3 HgbAIC, HTN, lipids), Asthma, Sleep Apnea, and 1 week of worsening DOE was admitted for r/o MI. Her BP was elevated at 150-160's/80-90 and was stabilized with IV lopressor and nitro paste. Her CV- cardiac enz was neg x3- ASA, no BB secondary Asthma. She was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, AMITRIPTYLINE HCL 25 MG PO QHS, FUROSEMIDE 40 MG PO QD, GLYBURIDE 10 MG PO BID, NOVOLIN INNOLET 70/30 (INSULIN 70/30 (HUMAN)) 100 UNITS SC BID (Number of Doses Required (approximate): 8), NORVASC (AMLODIPINE) 10 MG PO QD, and LIPITOR (ATORVASTATIN) 10 MG PO QD. An override notice was added on 6/23/04 by GASTINEAU, RAMIRO, M.D. for CLOTRIMAZOLE 1% CREAM TP (ref # 17426481) due to SERIOUS INTERACTION: ATORVASTATIN CALCIUM & CLOTRIMAZOLE, and an override was added on 6/23/04 by ARDELEAN, TRACY, M.D. for LIPITOR PO (ref # 90735952) due to Pt. having a PROBABLE allergy to SIMVASTATIN; reaction is myalgia. The patient was discharged with a diagnosis of r/o MI, SOB multifactorial deconditioning, pulmon disease, HTN, uncontrolled DM, Sleep Apnea, Asthma, and was given instructions to call her doctor if having chest pain, worsening shortness of breath with exertion or at rest, new onset back/shoulder pain, worsening fatigue or any other concerns. She was also prescribed a diet of House/ADA 2100 cals/dy and told to walk as tolerated. She was told to call her PCP to schedule an out patient Cardiac MIBI with adenosine. | Has this patient ever been treated with lipitor | {
"answer_end": [
914
],
"answer_start": [
887
],
"text": [
"LIPITOR PO (ref # 90735952)"
]
} |
Logan Czaplinski, an 833-08-42-8 patient, was admitted on 1/27/2001 and discharged on 5/18/2001 to his home with a prescription of ASA (Acetylsalicylic Acid) 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lasix (Furosemide) 80 MG PO BID, Ativan (Lorazepam) 1 MG PO BID PRN anxiety or insomnia, Lopressor (Metoprolol Tartrate) 12.5 MG PO BID, Thiamine (Thiamine HCl) 100 MG PO QD, Coumadin (Warfarin Sodium) 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), Insulin 70/30 (Human) 30 units SC BID, Imdur (Isosorbide Mononit.(SR)) 60 MG PO QD, KCL Slow Rel. 20 mEq x 1 PO BID, Allegra (Fexofenadine HCl) 60 MG PO QD, and Levofloxacin 250 MG PO QD Starting in AM (7/21). An override was added on 10/10/01 by Kent R. Kazee, MD with Potentially Serious Interactions: Aspirin & Warfarin, Simvastatin & Warfarin, and Levofloxacin & Warfarin. Food/Drug Interaction Instructions were also given. This 60-year-old male patient with ischemic CMP and AFib was started on Coumadin 5 weeks ago and was cardioverted via the AICD last Tuesday. He then developed SOB and fever, so he went to the local ED and was given Lasix and Rocephin. His WBC was elevated at 12.2 and he was sent to LMH where he had a low grade fever and required FM O2. He was treated empirically with Levofloxacin, diuresed, and assessed for underlying rhythm. His CXR showed interval improvement and his BCXs from LWMH were negative at 3 days. He was discharged on PO diuretics and a 14-day course of Levofloxacin, with ASA 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lopressor 12.5 MG PO BID, Thiamine 100 MG PO QD, Coumadin 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), and Ativan 1 MG PO BID PRN anxiety or insomnia. He should seek immediate medical attention if he develops chest pain, SOB, lightheadedness, fever, chills, palpitations, or falls. | How often does the patient take allopurinol | {
"answer_end": [
196
],
"answer_start": [
171
],
"text": [
"Allopurinol 300 MG PO QD,"
]
} |
The patient is a 71-year-old male with a history of nonischemic dilated cardiomyopathy, diabetes, obstructive sleep apnea, obesity hypoventilation syndrome, and atrial flutter status post ablation. He presented with shortness of breath and a witnessed apneic episode with loss of consciousness and cyanosis. In the Centsshealt Careman Inerist Medical Center Emergency Department, he was found to be saturating 91% on room air and 99% on a nonrebreather with a pH of 7.31 and a PCO2 of 55; he was tried on BiPAP without improvement in either PCO2 or PO2. He was admitted to the CCU with CHF/apnea/sinus arrest and had a history of having stopped his Lasix dose one week prior. He was initially treated with x1 , Solu-Medrol , and DuoNebs in the ED, and ultimately treated with diuresis and a pacemaker placement. On admission, he was maintained on captopril, which was up titrated to 25 mg t.i.d. (held at one point due to the rise in the creatinine), titrated up on metoprolol to 25 mg b.i.d., antibiotics, Allopurinol 100 mg p.o. daily, Iron, Lisinopril, Toprol-XL, Coumadin (discontinued on 2/4/05), Albuterol inhaler p.r.n., Aspirin, Flomax, Hytrin, Colace 100 mg p.o. b.i.d., Ferrous sulfate 325 mg p.o. daily, Heparin 5000 units subcutaneous t.i.d., Lopressor 25 mg p.o. b.i.d., Oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n., Flomax 0.4 mg p.o. daily, Nexium 20 mg p.o. daily, Keflex 250 mg p.o. q.i.d. x12 doses, starting on 7/7/05, Lasix 40 mg p.o. daily, and Regular Insulin sliding scale subcutaneous q.a.c. He was followed by the Electrophysiology Service and had sinus arrest of 8-9 seconds in the setting of apnea in the CCU, and 4 seconds in the setting of apnea on the floor. He underwent pacemaker placement through cephalic veins, and was started on antibiotics following his pacemaker placement, which included cefazolin while in-house, followed by Keflex, and he was expected to stay on Keflex for four days. He was discharged with medications including Albuterol inhaler two puffs inhaled q.i.d. p.r.n. wheezing, Allopurinol 100 mg p.o. daily, Captopril 25 mg p.o. t.i.d., Colace 100 mg p.o. b.i.d., Ferrous sulfate 325 mg p.o. daily, Lasix 40 mg p.o. daily, Heparin 5000 units subcutaneous t.i.d., Regular Insulin sliding scale subcutaneous q.a.c., Lopressor 25 mg p.o. b.i.d., Oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n., Keflex 250 mg p.o. q.i.d. x12 doses, starting on 7/7/05., Flomax 0.4 mg p.o. daily, and Nexium 20 mg p.o. daily. | allopurinol. | {
"answer_end": [
1037
],
"answer_start": [
1007
],
"text": [
"Allopurinol 100 mg p.o. daily,"
]
} |
The patient is a 26-year-old female with a past medical history significant for Hodgkin's lymphoma, splenectomy, asthma, and history of tobacco use, who presented to our service with symptoms of congestive heart failure. She underwent an elective mitral valvuloplasty on November, 2003, with size 26 Cosgrove-Edwards ring and vegectomy, where epinephrine was used to maintain proper pressure and subsequently weaned off. On postoperative day #1, diuresis was increased and a low dose beta blocker was started, which she tolerated well. Baby aspirin and Neurontin 300 mg q.d. were also begun. The patient was discharged to home with VNA assistance with follow up recommendations and medications including enteric-coated aspirin 81 mg p.o. q.d., Colace 100 mg p.o. b.i.d. x 7 days, Lasix 60 mg p.o. q.d., ibuprofen 800 mg p.o. q.8h. p.r.n. pain, Lopressor 25 mg p.o. t.i.d., Niferex 150 mg p.o. b.i.d., Atrovent nebulizer 0.5 mg nebulized q.i.d., Neurontin 300 mg p.o. q.d., K-Dur 30 mEq p.o. q.d. to be discontinued or decreased if Lasix dose is changed, and Flovent 44 mcg/inh b.i.d. The patient was also consulted with the Department of Neurology for persistent numbness and tingling of the left lower extremity, for which Neurontin 300 mg q.d. was prescribed. With aggressive diuresis, the patient was able to regain her postoperative weight and by the day of discharge was 1.7 kilograms below her preoperative weight. The patient is anticipated to return to her full preoperative level of independent functioning with continued cardiovascular rehabilitation and VNA assistance. | What pain medications have ever been prescribed for pt. in the VA or mentioned in the record | {
"answer_end": [
872
],
"answer_start": [
803
],
"text": [
"ibuprofen 800 mg p.o. q.8h. p.r.n. pain, Lopressor 25 mg p.o. t.i.d.,"
]
} |
A 65 year old African-American female with a history of chronic pancreatitis was admitted to the Staho Health 10 of November to 3 of May for her chronic pancreatitis and returned on the 24 of January with recurrent abdominal pain and symptoms consistent with her chronic pancreatitis. On admission, she had a low grade temperature of 100.2, was tachycardic with a heart rate of 131, respiratory rate 20, blood pressure 132/80. Abdominal exam was significant for decreased bowel sounds and abdominal tenderness in the midepigastric region with guarding. Laboratory data showed sodium 128, potassium 4.1, chloride 95, bicarb 26, BUN 23, creatinine 0.8, glucose 433, WBC 17.8, hematocrit 33, platelets 370, alk level of 434, T-bili was 0.6, D-bili was 0.2, lipase was 123, and amylase was 37. An ultrasound showed no gallstones and a 6 cm cyst in the region of the pancreatic head. EKG showed her to be in sinus tachycardia with the rate of 122. Her past medical history was significant for pancreatitis, asthma, insulin dependent diabetes mellitus, history of vascular necrosis of both hips, status post a total hip replacement on the right and left, known coronary artery disease, history of chronic obstructive pulmonary disease, history of GI bleed, status post a Nissen fundoplication with redo, hypertension, alpha thalassemia, history of congestive heart failure, and chronic low back pain secondary to spinal stenosis. Her medications included Metformin, Atrovent, Albuterol, Flovent, Elavil, Cisapride, Flexeril, Axid, NPH insulin, Cardizem CD, lisinopril, Lasix, magnesium oxide, Percocet, Premarin, Provera, Prilosec, Lipitor, Tums and multi-vitamins. She had allergies to Aspirin, Ibuprofen, meperidine, prednisone, penicillin, fophonomide, codeine, morphine, and was not a drinker or smoker. She had developed a urinary tract infection with yeast and was started on fluconazole, and was also begun on H. pylori therapy of Biaxin and bismuth. At the time of discharge, the patient was relatively pain-free, tolerating a p.o. diet, and afebrile and was discharged to the Triadnockum for rehabilitation on her usual medications plus the above-mentioned antibiotics, to complete a seven-day course, and will follow up in the Gug University in the next one to two weeks and will be followed by her primary care physician, Dr. Lorenzo. | Is the patient currently or have they ever taken cardizem cd | {
"answer_end": [
1550
],
"answer_start": [
1498
],
"text": [
"Cisapride, Flexeril, Axid, NPH insulin, Cardizem CD,"
]
} |
Patient Omar J. Coolbaugh, a 71-year-old female post cardiac transplant with allograft coronary artery disease, bilateral carotid disease, TIA, diabetes, and obesity, was admitted on 11/8/2007 and discharged on 4/14/2007 with s/p angioplasty and stenting. The medications on admission included Mycophenolate Mofetil 1000 mg PO BID, Oxybutynin Chloride XL 10 mg PO QD, Insulin Glargine 20 units SC QAM, Furosemide PO QD, Clopidogrel 75 mg PO QD, Pravastatin 40 mg PO QHS, Prednisone 5 mg PO QD, Cyclosporine (Sandimmune) 75 mg PO BID, Metoprolol Succinate Extended Release 50 mg PO QD, and Fenofibrate (Tricor) 48 mg PO QD. Elective cardiac catheterization was performed, revealing double vessel disease and successful PTCA/Stenting of LAD was done using XB3.5 guide, BMW, with no residual stenosis. The patient was advised to take Enteric Coated ASA 325 mg PO Daily, Plavix (Clopidogrel) 75 mg PO Daily, Cyclosporine (Sandimmune) 75 mg PO BID, Tricor (Fenofibrate (Tricor)) 48 mg PO Daily, Lasix (Furosemide) 40 mg PO Daily, Insulin Glargine 20 units SC Daily, Toprol XL (Metoprolol Succinate Extended Release) 50 mg PO Daily, CellCept (Mycophenolate Mofetil) 1,000 mg PO BID, Ditropan XL (Oxybutynin Chloride XL) 10 mg PO Daily, Pravachol (Pravastatin) 40 mg PO Bedtime, Prednisolone Sodium Phosphate 5mg/5ml 5 mg PO Daily, and vitamins, with ASA 325 and Plavix for life and other medications at usual doses, plus TNG 0.4 mg (Nitroglycerin 1/150 (0.4 mg)) 1 tab SL q5min x 3 doses PRN Chest Pain. The importance of both aspirin and taking medications consistently was stressed and the patient understands, with diet house/low chol/low sat. fat and activity light activity with no heavy lifting or driving x 2 days, ok to shower, no swimming or bathing x 5 days and lift restrictions of not lifting greater then 10-15 pounds. Follow up appointments were scheduled for Heart Failure Clinic 2-4 weeks and patient was discharged in stable condition and advised to drink plenty of fluids over the next several days, and to call with any questions or concerns. | Has the patient had prednisolone sodium phosphate 5mg/5ml in the past | {
"answer_end": [
1324
],
"answer_start": [
1272
],
"text": [
"Prednisolone Sodium Phosphate 5mg/5ml 5 mg PO Daily,"
]
} |
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. | nausea meds on in past | {
"answer_end": [
1283
],
"answer_start": [
1258
],
"text": [
"Zofran 4 mg daily p.r.n.,"
]
} |
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. | Has this patient ever been prescribed celexa | {
"answer_end": [
1290
],
"answer_start": [
1222
],
"text": [
"atorvastatin 10 mg q.d., Celexa 20 mg q.d., ibuprofen 800 mg b.i.d.,"
]
} |
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. | Is there a mention of of unasyn usage/prescription in the record | {
"answer_end": [
970
],
"answer_start": [
896
],
"text": [
"was treated with Unasyn and vancomycin, and then switched to levofloxacin,"
]
} |
Harrison Fullwood was admitted on 4/3/2005 for ICD placement for HCM. On 7/13/05, Medtronic Dual Chamber DDI/ICD was placed under general anesthesia with a CODE STATUS of Full Code and disposition of Home. ECHO 5/13 showed septal thickness 16mm, posterior wall thickness 19mm with preserved EF 65% and LV outflow tract peak gradient 125mmHg. Holter monitoring 0/2 without any arrhythmias. On admission PE, VS 96.4 74 140/90 20 93% RA. Labs/Studies included CBC, BMP, Coags wnl, EKG NSR. TW flat V5/V6 (old), CXR (portable): cardiomegaly, no e/o ptx, PA/lat CXR AM after no ptx, leads in place, no overt failure. The patient was prescribed Albuterol, Advair 250/50 bid, Rhinocort 2 sprays bid, Atrovent 2 puff qid, Singulair 10mg qhs, Nexium 40mg daily, Lasix 20mg daily (inc to 40 or 60 during period), Kcl 20meq daily, Verapamil 120mg daily, Patanol 1-2 OU bid prn, Loratidine 10mg daily, Zocor 20mg qhs, Effexor 75mg daily, Metformin 1250mg bid, Mgoxide 500mg daily, Ambien prn, Amox prior to procedures. On order for Motrin PO (ref# 234611479), the patient had a POSSIBLE allergy to Aspirin; reaction is Unknown. The patient was instructed to take Keflex for a 3 day total course, take all medications with food, and avoid grapefruit unless MD instructs otherwise. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A. ENDO: ISS. restarted Metformin on morning of d/c. NEURO: cont Effexor. On discharge, the patient was prescribed Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Wheezing, Lasix (Furosemide) 20 mg PO QD Starting Today (10/19) with instructions to titrate his dose 20mg/40mg/60mg as he normally does depending on his degree of swelling, Motrin (Ibuprofen) 600 mg PO Q6H PRN Pain, Headache, Magnesium Oxide 560 mg PO QD, Verapamil Sustained Release 120 mg PO QD Starting Today (10/19) with instructions to confirm home dose and resume home dose, Keflex (Cephalexin) 250 mg PO QID X 10 doses, Zocor (Simvastatin) 20 mg PO QHS, Ambien (Zolpidem Tartrate) 10 mg PO QHS PRN Insomnia, Loratadine 10 mg PO QD, Potassium Chloride Slow Rel. (KCl Slow Release) 20 mEq PO QD As per AH Potassium Chloride Policy, each 20 mEq dose to be given with 4 oz of fluid, Metformin 1,250 mg PO BID Starting IN AM (10/19), Rhinocort Aqua (Budesonide Nasal Inhaler) 2 Spray Inh BID, Singulair (Montelukast) 10 mg PO QD, Effexor XR (Venlafaxine Extended Release) 75 mg PO QD Number of Doses Required (approximate): 5, Advair Diskus 250/50 (Fluticasone Propionate/...) 1 Puff Inh BID, Nexium (Esomeprazole) 40 mg PO QD, Oxycodone 10 mg PO Q4H PRN Pain, and Atrovent HFA Inhaler (Ipratropium Inhaler) 2 Puff Inh QID. November of 2004, HF symptoms were controlled on Lasix and at baseline he could work. The patient was also advised to take all medications with food and to avoid grapefruit unless MD instructs otherwise, and to take Keflex for a 3 day total course and to take all other medications as the same. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A. | What medication did the patient take for hf symptoms | {
"answer_end": [
2793
],
"answer_start": [
2708
],
"text": [
"November of 2004, HF symptoms were controlled on Lasix and at baseline he could work."
]
} |
This 82-year-old RHM with a history of HTN, DM-2, CAD, and AVR (on Coumadin until 3/29) presented to the WTSMC ER for further work-up after receiving Mannitol. On exam, his VS were T: afebrile, BP: 145/64, P: 60, RR: 18, O2 sat: 97%r.a., HEENT anicteric and MMM without lesions, OP clear, neck supple with no LAD, CV had s1s2 paced, pronounce S2, 3/6 systolic murmur, 2/6 diastolic, resp CTAB, abd +BS Soft/NT/ND, ext no C/C/E, s/p above amputation, MS awake and alert, oriented to date, place, and self, attention DOW backwards, memory registration 3/3, recall 2/3 at 5 min 3/3 with prompting, language fluent, +comprehension, +repetition, +naming intact, nondominant no neglect to DSS, able to salute/brush teeth, CN II, III - pupils 3`2 bilaterally, VFF by confrontation; III, IV, VI - EOMI, no ptosis, no nystagmus; V - sensation intact to LT/PP, corneal reflex intact; VII - mild right facial weakness; VIII - hears finger rub; IX, X - voice dysarthric, palate elevates symmetrically, gag intact; XI - SCM/Trapezii 5/5 B; XII - tongue protrudes midline, motor right pronator drift, no asterixis, normal bulk and tone, no tremor, rigidity or bradykinesia, strength 5/5, DTRs C56, C6, C7, L34, S12, Plantar L2, 2, 2, 1, 0, amputated R1, 1, 1, 1, 0, up, sensory decreased LT, temperature, vibration distally up to knees, coord finger tap rapid & symm, FNF & finger follow intact (for weakness), foot tap rapid & symm, gait deferred. LABS showed Sodium 141 mmol/L, Potassium 4.7 mmol/L, Chloride 103 mmol/L, Total CO2 29 mmol/L, Anion Gap 9 mmol/L, CK 33 U/L, CKMB Quant 1.7 ng/mL, Calcium 9.0 mg/dL, Magnesium 1.6 mg/dL, cTn-I See Result Below ng/mL, and Glucose 130 mg/dL. Medications prescribed were COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN SBP>160mmHg, Insulin Regular Human Sliding Scale (subcutaneously) SC qAC, qHS, Lisinopril 20 mg PO QD, Magnesium Gluconate 500 mg PO BID, Milk of Magnesia (Magnesium Hydroxide) 30 mL PO QD PRN Constipation, Metoprolol Tartrate 25 mg PO TID starting in PM on 0/17, Xalatan (Latanoprost) 1 drop OU QPM, Flomax (Tamsulosin) 0.4 mg PO QD, Nexium (Esomeprazole) 20 mg PO QD, Glipizide 10 mg PO QD, Zocor 20 mg QD, Metformin 1000 mg BID, Niferex 150 BID, ASA 81 PO QD, and BRIMONIDINE 0.2% BID. Neurologic exam was stable with persistent dysarthria, right pronator drift, and mild right leg weakness; patient was evaluated by PT/OT and deemed appropriate candidate for acute rehab. Cardiovascular continued to be in atrial fibrillation, pacemaker was firing, but had an episode of HR 30's x few seconds, and HR 40's-50's for rest of night. EKG unchanged from admission, atrial fibrillation, left anterior fascicular block, some PVCs. Plan was to admit to NICU and transfer to the floor, control BP with home regimen and keep SBP<140, hold ASA and Coumadin, and hold Metformin for now and add insulin sliding scale. Medications included COLACE (Docusate Sodium) 100 mg PO BID, LASIX (Furosemide) 20 mg PO QD, Hydralazine HCl 10 mg IV Q6H PRN other: SBP>160 | Has the patient had previous glipizide | {
"answer_end": [
2201
],
"answer_start": [
2179
],
"text": [
"Glipizide 10 mg PO QD,"
]
} |
Mr. Lumadue is a 68-year-old man with significant cardiac history and vascular disease who came in with a chief complaint of hip pain after a mechanical fall. At that time, his hospital course was complicated by a non-Q wave MI, and Cardiology recommended medical management with Lopressor. An echocardiogram revealed an ejection fraction of 45%, and Dobutamine MIBI revealed a severe fixed perfusion defect in the inferoposterior and inferoseptal left ventricle with an ejection fraction of 26%. His medications included HCTZ 50 mg PO q.d., enteric-coated aspirin 325 mg PO q.d., Zestril 20 mg PO q.d., glyburide 5 mg PO q.d., multivitamins, and cough medicine PRN. Upon admission, his vital signs were afebrile, temperature 97.3, tachycardia, heart rate 106, blood pressure 162/77, oxygenation 94% on room air. X-rays of his left pelvis and femur revealed fracture of the left intertrochanter and subtrochanteric fracture with lesser trochanteric fracture intact by 3 cm, less than five degrees angulation. His femoral head was reduced. During his hospital course, the patient was started on a beta blocker, Ace inhibitor, and continued on an aspirin. He was aggressively diuresed with Lasix for diuresis and was treated with vancomycin, Flagyl, and levofloxacin for presumed aspiration pneumonia. He was continued on Lovenox 60 mg subcu. b.i.d. for prophylaxis against DVT post-hip surgery to continue for six months minimal followed by orthopedic surgery, and restarted on oral hypoglycemics prior to discharge in addition to sliding scale insulin. He was discharged on standing 20 mEq of K-Dur q.d., lisinopril 5 mg PO q.d., hold for systolic blood pressure less than 100, Lasix 100 mg PO q.d., Lovenox 60 mg subcu. b.i.d. x6 months, glipizide 2.5 mg PO q.d., sliding scale insulin, Nexium 20 mg PO q.d., Silvadene wet-to-dry dressing, DuoDerm to left lower leg wound and change q.3 days, and Lopressor 12.5 mg PO t.i.d., hold for systolic blood pressure less than 100. He was maintained on Nexium prophylaxis in the setting of his anticoagulation and on two liters of nasal cannula oxygen at the time of transfer to rehab. Upon discharge, he was instructed to follow up with his primary care physician, orthopedic surgery, cardiology, and pulmonary medicine within two weeks, with labs for a metabolic panel, magnesium, and calcium q.o.d. and physical therapy as needed, with a weightbearing status of non-weightbearing on the left lower extremity and weightbearing as tolerated on the right lower extremity. | Previous nexium | {
"answer_end": [
1809
],
"answer_start": [
1788
],
"text": [
"Nexium 20 mg PO q.d.,"
]
} |
Ms. Watterson, a 75 year old female with a history of CHF/CAD, A-fib, lung CA s/p R wedge resection, basal cell CA on lip s/p resection, and uterine CA s/p TAH, was admitted to the hospital with increasing SOB, weight gain, orthopnea, fever, chills, decreased UOP x1-2 days, L leg swelling, and a T98.6, P72, BP121/65, RR18. In the ED she was given O2 and 40mg of Lasix IV, and her daily meds included Acetylsalicylic Acid 325mg PO daily, Allopurinol 100mg PO daily, Docusate Sodium 100mg PO BID, Esomeprazole 20mg PO daily, Ferrous Sulfate 325mg PO TID, Glipizide 5mg PO BID, KCL Slow Release 20MEQ PO BID, Levothyroxine Sodium 100mcg PO daily, Lorazepam 0.5mg PO daily PRN Insomnia/Anxiety, Metolazone 2.5mg PO daily, Metoprolol Succinate Extended Release 100mg PO daily, Multivitamins 1tab PO daily, Pravastatin 40mg PO bedtime, Torsemide 20mg PO BID, and Warfarin Sodium 2mg PO QPM. CXR, diuresis with IV medications, EKG, R/O MI, and Abdo CT were performed and the patient improved clinically. Antibiotics such as Azithromycin and Levofloxacin were initiated for PNA, and Cefpodoxime 200mg PO QD x 7 days was added for gram pos coverage. In addition, she was given Tessalon Perels 100mg PO TID PRN cough, Guiatuss 10ml PO Q4H PRN cough, Loperamide 2mg PO Q6H PRN diarrhea, and Metolazone 2.5mg PO daily PRN weight gain. The patient was supertheraputic on Coumadin and it was held throughout her admission, INR remained 3.9 to 4.0 in the setting of hemoptysis, started on 1/2 her home coumadin with VNA/PCP f/u in 2 days, d/ced on Coumadin 1mg qpm, UA and urine CTX were negative, developed diarrhea concerning for c.diff but had only been on azithromycin x1 day, all stool studies were negative, presumed viral gastroenteritis, started on loperamide before discharge to be continued prn diarrhea, pt's po DM rx were held during her admission covered with Lantus and Insulin Asp SS, HgA1c was sent and was in nl range, home po rx were restarted on discharge, kept on her home dose of levoxyl, TSH was rechecked and within nl range, home po rx Allopurinol was also continued, the following antibiotics were added: Levofloxacin 500mg by mouth every 48 hours for 7 days, Cefpodoxime 200mg by mouth once daily for 7 days, Tessalon Perels 100mg by mouth three times daily as needed for cough, Guiatuss 10ml by mouth every 4 hours as needed for cough, Loperamide 2mg by mouth every 6 hours as needed for diarrhea, Coumadin: Were taking 2mg by mouth in the pm, now take 1mg by mouth in the pm, and instructions, pt took Metolazone 2.5mg and Torsamide 40mg x1 which did. During her stay the patient remained in afib with good rate control on her bblocker, rx of betablocker, ASA, statin, was diuresed with IV Lasix in the ED, Metolazone 2.5mg and Torsamide 40mg x1, on 2/22 pt's weight increased to 72.9 kg from 70.6kg, restarted on her home rx of torsemide 20mg po bid, was roughly negative 1.3L, pt's daily weights decreased off diuretics, was found to be supertheraputic on her coumadin which was held throughout admission, PNA was initially treated with azithromycin but as her cough and o2 levels persisted, pt was begun on ceftaz and levo for gram pos coverage (levo) double gram neg coverage, and ceftaz changed to cefpodoxime 200mg po qd x 7 days, however pt had only been on azithromycin x 1 day, all stool studies were negative, presumed viral gastroenteritis | Has the patient had lantus in the past | {
"answer_end": [
1922
],
"answer_start": [
1833
],
"text": [
"her admission covered with Lantus and Insulin Asp SS, HgA1c was sent and was in nl range,"
]
} |
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 | What was the dosage prescribed of levofloxacin | {
"answer_end": [
698
],
"answer_start": [
667
],
"text": [
"levofloxacin 500 mg p.o. daily,"
]
} |
The patient is a 75-year-old female with a history of 2. Diabetes , on insulin, congestive heart failure, bilateral occipital CVAs, hypertension, chronic renal insufficiency, coronary artery disease, visual impair with tunnel vision, monoclonal gammopathy, and left upper extremity thrombophlebitis. She was found at home with altered mental status and a fingerstick of 37, which increased to 42 with orange juice and normalized her mental status. She was given 1. Lasix 80 mg p.o q.d. in the morning , 40 mg p.o. q.d. in the evening, 2. Atenolol 75 mg p.o. q.d., 3. Lipitor 10 mg p.o. q.d., 4. Amitriptyline 25 to 50 mg p.o. q.h.s. p.r.n., 5. Multivitamins., 6. Aspirin 325 mg p.o. q.d., 7. Folate 100 mg p.o. q.d., 8. Lisinopril 20 mg p.o. q.d., 9. Iron gluconate 325 mg p.o. t.i.d., 10. Novolin 34 to 40 units subcu. q.d., 11. Epogen 5000 units subcu. q. week., 6. Aspirin 325 mg p.o. q.d., 7. Colace 100 mg p.o. b.i.d., and 2. Metoprolol 12.5 mg p.o. b.i.d. Her NPH dose was cut to 20 units subcu. q.d. with lispro sliding scale q.a.c. and q.h.s., and Metoprolol was changed to Toprol as her blood pressure tolerates. Lisinopril was switched to captopril, then discontinued given her bumping which might suggest thalassemia. She is on iron and Epogen with Prophylaxis: Heparin and H2 blocker. Her minimally needed insulin was 5 units a day and her sugars were well controlled otherwise low. Lasix was decreased to 80 mg p.o. b.i.d. and the x-ray on the day of her discharge showed it was unlikely consolidated lobar pneumonia because of the improved forward flow from discontinuation of her ACE inhibitor. She was admitted with hypoglycemic diabetes possibly secondary to infection or logistical and social barriers, and was treated initially with levofloxacin for her right lower lobe pneumonia versus CHF, pleural effusion which decreased only minimally with diuresis of 1 to 2 liters overnight and for diagnostic and therapeutic purposes she underwent a thoracentesis on 2/11/05. Her chronic renal insufficiency was noted with creatinine at baseline of 2.6 and it decreased significantly on this admission possibly because of improved forward flow from discontinuation of her ACE inhibitor. She was on iron and Epogen with an improved hematocrit from the prior admission but no change in her MCV which suggests that she has more than renal disease causing her microcytosis. Her diabetc diet was low sodium, low fat, low cholesterol and prophylaxis included Heparin and H2 blocker. Her discharge medications included 1. Lasix 80 mg p.o. b.i.d., 2. Metoprolol 12.5 mg p.o. b.i.d., 3. Lipitor 10 mg p.o. q.d., 4. Amitriptyline 25 to 50 mg p.o. q.h.s. p.r.n., 5. Multivitamins, 6. Aspirin 325 mg p.o. q.d., 7. Folate 100 mg p.o. q.d., 8. Lisinopril 20 mg p.o. q.d., 9. Iron gluconate 325 mg p.o. t.i.d., and 10. Epogen 5000 units subcu. q. week. She was screened for admission to Jack Nor Medical Center Of where she will go today with intense physical therapy and learning greater independence in her daily functioning. Her pelvic films were negative for fracture. She should be ambulated t.i.d. with follow up with Dr. Rufener when she is able, Lasix dose can be increased as needed for better diuresis, and studies pending include cytology and culture of pleural fluid and follow-up chest x-ray on the day of her discharge. | has there been a prior captopril | {
"answer_end": [
1195
],
"answer_start": [
1122
],
"text": [
"Lisinopril was switched to captopril, then discontinued given her bumping"
]
} |
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 there been a prior atorva | {
"answer_end": [
868
],
"answer_start": [
814
],
"text": [
"Atorva to Simva in house, Benazepril to Lisinopril 10,"
]
} |
Mr. Faiella is a 78 year old man who presented with two episodes of chest pain and had recently undergone a MV and TV repair with SVG to OM1. An EKG showed pacing and a CK revealed a TnI elevated at 0.17, while Adenosine MIBI revealed a fixed inf/lat defect, consistent with LCX disease. He was sent home with Nitroglycerin, and the pain recurred while watching TV, resolving with one Nitroglycerin tablet. CV: Ischemia was ruled out for MI, added Isordil to regimen, ASA, and continue Carvedilol, Captopril. Likely to have CAD, Adenosine MIBI origin, will stop nitrates. Pt was able to amubulate w/o SOB or CP, CHF: euvolemic, continue Lasix, Aldactone, Digoxin. Neuro: recent history of TIA, on Coumadin, may not want to reverse. On order, he was prescribed ECASA (Aspirin Enteric Coated) 325 mg PO QD, Coumadin PO (ref # 44750239), Captopril 12.5 mg PO TID, Aldactone PO (ref # 94240639), Digoxin 0.125 mg PO QOD, Lasix (Furosemide) 80 mg PO BID, Niferex-150 150 mg PO BID, Nitroglycerin 1/150 (0.4 mg) 1 tab SL q5min x 3 PRN chest pain HOLD IF: SBP < 100, Aldactone (Spironolactone) 25 mg PO QD, Coumadin (Warfarin Sodium) 6 mg PO QD, Carvedilol 3.125 mg PO BID HOLD IF: SBP < 100, and Celexa (Citalopram) 20 mg PO QD, with potential serious interactions between Aspirin & Warfarin, Captopril & Spironolactone, and Potassium Chloride & Digoxin. He was instructed to call his cardiologist and return to the emergency department if his chest pain recurs, worsens, or he becomes short of breath, and to make an appointment with Dr. Moxness within the next 1-2 weeks. VNA was asked to oversee medications, check vitals, and draw PT/INR once a week, while PT was asked to help Mr. Muskett regain strength, flexibility, and range of motion. Number of Doses Required (approximate): 5. There were overrides on orders for COUMADIN PO (ref # 44750239) and ALDACTONE PO (ref # 94240639) due to Potentially Serious Interactions: ASPIRIN & WARFARIN, CAPTOPRIL & SPIRONOLACTONE, and POTASSIUM CHLORIDE & SPIRONOLACTONE. | isordil | {
"answer_end": [
472
],
"answer_start": [
407
],
"text": [
"CV: Ischemia was ruled out for MI, added Isordil to regimen, ASA,"
]
} |
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 ever tried simvastatin | {
"answer_end": [
915
],
"answer_start": [
886
],
"text": [
"Simvastatin and Azithromycin,"
]
} |
This 54-year-old female patient with a history of pulmonary emboli in 1971 and 1988 presented with four days of pleuritic chest pain and left arm heaviness. Her past medical history includes dysfunctional uterine bleeding, iron deficiency anemia, lumbosacral disc disease, and a status post laminectomy three times. In July of 1994, she developed the acute onset of intermittent chest pressure and left arm heaviness, associated with night sweats, which progressed to constant and was unrelieved with two Advils. She had a History of Strep Pharyngitis in August of 1994, which was treated with Penicillin, and her medication on admission was Motrin prn. She had no known drug allergies and her past medical history was as pertinent to her admission. After a thrombotic workup, with the exception of the Russell viper venom which was pending at the time of dictation, all tests returned within normal limits. A chest X-ray, VQ scan, and EKG were performed with the VQ scan read as intermediate probability and the EKG revealing a sinus bradycardia at 54 with normal axis and intervals. A pulmonary arteriogram was performed on hospital day number two which revealed a mean RA pressure of 7 mm of mercury, a mean RV pressure of 12 mm of mercury, and no filling defects to suggest a pulmonary embolus. She received Heparin and was started on Naprosyn at 500 mg p.o. b.i.d. on hospital day number two. Coumadin therapy was discussed and the patient was discharged to home on Naprosyn 500 mg p.o. b.i.d. with meals and was to follow up with Dr. Owen Albertine on November, 1994 at 1:30 p.m. | What is her current dose of naprosyn | {
"answer_end": [
1397
],
"answer_start": [
1324
],
"text": [
"was started on Naprosyn at 500 mg p.o. b.i.d. on hospital day number two."
]
} |
Justin Eans, a 56 year old patient with a history of DM, HTN, hypertryglyceridemia and depression, was admitted to the medical service on 11/4/2004 with 2-day h/o increasing abdominal girth, 1-day h/o shortness of breath, pleuritic CP and an increase in nocturia from 2x to 6x. He was given i.v. Lasix for presumed CHF, and his discharge medications included Tylenol (Acetaminophen) 500 mg PO Q6H PRN Pain, Headache, Atenolol 100 mg PO QD, Calcium Citrate 950 mg PO BID, Colace (Docusate Sodium) 100 mg PO BID, Gemfibrozil 600 mg PO BID, Hydrochlorothiazide 25 mg PO QD, NPH Insulin Human (Insulin NPH Human) 15 UNITS SC At 10 p.m. (bedtime), Lisinopril 40 mg PO QD, Niferex-150 150 mg PO BID, Simethicone 80 mg PO QID PRN Upset Stomach, Vitamin E (Tocopherol-DL-Alpha) 1,200 UNITS PO QD, Vitamin B Complex 1 TAB PO QD, Triamcinolone Acetonide 0.5% (Triamcinolone A...) TOPICAL TP QID, Levofloxacin 500 mg PO QD, Miconazole Nitrate 2% Powder Topical TP BID, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, Metformin XR (Metformin Extended Release) 2,000 mg PO QD, Insulin Regular Human Sliding Scale (subcutaneously) SC AC, and Potassium Chloride Immed. Rel. PO (ref #93677429) with the instruction to separate doses by 2 hours. Overrides were added on 0/28/04 and 3/3/04 by WILBY, BRYANT BRYON, M.D., WASHMUTH, SCOTTIE CLEO, M.D., and BEILER, TOMMY L. respectively. Additionally, the patient was instructed to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose and if on tube feeds, to cycle (hold 1 hr before to 2 hr after) and take 2 hours before or 2 hours after dairy products, with a 14-day course of Levofloxacin and to take ASA/NSAIDs for 6 - 8 weeks. He was discharged in satisfactory condition and was instructed to follow up with Endocrine and PCP re diabetes and lipid management, follow up with PCP for management of chronic medical problems, including GERD, gastric erosions, hypertension, and obstructive sleep apnea, and follow up with an outpatient psychiatrist regarding reinitiation of medications. | What medicines have previously been tried for pain | {
"answer_end": [
416
],
"answer_start": [
359
],
"text": [
"Tylenol (Acetaminophen) 500 mg PO Q6H PRN Pain, Headache,"
]
} |
The patient is an elderly woman with known coronary artery disease status post coronary artery bypass graft who had her Beta blocker, Pendalol decreased from 5 mg to 2.5 mg prior to this trip to Glension Street. On return to the hospital she developed substernal chest pain that radiated down both arms, which was treated with Amoxicillin given to her by her son who is a physician. At this visit, he did start her on Prinivil and she took a sublingual nitroglycerin that completely relieved her symptoms. Laboratory studies were significant for a white blood cell count of 5.46, hematocrit 40.1, platelets 190, Cardiac Troponin I was 0.0, CK was 102, and Urinalysis was negative. Chest x-ray was clear with no infiltrates, and EKG was normal sinus rhythm with normal intervals and normal axis with a left bundle branch block pattern and first degree atrioventricular block with no change compared to an EKG done on January, 1997. MEDICATIONS ON ADMISSION: 1) Zocor 5 mg p.o. q.h.s., 2) Prinivil 5 mg p.o. q. day., 3) Pendalol 2.5 mg p.o. q. day., 4) Aspirin 325 mg p.o. q. day., 5) Synthroid 0.100 mg p.o. q. Monday, Wednesday and Friday and 0.12 mg p.o. Tuesday, Thursday, Saturday and Sunday., 6) Pepcid p.r.n. From here, she was managed medically with increases in her ACE inhibitor, Statin and the addition of nitrates. After the cardiac catheterization, she developed a large right groin hematoma at the puncture site and a bruit was noted. An ultrasound was done that revealed a pseudoaneurysm of the common femoral artery, which was later surgically repaired. MEDICATIONS ON DISCHARGE: 1) Aspirin 325 mg p.o. q. day., 2) Colace 100 mg p.o. b.i.d., 3) Synthroid 100 mcg p.o. q. Monday, Wednesday and Friday, 112 mcg p.o. q. Tuesday, Thursday, Saturday and Sunday., 4) Lisinopril 10 mg p.o. q. day., 5) Beclomethasone diproprionate double strength spray to each nostril b.i.d., 6) Zocor 20 mg p.o. q.h.s., 7) Toprol XL 75 mg p.o. q. day., 8) Imdur 30 mg p.o. q. day., 9) Augmentin one tablet p.o. q. day for seven additional days. The patient had been having low grade fevers and a cough productive of a green sputum, and experienced diaphoretic episodes, both at rest and exertion, which was relieved by a sublingual nitroglycerin. The latest echocardiogram in May of 1997 showed an ejection fraction of 35% with mid to distal septal and apical akinesis and inferior akinesis with mild mitral regurgitation, and she went 4 minutes and 18 seconds on an exercise tolerance test with Thallium which showed only fixed defects, no reversible defects. | Has this patient ever been on toprol xl | {
"answer_end": [
1944
],
"answer_start": [
1806
],
"text": [
"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.,"
]
} |
This 75-year-old female vasculopath was admitted for further evaluation of her peripheral vascular disease which was suspected to be contributing to her new ulcerations and progressively worsening bilateral foot pain, foot mottling and wrist pain as an exacerbating factor to likely atheroembolic phenomenon, status post coronary catheterizations earlier in the year. She was placed on broad-spectrum antibiotics and plan was made for an MRA to evaluate her anatomy, unfortunately, the patient was unable to tolerate the MR and did experience some mental status changes that prevented further noninvasive imaging when she received some narcotic following her hemodialysis round. Over the ensuing days she required rather significant doses of Zyprexa and Haldol to contain agitation and delirium, as the patient would also get physical and violent. This appeared to sedate her sufficiently and over the following days, she did manage to calm significantly and returned to her baseline mental status. Cardiology was consulted during this time to optimize her prior to the OR and her primary cardiologist, Dr. Fugle, did make some recommendations including an echocardiogram that showed preserved ejection fraction and no wall motion abnormalities. Her beta blockade was titrated up and she was instructed to follow up with cardiology. She did tolerate hemodialysis throughout this time without undue difficulty and they offered an angiogram to delineate aortic and bilateral lower extremity runoff anatomy. After extensive discussions with the patient and the patient's family, the patient did agree to a left femoral to dorsalis pedis bypass graft which was performed on 0/25/2006 without complication. By time of discharge, she was tolerating a regular diet and ambulating at baseline with her rolling walker. The pain was well controlled with minimal analgesics that were not narcotic based. Medications on admission included Aspirin 325 mg p.o. daily, Plavix 75 mg p.o. daily, Cardizem 60 mg p.o. t.i.d., Lipitor 80 mg daily, Atrovent 2 puffs four times a day, Albuterol 2 puffs b.i.d., Renagel 806 mg p.o. every meal, Allopurinol 100 mg p.o. daily, Zaroxylyn 2.5 mg p.o. daily p.r.n. overload, Lantus 10 units subcutaneous nightly, Regular insulin sliding scale, Valium 5 mg p.o. b.i.d. p.r.n., Isordil 40 mg p.o. t.i.d., Hydralazine 20 mg p.o. t.i.d., Lopressor 75 mg p.o. t.i.d., Zantac 150 mg p.o. b.i.d., Aciphex 20 mg p.o. daily, Neurontin 300 mg p.o. post-dialysis, Metamucil, Nitroglycerine p.r.n., Procrit 40,000 units subcutaneously every week, Lilly insulin pen, unknown dosage 20 units every morning and 10 units every evening, Loperamide 2 tabs p.o. four times a day, Ambien 10 mg p.o. nightly p.r.n., Tylenol 325 mg p.o. every four hours p.r.n. pain, Albuterol inhaler 2 puffs b.i.d., Calcitriol 1.5 mcg p.o. every Monday and every Friday, Darbepoetin alfa 100 mcg subcutaneous every week, Ferrous sulfate 325 mg p.o. t.i.d., Prozac 40 mg p.o. daily, Motrin 400 mg p.o. every eight hours p.r.n. pain, Insulin regular sliding scale, and Sevelamer 800 mg p.o. t.i.d. Discharge instructions included touchdown weightbearing on the left heel, legs are to be elevated as much as possible while sitting or lying down, all home medications were to be resumed except for Lopressor, VNA was ordered to assist with wound care including Betadine paint to incisions daily, showering only, no bathing or immersion in water for prolonged periods of time, and follow-up visits with Dr. Amorose in one to two weeks and Dr. Morici primary care physician in one week. | What was the dosage prescribed of plavix | {
"answer_end": [
1978
],
"answer_start": [
1954
],
"text": [
"Plavix 75 mg p.o. daily,"
]
} |
An 81-year-old Russian-speaking male with a history of coronary artery disease, multiple strokes, diabetes mellitus type 2, COPD, atrial fibrillation on anticoagulation and a partial pacemaker, congestive heart failure with an ejection fraction of 45-50%, BPH, and hypertension was admitted to Ghampemaw A Hospital for bacteremia with Streptococcus oralis and was treated with a course of IV penicillin through a PICC line, as well as oral Flagyl empirically for an elevated white count. At the rehab facility, he was treated with some sublingual nitroglycerin, and was brought to the Ellwis Medical Center Emergency Room where he was given IV fluid boluses, treated empirically with vancomycin and ceftazidime, and had a CPAP initiated. A head CT was performed which was negative and a right internal jugular line was placed. He was admitted to medicine for further management and a PEG tube placement was done on 4/2/06. His MEDICATIONS ON ADMISSION included Glucotrol 10 mg p.o. b.i.d. and lisinopril 5 mg p.o. q. day, metformin 500 mg p.o. t.i.d., sublingual nitroglycerin p.r.n., nystatin suspension q.i.d., Zyprexa 2.5 mg p.o. q. h.s., Penicillin G 3 million units IV q. 4h x7 days, Milk of Magnesia, Tylenol p.r.n., Dulcolax p.r.n., Colace p.r.n., atenolol 50 mg q. day, Lipitor 20 mg q. day, Senna liquid q. h.s., Flomax 0.4 q. day. He was initially diuresed mildly with Lasix, started on insulin sliding-scale and Lantus, and was kept on potassium and magnesium scales while in hospital. He was given an empiric 7-day course of Ceptaz and Flagyl for aspiration pneumonia, vancomycin, and his vancomycin was switched to IV penicillin and was continued for a full 3-4 week course on 8/14/07. Coumadin was held peri-procedure when he was getting his PEG placed and vitamin K had been administered in view of his supratherapeutic Coumadin. His Coumadin should be restarted on 9/23/07 and Nexium p.o. t.i.d., Flagyl 500 mg p.o. t.i.d. x10 days which was started on 2/5/06. He was oxygenated quickly with 2 liters of oxygen by nasal cannula, restarted on his home doses of aspirin, statin, beta blocker 2 pump, and ACE inhibitor, and his beta blocker and ACE inhibitor were restarted during his hospital stay. He was discharged to rehabilitation where they will focus primarily on his physical therapy and rehab needs. | What treatments if any has the patient tried for slightly hypotensive in the past | {
"answer_end": [
711
],
"answer_start": [
628
],
"text": [
"he was given IV fluid boluses, treated empirically with vancomycin and ceftazidime,"
]
} |
Ms. Hesby is a 36-year-old woman with very poorly controlled type 1 diabetes, end-stage renal disease, right eye blindness, lower extremity neuropathy, gastroparesis, and a history of extensive infections. She presented to Path Community Hospital with a right thigh burn and infection, and was given a prescription for antibiotics, 20 units of IV insulin, 500 mL normal saline boluses, and several 250 mL boluses, as well as 2 amps of calcium gluconate, Kayexalate, albuterol nebs, and Augmentin and IV vancomycin for her right thigh cellulitis. For long-term management, she was prescribed Lantus 24 units subcu each night, NovoLog sliding scale, PhosLo, Nephrocaps, Vitamin D, Sevelamer 1600 t.i.d., Toprol 100 mg p.o. daily, Lisinopril 5 mg p.o. daily, Plavix 75 mg p.o. daily, Keppra 500 mg p.o. b.i.d., Flovent two puffs b.i.d., Albuterol p.r.n., Baclofen 5 mg p.o. t.i.d., and Ambien 10 mg p.o. at bedtime p.r.n. The patient was admitted with a diagnosis of Diabetic Ketoacidosis (DKA) and was stabilized in the MICU on an insulin waves. She was then transitioned to NPH and finally to Lantus 24 units subcu and her hypertension is being managed on her home dose of Lopressor 25 q.i.d. and switched to Captopril, which is being titrated. Her area of cellulitis has completely resolved, and if she becomes acidotic, the patient can be managed with sodium bicarbonate and D5W in small boluses. The patient is taking her Nephrocaps and sevelamer and is receiving prophylaxis with heparin 5000 units subcu t.i.d., however she has consistently refused her heparin. Of note, on the night of 1/26/06, the patient complained of severe cramping, right lower quadrant pain, which is new. She noted this pain has increased rapidly in the setting of diarrhea. Several C. diff studies, which were sent recently have been negative and the patient has had no blood in her diarrhea. Presumed cause is Augmentin, which has been stopped. The patient has continued to eat freely and is passing diarrhea despite her complaints of 10/10 severe abdominal pain. A CT scan of her abdomen was ordered, but she refused to take oral or IV contrast. The results of this CT scan are pending and will be followed up by the new medical team. | What types of medications have been tried for an infection management | {
"answer_end": [
331
],
"answer_start": [
290
],
"text": [
"was given a prescription for antibiotics,"
]
} |
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. | lorazepam | {
"answer_end": [
1908
],
"answer_start": [
1887
],
"text": [
"LORAZEPAM 1 MG PO QD,"
]
} |
Mr. Serafine is a 78-year-old gentleman with class III heart failure and aortic stenosis. He was admitted to the Intensive Care Unit on 3 mcg of epinephrine and insulin and Precedex. He was prescribed Atenolol 12.5 mg daily, aspirin 325 mg daily, metformin 500 mg b.i.d., and Humalog insulin 12 units q.i.d., intravenous Lasix but had weaned Lasix drip and had intermittent boluses of 40 mg IV to promote diuresis with good result. He was also found to have a positive urinary tract infection and was started on ciprofloxacin for a total of five days. The patient at one point required 5 liters of nasal cannula to get his saturations in the 90s. He was prescribed three days, Motrin 400 mg q.8h. p.r.n. pain, NovoLog 24 units subq q.a.c., Lantus 60 units subcutaneous q.10 p.m., Toprol-XL 300 mg daily, patient was also discharged on NovoLog sliding scale subcutaneous q.a.c. with doses of Lasix 40 mg b.i.d., baby aspirin 81 mg daily, and potassium chloride slow release 20 mEq b.i.d. for three days. He was then discharged to home in stable condition with visiting nurse and medications including Atenolol 12.5 mg daily, aspirin 325 mg daily, metformin 500 mg b.i.d., and Humalog insulin 12 units q.i.d., Ciprofloxacin 500 mg q.6h. for remaining four doses, baby aspirin 81 mg daily, Lasix 40 mg b.i.d., for three days along with potassium chloride slow release 20 mEq b.i.d. for three days, Motrin 400 mg q.8h. p.r.n. pain, NovoLog 24 units subq q.a.c., Lantus 60 units subcutaneous q.10 p.m., Toprol-XL 300 mg daily, and NovoLog sliding scale subcutaneous q.a.c. His beta-blocker was increased with good result and he underwent a minimally invasive aortic valve replacement with a 25-mm Carpentier-Edwards pericardial valve. He was then to follow up with Dr. Collin Hyman in six weeks and his cardiologist Dr. Louie W Eilders in one week. | What does the patient take nasal cannula for | {
"answer_end": [
676
],
"answer_start": [
615
],
"text": [
"get his saturations in the 90s. He was prescribed three days,"
]
} |
The patient is a 46-year-old gentleman with End stage renal disease thought to be secondary to hepatitis C virus positive, on chronic hemodialysis who was admitted status post fall and seizure. On the day of admission, he complained of feeling dizzy and slumped onto the floor, and was given 500 ccs of normal saline and was no longer orthostatic, comfortably sitting up in the bed. Past medical history reveals mild mental retardation since about 10 years ago, movement disorder (tics) on Stelazine, end stage renal disease thought to be secondary to hypertension, status post parathyroidectomy for secondary hyperparathyroidism, partial thyroidectomy for goiter incidentally found at surgery, status post partial gastrectomy for peptic ulcer disease in the 1960's, history of MRSA from wound in 1988, hepatitis B surface antibody positive and hepatitis C virus positive. Medications on admission included Calcium carbonate, 1250 mg PO tid; nephrocaps, 1 PO qd; DHT, 0.2 mg PO qd; and Stelazine, 2 mg PO tid. There are no known allergies and the patient was a former smoker with a history of alcohol abuse but no IV drug use. Vital signs showed lying blood pressure of 96/60, pulse 80, sitting up blood pressure 104/70, pulse 96, temperature 97.5, O2 sat 95% on room air, JVD of 4 cms, no lymphadenopathy, chest clear to auscultation, heart revealed S1, S2, normal rate and rhythm with a 1/6 systolic murmur best heard at the left upper sternal border, no CVA tenderness, abdomen soft, non-tender, no masses, bowel sounds positive, guaiac negative with brown stool, tender, edematous dorsal aspect of right foot, with full range of motion at the ankle joint, left extremity benign, neuro exam was grossly nonfocal. Laboratory data revealed sodium 142, potassium 4.8, chloride 94, bicarb 32, BUN 38, creatinine 8.6, glucose 168, white count of 8.82, hematocrit 35, platelets 246, calcium 9.7. Chest x-ray revealed mild pulmonary vascular redistribution with no significant CHF and no infiltrates, ankle x-rays on the right revealed no fracture or dislocation, EKG revealed normal sinus rhythm at a rate of 76, axis 2 degrees, some 1 mm ST elevations in I and AVL, T-waves flat in lead III. The patient was observed overnight, put on an oral renal diet, checking orthostatics frequently, and underwent dialysis again with no orthostasis. Right foot films revealed non-displaced fractures of the second, third, fourth and fifth metatarsal bones, and Orthopaedic service was consulted who put the patient in a bivalve cast with a toe plate. Physical therapy was consulted and the patient was allowed to sit in a chair and engage in non-weight bearing activities and his foot was elevated on three pillows for 72 hours, and discharged on his medications from admission to a rehab/skilled nursing facility per wishes of patient, family and per recommendation of physical therapy. | Why did the patient have normal saline | {
"answer_end": [
1220
],
"answer_start": [
1146
],
"text": [
"lying blood pressure of 96/60, pulse 80, sitting up blood pressure 104/70,"
]
} |
Ms. Halnon is a 67-year-old female with multiple medical comorbidities and a past medical history significant for cardiac transplant in 1993, and hip replacement in July 2005, complicated by wound infection, and need for prolonged rehabilitation who presented from Port Medical Center to Ephma Mersources Ni Memorial Hospital with three days of progressive worsening shortness of breath. Upon admission, her mental status was borderline, but it improved with discontinuation of standing analgesic and decreasing of her clonazepam. A head CT showed no acute processes. She had a right upper arm cellulitis and urinary tract infection on screening urinalysis. She was anemic and was found to be vancomycin resistant Enterococcus positive, but repeated cultures demonstrated MRSA negative. For her heart failure, she was diuresed with IV and transitioned to oral torsemide and they entered discharge dose of torsemide 200 mg p.o. twice per day. She was given a five-day course of levofloxacin (used to address recurrent UTI) and then a two-day course of Ancef, her cellulitis was initially treated with levofloxacin and transitioned to Bactrim based on antibiogram sensitivities. A long-term Foley was placed for comfort with catheter in place. While on Bactrim for her UTI, her creatinine rose from 1.5 to 1.6, but cleared with this regimen. For her chronic anemia, the patient was continued on iron (which was increased to three times per day) and darbepoetin, folate was added. She was asymptomatic from her chronic anemia. She was given two units of packed red blood cells in March, 2005, and two more units on February, 2006. Her admission weight was 133 kg and her creatinine was 1.6. At discharge, she was hemodynamically stable, afebrile, and breathing comfortably on three liters of oxygen. Her discharge medications included Vitamin C 500 mg twice per day, Imuran 25 mg daily, PhosLo 667 mg three times per day, clonazepam 0.25 mg twice daily, iron sulfate 325 mg three times per day, folate 1 mg daily, Dilaudid 2 mg every six hours as needed for pain, lactulose 30 mL four times per day as needed for constipation, prednisone 5 mg every morning, Sarna topical every day apply to affected areas, multivitamin daily, Coumadin 2.5 mg daily, goal INR 2 to 3, zinc sulfate 220 mg daily, Ambien 5 mg before bed as needed for insomnia, torsemide 200 mg by mouth two times per day, cyclosporine 50 mg twice daily, Colace 100 mg twice daily, insulin NPH 14 units every evening, insulin NPH 46 units every morning, esomeprazole 20 mg once per day, DuoNeb 3/0.5 mg inhaled every six hours as needed for shortness of breath, Aranesp 50 mcg subcutaneously once per week, NovoLog sliding scale before meals, Lexapro 20 mg once per day, Maalox one to two tablets every six hours as needed for upset stomach, and Lipitor 20 mg once per day. Outstanding issues include following INR the goal of 2 to 3, following weight and clinical signs of volume overload, following up on loose stools for possible Clostridium difficile infection, and following clinical signs for evidence of urinary tract infection treating with antibiotics as necessary. | Has the patient ever had prednisone | {
"answer_end": [
2203
],
"answer_start": [
2061
],
"text": [
"lactulose 30 mL four times per day as needed for constipation, prednisone 5 mg every morning, Sarna topical every day apply to affected areas,"
]
} |
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 the patient ever been on digoxin | {
"answer_end": [
797
],
"answer_start": [
734
],
"text": [
"included amiodarone, digoxin, colchicine, Atrovent, lisinopril,"
]
} |
This 54-year-old male with ischemic cardiomyopathy, severe pulmonary hypertension, and chronic kidney disease (Cr 2.5) was admitted to MSCH 3 weeks ago for CHF and diuresis and volume resuscitated with creatinine decreasing to 3.9. He was discharged on 8/27/06 at 2:00 PM with a full code status and disposition to home with medications Aspirin Enteric Coated 81 MG PO DAILY, LIPITOR (ATORVASTATIN) 10 MG PO DAILY, COLESTIPOL HYDROCHLORIDE 10 GM PO DAILY, INSULIN GLARGINE 14 UNITS SC DAILY, HUMALOG INSULIN (INSULIN LISPRO) Sliding Scale (subcutaneous) SC AC, IMDUR ER (ISOSORBIDE MONONITRATE (SR)) 60 MG PO DAILY, KLOR-CON (KCL SLOW RELEASE) 20 MEQ PO DAILY (each 20 mEq dose to be given with 4 oz of fluid), TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 50 MG PO BEDTIME, TORSEMIDE 150 MG PO DAILY, metolazone on an as-needed basis for weight, but presented to ED with Cr 5.1, ZEMPLAR 1MG DAILY, Klorcon slow release 20 mEq daily, Flomax 0.4 qd, colestipol 1g qd, toprol-XL 50 qhs, lantus 14 unit sc, humalog scale, and metolazone 5mg as needed with the instructions to take Torsemide and Klor-Con as per his normal routine and to take Flomax, Colestipol, and Toprol-XL consistently with meals or on an empty stomach, and to continue his home medications otherwise. The patient was also advised to return Monday for his second dialysis run and not take Torsemide on Monday with a Number of Doses Required (approximate): 5. | Has the patient had previous klor-con | {
"answer_end": [
1130
],
"answer_start": [
1077
],
"text": [
"take Torsemide and Klor-Con as per his normal routine"
]
} |
The patient was a 46 year old woman with a history of asthma who was admitted with an asthma exacerbation. She had asthma since childhood and was never intubated nor previously treated with steroids. On admission, her physical examination showed wheezes bilaterally in the lungs. Her laboratory examination showed hematocrit of 41.6, white count of 9.66, and platelets of 199,000. She was treated with steroids, Solu-Medrol and then prednisone 60 milligrams orally, beta agonist, nebulizer and ampicillin, and continued her oral theophylline as she had been using as an outpatient. Her medications on admission were Theo-Dur 200 milligrams by mouth 3 times a day, prednisone 60 milligrams by mouth each day, Albuterol nebulizer, ampicillin 500 milligrams by mouth 3 times a day and Bronkosol. Allergies included sulfa drugs. She slowly improved with decreased wheezing in her breath sounds and increased peak flow from 300. She was discharged on May 3rd with all her usual medications, plus Keflex 500 milligrams by mouth 4 times a day and prednisone 50 milligrams by mouth each day, and was to follow up with her doctor. | Is there history of use of steroids | {
"answer_end": [
465
],
"answer_start": [
428
],
"text": [
"then prednisone 60 milligrams orally,"
]
} |
The patient is a 60 year-old woman with adult onset diabetes mellitus, hypertension, and elevated cholesterol admitted with chest pain, bradycardia, and decreased blood pressure. When her blood pressure is elevated, she takes Nifedipine and the pain became three to four out of ten, so she took Cardizem without relief and called EMS. The pain was relieved with the EMTs gave nitroglycerin times two and they found her to have blood pressure of 190/100, heart rate 76, and normal sinus rhythm. They gave two nitrospray, blood pressure decreased to 150/80, heart rate 76, and after two minutes in the vehicle, she had sinus bradycardia at 30-40, blood pressure 120/80. She was given 0.5 mg of Atropine times one without any affect and brought to the hospital with a systolic blood pressure of 100, then suddenly she had bradycardia with heart rate of 30-40 and systolic blood pressure of 75. She was given intravenous fluids and Atropine 0.5 mg times one which increased her blood pressure systolic to 100 and her heart rate increased to 60. On admission, she was given Nifedipine 10 mg p.r.n. for elevated blood pressure, Lasix 20 mg q. day, Glucotrol 15 mg q. day, Cardizem 300 mg q. day, Coumadin 3.75 mg q. day, Colace 100 mg b.i.d., and Iron 325 mg q. day. On discharge, she was given Aspirin 325 mg q. day, Atenolol 50 mg q. day, Lisinopril 10 mg q. day, Pravachol 20 mg q. day, Glucotrol XL 15 mg q. AM, Lasix 20 mg q. day, and Nitroglycerin tablets sublingual p.r.n. chest pain. She underwent exercise tolerance test on a standard Bruce protocol and angiography which showed left main OK, LAD proximal 20%, D2 60%, ostial 90% mid, left circumflex mid 30%, OM2 distal 60-70%, OM1 mild diffuse disease. She underwent PTCA of her diagonal two which went from 90% to 0% stenosis and she received Heparin overnight and the sheaths were pulled on the following day. She is to follow-up in the VERAREA UNIVERSITY HOSPITAL Clinic with Dr. Van Rothenberg. | Did the patient ever take any medication for her elevated blood pressure in the past | {
"answer_end": [
1092
],
"answer_start": [
1069
],
"text": [
"Nifedipine 10 mg p.r.n."
]
} |
The 90+-year-old female patient presented to the Trinmo Rybay Bethmorgreene Burgstern Medical University Of Medical Center Department on 5/1/06 with an intermittently cold and blue right foot, and gangrene was noticed in the second and third right lower extremity toes. She had significant medical issues such as dementia, coronary artery disease, diabetes, and PVOD. She underwent and tolerated a right AKA on 7/8/06 without any complications, and after recovery from anesthesia was admitted to the general care floor. Her diet was advanced as tolerated and the pain was well controlled with oral pain medications and she was evaluated by physical therapy. She was treated with perioperative ancef and switched to one week of p.o. linezolid just prior to discharge. At the time of discharge, the patient was afebrile, vital signs stable, with the right AKA stump well healed and with mild erythema inferior to the incision. Her discharge medications included Trazodone 50 mg nightly, Celexa 20 mg daily, Colace 100 mg b.i.d., Hydrochlorothiazide 25 mg daily, Novolog sliding scale, Lantus 20 units subcutaneously q.a.m., FiberCon one tablet, MVI daily, Synthroid 25 mcg daily, Linezolid 600 mg p.o. q.12h. x10 doses starting today, Zyprexa 2.5 mg p.o. q.p.m., and Tylenol Elixir 1000 mg p.o. q.6h. p.r.n. pain and Lactulose 30 mL p.o. daily p.r.n. constipation. She was discharged to her skilled nursing facility with plans to follow up with her primary care physician and Dr. Wynder in one to two weeks. The patient is DNR/DNI. | Has the patient ever tried novolog | {
"answer_end": [
1082
],
"answer_start": [
1060
],
"text": [
"Novolog sliding scale,"
]
} |
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. | has there been a prior methotrexate | {
"answer_end": [
1172
],
"answer_start": [
1142
],
"text": [
"magnesium oxide 400 mg b.i.d.,"
]
} |
Mr. Esbenshade is a 70-year-old Caucasian male with CAD, stented five years ago, known as calcific aortic stenosis with progression of exertional dyspnea. He was admitted to CSS and stabilized for surgery on 9/13/06, which included AVR with a 25 CE magna valve, CABG x2 with LIMA to LAD and SVG1 to PDA, pulmonary vein isolation, and left atrial appendage resection, with no complications. He is currently on 5 liters of O2 and some pulmonary edema, improving with Lasix 20 mg IV t.i.d. and diuresis, on Osmolite tube feeds at 20 mL an hour, with prophylactic antibiotics for chest tubes, medications IV, Toprol 50 mg q.a.m. and 25 mg q.p.m., Coumadin, Lasix 20 mg daily, atorvastatin 20 mg daily, Neurontin 100 mg t.i.d., metformin 1000 mg b.i.d., and glipizide 2.5 mg b.i.d. Cardiac meds include Aspirin, Lopressor, and Coumadin. He has been followed by psych for postoperative confusion/possible suicidal ideation, with Celexa ordered per psych. He is also on Acetaminophen 325-650 mg q. 4h. p.r.n. pain or temperature greater than 101, DuoNeb q. 6h. p.r.n. wheezing, enteric-coated aspirin 81 mg daily, Dulcolax 10 mg PR daily p.r.n. constipation, Celexa 10 mg daily, Colace 100 mg t.i.d., Nexium 20 mg daily, K-Dur 10 mEq daily for five days, Toprol-XL 200 mg b.i.d., miconazole nitrate powder topical b.i.d., Niferex 150 mg b.i.d., simvastatin 40 mg at bedtime, multivitamin therapeutic one tab daily, INR, and Boudreaux's Butt Paste topical apply to effected areas. He has been running a bit fast in Afib and is on Coumadin and aspirin for atrial fibrillation, and is awaiting a rehabilitation bed. Cipro x3 days has been started due to a UA from 10/5/06 with probable enterogram-negative rods. His mood has improved and beta-blocker has been titrated. He has been advised to make all follow-up appointments, local wound care, wash wounds daily with soap and water, shower patient daily, keep legs elevated while sitting/in bed, watch all wounds for signs of infection, redness, swelling, fever, pain, discharge, and to call PCP/cardiologist or Anle Health Cardiac Surgery Service at 282-008-4347 with any questions. | Has the patient ever tried beta-blocker | {
"answer_end": [
1759
],
"answer_start": [
1702
],
"text": [
"His mood has improved and beta-blocker has been titrated."
]
} |
Dion Scarberry (926-57-39-3) was admitted on 9/0/2005 with a diagnosis of COPD flare and right heart failure and was discharged on 5/28/05 at 02:00 PM with a disposition of Home w/ services. He had a number of medications including Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17), Elavil (Amitriptyline HCL) 10mg PO QHS, Atenolol 25mg PO QD Starting in AM (7/17), Colace (Docusate Sodium) 100mg PO BID, Furosemide 20mg PO QD Starting Today (6/25), Guaifenesin 10ml PO TID Starting Today (6/25) PRN Other:cough, Oxycodone 5mg PO TID Starting Today (6/25) PRN Pain, Quinine Sulfate 325mg PO HS Starting Today (6/25), Senna Tablets (Sennosides) 2 Tab PO BID, MVI Therapeutic (Therapeutic Multivitamins) 1 Tab PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: will monitor, Zocor (Simvastatin) 20mg PO QHS, Morphine Controlled Release 15mg PO Q12H, Felodipine 5mg PO QD Food/Drug Interaction Instruction, Flonase (Fluticasone Nasal Spray) 1 Spray INH QD, Advair Diskus 500/50 (Fluticasone Propionate/...) 1 Puff INH BID, Caltrate+D (Calcium Carbonate 1,500mg (600...) 1 Tab PO BID, Novolog Mix 70/30 (Insulin Aspart 70/30) 35 Units QAM; 22 Units QPM SC 35 Units QAM 22 Units QPM, Prednisone Taper PO Give 60mg q 24 h X 5 dose(s), then Give 50mg q 24 h X 3 dose(s), then Give 40mg q 24 h X 3 dose(s), then Give 30mg q 24 h X 3 dose(s), then Give 20mg q 24 h X 3 dose(s), then Give 10mg q 24 h X 3 dose(s), then Give 5mg q 24 h X 3 dose(s), then Starting Today (6/25), Combivent (Ipratropium and Albuterol Sulfate) 2 Puff INH QID. He was also given a diet of 4 gram Sodium, activity to resume regular exercise, and follow up appointment(s) with primary care doctor at the BCCMC early next week. He had allergies to Erythromycins and was given Azithromycin and supplemental O2 and Levofloxacin and admitted with a diagnosis of COPD flare. Home meds include Atenolol 25mg PO qd, HCTZ 25mg PO qd, Felodipine 5mg PO qd, Zocor 20mg PO qhs, ASA 81mg PO qd, Advair 1 puff bid, Combivent 2 puffs qid, Loratidine 10mg PO qd, Guqifenesin 600mg PO q12h, Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid, Senna 2 tab PO qd, Calcium+Vim D 125 units PO qd, Elavil 10mg PO qhs. He was treated for COPD flare with supplemental O2, DuoNebs, and steroids and received a V/Q scan which reported a low probability of PE, as well as a cardiac MRI which demonstrated normal cardiac anatomy and function, with an LVEF of 73% and no valvular dysfunction. His diabetes was managed with his home regimen of Novolog and chronic pain and insomnia were managed with his out-pt regimen of morphine and oxycodone, and he was given Elavil for sleep. Because of his history of cancer, he was placed on Lovenox for anticoagulation. Additional Comments include the instruction to use his home oxygen when sleeping at night, the addition of Combivent inhalers and a steroid taper to his medicines, and to stop the hydrochlorathiazide (HCTZ) 25mg and take Lasix 20mg once a day. His discharge condition was stable, and he was instructed to continue Lasix 40mg PO QD at home and D/C home HCTZ, to do a slow prednisone | Is there history of use of combivent inhalers | {
"answer_end": [
2954
],
"answer_start": [
2898
],
"text": [
"Combivent inhalers and a steroid taper to his medicines,"
]
} |
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 was tylenol (acetaminophen ) originally prescribed | {
"answer_end": [
788
],
"answer_start": [
737
],
"text": [
"Tylenol (Acetaminophen) 650 mg PO Q4H PRN Headache,"
]
} |
Mr. Klaja is an 81-year-old gentleman who presented with abdominal pain and diarrhea, and an abdominal CT revealed an infectious inflammatory bowel process. Stool samples were sent for C. diff toxin and assay, all were negative, while stool cultures did not grow anything out. Empiric treatment with p.o. vancomycin was started, and the patient's abdominal pain resolved and he was afebrile by discharge. A flexible sigmoidoscopy showed colitis consistent with inflammatory etiology, and the patient was discharged with a presumed C. diff colitis diagnosis on a 2-week course of vancomycin. The patient had a DVT followed by bacteremia with multi-resistant Klebsiella pneumoniae, treated with meropenem for 14 days with the course. The patient had no evidence of acute coronary syndrome on admission, and his coronary artery disease, CHF, and chronic kidney disease were managed with MEDICATIONS: aspirin 81 mg, Plavix 75 mg, Coumadin 5 mg, digoxin 0.125 mg, Lasix 49 mg daily, lisinopril 10 mg daily, Lopressor 25 mg b.i.d., Zocor 80 mg daily, Flomax 0.4 mg daily and Flovent 110 mcg b.i.d., lactobacillus p.o. for probiotics and patient also had flex sig 2-week course p.o. vancomycin alone. He was given gentle hydration therapy with 2 liters of IV fluids, and restarted on Lasix 40 mg p.o. daily for diuresis. He was also discharged on a course of lactobacillus p.o. for probiotics, with DISCHARGE MEDICATIONS: Included aspirin 81 mg p.o. daily, Plavix 75 mg p.o. daily, digoxin 0.125 mg p.o. daily, Nexium 20 mg p.o. daily, lactobacillus 2 tabs p.o. t.i.d., metoprolol 25 mg p.o. b.i.d., simvastatin 80 mg p.o. at bed time, Flomax 0.4 mg p.o. every evening, vancomycin 250 mg p.o. every 6 hours x8 days at supertherapeutic, Coumadin 6 mg p.o. daily, Flovent 110 mcg inhale b.i.d., Lasix 40 mg p.o. daily, his daily dose at home. | What is the current dose of the patient's lasix | {
"answer_end": [
977
],
"answer_start": [
959
],
"text": [
"Lasix 49 mg daily,"
]
} |
The 65-year-old female patient with a history of hypertension, hypercholesterolemia, non-insulin-dependent diabetes mellitus, and no known hx of CAD was admitted with chest pain. On November 1997, an exercise treadmill test revealed a maximal heart rate of 127 and maximal blood pressure of 134/80, with 1 millimeter of ST depression in V5 and T-wave inversions in V4-V6, consistent with, but not diagnostic ischemia. She had a history of sarcoidosis, seizure disorder, pacemaker placement, appendectomy, total abdominal hysterectomy for cervical cancer, adult onset diabetes mellitus, and left calf deep vein thrombosis in 1993. Medications at the time of admission included Linsinopril 5 mg q.d., Pravachol 20 mg q.h.s., aspirin 325 mg q. day, atenolol 0.5 mg b.i.d., Dilantin 200 mg b.i.d., Ventolin inhaler p.r.n., and ferrous gluconate 325 mg t.i.d. Hematocrit on June 1997 was noted to be 29.3 and the patient had been on iron supplements since then. On admission, she was given Nitrol paste and, for her ischemia, she was transfused with one unit of packed red cells. Diagnostic ischemia was present, and she was started on aspirin and atenolol. In the past, she has been treated with prednisone and black secondary to iron supplementation. Two cardiac catheterizations were performed, which showed a 70% residual osteal diagonal stenosis and 0% left anterior descending stenosis. A stent was placed in the diagonal artery with 0% residual stenosis and her left anterior descending was stented. At the time of discharge her medications included Ticlid 250 mg p.o. b.i.d., albuterol inhaler 2 puffs q.i.d. as needed for shortness of breath, enteric-coated aspirin 325 mg p.o. q.d., atenolol 37.5 mg p.o. b.i.d., nitroglycerin 1/150 sublingual one tablet q. 5 minutes times three for chest pain, and Dilantin 200 mg p.o. b.i.d. She was also taking linsinopril 5 mg q.d., Pravachol 20 mg q.h.s., ferrous gluconate 325 mg t.i.d., and Ventolin inhaler p.r.n. She is scheduled to followup with Dr. Doug Millis in her office in one week and will follow up with cardiology as an outpatient. | Has the patient had linsinopril in the past | {
"answer_end": [
698
],
"answer_start": [
676
],
"text": [
"Linsinopril 5 mg q.d.,"
]
} |
A 45-year-old female with a history of IDDM, sleep apnea, asthma on chronic prednisone, HTN, and CAD s/p NSTEMI in 6/10 with a stent to the LAD presented with 3 days of worsening dyspnea and chest pressure. She was treated for an asthma exacerbation with Prednisone 40 mg PO QAM x 10 doses, Instructions: Taper: 40mg for 2 days, then 35mg for 2days, then 30mg for 2days, then 25mg for 2days, then 20mg, ECASA (ASPIRIN ENTERIC COATED) 325 mg PO QD, CARDIZEM SR (DILTIAZEM SUSTAINED RELEASE) 120 mg PO QD, Override Notice: Override added on 0/9/05 by DUHART, RANDY M., M.D. on order for LOPRESSOR PO (ref #31219927), POTENTIALLY SERIOUS INTERACTION: DILTIAZEM HCL & METOPROLOL TARTRATE Reason for override: aware, HYDROCHLOROTHIAZIDE 25 MG PO QD, LISINOPRIL 30 MG PO QD, on order for POTASSIUM CHLORIDE IMMED. REL. PO (ref #73021085), POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE Reason for override: aware, LORAZEPAM 0.5 MG PO BID PRN Anxiety, LOPRESSOR (METOPROLOL TARTRATE) 12.5 MG PO BID, on order for CARDIZEM SR PO (ref #76249027), on order for CARDIZEM PO (ref #49626929), COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, ADVAIR DISKUS 500/50 (FLUTICASONE PROPIONATE/...), ATOVAQUONE 750 mg PO BID, NAPROSYN (NAPROXEN) 250-500 mg PO BID PRN Pain, CALCIUM CARB + D (600MG ELEM CA + VIT D/200 IU), ZOLOFT 1 TAB PO QD, Alert overridden: Override added on 4/2/05 by : POTENTIALLY SERIOUS INTERACTION: CLOPIDOGREL BISULFATE & NAPROXEN Reason for override: musculoskeletal pain, diabetes mellitus 2/2 chronic steroid use, Ischemia: continue Zocor, Clopidogrel, ECASA, nitrates as needed., Pump: continue lisinopril, HCTZ, Cardizem, Lopressor 12.5 mg PO BID, presentation. Never hospitalized, chronic prednisone therapy, s/p gentle diuresis, Pred, nebs with improvement of symptoms, D-dimer < 200, admission peak flow 150 (baseline NL 300-350), at discharge 275-300, ambulatory O2 sat WNL., Musculoskeletal workup showed reproducible sternal pain on palpation consistent with costochondritis and Naprosyn PRN pain, Psych: Continue Zoloft for depression and Lorazepam for anxiety, PPx was managed with PPI., Discharge condition was stable. Plan was to assess efficacy of Prednisone 20 mg upon completion of taper, status of dyspnea/asthma symptoms on low dose beta-blocker, chest pain/costochondritis with PRN NSAIDs, and ENDO: Chronic steroid use, Insulin SS in-house. -calcium/vit D supplement, with food/drug interaction instruction to give with meals and take with food, to resume regular exercise, and follow up appointments with Dr. BALVANZ, PCP in 2 weeks and ENDO indefinitely. | Has patient ever been prescribed lopressor | {
"answer_end": [
614
],
"answer_start": [
504
],
"text": [
"Override Notice: Override added on 0/9/05 by DUHART, RANDY M., M.D. on order for LOPRESSOR PO (ref #31219927),"
]
} |
An 81-year-old Russian-speaking male with a history of coronary artery disease, multiple strokes, diabetes mellitus type 2, COPD, atrial fibrillation on anticoagulation and a partial pacemaker, congestive heart failure with an ejection fraction of 45-50%, BPH, and hypertension was admitted to Ghampemaw A Hospital for bacteremia with Streptococcus oralis and was treated with a course of IV penicillin through a PICC line, as well as oral Flagyl empirically for an elevated white count. At the rehab facility, he was treated with some sublingual nitroglycerin, and was brought to the Ellwis Medical Center Emergency Room where he was given IV fluid boluses, treated empirically with vancomycin and ceftazidime, and had a CPAP initiated. A head CT was performed which was negative and a right internal jugular line was placed. He was admitted to medicine for further management and a PEG tube placement was done on 4/2/06. His MEDICATIONS ON ADMISSION included Glucotrol 10 mg p.o. b.i.d. and lisinopril 5 mg p.o. q. day, metformin 500 mg p.o. t.i.d., sublingual nitroglycerin p.r.n., nystatin suspension q.i.d., Zyprexa 2.5 mg p.o. q. h.s., Penicillin G 3 million units IV q. 4h x7 days, Milk of Magnesia, Tylenol p.r.n., Dulcolax p.r.n., Colace p.r.n., atenolol 50 mg q. day, Lipitor 20 mg q. day, Senna liquid q. h.s., Flomax 0.4 q. day. He was initially diuresed mildly with Lasix, started on insulin sliding-scale and Lantus, and was kept on potassium and magnesium scales while in hospital. He was given an empiric 7-day course of Ceptaz and Flagyl for aspiration pneumonia, vancomycin, and his vancomycin was switched to IV penicillin and was continued for a full 3-4 week course on 8/14/07. Coumadin was held peri-procedure when he was getting his PEG placed and vitamin K had been administered in view of his supratherapeutic Coumadin. His Coumadin should be restarted on 9/23/07 and Nexium p.o. t.i.d., Flagyl 500 mg p.o. t.i.d. x10 days which was started on 2/5/06. He was oxygenated quickly with 2 liters of oxygen by nasal cannula, restarted on his home doses of aspirin, statin, beta blocker 2 pump, and ACE inhibitor, and his beta blocker and ACE inhibitor were restarted during his hospital stay. He was discharged to rehabilitation where they will focus primarily on his physical therapy and rehab needs. | Has this patient ever been treated with glucotrol | {
"answer_end": [
988
],
"answer_start": [
961
],
"text": [
"Glucotrol 10 mg p.o. b.i.d."
]
} |
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. | What is the current dose of novolog | {
"answer_end": [
1253
],
"answer_start": [
1198
],
"text": [
"Lantus 5 units subcu q.p.m., NovoLog 3 units subcu a.c."
]
} |
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 | What is the dosage of coumadin ( warfarin sodium ) | {
"answer_end": [
1577
],
"answer_start": [
1536
],
"text": [
"COUMADIN ( WARFARIN SODIUM ) 1 MG PO QPM,"
]
} |
75 yo Spanish speaking F was admitted for pre-syncope and discharged on 9/15/04 with full code status to home with medications including TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, ALBUTEROL INHALER 2 PUFF INH QID Starting Today (2/9), ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, ATENOLOL 25 MG PO BID, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, ZOCOR (SIMVASTATIN) 40 MG PO QHS with food/drug interaction instruction to avoid grapefruit unless MD instructs otherwise and IMDUR (ISOSORBIDE MONONIT.(SR)) 30 MG PO QD with food/drug interaction instruction to give on an empty stomach (give 1hr before or 2hr after food) and ZANTAC (RANITIDINE HCL) 150 MG PO BID and CELEBREX (CELECOXIB) 200 MG PO QD with food/drug interaction instruction to take with food with diet of house/low chol/low sat. fat and activity of walking as tolerated. An EKG showed sinus brady and a TSH test was mildly elevated at 5.3. Labs showed an elevated LDL, cardiac enzymes negative, UA negative, Hct 40 at baseline, and an aMIBI 3/24 showed a small reversible defect of mild intensity in the distal ant wall and apex c/w small area ischemia in the distal LAD. The patient was given TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Headache, ALBUTEROL INHALER 2 PUFF INH QID Starting Today (2/9), ECASA (ASPIRIN ENTERIC COATED) 81 MG PO QD, ATENOLOL 25 MG PO BID, LEVOXYL (LEVOTHYROXINE SODIUM) 75 MCG PO QD, ZOCOR (SIMVASTATIN) 40 MG PO QHS on order for ZOCOR PO (ref # 63128567), IMDUR (ISOSORBIDE MONONIT.(SR)) 30 MG PO QD, ZANTAC (RANITIDINE HCL) 150 MG PO BID, CELEBREX (CELECOXIB) 200 MG PO QD, NSAIDS, and LOVENOX for DVT ppx. The patient was advised of the benefits of ASA for her and was started on 81mg qd and may benefit from EGD as well as increasing Imdur if persistent hypertension. It is important to call Dr. Mcquade for a follow up appointment within the next 1-2 weeks and to take all medications on the discharge list at the doses specified. The patient presents with pre-syncope, hypothyroidism, asthma, left hip pain, headache and polyarthralgias. The patient was monitored on tele and the atenolol could be a contributing factor to the bradycardia and was switched to bid frequency with 1/2 dose (25mg). GI symptoms include dyspepsia and was started on PPI and checked for H.pylori. Endocrine symptoms included a mildly subtherapeutic levoxyl which was increased to 75mcg qd. Pulmonary symptoms included asthma which was continued on albuterol inhaler PRN and DVT ppx with Lovenox. MSK symptoms included trochanteric bursitis which was treated with Tylenol. | Has the patient ever been on zantac ( ranitidine hcl ) | {
"answer_end": [
1543
],
"answer_start": [
1505
],
"text": [
"ZANTAC (RANITIDINE HCL) 150 MG PO BID,"
]
} |
The patient is a 58-year-old female with chronic renal insufficiency, diabetes mellitus, hypertension, and anemia who presented with two weeks of diffuse abdominal pain that acutely worsened one day prior to admission with associated nausea, nonbloody emesis, and chills. She was initially given a seven-day course of ciprofloxacin and oxycodone for pain, but stopped taking them after developing constipation. She currently presents with complaints of diarrhea and was given ampicillin 2 g IV, gentamicin 80 mg IV, Flagyl 500 mg IV and 8 units of insulin. She was put on levofloxacin, vancomycin, and Flagyl as her left foot had been encasted with evidence of underlying infection, and her blood cultures grew MRSA, which is presumed to need eight weeks of vancomycin. She was put on erythromycin with a change to Reglan on 8/6/06 per renal or liver disease and kept on Compazine for nausea. Later, it was determined that the patient was iron deficient and she was put on iron supplementation and darbepoetin initially and changed to erythropoietin later during dialysis. She was maintained on aspirin, a statin, and calcium channel blocker, and started on prophylactic beta-blocker during her hospital course. Her insulin regimen was titrated to good glycemic response, and she was kept on heparin and Nexium. Other medications included Tylenol 650 mg p.o. q.4. p.r.n. headache, Colace 100 mg p.o. b.i.d., Dilaudid 0.4-0.8 mg p.o. q.4. p.r.n. pain, Insulin NPH human 20 units subq b.i.d., Lopressor 50 mg p.o. q.i.d., Senna tablets two tabs p.o. b.i.d., Norvasc 10 mg p.o. daily, Nephrocaps one tab p.o. daily, Insulin Aspart sliding scale subq a.c., Lipitor 80 mg p.o. daily, Protonix 40 mg p.o. daily, Vancomycin 1 g IV three times a week, Reglan 5 mg p.o. q.a.c., Reglan 5 mg p.o. q.h.s., Compazine 5-10 mg p.o. q.6h. p.r.n. nausea, Ergocalciferol 50,000 units p.o. q. week for six weeks, Aspirin 81 mg p.o. daily, Heparin 5000 units subq t.i.d., and Lactulose 30 mL p.o. q.i.d. p.r.n. constipation. | has the patient had norvasc | {
"answer_end": [
1581
],
"answer_start": [
1556
],
"text": [
"Norvasc 10 mg p.o. daily,"
]
} |
Mr. Boyles is a 73-year-old man with a past medical history significant for extensive coronary artery disease, diabetes, hypertension, hypercholesterolemia, and smoking, who presents with chest pain and is admitted for rule out myocardial infarction. His vital signs are normal, his lungs are clear, his jugular venous pressure is less than 5.0 centimeters, and his PMI is nonpalpable. His cardiac risk factors include age, diabetes, hypertension, cholesterol, smoking, and family history. On the morning of admission, he experienced chest pain for 1-2 minutes, which dissipated. At 7:00 p.m., he took one sublingual nitroglycerin with a decrease of pain and at 11:00 p.m., he took one sublingual nitroglycerin. His medications include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was placed on Plavix, continued aspirin, and restarted Coumadin after heparin and intravenous TNG. Cozaar 25 milligrams q.d. and amlodipine were added, and he was given normal saline intravenous fluids to equalize his ins and outs. His hematocrit dropped to 28.0, and he was transfused two units with an appropriate bump back to 33.0. His diabetes was managed on NPH 30/10 and 4 regular q.p.m., and Rezulin. His genitourinary issue was managed with Finasteride 5 milligrams q.d. and Levofloxacin 500 milligrams q.d. He developed point tenderness in his right knee, and was managed with Colchicine and a prednisone taper starting at 40 milligrams. His medications on discharge include Coumadin 5 milligrams q.d., Atenolol 25 milligrams q.d., Mitozalone 5 milligrams q.d., Lasix 160 milligrams q.d., Atorvastatin 20 milligrams q.h.s., K-Dur 60 mEq q.d., Rezulin 400 q.d., NPH 34 q.a.m., 10 q.p.m., regular insulin 4 q.p.m., Finasteride 5 q.d., Colchicine 0.6 milligrams p.r.n., Aspirin 81 milligrams q.d., Restoril 30 milligrams p.r.n., Nitroglycerin 0.4 milligrams p.r.n. chest pain, sublingual, may repeat times three q.5 minutes., Magnesium oxide 280 milligrams q.d., and Ciprofloxacin 500 milligrams b.i.d. or Levofloxacin 500 milligrams q.d. He was taken back for a left subclavian artery stent and a left brachial artery angioplasty, and further managed with catheterization, finding a saphenous vein graft to the diagonal one was 100 percent occluded, SVG to PDA was open, LMA was 30 percent occluded, LAD was 99 percent occluded, diagonal one was 100 percent occluded, and LCX was 80 percent occluded. He was discharged to home in stable condition, with follow-up appointments with his primary doctor, cardiologist, and the doctor who performed the procedure. | Has the patient taken medication for his magnesium | {
"answer_end": [
1220
],
"answer_start": [
1184
],
"text": [
"Magnesium oxide 280 milligrams q.d.,"
]
} |
Mr. Vendetti is a 61 year old man who was admitted to the cardiac surgical service on 0/14/97 for aortic valve replacement, mitral valve replacement. He had an echocardiogram at an outside hospital that demonstrated a dilated left ventricle and an ejection fraction of 55% with moderate aortic stenosis with moderate to severe aortic insufficiency with a peak gradient of 35 millimeters of mercury, mild to moderate mitral stenosis and moderate mitral insufficiency with a mitral valve area of 1.1 cm squared. His cardiac catheterization on 4/21/97 demonstrated a 95% proximal right coronary artery lesion and an ejection fraction of 50%. His past medical history included rheumatic heart disease and hypertension, and he is a former smoker with a twenty pack year history. On admission, he was taking Toprol XL 50 once a day, aspirin once a day, sublingual nitroglycerin and Zocor 50 once a day. He went to the operating room on 5/16/97 where he had a mitral valve replacement with a #31 St. Jude mechanical prosthesis and an aortic valve replacement with a #25 St. Jude mechanical prosthesis and a right internal mammary artery bypass grafting to the right coronary artery. He had no complications and is being discharged on post-op day four without complications, on Lopressor 50 mg twice a day, Lasix 40 mg once a day for two days with potassium, K-Dur tabs 10 mEq once a day for two days with Lasix, Coumadin 5 mg one tab once a day or as directed, restarted for right leg DVT that was discovered post cardiac catheterization and is to be continued for a total of three months. Percocet is one tab q.4h. prn for pain and he is being discharged to the care of Dr. Sterling Goodson. | What is the current dose of the patient's k-dur tabs | {
"answer_end": [
1404
],
"answer_start": [
1351
],
"text": [
"K-Dur tabs 10 mEq once a day for two days with Lasix,"
]
} |
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 pt. ever been on lasix before | {
"answer_end": [
1391
],
"answer_start": [
1335
],
"text": [
"In the ED, he received Duonebs, ASA 325, and Lasix 80mg."
]
} |
This 63 year-old male with a history of peripheral vascular disease, hypertension, non-insulin dependent diabetes mellitus, coronary artery disease, aortic stenosis, and status post bilateral lower extremity bypass grafts presented to the hospital with increasing left lower extremity pain. At which time tPA infusion was commenced and an occlusion of the left lower extremity vein graft was found in the area of the mid-thigh with no passage of contrast and minimal reconstitution of collaterals to his foot. He was managed medically for a few days and underwent catheterization which revealed a right dominant system, a discreet 40% lesion in the proximal left main, a discreet 30% lesion in the proximal left anterior descending artery, 100% lesion in the first marginal branch of the left circumflex artery, as well as 100% lesion in the second marginal branch of the left circumflex artery. He was taken to the operating room on 0/27/02 for an aortic valve replacement with a #23 Carpentier-Edwards pericardial valve and mitral valvuloplasty with an Alfieri suture repair, as well as coronary artery bypass graft times three with left internal mammary artery to the left anterior descending artery, left radial to obtuse marginal one, and left radial to posterior descending artery. During his hospital course he was on MEDICATIONS: Glipizide 5 mg b.i.d., Hydrochlorothiazide 50 mg q.d., Lisinopril 20 mg q.d., Simvastatin 20 mg q.d., Amlodipine 5 mg q.d., Imdur 30 mg q.d., and Toprol 100 mg q.d. and enteric coated aspirin, and he remained on his aspirin and Lopressor, as well as Coumadin. He was placed on the Portland protocol and remained on a full ten-day course of Flagyl and Cefotaxime for his preoperative pneumonia. On his pre-discharge examination he was discharged to rehabilitation with DISCHARGE MEDICATIONS: Coumadin 4 mg p.o. q.hs to maintain INR between 2 and 3, aspirin, Diltiazem 30 mg t.i.d., Simvastatin 20 mg q.d., Colace 100 mg t.i.d., Nexium 20 mg q.d., Niferex-150 b.i.d., Glipizide 5 mg b.i.d., Lasix 40 mg b.i.d., and Lopressor 50 mg b.i.d. with CZI sliding scale. | Has the pt. ever been on flagyl before | {
"answer_end": [
1684
],
"answer_start": [
1627
],
"text": [
" protocol and remained on a full ten-day course of Flagyl"
]
} |
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. | What was the dosage prescribed of steroids | {
"answer_end": [
904
],
"answer_start": [
838
],
"text": [
"he was treated with stress steroids to prevent steroid withdrawal."
]
} |
GOMEY , REGGIE 802-36-83-4, a 70-year-old female with known CAD, DM, and schzioaffective disorder, presented with intermittent chest pain for 12 hours, with diaphoresis and no nausea/vomiting/fever/cough/shortness of breath. She had a recent cardiac workup with a moderate defect in the circumflex, but decided against medical treatment. Upon discharge, the patient was prescribed ACETYLSALICYLIC ACID 325 MG PO DAILY, ATENOLOL 12.5 MG PO QAM HOLD IF: SBP<100 or HR<50, LIPITOR (ATORVASTATIN) 80 MG PO DAILY, COGENTIN (BENZTROPINE MESYLATE) 1 MG PO QAM, THORAZINE (CHLORPROMAZINE HCL) 400 MG PO QAM (on order, ref # 417100958) with a potentially serious interaction with Benztropine Mesylate and Chlorpromazine HCL, ECASA 325 MG PO DAILY, GLIPIZIDE XL 10 MG PO DAILY, SYNTHROID (LEVOTHYROXINE SODIUM) 100 MCG PO DAILY, LISINOPRIL 20 MG PO DAILY HOLD IF: SBP<100, METFORMIN 1,000 MG PO BID HOLD IF: NPO, and TRAZODONE 50 MG PO BEDTIME PRN Insomnia. CVD ROMI x2 with troponin and ck and CKMB were normal and the patient continued her cardiac medications for BP control and ECG showed early R wave but no ST changes. DM was managed with oral hypoglycemics and the patient was prescribed Heparin for prophylaxis. She was also prescribed a diet of House/Low chol/low sat. fat and 2 gram Sodium and given instructions to walk as tolerated. Follow up appointments were scheduled with Dr. Mike Kalafarski on 10/1/06. | Is the patient currently or have they ever taken chlorpromazine hcl | {
"answer_end": [
715
],
"answer_start": [
696
],
"text": [
"Chlorpromazine HCL,"
]
} |
This is a 72 year old black female with a history of hypertension, angina, adult onset diabetes, and recurrent syncopal events who was treated with Dilantin for less than a year in 1970 and her last episode was in 1989. She was given Nitro Paste and 1 amp of D50 when she experienced a syncopal event on the morning of admission and her fingerstick glucose was checked. Her medications on admission include aspirin one tablet q d, Questran one pack q d, Micronase 5 mg po q d, Betaxolol eye drops bid to each eye, Pilocarpine eye drops tid to each eye, and eye drops bid to each eye. She also receives monthly Vitamin B12 injections and takes nitroglycerin with chest pain. Physical examination revealed pinpoint constriction of her pupils secondary to her glaucoma eyedrops, bibasilar, coarse crackles in the chest, no jugular venous distention, and nonfocal neurologic exam. Laboratory data includes sodium of 143, potassium of 4.3, chloride of 109, bicarbonate of 20, BUN of 21, creatinine of 1.0, glucose of 160, hematocrit of 43.4, white count of 6.45, and normal coagulation factors. Chest X ray showed a calcific aorta, C spine X ray and head CT were negative, and EKG showed no changes from her baseline. The patient was started on Isordil and Lopressor empirically but these were discontinued and her chest pain is relieved with nitroglycerin. She was discharged to home with plans for a repeat 24 hour Holter as an outpatient with diagnoses of syncope, borderline type II diabetes, stable exertional angina, and glaucoma. Discharge medications include aspirin one tablet po q d, Questran one package po q d, Pilocarpine eye drops tid per eye, Betaxolol eye drops bid per eye, eye drops bid per eye, sublingual nitroglycerin prn chest pain, and Naprosyn 375 mg tid prn. | What was the indication for my patient's nitroglycerin | {
"answer_end": [
673
],
"answer_start": [
633
],
"text": [
"and takes nitroglycerin with chest pain."
]
} |
The patient is a 70-year-old woman with a history of Congestive Heart Failure due to diastolic dysfunction, Crohn's colitis, right breast carcinoma, diabetes mellitus, obstructive sleep apnea, gastroesophageal reflux disease, hypercholesterolemia, and osteoarthritis. She was admitted with volume overload for diuresis, having developed fluid retention with gradual worsening, shortness of breath and lower extremity edema. During the hospitalization, she was started on IV Lasix along with Zaroxolyn and oral torsemide, and heparin while starting anticoagulation with Coumadin. The patient was also treated for a urinary tract infection with IV levofloxacin, which was subsequently changed to p.o. cefixime which she completed a five-day course of. Her diabetes mellitus was maintained with insulin subcutaneous injections. Upon discharge she was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o. q.h.s., Vitamin E 400 U p.o. q.d., Coumadin 5 mg p.o. q.h.s., multivitamins 1 tablet p.o. q.d., Zocor 40 mg p.o. q.h.s., insulin 70/30 35 U subcu. q.a.m., Neurontin 300 mg p.o. q.a.m., 100 mg p.o. at 2:00 p.m., 300 mg p.o. q.h.s., Serevent inhaled 1 puff b.i.d., torsemide 100 p.o. q.a.m., Trusopt 1 drop b.i.d., Flonase nasal 1-2 sprays b.i.d., Xalatan 1 drop ocular q.h.s., Pulmicort inhaled 1 puff b.i.d., Celebrex 100 mg p.o. b.i.d., Avandia 4 mg p.o. q.d., Hyzaar 12.5 mg/50 mg 1 tablet p.o. q.d., Nexium 20 mg p.o. q.d., potassium chloride 20 mEq p.o. b.i.d., Suprax 400 mg p.o. q.d. x4 days, albuterol inhaled 2 puffs q.i.d. p.r.n. wheezing, miconazole 2% powder applied topically on skin b.i.d. for itching. During the hospitalization, she responded with a brisk diuresis over the course of the admission, resulting in a 5.2 kg weight decline and estimated 15 liters of fluid removed. Atrial fibrillation was noted and anticoagulated with IV heparin and Coumadin, reaching a therapeutic INR of 2.5 within 4-5 days. Urinalysis showed evidence of an urinary tract infection with 20-30 white blood cells and was leukocyte esterase positive, and a urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin and the patient had been started on IV levofloxacin and subsequently changed to p.o. cefixime. The patient completed a five-day course of p.o. cefixime while in the hospital and was discharged on that medicine to complete a 10-day course. Of note, the initial symptoms the patient presented with indicated a bacterial urinary tract infection. Subsequent urine culture grew out E. coli, which was subsequently determined to be resistant to levofloxacin. The patient has a long history of diabetes requiring insulin treatment and was followed by an endocrinologist at the Kingnix Lowemar W.kell Medical Center, and her blood sugars were maintained with insulin subcutaneous injections. Upon discharge, the patient was prescribed Vitamin C 500 mg p.o. q.d., ferrous sulfate 300 mg p.o. q.d., insulin Lente subcutaneous 30 U q.h.s., insulin Regular subcutaneous 30 U q.h.s., Synthroid 200 mcg p.o. q.d., Zaroxolyn 5 mg p.o. q.a.m., tamoxifen 20 mg p.o. | Has this patient ever been prescribed cefixime | {
"answer_end": [
2482
],
"answer_start": [
2416
],
"text": [
"cefixime. The patient completed a five-day course of p.o. cefixime"
]
} |
Logan Czaplinski, an 833-08-42-8 patient, was admitted on 1/27/2001 and discharged on 5/18/2001 to his home with a prescription of ASA (Acetylsalicylic Acid) 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lasix (Furosemide) 80 MG PO BID, Ativan (Lorazepam) 1 MG PO BID PRN anxiety or insomnia, Lopressor (Metoprolol Tartrate) 12.5 MG PO BID, Thiamine (Thiamine HCl) 100 MG PO QD, Coumadin (Warfarin Sodium) 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), Insulin 70/30 (Human) 30 units SC BID, Imdur (Isosorbide Mononit.(SR)) 60 MG PO QD, KCL Slow Rel. 20 mEq x 1 PO BID, Allegra (Fexofenadine HCl) 60 MG PO QD, and Levofloxacin 250 MG PO QD Starting in AM (7/21). An override was added on 10/10/01 by Kent R. Kazee, MD with Potentially Serious Interactions: Aspirin & Warfarin, Simvastatin & Warfarin, and Levofloxacin & Warfarin. Food/Drug Interaction Instructions were also given. This 60-year-old male patient with ischemic CMP and AFib was started on Coumadin 5 weeks ago and was cardioverted via the AICD last Tuesday. He then developed SOB and fever, so he went to the local ED and was given Lasix and Rocephin. His WBC was elevated at 12.2 and he was sent to LMH where he had a low grade fever and required FM O2. He was treated empirically with Levofloxacin, diuresed, and assessed for underlying rhythm. His CXR showed interval improvement and his BCXs from LWMH were negative at 3 days. He was discharged on PO diuretics and a 14-day course of Levofloxacin, with ASA 81 MG PO QD, Allopurinol 300 MG PO QD, Digoxin 0.25 MG PO QD, Folic Acid 1 MG PO QD, Lopressor 12.5 MG PO BID, Thiamine 100 MG PO QD, Coumadin 5 MG PO QHS, Simvastatin and Warfarin, Levofloxacin 250 MG PO QD starting in AM (7/21), and Ativan 1 MG PO BID PRN anxiety or insomnia. He should seek immediate medical attention if he develops chest pain, SOB, lightheadedness, fever, chills, palpitations, or falls. | Has patient ever been prescribed lasix | {
"answer_end": [
1196
],
"answer_start": [
1160
],
"text": [
"ED and was given Lasix and Rocephin."
]
} |
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 current dose of vitamin c | {
"answer_end": [
1398
],
"answer_start": [
1374
],
"text": [
"Vitamin C 500 mg b.i.d.,"
]
} |
A 45-year-old male with morbid obesity presented with chest pain and hypertensive urgency. He was ruled out for MI with negative serial enzymes and EKGs and a cardiac PET showed 2 small areas of reversible ischemia in the mid PDA and distal LAD territory. For CV treatment, he was given Aspirin 81mg PO daily, beta blocker, and HCTZ 25mg PO daily and Atenolol 50mg PO daily for HTN control. For Pulmonary issues, he had very mild asthma exacerbation and a restrictive ventilatory defect from obesity and was given Advair 500/50 BID, Albuterol Nebulizer 2.5 mg neb q2h, Albuterol Inhaler 2 puff inh qid PRN Shortness of Breath and prednisone 60mg QD x 3 doses. For GI issues, he had trace guaiac+ stool and a viral gastroenteritis causing diarrhea and some nausea. For endocrine issues, his A1C was 7.4 and he was educated on low sugar, low carbohydrate diet. For prevention, he was given Lovenox BID. Additional comments included taking HCTZ 25mg daily and Atenolol 50mg daily for blood pressure, eating a low sugar, low carbohydrate diet, and follow-up with cardiology on 11/0. He was discharged in a stable condition with a recommendation for monitor blood sugars and A1C, outpatient colonoscopy, and consider statin therapy, as well as Fluticasone Propionate/Salmeterol 250/50 1 puff inh BID, Albuterol Inhaler 2 puff inh QID, Artificial Tears 2 drop OD TID, Loratadine 10 mg PO QD, Hydrochlorothiazide 25 mg PO QD, Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Albuterol Nebulizer 2.5 mg neb q4h, Acetylsalicylic Acid 81 mg PO daily, and Miconazole Nitrate 2% powder topical TP daily. | has the patient used hctz in the past | {
"answer_end": [
346
],
"answer_start": [
328
],
"text": [
"HCTZ 25mg PO daily"
]
} |
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 | MEDS RECORD | {
"answer_end": [
1743
],
"answer_start": [
1676
],
"text": [
"Medications prescribed were COLACE (Docusate Sodium) 100 mg PO BID,"
]
} |
The patient is a 62-year-old white male with a long-standing hypotension of 30 to 40 mmHg who is treated with hypoglycemics and has a significant history of diabetes of 20 years without neurological or retinopathy. He also has a positive family history of cardiac risk factors and denies cigarettes. He had a percutaneous transluminal coronary angioplasty at the Ribush Bassta Syark Hospital in 1985 and has had rule outs for myocardial infarction since, with the last one approximately in 1990 at Dormro General Hospital. At 1:00 a.m., the patient had recurrent chest pain and took four to five Nitroglycerins without relief and was front-loaded with TPA, Heparin, Aspirin, Morphine sulfate, and Nifedipine. The patient was placed on an intra-aortic balloon pump in preparation for coronary artery bypass surgery and was discharged on prophylactic anticoagulation with Coumadin, taking Diltiazem 60 t.i.d., Glyburide, and Lisinopril 20 PO q.day. The patient had a coronary artery bypass graft x three with a saphenous vein graft to the LAD, first branch of the obtuse marginal and the posterior descending artery. On postoperative day #3, the patient had atrial fibrillation which was treated and controlled pharmacologically, and he was requested to follow-up with Dr. Schoening in 6 weeks and his cardiologist in 2 weeks. | Is there history of use of lisinopril | {
"answer_end": [
946
],
"answer_start": [
908
],
"text": [
"Glyburide, and Lisinopril 20 PO q.day."
]
} |
Mr. Vendetti is a 61 year old man who was admitted to the cardiac surgical service on 0/14/97 for aortic valve replacement, mitral valve replacement. He had an echocardiogram at an outside hospital that demonstrated a dilated left ventricle and an ejection fraction of 55% with moderate aortic stenosis with moderate to severe aortic insufficiency with a peak gradient of 35 millimeters of mercury, mild to moderate mitral stenosis and moderate mitral insufficiency with a mitral valve area of 1.1 cm squared. His cardiac catheterization on 4/21/97 demonstrated a 95% proximal right coronary artery lesion and an ejection fraction of 50%. His past medical history included rheumatic heart disease and hypertension, and he is a former smoker with a twenty pack year history. On admission, he was taking Toprol XL 50 once a day, aspirin once a day, sublingual nitroglycerin and Zocor 50 once a day. He went to the operating room on 5/16/97 where he had a mitral valve replacement with a #31 St. Jude mechanical prosthesis and an aortic valve replacement with a #25 St. Jude mechanical prosthesis and a right internal mammary artery bypass grafting to the right coronary artery. He had no complications and is being discharged on post-op day four without complications, on Lopressor 50 mg twice a day, Lasix 40 mg once a day for two days with potassium, K-Dur tabs 10 mEq once a day for two days with Lasix, Coumadin 5 mg one tab once a day or as directed, restarted for right leg DVT that was discovered post cardiac catheterization and is to be continued for a total of three months. Percocet is one tab q.4h. prn for pain and he is being discharged to the care of Dr. Sterling Goodson. | Was the patient on any medication for her pain | {
"answer_end": [
1621
],
"answer_start": [
1583
],
"text": [
"Percocet is one tab q.4h. prn for pain"
]
} |
The patient is a 68 year old female with a history of long standing hypertension and diabetes who experienced an increase in shortness of breath, dyspnea on exertion and paroxysmal nocturnal dyspnea while in Tempefayscot, Michigan 76498. She was admitted to the Short Stay Unit for evaluation with a systolic blood pressure greater than 200, and was administered Procardia XL 20 mg p.o. x 1, Aspirin, Nitropaste, and IV Lasix, to which she had a significant response. Her past medical history includes a stress echocardiogram which showed mitral regurgitation, hypokinesis of the septum and AV block on exertion with an ejection fraction of about 40%. On admission, she was taking Cardura, Vasotec, and Metoprolol. Her electrocardiogram showed bradycardia at 40 with a left bundle branch pattern and she had 2:1 AV block. Her chest x-ray showed an enlarged heart with pleural effusions and cephalization, and her laboratory data SMA-7 was within normal limits. She underwent pacemaker placement without any difficulty and it was interrogated the day after placement without any problem. She was discharged in stable condition with no reportable disease and no adverse drug reactions on Keflex 250 mg p.o. q.i.d. for 5 days; Norvasc 5 mg p.o. qd; Hydrochlorothiazide 25 mg p.o. qd and Vasotec 20 mg p.o. b.i.d. She will follow-up with her Cardiologist in one week and will probably have her blood pressure medications further adjusted at that point. | What is the patient's current dose does the patient take of her procardia xl | {
"answer_end": [
386
],
"answer_start": [
238
],
"text": [
"She was admitted to the Short Stay Unit for evaluation with a systolic blood pressure greater than 200, and was administered Procardia XL 20 mg p.o."
]
} |
Stettler, Hal 223-66-98-9, an 81 y.o. woman, was admitted to the hospital on 1/15/2004 with pneumonia and discharged on 6/18/2004. Mrs. Marnett presented with chest pain, difficulty speaking, nausea, and lightheadedness and had URI symptoms two weeks prior. On arrival to the floor, a raised, painful area was noted on her L forearm. PMedHx includes H/o agina, Echo (1/29) with EF 55%, abnormal septal motion, mild AR, no MR, mod TR, Holter 0/2 with multiform VE (bigem, cooup), SVE's 1st degree A-V block, D.M. AGA1c 6.1 (6/17), subacute thalamic stroke noted on CT 1/29, Afib - on COUMADIN, Mitral stenosis - MVR St Jude (4/27), CHF, Restrictive lung disease- 5/23 PFTs FVC 1.33, FEV1 0.98, Sigmoid colostomy, Ventral hernia repair, Bladder calcifications on CT urogram (1/29), HTN, RA, and Recent eye hemorrhage. VS: T 98.9 P 103, BP 160/74, RR 20, OxySat 97% 2L NC, FSG 172. On order for COUMADIN PO (ref # 17623917), the patient was prescribed AMIODARONE 200 MG PO QD, GLIPIZIDE 2.5 MG PO QD, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, SARNA TOPICAL TP QD Instructions: to lower extremities, COUMADIN (WARFARIN SODIUM) 2.5 MG PO QOD, HYDROCORTISONE 1% -TOPICAL CREAM TP BID Instructions: to R elbow eczema, LEVOFLOXACIN 250 MG PO QD Starting IN AM (3/0), NIZORAL 2% SHAMPOO (KETOCONAZOLE 2% SHAMPOO) TOPICAL TP tiweek, GUAIFENESIN 10 MILLILITERS PO Q6H Starting Today (2/12) PRN Other:cough, SYNALAR 0.025% CREAM (FLUOCINOLONE 0.025% CREAM) TOPICAL TP BID Instructions: `, PLAQUENIL (HYDROXYCHLOROQUINE) 200 MG PO BID, NORVASC (AMLODIPINE) 10 MG PO QD, and was instructed to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose. POTENTIALLY SERIOUS INTERACTIONS between AMIODARONE HCL & WARFARIN, LEVOFLOXACIN & WARFARIN, and LEVOFLOXACIN & AMIODARONE HCL were Override Notices added on 2/19/04, and an Alert was overridden for POSSIBLE ALLERGY (OR SENSITIVITY) to SULFA. The patient was discharged on 1/29/04 at 05:00 PM contingent upon attending evaluation, and the code status was Full Code with the disposition home with services. The patient was to finish 6 more days of Levo (total 10) and was monitored as an outpatient while on levofloxacin. Her INR was 3 after 2 days of levofloxacin and will be checked again by VNA 3 days, and if fever, SOB, increasing left arm pain, or other symptoms, the patient was to call the doctor, weigh herself daily, and not restart HTN meds until Dr. Schoville tells her to. | Has the patient ever had coumadin | {
"answer_end": [
921
],
"answer_start": [
879
],
"text": [
"On order for COUMADIN PO (ref # 17623917),"
]
} |
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. | What is the current dose of the patient's ultram ( tramadol ) | {
"answer_end": [
1244
],
"answer_start": [
1205
],
"text": [
"ULTRAM (TRAMADOL) 50 MG PO Q6H PRN Pain"
]
} |
Ms. Watterson, a 75 year old female with a history of CHF/CAD, A-fib, lung CA s/p R wedge resection, basal cell CA on lip s/p resection, and uterine CA s/p TAH, was admitted to the hospital with increasing SOB, weight gain, orthopnea, fever, chills, decreased UOP x1-2 days, L leg swelling, and a T98.6, P72, BP121/65, RR18. In the ED she was given O2 and 40mg of Lasix IV, and her daily meds included Acetylsalicylic Acid 325mg PO daily, Allopurinol 100mg PO daily, Docusate Sodium 100mg PO BID, Esomeprazole 20mg PO daily, Ferrous Sulfate 325mg PO TID, Glipizide 5mg PO BID, KCL Slow Release 20MEQ PO BID, Levothyroxine Sodium 100mcg PO daily, Lorazepam 0.5mg PO daily PRN Insomnia/Anxiety, Metolazone 2.5mg PO daily, Metoprolol Succinate Extended Release 100mg PO daily, Multivitamins 1tab PO daily, Pravastatin 40mg PO bedtime, Torsemide 20mg PO BID, and Warfarin Sodium 2mg PO QPM. CXR, diuresis with IV medications, EKG, R/O MI, and Abdo CT were performed and the patient improved clinically. Antibiotics such as Azithromycin and Levofloxacin were initiated for PNA, and Cefpodoxime 200mg PO QD x 7 days was added for gram pos coverage. In addition, she was given Tessalon Perels 100mg PO TID PRN cough, Guiatuss 10ml PO Q4H PRN cough, Loperamide 2mg PO Q6H PRN diarrhea, and Metolazone 2.5mg PO daily PRN weight gain. The patient was supertheraputic on Coumadin and it was held throughout her admission, INR remained 3.9 to 4.0 in the setting of hemoptysis, started on 1/2 her home coumadin with VNA/PCP f/u in 2 days, d/ced on Coumadin 1mg qpm, UA and urine CTX were negative, developed diarrhea concerning for c.diff but had only been on azithromycin x1 day, all stool studies were negative, presumed viral gastroenteritis, started on loperamide before discharge to be continued prn diarrhea, pt's po DM rx were held during her admission covered with Lantus and Insulin Asp SS, HgA1c was sent and was in nl range, home po rx were restarted on discharge, kept on her home dose of levoxyl, TSH was rechecked and within nl range, home po rx Allopurinol was also continued, the following antibiotics were added: Levofloxacin 500mg by mouth every 48 hours for 7 days, Cefpodoxime 200mg by mouth once daily for 7 days, Tessalon Perels 100mg by mouth three times daily as needed for cough, Guiatuss 10ml by mouth every 4 hours as needed for cough, Loperamide 2mg by mouth every 6 hours as needed for diarrhea, Coumadin: Were taking 2mg by mouth in the pm, now take 1mg by mouth in the pm, and instructions, pt took Metolazone 2.5mg and Torsamide 40mg x1 which did. During her stay the patient remained in afib with good rate control on her bblocker, rx of betablocker, ASA, statin, was diuresed with IV Lasix in the ED, Metolazone 2.5mg and Torsamide 40mg x1, on 2/22 pt's weight increased to 72.9 kg from 70.6kg, restarted on her home rx of torsemide 20mg po bid, was roughly negative 1.3L, pt's daily weights decreased off diuretics, was found to be supertheraputic on her coumadin which was held throughout admission, PNA was initially treated with azithromycin but as her cough and o2 levels persisted, pt was begun on ceftaz and levo for gram pos coverage (levo) double gram neg coverage, and ceftaz changed to cefpodoxime 200mg po qd x 7 days, however pt had only been on azithromycin x 1 day, all stool studies were negative, presumed viral gastroenteritis | Has the pt. ever been on asa before | {
"answer_end": [
2683
],
"answer_start": [
2652
],
"text": [
"rx of betablocker, ASA, statin,"
]
} |
The 68-year-old retired social worker was admitted with atrial flutter and NSTEMI and underwent catheterization which revealed 95% OM1, 70% OM2, and LCX lesions stented with 2.5x13-mm, 2.5x13-mm, and 3.5x13-mm DES respectively, to 0% with TIMI 3 flow. Exam showed faint bibasilar crackles, S1S2 intermittent gallop, no LE edema. Initially rate-controlled on beta-blocker and diltiazem for goal rate in 60s; she was discharged on ATENOLOL 100 MG PO QD, LASIX (FUROSEMIDE) 40 MG PO QD, LISINOPRIL 5 MG PO QD with POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL, NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: ATORVASTATIN CALCIUM & WARFARIN, LOVENOX (ENOXAPARIN) 90 MG SC BID with SERIOUS INTERACTION: HEPARIN & ENOXAPARIN SODIUM, FLOVENT (FLUTICASONE PROPIONATE) 110 MCG INH BID, LIPITOR (ATORVASTATIN) 80 MG PO QD with POTENTIALLY SERIOUS INTERACTION: ATORVASTATIN CALCIUM & WARFARIN, PLAVIX (CLOPIDOGREL) 75 MG PO QD, MAGNESIUM OXIDE (241 MG ELEMENTAL MG) 800 MG PO BID, DIET: Patient should measure weight daily, DIET: Fluid restriction, DIET: House / Low chol/low sat. fat, DIET: 4 gram Sodium, and RETURN TO WORK: Not Applicable. Additionally, CONTINGENT UPON 7pm dose of Lovenox, on order for Coumadin PO (ref# 758570817) and on order for Coumadin PO 5 mg QPM (ref# 370510168) were included with instructions to take all medicines as directed and not to miss a single dose of Plavix, due to potentially serious interactions with Aspirin & Warfarin, Potassium Chloride & Nitroglycerin, and Atorvastatin Calcium & Enoxaparin Sodium; as well as a serious interaction with Heparin & Enoxaparin Sodium. | has there been a prior atenolol | {
"answer_end": [
451
],
"answer_start": [
429
],
"text": [
"ATENOLOL 100 MG PO QD,"
]
} |
A 83 year old female with hereditary angioedema was admitted to the hospital with abdominal pain which was not relieved by Stanazolol, and she had diarrhea, nausea/vomiting, sweats, and decreased PO intake. She was given 6 units FFP with premedication of IV Benadryl on the first night of her hospitalization, Stanazolol 4 mg q4h overnight, which was changed to bid on second hospital day, Zantac, and Lovenox. The patient was maintained on Acetylsalicylic Acid 81 mg PO qd, Vit C 500 mg PO bid, Atenolol 75 mg PO qd, hold if sbp <100 or hr <60, Digoxin 0.125 mg PO qod (Sun, Tues, Thurs), Potentially serious interaction: Digoxin & Levothyroxine Sodium, Vit E 400 units PO qd, Pepcid 20 mg PO qd, Colace 100 mg PO bid PRN constipation, Senna Tablets 2 tab PO bid PRN constipation, Lasix 20 mg PO qd, Keflex 500 mg PO qid x 28 doses, and on order for Synthroid PO (ref. #66804792), Lasix PO (ref. #91042032), and Keflex PO (ref. #63524947). She was also continued on her home dose of Synthroid, Rhinocort (Budesonide Nasal Inhaler) 2 spray na bid, and Allegra (Fexofenadine HCl) 60 mg PO bid. She was discharged with instructions to follow up with allergy and to call her doctor if she develops fevers, worsening of her abdominal pain, or other concerning symptoms. Follow up appointments were made with Dr. Morrell and Dr. Guadagnolo or Dr. Yoes for 1-2 weeks. | What was the dosage prescribed of synthroid (levothyroxine sodium) | {
"answer_end": [
654
],
"answer_start": [
590
],
"text": [
"Potentially serious interaction: Digoxin & Levothyroxine Sodium,"
]
} |
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. | Is the patient currently or have they ever taken dopamine | {
"answer_end": [
398
],
"answer_start": [
345
],
"text": [
"we started a low-dose dopamine drip at 2 mcg per hour"
]
} |
Mr. Quigg is a 42-year-old man with history of diabetes, end-stage renal disease on hemodialysis, left Charcot foot complicated by recurrent cellulitis who presented with left lower leg swelling, erythema, and pain. On admission, his temperature was 100.8, heart rate was 111, and blood pressure was 140/70. His left lower extremity had 1+ pitting edema with erythema on the anterior shin and foot. He was uptitrated to 5mg and also lopressor, started on Lyrica and oxycodone for breakthrough pain, and received Fentanyl PCA. His home medications included Colace 100 mg b.i.d., folate 1 mg p.o. daily, gemfibrozil 600 mg b.i.d., Lantus 30 mg subcu q.p.m., Lipitor 80 mg nightly, Nephrocaps, Neurontin 300 mg daily, PhosLo 2001 mg t.i.d., Protonix 40 mg daily, Renagel 3200 mg t.i.d., Requip 2 mg p.o. b.i.d., and Coumadin. His Lipitor was decreased to 20mg due to rhabdomylosis risk, and he was also started on low dose b-blocker to reduce perioperative MI risk prior to his surgery. His Vancomycin was continued given his history of MRSA cellulitis, with a goal of a level less than 20, and he was bridged with heparin with a goal PTT of 60-80. He was restarted on his Lantus and Aspart doses with meals, and his Coumadin was held prior to surgery and decreased to 20mg with a repeat lipid panel in 4-6 weeks. He required antibiotics which were discontinued at this time and he was discharged with dry sterile dressing changes to his residual limb daily, PTT goal 60-80, INR goal 2-3 until stable off of levofloxacin, monitoring of FS and adjustment of DM regimen, monitoring pain scale and decreasing pain medications as pain improves, hemodialysis M/W/F, and follow up with Dr. Carpino voice message left on his medical assistant's voice mail and Dr. Lynes 6/10/06 at 9:30am. Psychiatry service was consulted who recommended low dose Ativan prior to him going for dialysis. He was initially placed on a ketamine drip and given IV Levofloxacin and IV Flagyl to cover gram negatives and anaerobes respectively, and started on oxycontin 80mg tid with oxycodone for breakthrough pain and Lyrica for neuropathic pain. He was comfortable prior to discharge on this current regimen. | Has this patient ever been on pain medications | {
"answer_end": [
1637
],
"answer_start": [
1592
],
"text": [
"decreasing pain medications as pain improves,"
]
} |
This 70-year-old woman with no known CAD, cardiac RF: HTN, DM, hyperchol., current tob., H/O PAF on no anticoag 2/2 distant h/o LGIB, a/w palpitations followed by 10 hrs of chest pain was admitted on 1/10/2001 and treated medically with lovenox/integrilin (refused cath) for NSTE MI. In the ED, pain was relieved with NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 and SLNG, and 2" NTP. EKG with TWflattening v5-6 but no ST elevations, and CK160, TnI 0.3. During her stay, she was on heparin, integrelin for NSTE MI, ASA, BB, ACEI, statin, nexium, colace, and levofloxacin for UTI, and lovenox for DVT proph. Her blood pressure was titrated to 130-160 and HCTZ was added for better control because her HR was in the 50's, and a repeat echo was done to check for any changes in function. Upon discharge, she will be on ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, MICRONASE (GLYBURIDE) 5 MG PO QD, HCTZ (HYDROCHLOROTHIAZIDE) 25 MG PO QD, NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3, ZOCOR (SIMVASTATIN) 20 MG PO QHS, LEVOFLOXACIN 250 MG PO QD X 4 Days, ZESTRIL (LISINOPRIL) 20 MG PO QD, ATENOLOL 50 MG PO QD Food/Drug Interaction Instruction, PRILOSEC (OMEPRAZOLE) 20 MG PO QD, and POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL, POTENTIALLY SERIOUS INTERACTION: HYDROCHLOROTHIAZIDE & OMEPRAZOLE, and SLNG PRN. She was also instructed to take atenolol consistently with meals or on empty stomach and to avoid grapefruit unless MD instructs otherwise. Follow up appointments were scheduled with Dr. Truman Thro 1-2 wks, Dr. Stevie Gilani, cardiology, Mon, 1/2/02 1:00 pm, and Bock 0/12/02. | Why was heparin prescribed | {
"answer_end": [
492
],
"answer_start": [
485
],
"text": [
"heparin"
]
} |
The patient is a 65-year-old female who presented with the sudden onset of right upper quadrant and epigastric abdominal pain. She had been given some Demerol with some relief but she had persistent pain. An ultrasound two years prior to admission showed sludge in her gallbladder with no other abnormalities noted and an ultrasound on the night of admission showed multiple small stones and a gallbladder with sludge and thickening of the gallbladder wall. She was admitted to the Teeleah Valley Medical Center, given Vistaril, Premarin, Clinoril, and triple intravenous antibiotics, kept NPO, and placed on intravenous hydration. On 10 of May, she underwent an esophagogastroduodenoscopy, a cholecystectomy with an intraoperative cholangiogram, and common bile duct exploration with T-Tube placement. Intraoperatively, she was found to have a large inflamed gallbladder with multiple small cholesterol stones in her gallbladder and two stones in her common duct. Post-operatively, she remained stable and was transferred to the Recovery Room and eventually back to the floor. On 0/30/9l, she was started on sips of clear fluids and was up out of bed voiding on her own. By 10/19/9l, she was tolerating a regular diet. On 1/12/9l, she had a normal T-Tube cholangiogram and was clamped and was discharged to home on 1/9/9l to be followed up by Dr. Tendick in Clinic. | Has the patient ever been on demerol | {
"answer_end": [
204
],
"answer_start": [
127
],
"text": [
"She had been given some Demerol with some relief but she had persistent pain."
]
} |
The patient was admitted on 4/12/04 with a right plantar surface neurotrophic ulcer, low-grade fevers and chills, and a history of diabetes mellitus, hypertension, distant past of pancreatitis, gout, neuropathy, high cholesterol, and chronic renal insufficiency. Significant labs at the time of admission included a potassium of 4.3, BUN of 38, creatinine of 3.2, and blood glucose of 187. The patient was started on 1. Lantus 100 mg q.p.m., 2. Humalog 20 units q.p.m., 4. Neurontin 300 mg t.i.d., 5. Lisinopril 40 mg q.d., 6. Allopurinol 300 mg q.d., 7. Hydrochlorothiazide 25 mg q.d., 8. Zocor 20 mg q.d., 9. TriCor 50 mg b.i.d., 10. Atenolol 25 mg q.d., 11. Eyedrops prednisolone and atropine, and 12. iron supplementation. The patient underwent an amputation of the third and fourth toe as well as metatarsal heads, and was started on Dr. Tosco's suggested antibiotics, vancomycin, levofloxacin, and Flagyl. To manage temperature greater than 101, the patient was prescribed Tylenol 650 to 1000 mg p.o. q.4h. p.r.n., allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Colace 100 mg p.o. b.i.d., Epogen 10,000 units q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient was seen by Dr. Ulvan in the renal staff and by the diabetes management service by Dr. Clint Holets. Postoperative lab checkup revealed that the patient's creatinine bumped to 4.9 with a BUN of 61, and the renal service was consulted. The patient was given Lopressor 100 mg b.i.d. to control the blood pressure, and was eventually started on PhosLo and Ferrlecit as well as Epogen 10,000 units q. week. Levofloxacin was continued for a one week course, and the patient was discharged to the rehab facility with Tylenol 650 to 1000 mg p.o. q.4h. p.r.n. for temperature greater than 101, allopurinol 100 mg p.o. q.d., enteric-coated aspirin 81 mg p.o. q.d., Lopressor 100 mg p.o. b.i.d., PhosLo 1334 mg p.o. q.a.c., Colace 100 mg p.o. b.i.d., Epogen 10,000 units delivered subcuticularly q. week, iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain, prednisolone 1% one drop in the effected eye b.i.d., Zocor 20 mg p.o. q.h.s., Neurontin 300 mg p.o. b.i.d., atropine 1 mg one drop in the affected eye, levofloxacin 250 mg p.o. every morning, Lispro 6 units subcuticularly q.a.c., Lantus 25 units subcutaneous q.d., and DuoNeb 3/0.5 mg nebulizer q.6h. p.r.n. wheezing. The patient is to be followed up at the rehab facility at Ing Mansy General Hospital and should follow up with the renal service and Dr. Knaub in two to three weeks and one to two weeks, respectively. The | What is the current dose of the patient's neurontin | {
"answer_end": [
497
],
"answer_start": [
473
],
"text": [
"Neurontin 300 mg t.i.d.,"
]
} |
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. | How often does the patient take ativan | {
"answer_end": [
832
],
"answer_start": [
825
],
"text": [
"Ativan,"
]
} |
This 75 year old woman with a history of hypertension, hyperlipidemia, past tobacco use, and angina presented with syncope and was found to be status post non ST elevation myocardial infarction. She was treated with Aspirin, Heparin, Lopressor, Captopril, and Cozaar initially with heart rate and blood pressure secondary to COPD, and was started on Atrovent nebs and given fluids until she had good urine output. Cardiovascular examination revealed ischemia, ST elevation, and myocardial infarction, while Pulmonary examination revealed wheezing and renal examination showed likely dehydration. The patient is currently on Aspirin, Lisinopril, and Atenolol, and was given IV fluids for dehydration. Her neurological examination showed intact PERRL and cranial nerves II-XII, regular rate and rhythm, normal S1, S2, and no murmurs, rubs, or gallops. Respiratory examination revealed wheezing with increased respiratory phase. Abdomen was obese, non-tender, and non-distended with left groin erythematous and scaling. Extremities had no edema and 1+ dorsalis pedis pulses. Neuro examination showed alertness and 4/5 bilateral lower extremity strength with 1+ deep tendon reflexes and normal sensation. Following discharge she requires physical therapy and follow up with Gynecology for incontinence and a possible uterine prolapse. | What does the patient take atrovent for | {
"answer_end": [
595
],
"answer_start": [
507
],
"text": [
"Pulmonary examination revealed wheezing and renal examination showed likely dehydration."
]
} |
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 patient had lasix | {
"answer_end": [
2417
],
"answer_start": [
2337
],
"text": [
"on torsemide 100mg bid at baseline, with po lasix increased to 200bid x 2 doses,"
]
} |
Mr. Gerache is a 59 yo man with poorly controlled diabetes and asthma who presented with chest pain. He had intermittent chest pain with activity lasting 5 minutes, relieved with rest, as well as shortness of breath when climbing stairs. Cardiac catheterization showed LAD prox 40%, no LCX lesions, no RCA lesions, and R PDA mid 30% lesion. Beta blocker was started, cholesterol was checked (elevated triglycerides 308, total cholesterol 146, HDL 29), statin was started and aspirin was held because of the patient's stated allergy to aspirin (causing asthma type symptoms). He was started on low-dose lisinopril and no prior echo was considered as outpatient. Patient was continued on home regimen of NPH insulin but clearly needs better control of his sugars as outpatient. Hemoglobin A1c is 10.7 and he will need better control of his sugars as outpatient. He has had asthma as a child and no record of PFTs but should obtain as outpatient, with home inhalers continued. Mr. Gaulding currently has good renal function but needs to have his Cr checked after starting the lisinopril. The patient was advised to consider carefully his lifestyle, including diet and exercise plans, and to take medications including VENTOLIN NEBULIZER (ALBUTEROL NEBULIZER) 2.5 MG NEB Q4H PRN Shortness of Breath, ATENOLOL 12.5 MG PO QD Starting IN AM (8/7), NPH HUMULIN INSULIN (INSULIN NPH HUMAN) 60 UNITS QAM; 70 UNITS QPM SC 60 UNITS QAM 70 UNITS QPM, LISINOPRIL 5 MG PO QD, ZOCOR (SIMVASTATIN) 20 MG PO QHS, FLOVENT (FLUTICASONE PROPIONATE) 44 MCG INH BID, COMBIVENT (IPRATROPIUM AND ALBUTEROL SULFATE) 2 PUFF INH QID, and make an appointment with his primary care doctor, take his medications as instructed, and follow up with his cardiologist within 4-6 weeks. He was also placed on a House / Low chol/low sat. fat diet, ADA 2100 cals/dy diet, 2 gram Sodium diet. He was discharged with Full code status and disposition to Home. | Has the patient had previous ventolin nebulizer ( albuterol nebulizer ) | {
"answer_end": [
1270
],
"answer_start": [
1215
],
"text": [
"VENTOLIN NEBULIZER (ALBUTEROL NEBULIZER) 2.5 MG NEB Q4H"
]
} |
Dion Scarberry (926-57-39-3) was admitted on 9/0/2005 with a diagnosis of COPD flare and right heart failure and was discharged on 5/28/05 at 02:00 PM with a disposition of Home w/ services. He had a number of medications including Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17), Elavil (Amitriptyline HCL) 10mg PO QHS, Atenolol 25mg PO QD Starting in AM (7/17), Colace (Docusate Sodium) 100mg PO BID, Furosemide 20mg PO QD Starting Today (6/25), Guaifenesin 10ml PO TID Starting Today (6/25) PRN Other:cough, Oxycodone 5mg PO TID Starting Today (6/25) PRN Pain, Quinine Sulfate 325mg PO HS Starting Today (6/25), Senna Tablets (Sennosides) 2 Tab PO BID, MVI Therapeutic (Therapeutic Multivitamins) 1 Tab PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: will monitor, Zocor (Simvastatin) 20mg PO QHS, Morphine Controlled Release 15mg PO Q12H, Felodipine 5mg PO QD Food/Drug Interaction Instruction, Flonase (Fluticasone Nasal Spray) 1 Spray INH QD, Advair Diskus 500/50 (Fluticasone Propionate/...) 1 Puff INH BID, Caltrate+D (Calcium Carbonate 1,500mg (600...) 1 Tab PO BID, Novolog Mix 70/30 (Insulin Aspart 70/30) 35 Units QAM; 22 Units QPM SC 35 Units QAM 22 Units QPM, Prednisone Taper PO Give 60mg q 24 h X 5 dose(s), then Give 50mg q 24 h X 3 dose(s), then Give 40mg q 24 h X 3 dose(s), then Give 30mg q 24 h X 3 dose(s), then Give 20mg q 24 h X 3 dose(s), then Give 10mg q 24 h X 3 dose(s), then Give 5mg q 24 h X 3 dose(s), then Starting Today (6/25), Combivent (Ipratropium and Albuterol Sulfate) 2 Puff INH QID. He was also given a diet of 4 gram Sodium, activity to resume regular exercise, and follow up appointment(s) with primary care doctor at the BCCMC early next week. He had allergies to Erythromycins and was given Azithromycin and supplemental O2 and Levofloxacin and admitted with a diagnosis of COPD flare. Home meds include Atenolol 25mg PO qd, HCTZ 25mg PO qd, Felodipine 5mg PO qd, Zocor 20mg PO qhs, ASA 81mg PO qd, Advair 1 puff bid, Combivent 2 puffs qid, Loratidine 10mg PO qd, Guqifenesin 600mg PO q12h, Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid, Senna 2 tab PO qd, Calcium+Vim D 125 units PO qd, Elavil 10mg PO qhs. He was treated for COPD flare with supplemental O2, DuoNebs, and steroids and received a V/Q scan which reported a low probability of PE, as well as a cardiac MRI which demonstrated normal cardiac anatomy and function, with an LVEF of 73% and no valvular dysfunction. His diabetes was managed with his home regimen of Novolog and chronic pain and insomnia were managed with his out-pt regimen of morphine and oxycodone, and he was given Elavil for sleep. Because of his history of cancer, he was placed on Lovenox for anticoagulation. Additional Comments include the instruction to use his home oxygen when sleeping at night, the addition of Combivent inhalers and a steroid taper to his medicines, and to stop the hydrochlorathiazide (HCTZ) 25mg and take Lasix 20mg once a day. His discharge condition was stable, and he was instructed to continue Lasix 40mg PO QD at home and D/C home HCTZ, to do a slow prednisone | has there been a prior acetylsalicylic acid | {
"answer_end": [
286
],
"answer_start": [
232
],
"text": [
"Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17),"
]
} |
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 patient ever been prescribed lasix | {
"answer_end": [
1454
],
"answer_start": [
1399
],
"text": [
"diurese aggressively with lasix 100 bid, replete lytes,"
]
} |
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. | Has this patient ever been treated with morphine | {
"answer_end": [
1342
],
"answer_start": [
1319
],
"text": [
"MORPHINE & TRAMADOL HCL"
]
} |
The patient was admitted on 5/5/2006 with a history of mechanical fall, with the attending physician being Dr. Clemente Armand Bolstad, with a full code status and disposition of Rehabilitation. Medications on Admission included Amiodarone 100 QD, Colace 100 bid, lasix 40mg QD, Glyburide 5mg bid, Plaquenil 200mg bid, Isordil 20mg tid, Lisinopril 20mg QD, Coumadin 5mg 3dys/week, 2.5mg 4dys/week, Norvasc 10mg QD, Neurontin 300mg TID, with APAP prn. An override was added on 10/2/06 by Gerad E. Dancy, PA for POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & WARFARIN with the reason for override being monitoring. The patient was rehydrated with IVF and PO's were encouraged, holding Glypizide while in house, Novolog sliding scale was started on 1/2, Low dose NPH 6 units BID was started on 1/2, bridged with lovenox and INR therapeutic 1/2 and restarted on home regimen of 5/2.5mg variable dose. Pain was controlled with TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Pain, Headache. A CT pelvis showed a right adnexal cyst which will need further characterization by US and outpatient follow up. The patient has an extensive cardiac history and the fall is not likely related to a cardiac issue as it appears mechanical, with no syncope, chest pain, etc. She was diagnosed with an NSTEMI with a small TnI leak, likely demand related in the setting of hypovolemia and the fall. Enzymes trended down. She was dry on admission and rehydrated with IVF, PO's encouraged, and became euvolemic by 1/2. Her JVP was up to 12cm, although it was difficult to gauge her volume status due to TR. She had a prolonged QT on admission, on telemetry, of unclear etiology, possibly starvation. This was monitored on telemetry until ROMI and drugs that confound were avoided. The QTc resolved to low 500s and a DDD pacer was functioning with V-pacing at 60bpm. Additional medications included NATURAL TEARS (ARTIFICIAL TEARS) 2 DROP OU BID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, PLAQUENIL SULFATE (HYDROXYCHLOROQUINE) 200 MG PO BID, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, LISINOPRIL 20 MG PO DAILY HOLD IF: SBP <110, MILK OF MAGNESIA (MAGNESIUM HYDROXIDE) 30 MILLILITERS PO DAILY PRN Constipation, COUMADIN (WARFARIN SODIUM) 2.5 MG PO QPM, NORVASC (AMLODIPINE) 10 MG PO DAILY HOLD IF: SBP <110, NEURONTIN (GABAPENTIN) 300 MG PO TID, NEXIUM (ESOMEPRAZOLE) 20 MG PO DAILY, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, DULCOLAX RECTAL (BISACODYL RECTAL) 10 MG PR DAILY PRN Constipation, CLOTRIMAZOLE 1% TOPICAL TOPICAL TP BID, GLYBURIDE 5 MG PO BID, LASIX (FUROSEMIDE) 20 MG PO DAILY, and corrected pt restarted on lasix 20 qd on d/c. A PT consult was obtained 3/21 and to follow daily at rehab. Labs showed Na 146, CK 3320, CKMB 12.9, Trop 0.23--->0.10, AST 107, Cr 1.2-->1.6. Pain was controlled with TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Pain, Headache, rehydrated with IVF, po's encouraged, holding Glypizide while in house, Novolog sliding scale was started on 1/2, Low dose NPH 6 units BID was started on 1/2, bridged with lovenox and INR therapeutic 1/2 and restarted on home regimen of 5/2.5mg variable | Has a patient had norvasc ( amlodipine ) | {
"answer_end": [
2283
],
"answer_start": [
2229
],
"text": [
"NORVASC (AMLODIPINE) 10 MG PO DAILY HOLD IF: SBP <110,"
]
} |
The 62M with a history of CAD and prior MI leading to CABG in 5/23 was admitted to RCH 6/17 with chest pain and ruled out for MI. A Cath showed non-occlusive disease (70%) and an OM which was stented. The patient experienced frequent chest pain with minimal exertion and experienced an episode of chest pain, SOB, 5/10, no radiation/LH/palpitations, c/o nausea and vomiting, and called EMS to BWSH EW. The patient was given 2 NTG with resolution of symptoms, concerning for increasing frequency of chest pain. The patient was discharged on 8/4/03 with a full code and disposition of home with discharge medications of ACETYLSALICYLIC ACID 325 MG PO BID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, ENALAPRIL MALEATE 5 MG PO QD, ZOCOR (SIMVASTATIN) 20 MG PO QHS, INSULIN 70/30 (HUMAN) 80 UNITS QAM; 60 UNITS QPM SC, PLAVIX (CLOPIDOGREL) 75 MG PO QD, PSYLLIUM 2 TSP PO QD, TOPROL XL (METOPROLOL (SUST. REL.)) 25 MG PO QD, LASIX (FUROSEMIDE) 20 MG PO QD, FAMOTIDINE 20 MG PO BID, and instructions to increased dose for costochondritis as pt. does not wish to take 650 QID dosing. The patient was given instructions to measure weight daily, fluid restriction of 2 liters, house/low chol/low sat. fat, and 2 gram sodium, with advice to resume regular exercise and follow up appointments with Curts 1-2 weeks. The patient also had allergy to codeine, admitting diagnosis of chest pain and CAD, and principal discharge diagnosis of atypical noncardiac chest pain. The patient was also advised to follow up with Dr. Kump and Dr. Sixkiller regarding liver function tests and Dr. Tippen regarding bleeding with bowel movements, respectively. | Is there history of use of psyllium | {
"answer_end": [
866
],
"answer_start": [
845
],
"text": [
"PSYLLIUM 2 TSP PO QD,"
]
} |
This 64-year-old male with a history of coronary artery disease, CHF, EF of 15%, status post AVR, and NSTEMI initially presented to outside hospital with chief complaint of shortness of breath and was found to have a BNP of 747 as well as a troponin I of 0.43. He was diuresed, started on Carvedilol and improved, and placed on a heparin drip. His medications on admission included Aspirin 81, Lisinopril 20, Plavix 75, Verapamil 240 sustained release, Gemfibrozil 600 b.i.d., Nystatin 500 b.i.d., Paxil 20 daily, Glipizide 10 daily, Coumadin 4 prior to admission to outside hospital, Carvedilol 6.25 daily, heparin drip and Spironolactone. During his hospital stay, he was continued on Aspirin, Plavix, beta-blocker and ACE inhibitor, which were titrated to effect, started on a statin and continued on Niaspan, and maintained on a nicotine patch. He was also prescribed Spironolactone 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, and Coumadin 5 mg p.o. at night. The patient's diabetes was controlled with regular insulin and placed back on his oral hypoglycemics, which were discontinued on admission and was encouraged to stop smoking. He had runs of ectopy and SVT, so was placed on a heparin drip. Left heart cath revealed wall defect consistent with a right coronary artery infarct and the patient was continued on Spironolactone. He was discharged in a stable condition on Aspirin 325 p.o. daily, Lisinopril 4 mg p.o. daily, Nicotine patch 14 mg per day topical, Spironolactone 25 mg p.o. daily, Paxil 25 mg p.o. daily, Atorvastatin 80 mg daily, Niaspan 0.5 gm p.o. twice daily, Carvedilol 12.5 mg p.o. twice daily, Plavix 75 mg daily, Gemfibrozil 900 mg p.o. twice daily and Coumadin 5 mg p.o. at night, with instructions to follow up with PCP and Cardiology as well as EP, to check his daily weights and report any increases to his PCP, and to arrange to have his INR drawn on 6/21/06 and follow-up INRs to be drawn every seven days. | Is there a mention of of coumadin usage/prescription in the record | {
"answer_end": [
607
],
"answer_start": [
534
],
"text": [
"Coumadin 4 prior to admission to outside hospital, Carvedilol 6.25 daily,"
]
} |
Mr. Esbenshade is a 70-year-old Caucasian male with CAD, stented five years ago, known as calcific aortic stenosis with progression of exertional dyspnea. He was admitted to CSS and stabilized for surgery on 9/13/06, which included AVR with a 25 CE magna valve, CABG x2 with LIMA to LAD and SVG1 to PDA, pulmonary vein isolation, and left atrial appendage resection, with no complications. He is currently on 5 liters of O2 and some pulmonary edema, improving with Lasix 20 mg IV t.i.d. and diuresis, on Osmolite tube feeds at 20 mL an hour, with prophylactic antibiotics for chest tubes, medications IV, Toprol 50 mg q.a.m. and 25 mg q.p.m., Coumadin, Lasix 20 mg daily, atorvastatin 20 mg daily, Neurontin 100 mg t.i.d., metformin 1000 mg b.i.d., and glipizide 2.5 mg b.i.d. Cardiac meds include Aspirin, Lopressor, and Coumadin. He has been followed by psych for postoperative confusion/possible suicidal ideation, with Celexa ordered per psych. He is also on Acetaminophen 325-650 mg q. 4h. p.r.n. pain or temperature greater than 101, DuoNeb q. 6h. p.r.n. wheezing, enteric-coated aspirin 81 mg daily, Dulcolax 10 mg PR daily p.r.n. constipation, Celexa 10 mg daily, Colace 100 mg t.i.d., Nexium 20 mg daily, K-Dur 10 mEq daily for five days, Toprol-XL 200 mg b.i.d., miconazole nitrate powder topical b.i.d., Niferex 150 mg b.i.d., simvastatin 40 mg at bedtime, multivitamin therapeutic one tab daily, INR, and Boudreaux's Butt Paste topical apply to effected areas. He has been running a bit fast in Afib and is on Coumadin and aspirin for atrial fibrillation, and is awaiting a rehabilitation bed. Cipro x3 days has been started due to a UA from 10/5/06 with probable enterogram-negative rods. His mood has improved and beta-blocker has been titrated. He has been advised to make all follow-up appointments, local wound care, wash wounds daily with soap and water, shower patient daily, keep legs elevated while sitting/in bed, watch all wounds for signs of infection, redness, swelling, fever, pain, discharge, and to call PCP/cardiologist or Anle Health Cardiac Surgery Service at 282-008-4347 with any questions. | How much glipizide does the patient take per day | {
"answer_end": [
776
],
"answer_start": [
723
],
"text": [
"metformin 1000 mg b.i.d., and glipizide 2.5 mg b.i.d."
]
} |
This 70-year-old woman with a complex medical history, including cerebrovascular accident x two in 1980s without deficits, seizure history probably secondary to ETOH withdrawal, hypertension x 30 years, asthma, gout, and status post repair of subclavian artery stenosis in 1993, presented to the Dagha Medical Center with severe chest pain. A chest CT revealed a 2.3 x 2.8 cm lobulated mass in the right lower lobe involving the pleura, with extensive hilar and mediastinal constitutions consistent with prior granulomatous disease, and tests were positive for multiple precarinal and right peritracheal areas of adenopathy recent from metastatic disease. The patient was admitted to the Thoracic Surgery Service on 3/27/99 and taken to the Operating Room for a video assisted thorascopic right lower lobe lobectomy by Dr. Minick. Postoperatively, the patient did well, with no complications, and was followed by the Internal Medicine Service. The patient went into rapid atrial fibrillation postoperatively, and was successfully converted into a normal sinus rhythm using Diltiazem IV, which was converted to p.o. Diltiazem. The patient's postoperative course was largely unremarkable but for dysrhythmia, and the patient's pain was well controlled with p.o. pain medications, Percocet. Final pathology was read as squamous cell carcinoma, 4.0 cm., moderately differentiated with focal characterization with extensive necrosis. The patient was discharged to home with medications including Adalat 200 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Magnesium Oxide 40 mg t.i.d., Ultram 300 mg q.d., Trazodone 100 mg q.h.s., Azmacort 80 mg p.r.n., aspirin 81 mg q.d., Dyazide 25 mg q.d., nose spray b.i.d., calcium chloride pills q.d., Colchicine 600 mg q.d., cyproheptadine hydrochloride 4 mg b.i.d. q.h.s., anticholesterol med., Albuterol nebulizers 250 mg q.4h., Allopurinol 300 mg q.d., Colchicine 0.6 mg q.d., cyproheptadine hydrochloride by mouth 400 mg q.d., Digoxin 0.125 mg q.d., Diltiazem 30 mg t.i.d., Colace 100 mg t.i.d., Lasix 40 mg p.o. q.d., Percocet 1-2 tablets p.o. q.4h. p.r.n., Dilantin 200 mg p.o. b.i.d., and Trazodone 100 mg p.o. q.h.s., with follow-up with Thoracic Surgery Service as well as with primary care physician and Cardiology as needed. | What is the current dose of the patient's trazodone | {
"answer_end": [
1662
],
"answer_start": [
1595
],
"text": [
"Trazodone 100 mg q.h.s., Azmacort 80 mg p.r.n., aspirin 81 mg q.d.,"
]
} |
The 90+-year-old female patient presented to the Trinmo Rybay Bethmorgreene Burgstern Medical University Of Medical Center Department on 5/1/06 with an intermittently cold and blue right foot, and gangrene was noticed in the second and third right lower extremity toes. She had significant medical issues such as dementia, coronary artery disease, diabetes, and PVOD. She underwent and tolerated a right AKA on 7/8/06 without any complications, and after recovery from anesthesia was admitted to the general care floor. Her diet was advanced as tolerated and the pain was well controlled with oral pain medications and she was evaluated by physical therapy. She was treated with perioperative ancef and switched to one week of p.o. linezolid just prior to discharge. At the time of discharge, the patient was afebrile, vital signs stable, with the right AKA stump well healed and with mild erythema inferior to the incision. Her discharge medications included Trazodone 50 mg nightly, Celexa 20 mg daily, Colace 100 mg b.i.d., Hydrochlorothiazide 25 mg daily, Novolog sliding scale, Lantus 20 units subcutaneously q.a.m., FiberCon one tablet, MVI daily, Synthroid 25 mcg daily, Linezolid 600 mg p.o. q.12h. x10 doses starting today, Zyprexa 2.5 mg p.o. q.p.m., and Tylenol Elixir 1000 mg p.o. q.6h. p.r.n. pain and Lactulose 30 mL p.o. daily p.r.n. constipation. She was discharged to her skilled nursing facility with plans to follow up with her primary care physician and Dr. Wynder in one to two weeks. The patient is DNR/DNI. | What is the current dose of the patient's tylenol elixir | {
"answer_end": [
1310
],
"answer_start": [
1265
],
"text": [
"Tylenol Elixir 1000 mg p.o. q.6h. p.r.n. pain"
]
} |
Mr. Neilsen is a 59-year-old morbidly obese man with a history of morbid obesity, paroxysmal atrial fibrillation, ejection fraction of 40 percent, obstructive sleep apnea on continuous positive airway pressure, history of cellulitis, and presenting with progressive lower extremity weakness bilaterally and urinary incontinence. On admission, EMG showed decreased recruitment in the tibialis anterior and gastrocnemius bilaterally, and he was treated with seven days of Bactrim for resolution of his incontinence and he was not anticoagulated at the moment though Coumadin should be a consideration given his risk of stroke. Two weeks prior to admission he noted some lumbar and sacral pain, nonradiating, worse while moving his right leg, and increasing urinary frequency without burning or urinary incontinence. On the night of admission, while getting up from a chair, his right leg gave out and he fell to the floor without injury or head trauma. His laboratory data on admission showed sodium 140, potassium 4.5, chloride 102, bicarbonate 26, BUN 20, creatinine 0.9, glucose 101, white blood cell count of 9 with 76 polys, 4 bands, hematocrit 37.6 and platelet count of 236, and urinalysis showed 3+ blood and positive leukocyte esterase with 15-20 white blood cells, one plus bacteria and one plus squamous cells. He was started on a trial of Lasix p.o. q day to decrease his peripheral edema to help him with rehabilitation, and he was instructed to apply Nystatin powder for his pannus rash. His medications on discharge included Aspirin 325 mg p.o. q day, Colace 100 mg p.o. b.i.d., Lasix 40 mg p.o. q a.m., Indomethacin 25 mg p.o. t.i.d. p.r.n. pain, Lisinopril 15 mg p.o. q day, multivitamin one tablet p.o. q day, Bactrim DS one tablet p.o. t.i.d., Tamsulosin 0.4 mg p.o. q day, and Miconazole 2% topical powder b.i.d., and he was discharged to rehabilitation care for leg strengthening in a stable condition. | What medications have been previously used for the treatment of pain | {
"answer_end": [
1660
],
"answer_start": [
1617
],
"text": [
"Indomethacin 25 mg p.o. t.i.d. p.r.n. pain,"
]
} |
Mr. Esbenshade is a 70-year-old Caucasian male with CAD, stented five years ago, known as calcific aortic stenosis with progression of exertional dyspnea. He was admitted to CSS and stabilized for surgery on 9/13/06, which included AVR with a 25 CE magna valve, CABG x2 with LIMA to LAD and SVG1 to PDA, pulmonary vein isolation, and left atrial appendage resection, with no complications. He is currently on 5 liters of O2 and some pulmonary edema, improving with Lasix 20 mg IV t.i.d. and diuresis, on Osmolite tube feeds at 20 mL an hour, with prophylactic antibiotics for chest tubes, medications IV, Toprol 50 mg q.a.m. and 25 mg q.p.m., Coumadin, Lasix 20 mg daily, atorvastatin 20 mg daily, Neurontin 100 mg t.i.d., metformin 1000 mg b.i.d., and glipizide 2.5 mg b.i.d. Cardiac meds include Aspirin, Lopressor, and Coumadin. He has been followed by psych for postoperative confusion/possible suicidal ideation, with Celexa ordered per psych. He is also on Acetaminophen 325-650 mg q. 4h. p.r.n. pain or temperature greater than 101, DuoNeb q. 6h. p.r.n. wheezing, enteric-coated aspirin 81 mg daily, Dulcolax 10 mg PR daily p.r.n. constipation, Celexa 10 mg daily, Colace 100 mg t.i.d., Nexium 20 mg daily, K-Dur 10 mEq daily for five days, Toprol-XL 200 mg b.i.d., miconazole nitrate powder topical b.i.d., Niferex 150 mg b.i.d., simvastatin 40 mg at bedtime, multivitamin therapeutic one tab daily, INR, and Boudreaux's Butt Paste topical apply to effected areas. He has been running a bit fast in Afib and is on Coumadin and aspirin for atrial fibrillation, and is awaiting a rehabilitation bed. Cipro x3 days has been started due to a UA from 10/5/06 with probable enterogram-negative rods. His mood has improved and beta-blocker has been titrated. He has been advised to make all follow-up appointments, local wound care, wash wounds daily with soap and water, shower patient daily, keep legs elevated while sitting/in bed, watch all wounds for signs of infection, redness, swelling, fever, pain, discharge, and to call PCP/cardiologist or Anle Health Cardiac Surgery Service at 282-008-4347 with any questions. | Has patient ever been prescribed boudreaux's butt paste | {
"answer_end": [
1472
],
"answer_start": [
1408
],
"text": [
"INR, and Boudreaux's Butt Paste topical apply to effected areas."
]
} |
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