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Ms. Lofstrom is a 57-year-old female with a past medical history of hypertension, diabetes mellitus, multinodular goiter, arthritis and questionable recurrent bouts of generalized weakness who was admitted for new onset of right sided weakness, right leg numbness and weakness, right arm clumsiness followed by dysarthria. Laboratory tests showed glucose of 353, sodium 138, potassium 4.9, chloride 98, CO2 28, BUN 33, creatinine 1.1, calcium 10.3, magnesium 2.0, troponin 0.09, white count 8.4, hematocrit 39.8, platelet count 367,000, PT 12.1, PTT 19.5, INR 1.0. An echocardiogram revealed evidence of concentric LVH with preserved systolic function, calculated ejection fraction of 55%, one plus tricuspid regurgitation and normal peak doppler flow velocity across the tricuspid valve. Carotid noninvasive studies showed no evidence of hemodynamically significant disease in either carotid artery. MRI showed a focal area of increased T2 signal in the posterior limb of the left internal capsule, close the genu and a similar smaller area of signal abnormality in the left globus pallidus adjacent to the left internal capsule abnormality. The patient had not taken her insulin for several days prior to admission, and was placed on her regular insulin schedule as well as a sliding scale with blood sugar between 150 and high 200s. Her medications included Hydrochlorothiazide 12.5 milligrams once a day, Norvasc 5 milligrams once a day, Taxol 28 milligrams once a day, Premarin 0.625 milligrams once a day, Trazodone, insulin 12 units of regular and 50 units of NPH in the morning and Ansaid 100 milligrams p.o. b.i.d. p.r.n. joint pain. She was also reportedly taking a baby aspirin 81 milligrams once a day, and was placed on subcu heparin and started on full dose aspirin 325 milligrams p.o. q.d. while her antihypertensives were held in order to maintain a systolic blood pressure between 140-160 with a diastolic blood pressure of 85-90. The patient was rehydrated with IV fluids, and close observation was paid to her electrolytes including her potassium. Rheumatology was consulted and recommended checking a urinalysis to check for red blood cells and casts, which showed no protein, no blood, 0-2 red blood cells, and no casts. He therefore suggested to continue aspirin, but in higher doses to alleviate her left shoulder pain. The patient's Norvasc continued to be held with excellent control of her blood pressure between systolic of 140-160, and should not be reinitiated until roughly ten days after her stroke. Social work was consulted due to a history of abuse by her husband, but no further abuse history was elicited since his death. The patient was considered stable and ready for discharge to a rehabilitation facility. | has the patient had premarin | {
"answer_end": [
1522
],
"answer_start": [
1474
],
"text": [
"Premarin 0.625 milligrams once a day, Trazodone,"
]
} |
This is a 66-year-old man with diabetes, hypertension, obesity and non-Hodgkin's lymphoma of the right hip on chemotherapy (R-CHOP) which began on 4/10/06 and will continue for 18 weeks, reporting no complications from ischemic chemotherapy. The patient presented to the emergency room with syncope and was hypotensive on arrival, receiving IV normal saline as volume resuscitation. The second set of cardiac enzymes was positive with a troponin of 2, and an echocardiogram the morning following admission showed a dilated right ventricle consistent with right ventricular strain. A PE protocol CT scan showed a large saddle embolus, and the patient was treated initially with IV heparin, transitioned to Coumadin and then the decision was made to try Lovenox therapy for long-term anticoagulation. Cardiac enzymes normalized and repeat echocardiogram showed mild improvement in right heart function. On admission, the patient's medications were Atenolol 50 daily, lisinopril 5 daily, Protonix 40 daily, metformin 1500 daily, Lantus 60 daily, Humalog 20 before meals, Byetta 5 mcg twice daily, levothyroxine (dose unknown), OxyContin 40 every eight hours, Percocet two tabs every 3 hours as needed for pain and gabapentin (dose unknown). | What types of medications have been tried for long-term anticoagulation. management | {
"answer_end": [
798
],
"answer_start": [
723
],
"text": [
"the decision was made to try Lovenox therapy for long-term anticoagulation."
]
} |
A 31-year-old female with a history of Type 2 DM, morbid obesity, and borderline HTN was admitted to the MTCH ED for treatment of hyperglycemia due to poor diabetes management for an entire year and symptoms of polydipsia and polyuria, tingling in her fingers and toes, and worsening vision. Upon further examination, she was also diagnosed with a UTI. The discharge medications included LISINOPRIL 5 MG PO QD, POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL, METFORMIN 1,000 MG PO BID, LEVOFLOXACIN 250 MG PO QD X 1 doses, LANTUS (INSULIN GLARGINE) 20 UNITS SC QD, and an instruction to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose. The patient was discharged with a goal blood glucose of less than 200 mg/dL, an increase of Lantus to 25 mg SC QD, an increase of Metformin to 1000 mg PO BID, and diabetes home medication regimen/glucometer/test strips. HTN: Lisinopril 5 mg PO QD was also prescribed. F/E/N: KCl PO replacement scale. MgSulfate sliding scale.GI: Colace PRN, MOM PRN, and diabetes education, checking sugars TID, self-FSBG checks, and a 30-45 min walk at least 5 times per week were also included in the treatment plan. | Has patient ever been prescribed iron products | {
"answer_end": [
657
],
"answer_start": [
616
],
"text": [
"iron products a minimum of 2 hours before"
]
} |
The 68-year-old female patient presented with lower extremity swelling and erythema at the lower pole of her sternal wound, and her past medical history includes hypertension, diabetes, hypothyroidism, hypercholesterolemia, COPD, GERD, depression, history of GI bleed on Coumadin therapy, and pulmonary hypertension. On admission, the patient was started on 1. Toprol 25 p.o. daily., 2. Valsartan 40 mg p.o. daily., 3. Aspirin 81 mg p.o. daily., 4. Plavix 75 mg p.o. daily., 6. Lasix 40 mg p.o. b.i.d., 7. Spironolactone 25 mg p.o. daily., 8. Simvastatin 20 mg p.o. daily., 9. Nortriptyline 50 mg p.o. daily., 10. Fluoxetine 20 mg p.o. daily., 11. Synthroid 88 mcg p.o. daily., and a Lasix drip and Diuril with antibiotics for coverage of possible lower extremity cellulitis. After transthoracic echocardiogram revealed an ejection fraction of 40% to 45% and a stable mitral valve, the patient was started on a Lasix drip and Diuril with improvement of symptoms, and the Pulmonary team was consulted and recommended regimen of Advair and steroid taper for her COPD, and she was empirically covered for pneumonia with levofloxacin and Flagyl and continued to diurese well on a Lasix drip. Her preadmission cardiac meds, as well as her Coumadin for atrial fibrillation, were restarted, and the patient required ongoing aggressive diuresis to eventually achieve a fluid balance of is negative 1 liter daily. Liver function tests, as well as amylase and lipase, were checked and noted to be normal, and the patient's nausea and vomiting resolved when her bowels began to move. The patient was discharged to home in good condition on hospital day #8 with medications including Enteric-coated aspirin 81 mg p.o. daily, Zetia 10 mg p.o. daily, Fluoxetine 20 mg p.o. daily, Advair Diskus one puff nebulized b.i.d., Lasix 60 mg p.o. b.i.d., NPH insulin 30 units subcutaneously q.p.m., NPH insulin 20 units subcutaneously q.a.m., Potassium slow release 30 mEq p.o. daily, Levofloxacin 500 mg p.o. q.24 h. x4 doses, Levothyroxine 88 mcg p.o. daily, Toprol-XL 100 mg p.o. daily, Nortriptyline 50 mg p.o. nightly, Prednisone taper 30 mg q.24 h. x3 doses, 20 mg q.24 h. x3 doses followed by a 10 mg q.24 h. x3 doses, then 5 mg q.24 h. x3 doses, Simvastatin 40 mg p.o. nightly, Diovan 20 mg p.o. daily, and Coumadin to be taken as directed to maintain INR 2 to 2.5 for atrial fibrillation, with followup appointments with her cardiologist, Dr. Schwarzkopf in one to two weeks with her cardiac surgeon, Dr. Carlough in four to six weeks, and VNA will monitor her vital signs, weight, and wounds, and the patient's INR and Coumadin dosing will be followed by S Community Hospital Anticoagulation Service at 300-135-5841. | has the patient used enteric-coated aspirin in the past | {
"answer_end": [
1712
],
"answer_start": [
1672
],
"text": [
"Enteric-coated aspirin 81 mg p.o. daily,"
]
} |
This is a 70-year-old woman with ischemic cardiomyopathy, coronary artery disease status post MI, insulin-dependent diabetes, peripheral vascular disease, and chronic renal insufficiency who presented in volume overload after a previous admission. She had been diuresed with a Lasix drip at 10 mg per hour and Zaroxolyn at 2.5 mg p.o. daily, and her Lopressor was held for a decompensated heart failure. She was then started on amiodarone and Coumadin for a new paroxysmal atrial fibrillation. Her Lasix drip was increased to 20 mg per hour and the Zaroxolyn was increased to b.i.d. After transition from Zaroxolyn to Diuril, which was given 250 mg IV b.i.d., she was prescribed Ativan 0.5 mg p.o. t.i.d. p.r.n. anxiety, Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Lantus 18 units subcutaneously nightly, Lopressor 25 mg p.o. b.i.d., Procrit 40,000 units subcutaneously every other week, Nitroglycerin sublingual p.r.n. chest pain, Aspirin 81 mg p.o. daily, Vitamin B12 subcutaneous injections at clinic, Iron 325 mg p.o. t.i.d., Metolazone p.r.n., Multivitamin one tablet p.o. daily, Torsemide 100 mg q.a.m. and 50 mg q.p.m., Coumadin 1 mg q.p.m., and Amiodarone 200 mg p.o. daily. Despite the dose of Coumadin being decreased from her home dose of 1 mg q.p.m. to a 0.5 mg q.p.m., her INR continued to rise greater than 200. She was started on q.a.c. NovoLog regimen with her Lantus insulin dose decreased from 18 units to 16 units and the NovoLog sliding scale was started. She was monitored on telemetry with no other events and required repletion of both potassium and magnesium despite her renal insufficiency throughout the admission in the setting of injected insulin in the setting of worsening renal failure, so, studies were also normal. She was continued on Aranesp through the admission and was discharged home on a similar regimen to her home regimen simply to Torsemide after the last discharge as her outpatient p.o. Torsemide regimen of 100 mg p.o. q.a.m. and 50 mg q.p.m., Lantus 12 units subcutaneously nightly, Ativan 0.5 mg p.o. t.i.d., Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Multivitamin one tablet p.o. daily, Coumadin 1 mg q.p.m., Metolazone 2.5 mg p.o. daily as needed for fluid retention, Iron 325 mg p.o. t.i.d., and Aspirin 81 mg p.o. daily. She was maintained on a cardiac diet and prophylaxis with Coumadin and Nexium. Potassium and magnesium were repleted as needed and she was maintained on aspirin and Lipitor throughout the admission. She will follow up with her primary care provider, SRRH Cardiology Clinic, and Renal Clinic. | Is there a mention of of folate usage/prescription in the record | {
"answer_end": [
744
],
"answer_start": [
721
],
"text": [
"Folate 1 mg p.o. daily,"
]
} |
Patient Mickey Corkill was admitted to the hospital on 5/29/2004 for dizziness and discharged on 7/17/2004. During this time, the patient was given ACETYLSALICYLIC ACID 81 MG PO QD Starting STAT ( 0/17 ), AMIODARONE 200 MG PO QD, DIGOXIN 0.125 MG PO QD, COLACE ( DOCUSATE SODIUM ) 100 MG PO BID, LASIX ( FUROSEMIDE ) 120 MG PO BID, NPH HUMULIN INSULIN ( INSULIN NPH HUMAN ) 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ) 30 MILLILITERS PO QD PRN Constipation, COUMADIN ( WARFARIN SODIUM ) 2 MG PO QPM, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & WARFARIN, NORVASC ( AMLODIPINE ) 10 MG PO QD HOLD IF: SBP < 95, IMDUR ( ISOSORBIDE MONONIT.( SR ) ) 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR ( LOSARTAN ) 100 MG PO QHS Starting STAT ( 4/13 ), PLAVIX ( CLOPIDOGREL ) 75 MG PO QD Starting STAT ( 0/17 ), NEXIUM ( ESOMEPRAZOLE ) 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, Sliding Scale ( subcutaneously ) SC AC+HS, and HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. Due to the potential for serious interactions between WARFARIN and ASPIRIN, WARFARIN and AMIODARONE HCL, DIGOXIN and AMIODARONE HCL, and SIMVASTATIN and WARFARIN, overrides were added on 8/6/04 and 9/23/04 by various physicians, with the MDs being aware that the patient was already on the regimen at home. The patient was also advised to avoid high Vitamin-K containing foods and to avoid grapefruit unless the MD instructed otherwise. The patient's BB was held while in house because of worry about bradyarrhythmia and hypotension. The patient was also continued on home insulin regimen with coverage with insulin sliding scale, and was found to have a TSH of 158 FT4 1.8, FT3 56. The patient was also started on synthroid to be f/u for hypothyroidism and given prophylaxis with Nexium. Treatment included CV, NEURO, ENDO, and Prophylaxis, with the patient to follow-up with various doctors for management of CHF/BP, potential neurovascular etiology of symptoms, and hypothyroidism. The patient was anticoagulated with ACETYLSALICYLIC ACID 81 MG PO QD, AMIODARONE 200 MG PO QD, WARFARIN 2 MG PO QPM, COLACE 100 MG PO BID, LASIX 120 MG PO BID, NPH HUMULIN INSULIN 47 UNITS SC QAM, INSULIN REGULAR HUMAN, MILK OF MAGNESIA 30 MILLILITERS PO QD PRN Constipation, COUMADIN 2 MG PO QPM, NORVASC 10 MG PO QD HOLD IF: SBP < 95, IMDUR 60 MG PO QD, KCL IMMEDIATE RELEASE 40 MEQ PO BID, COZAAR 100 MG PO QHS, PLAVIX 75 MG PO QD, NEXIUM 20 MG PO QD, LEVOTHYROXINE SODIUM 50 MCG PO QD, and SIMVASTATIN 80 MG PO QHS HOLD IF: SBP < 95 Number of Doses Required ( approximate ): 3. The patient was discussed with the cardiologist, and Coreg was held prior to admit for low BP's, with the plan to d/c pt off Coreg and defer to Dr. Doniel for reinstitution of beta blockade. Neuro exam was normal with no focal signs, and no signs of cerebellar dysfunction. The patient was also started on synthroid to be f/u with endocrine for management of hypothyroidism. | What is her current dose of imdur ( isosorbide mononit.( sr ) ) | {
"answer_end": [
695
],
"answer_start": [
647
],
"text": [
"IMDUR ( ISOSORBIDE MONONIT.( SR ) ) 60 MG PO QD,"
]
} |
The patient is a 37 year old woman with dilated cardiomyopathy admitted with positional chest pain associated with viral prodrome. Her past medical history revealed she was diagnosed with dilated cardiomyopathy in 10-89 and discharged on Lasix, digoxin, and an ACE inhibitor. On 20 May, she was admitted to Orecross Medical Center after complaining of positional chest pain, shortness of breath, and fatigue. On 4 October, she underwent right ventriculogram which showed ejection fraction 24% and global hypokinesis. On 28 May, she complained of four days of diarrhea, nausea, vomiting, and malaise, followed by sharp severe chest pain in the mid chest below the left breast radiating to the back, which was relieved by lying on the left and aggravated by leaning forward or lying on the right. Her past medical history was significant for cardiomyopathy, hypertension, gastritis, ex-intravenous drug abuser for 10 years, anemia, and recent crack cocaine use. On admission, her medications included Lasix, Enalapril, and digoxin with no known drug allergies. Her hospital course was consistent with continuation of her pain through the first day of hospitalization despite an aggressive anti-ischemic regimen. It was found that her myocardial band electrophoresis showed no myocardial band fraction detected and it was decided to shift therapy to a more anti-inflammatory regimen to control her pericarditis with Indocin. With the resolution of her chest pain, the T-wave inversions corrected and she was transerred to the floor on Indocin 50 milligrams 3 times a day, aspirin, Bactrim, Enalapril, and Carafate and remained without chest pain for the next 2 days. The patient was discharged to home with medications on discharge including aspirin, Indocin 50 milligrams by mouth 3 times a day, Enalapril 10 milligrams by mouth each day, and Carafate 1 gram by mouth 4 times a day with follow-up with Dr. Dewitt A. Sisler. | Was the patient ever prescribed anti-ischemic regimen. | {
"answer_end": [
1209
],
"answer_start": [
1132
],
"text": [
"the first day of hospitalization despite an aggressive anti-ischemic regimen."
]
} |
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. | What was the dosage prescribed of insulin. | {
"answer_end": [
556
],
"answer_start": [
495
],
"text": [
"gentamicin 80 mg IV, Flagyl 500 mg IV and 8 units of insulin."
]
} |
Patient KOMLOS, COLEMAN 223-66-98-9 was admitted on 10/26/2000 and discharged on 9/4 AT 04:00 PM to Home w/ services with a code status of Full code. A 78F with HTN, PAFon amiodarone, MS s/p MVR on coumadin, and ?CAD/IMI with clean coronaries on cath '91, presented with two episodes of ?syncope. The patient had 2.1 CXR showing mild CHF and is on an extensive cardiac regimen including TYLENOL (ACETAMINOPHEN) 650-1,000 MG PO Q4H PRN pain, AMIODARONE 200 MG PO QD, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LASIX (FUROSEMIDE) 80 MG PO BID, MICRONASE (GLYBURIDE) 10 MG PO BID, PLAQUENIL (HYDROXYCHLOROQUINE) 200 MG PO BID, ISORDIL (ISOSORBIDE DINITRATE) 40 MG PO TID, LISINOPRIL 20 MG PO BID, KCL IMMEDIATE REL. PO SCALE QD, LOPRESSOR (METOPROLOL TARTRATE) 25 MG PO BID, NITROGLYCERIN 1/150 (0.4 MG) 1 TAB SL q5min x 3 PRN chest pain HOLD IF: SBP <100, COUMADIN (WARFARIN SODIUM) EVEN days: 5 MG qTTHSat; ODD days: 2.5 MG qMWF PO QD, NORVASC (AMLODIPINE) 10 MG PO QD HOLD IF: sbp <100, LOVENOX (ENOXAPARIN) 70 MG SC Q12H X 4 Days. Override Notices were added on 0/28 by KNIGHTSTEP, HAYDEN S. on order for COUMADIN PO (ref # 03417627) for POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & WARFARIN, POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE Reason for override: tolerates. Cardiology consulted, and recommended an event monitor to assess for specific rhythms while she is symptomatic. Follow up plan: Event monitor to be ordered. Patient to follow up with Dr. Bergerson and Dr. Gamma in 1-2 weeks. Visiting nurse to do home safety eval, and monitor INR/administer Lovenox if needed, and check BP/HR/symptoms. For visiting nurse: Please draw blood qd for 5 days to check INR. If it is less than 2 please give the Lovenox injections for the day. If it remains in 2-3 range, just continue the regular Coumadin dosing. Please check BP and heart rate and call primary doctor Dr. Mickles if it is excessively low or high and patient is complaining of symptoms. Please ensure she is wearing her event monitor. | has the patient had isordil ( isosorbide dinitrate ) | {
"answer_end": [
665
],
"answer_start": [
621
],
"text": [
"ISORDIL (ISOSORBIDE DINITRATE) 40 MG PO TID,"
]
} |
This 46-year-old male with a history of Insulin dependent diabetes, currently managed with 32 units of NPH Humulin, presented with pain with motion of the subtalar joint or the mid foot. He had a long history of ankle pain on the right side due to two fractures, one as a child and one due to a fall from a ladder, and was controlling his pain with Darvocet as well as intramuscular Tordal 15 to 30 mg four times a day. He was admitted as a same day surgery candidate and underwent tibiotalar fusion with cross-cannulated AO screws and local bone graft, with a tourniquet time of 1 hour and 57 minutes and received 2500 cc of crystalloid intraoperatively. His current medications include NPH Insulin 32 units every morning, Procardia XL 90 mg q.a.m., Lotensin 40 mg p.o. q.d., Lasix 40 mg p.o. q.d., potassium supplement, Ketorolac 15-30 mg intramuscularly q.i.d., and Darvocet N-100 one to four tablets q.d., with no known drug allergies. He was also prescribed Vicodan one to two p.o. q.3-4h. p.r.n., Naprosyn 500 mg p.o. b.i.d. as a substitute for the Tordal, and Halcion 0.125 to 0.25 mg p.o. q.h.s. p.r.n. Post-operatively, his motor and sensory examinations were intact and he was discharged on post-operative day three with the medications prescribed. He will follow-up with Dr. Norman Dutko in approximately three weeks at which time the cast will be changed and stitches removed. | How often does the patient take nph insulin | {
"answer_end": [
776
],
"answer_start": [
724
],
"text": [
"Procardia XL 90 mg q.a.m., Lotensin 40 mg p.o. q.d.,"
]
} |
A 43 year old female with metastatic tall cell papillary cancer to bilateral IJ nodes, who had undergone RAI, left paratracheal and modified radial neck dissection, and a total thyroidectomy in 1/24, was admitted to the hospital. During her hospital stay, she was started on ROCALTROL (CALCITRIOL) 0.5 MCG PO BID, CALCIUM CARBONATE (500 MG ELEMENTAL CA++) 1,000 MG PO Q6H, HYDROCHLOROTHIAZIDE 25 MG PO DAILY, SYNTHROID (LEVOTHYROXINE SODIUM) 200 MCG PO BID, and OXYCODONE 5-10 MG PO Q4H PRN Pain. ATENOLOL 100 MG PO DAILY was started the following day. Her diet was advanced and pain was well controlled on oral medications. She required multiple doses of IV medication (labetalol and hydralazine) to control her hypertension on pod#0. Her serum calcium levels were 7.5 and 8.1 on recheck, and she was neurologically intact, af, hd stable and wound was c/d/i. She was discharged to follow up with Dr. Macky and her primary care provider. Medications instructed were: erythromycin leads to GI upset, 500mg elemental calcium is the equivalent of 1250mg of calcium carbonate, and typical dose of Synthroid is 1 mcg per pound. She was also instructed to not immerse wound in bath, swimming or sauna for two weeks, not to drive while taking narcotics, and to follow up with primary care provider concerning hospitalization. | Has the patient ever had erythromycin | {
"answer_end": [
998
],
"answer_start": [
967
],
"text": [
"erythromycin leads to GI upset,"
]
} |
Mr. Wolfinbarger is a 55 year old male with Coronary Artery Disease who was admitted to Enreen Dallout Medical Center for cardiac catheterization. His Past Medical History includes non-Hodgkin's lymphoma, status bone marrow transplant and chemotherapy in 1992 and 1993; history of hypercholesterolemia, hypertension, insulin dependent diabetes, gastroesophageal reflux disorder and chronic renal insufficiency. He is allergic to Benadryl. His medications on admission included Toprol XL 200 mg q.d. Procardia XL 90 mg q.d, Lipitor 20 mg q.d., aspirin 325 mg q.d., Zantac 150 mg b.i.d., NPH humulin insulin 32 units each morning and 18 units each evening subcutaneously, Valium 5 mg q.d., Minipress 1 mg b.i.d. His physical examination was within normal limits, no varicosities. He underwent harvesting of the left radial artery for graft and a coronary artery bypass grafting x three with a left internal mammary artery to the left anterior descending coronary artery, saphenous vein graft from the posterior descending coronary artery to the aorta and a radial artery from the saphenous vein graft to the obtuse marginal coronary artery. Postoperatively, he had an episode of rapid atrial flutter and was chemically converted to sinus rhythm with Corvert and has remained in sinus rhythm on Lopressor and diltiazem for 24 hours. His saphenous vein harvest site showed some slight erythema to be treated with antibiotics by mouth. He is discharged on Axid 150 mg b.i.d, Lipitor 20 mg q.d., NPH Humulin insulin 32 Units every morning, 18 Units every evening; Diltiazem 60 mg t.i.d., Lopressor 150 mg b.i.d., enteric coated aspirin 125 mg once a day, Valium 5 mg once a day, Keflex 500 mg four times a day for 7 days, Percocet 1 to 2 tablets every four hours as needed for pain. | What is the current dose of the patient's percocet | {
"answer_end": [
1739
],
"answer_start": [
1673
],
"text": [
"Keflex 500 mg four times a day for 7 days, Percocet 1 to 2 tablets"
]
} |
Mrs. Wetterauer is a 54-year-old female with coronary artery disease status post inferior myocardial infarction in March of 1997, with sick sinus syndrome, status post permanent pacemaker placement, and paroxysmal atrial fibrillation controlled with amiodarone; also with history of diabetes mellitus and hypertension. On 1/11, she experienced severe respiratory distress and was unable to be intubated on the field. She was ultimately intubated at Sirose, and an echocardiogram showed an ejection fraction of 25 to 30 percent with flat CKs. She was diuresed six liters and a right heart catheterization showed a pulmonary artery pressure of 40/15, wedge of 12, and cardiac output of 5.2. Hemodynamics indicated her cardiac output was dependent on her SVR. At the outside hospital, a right upper lobe infiltrate was noted and she was given gentamicin 250 mg times one, and clindamycin 600 mg. She was diagnosed with pneumonia and treated with clindamycin, which caused resolution of her white count. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. Her last admission was on 10/6 for atypical chest pain, and she was placed on Bactrim Double Strength b.i.d. times a total of seven days, as well as Lovenox 60 mg b.i.d., aspirin 325 p.o. q.d., lisinopril 40 mg p.o. b.i.d., digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. Home medications include amiodarone 200 mg p.o. q.d., Glyburide 5 mg p.o. q.d., Lopressor 50 mg p.o. b.i.d., Prempro 0.625/2.5 p.o. q.d., lisinopril 40 mg p.o. q.d., Coumadin, nitroglycerin sublingual, Zantac, beclomethasone, and Ventolin. Medications on transfer, Lovenox 60 mg b.i.d., aspirin 325 p.o. q.8, digoxin 0.25, Lopressor 100 mg b.i.d., Zantac, Albuterol, Flovent, Solu-Medrol, and amiodarone 300 mg once a day. The patient was also placed on Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Tapazole 10 mg p.o. b.i.d., Zantac 150 mg p.o. b.i.d., Coumadin 5.0 mg p.o. q.p.m., Bactrim Double Strength one tablet p.o. b.i.d., Glyburide 5 mg p.o. q.d., Lasix 20 mg p.o. q.d., atenolol 150 mg p.o. q.d., diltiazem CD 240 mg p.o. q.d., and resolved with 20 mg of Lasix p.o. q.d. Mrs. Wetterauer was admitted to the Aley Coness-o Meoak Medical Center for paroxysmal atrial fibrillation controlled with amiodarone, and had an increase in her Lasix and lisinopril dose, as well as her amiodarone. She was also given Solu-Medrol 40 mg intravenous q.6 hours for possible asthma. For her anxiety, the patient was treated acutely with Ativan and her problem resolved quite well, and she became more comfortable in the hospital. Diabetes Mellitus was managed with Glyburide held initially on admission, covered with insulin sliding scale, and restarted on discharge. Edema was managed with Lasix 20 mg p.o. q.d. and resolved with 20 mg of Lasix p.o. q.d. Urinary Tract Infection was managed with antibiotics. She was discharged with medications including amiodarone 200 mg p.o. q.d., lisinopril 40 mg p.o. b.i.d., Tapazole 10 mg | Was the patient on any medication for her fluid accumulation | {
"answer_end": [
2265
],
"answer_start": [
2243
],
"text": [
"Lasix 20 mg p.o. q.d.,"
]
} |
This is a 59-year-old female with a history of rheumatic heart disease, endocarditis, diabetes mellitus, hypertension, and congestive heart failure who presented with increasing shortness of breath, nausea, vomiting, and abdominal pain. She was given recent Levaquin for an upper respiratory tract infection, then started on Flagyl for a possible C. difficile infection and was diuresed with IV Lasix with good output per report. She complained of 10/10 abdominal pain and was given some Dilaudid. Her hematocrit at one point required two units of packed red blood cells, and she was placed on a heparin drip at 950 units per hour to maintain a PTT between 60 and 80 secondary to atrial fibrillation that has been rate controlled with a beta-blocker. She was discharged on diltiazem 30 mg q.i.d. and a normal dosing of Nexium 40 mg p.o. q.d. while in-house. She was given Darvon and Codeine as needed for pain, and was prescribed Caltrate plus Vitamin D 600 mg, Maalox tablets, Magnesium oxide 400 mg, Multivitamin, Niferex 150 mg, and Lovenox 60 mg subcutaneously b.i.d. with a renal adjustment and NovoLog 15 units subcutaneously with breakfast and dinner. The patient was instructed to call Dr. Mccutchan office to coordinate her appointment for her valve repair in the next one to two weeks pending her surgeon's return and to call Dr. Doug Schlanger on March 2005 to discuss surgical plans and also to follow up. All her blood cultures should be followed up prior to her surgery and if any of her blood cultures become positive in the interim, a long course of antibiotic therapy should be started and surgery should be delayed at the discussion of the Cardiovascular Service. Her medications included Lasix 40 mg p.o. q.o.d. alternating with 80 mg p.o. Lasix q.o.d., Digoxin 0.125 mg q.o.d. alternating with 0.25 q.o.d., Lisinopril 20 mg p.o. q.d., Coumadin 6 mg p.o. q.o.d. alternating with 4 mg q.o.d., Omeprazole 20 mg b.i.d., Metformin 500 mg daily, Insulin 70/30 65 units q.a.m., 35 units q.p.m., Calcium 600 mg p.o. b.i.d., Magnesium 400 mg p.o. b.i.d., Multivitamin, Iron tablets, Actonel every Wednesday, Caltrate plus vitamin D 600 mg one tablet p.o. b.i.d., Maalox tablets quick dissolve, Magnesium oxide 400 mg p.o. b.i.d., Niferex 150 mg p.o. b.i.d., Colace 100 mg p.o. b.i.d., Senokot three tablets p.o. b.i.d., Codeine 15 mg to 30 mg p.o. q.4h. p.r.n. pain. She was required to increase her dosage of Nexium secondary to GERD-like symptoms and was maintained on a stable regimen of NPH 60 units in the morning, NPH 30 units in the evening, and NovoLog of 15 units in the morning with breakfast and 15 at dinner with a sliding scale. She was also transitioned to Lovenox 60 mg b.i.d. with a renal adjustment and was sent to the ED for diuresis where she was given 60 mg of Lasix. | What medications have been previously used for the treatment of her pain. | {
"answer_end": [
910
],
"answer_start": [
883
],
"text": [
"Codeine as needed for pain,"
]
} |
A 69-year-old female with a history of coronary disease status post prior myocardial infarction and surgery in 2002 presented to R.healt Medical Center Emergency Department on 10/9/05 with three days of chest pain and shortness of breath. Of note, she had been noncompliant with prior regimens and treatments and despite diuretics started three days by her primary care physician she reported new shortness of breath and chest pain at rest. An EKG in the emergency department revealed widespread ST depressions, prompting treatment for pulmonary edema with IV nitroglycerin, Lasix, aspirin, heparin, beta-blockers, and urgent transfer to the cath lab where coronary angiography revealed a left main coronary artery thrombosis with proximal and distal stenoses of about 70%, 50% of her LAD, and 60% of her first diagonal. After placement of an intraaortic balloon pump for further management and evaluation, the patient was transferred to the coronary care unit and her home medications included Aspirin, hydralazine, nitroglycerin, quinine, Norvasc, Lasix, Toprol, lisinopril, albuterol, and famotidine. Despite treatment, her condition continued to deteriorate, necessitating an exploratory laparotomy and emergent intubation, and ultimately, the family decided to withdraw care on 11/12/05 at 2:20 a.m., leading to her death at 2:24 a.m. the same day. | Why did the patient need aspirin | {
"answer_end": [
581
],
"answer_start": [
512
],
"text": [
"prompting treatment for pulmonary edema with IV nitroglycerin, Lasix,"
]
} |
This is a 46-year-old morbidly obese female with a history of insulin-dependent diabetes mellitus complicated by BKA on two prior occasions, who was admitted to the MICU with BKA, urosepsis, and a non-Q-wave MI. On presentation to the Emergency Department, her vital signs were notable for a blood pressure of 189/92, pulse rate of 120, respiratory rate of 20, and an O2 sat of 90%. She was given insulin, sublingual nitroglycerin x three, 4 mg of morphine, 5 mg of Lopressor, and started on a heparin drip and IV antibiotics, and admitted to the MICU for further management. Her past medical history included insulin-dependent diabetes mellitus for how many years, positive ethanol use, approximately one drink per week, and denied IV drug use or other illicit drug use. She was placed on an insulin drip and hydrated with intravenous fluids, with improvement, and eventually transitioned to NPH with insulin sliding scale coverage. Despite escalating her dose of NPH up to 65 U subcu b.i.d. on the day of discharge, she continued to have elevated blood sugars >200 and required coverage with insulin sliding scale. This issue will need to be addressed as an outpatient. She was also placed on cefotaxime for gram negative coverage, with both her blood cultures and urine cultures growing out E. coli which were sensitive to cefotaxime and gentamycin. As she initially continued to be febrile and continued to have positive blood cultures, one dose of gentamycin was given for synergy, and she was eventually transitioned to p.o. levofloxacin and will take 7 days of p.o. levofloxacin to complete a total 14-day course of antibiotics for urosepsis. She was initially placed on aspirin, heparin, and a beta blocker, and once her creatinine normalized, an ACE inhibitor was also added. Heparin was discontinued once the concern for PE was alleviated, and her beta blocker and ACE inhibitor were titrated up for a goal systolic blood pressure of <140 and a pulse of <70. On admission, the patient was on several pain medicines, including amitriptyline, Flexeril, and Valium for reported history of sciatica and low back pain, which were discontinued and she was placed on Neurontin for likely diabetic neuropathy. She was also placed on GI prophylaxis with Carafate and treated symptomatically with Imodium p.r.n. diarrhea. The patient was discharged with enteric coated aspirin 325 mg p.o. q.d., NPH Humulin insulin 65 U subcu b.i.d., human insulin sliding scale: for blood sugars 151-200 give 4 U, for blood sugars 201-250 give 6 U, for blood sugars 251-300 give 8 U, for blood sugars 301-350 give 10 U, Imodium 2 mg p.o. q. 6 hrs. p.r.n. diarrhea, Niferex 150 mg p.o. b.i.d., nitroglycerin 1/150 one tab sublingual q. 5 min. x 3 p.r.n. chest pain, multivitamin one tab p.o. q.d., simvastatin 10 mg p.o. q.h.s., Neurontin 600 mg p.o. t.i.d., levofloxacin 500 mg p.o. q.d. x 5 days, Toprol XL 400 mg p.o. q.d., lisinopril 40 mg p.o. q.d. The patient was evaluated by the physical therapist, who noted her to walk around the hospital without significant difficulty. | Is there history of use of insulin drip | {
"answer_end": [
843
],
"answer_start": [
793
],
"text": [
"insulin drip and hydrated with intravenous fluids,"
]
} |
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 the patient ever had k-dur | {
"answer_end": [
2468
],
"answer_start": [
2423
],
"text": [
"simvastatin 20 mg q.h.s., K-Dur 30 mEq b.i.d."
]
} |
Patient was admitted to the Toott Hospital surgery service after undergoing LRYGB and was transferred to the floor from the PACU in stable condition. Pain was controlled and no issues were reported overnight into POD1. The patient had an UGI on POD1 that was negative for obstruction or leak, and was started on a Stage I diet which was tolerated well. The following day the patient was started on a Stage II diet that was tolerated as well, but initially struggled to have adequate intake. The patient was started on ALBUTEROL INHALER 2 PUFF INH QID PRN Shortness of Breath, Wheezing, LANTUS (INSULIN GLARGINE) 60 UNITS SC DAILY, ROXICET ORAL SOLUTION (OXYCODONE+APAP LIQUID) 5-10 MILLILITERS PO Q4H PRN Pain, ZANTAC SYRUP (RANITIDINE HCL SYRUP) 150 MG PO BID, ACTIGALL (URSODIOL) 300 MG PO BID, and LEVAQUIN (LEVOFLOXACIN) 500 MG PO DAILY with instructions to administer iron products a minimum of 2 hours before or after a levofloxacin or ciprofloxacin dose dose, and to cycle (hold 1 hr before to 2 hr after) if on tube feeds, and to take 2 hours before or 2 hours after dairy products. Sugars remained high in 200's during admission and patient was seen by Endocrine service and sugars finally improving with lantus 60 sc hs. The patient also had some difficulties with urination on POD4 and required a foley catheter for about a day, but was d/c'd the AM before she was discharged and urinated without incident. Patient was noted to have a UTI at discharge and was started on three day course of levaquin. The patient was discharged in stable condition, tolerating stage II diet well, ambulating, voiding independently, and with adequate pain control. The patient was given explicit instructions to follow-up in clinic with Dr. Truglia in 1-2 weeks and sent home with VNA for wound checks and close sugar control with instructions to f/u with Leland Bredeson by phone and record fingersticks, and to f/u with her PCP if she has further problems with urination. The patient was also instructed to shower but not bathe, swim or otherwise immerse her incision, not to lift anything heavier than a phone book, not to drive or drink alcohol while taking narcotic pain medication, and to resume all of her home medications, and to call her doctor or go to the nearest emergency room if she has fevers > 101.5 F, vomiting, or increased redness, swelling, or discharge from her incision. | What wheezing medications have ever been prescribed for pt. in the VA or mentioned in the record | {
"answer_end": [
575
],
"answer_start": [
518
],
"text": [
"ALBUTEROL INHALER 2 PUFF INH QID PRN Shortness of Breath,"
]
} |
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. | Why was the patient on lovenox | {
"answer_end": [
900
],
"answer_start": [
875
],
"text": [
"he was given Lovenox BID."
]
} |
A 77-year-old woman presented to the ED with sudden onset of severe sharp chest pain, diaphoresis, and nausea; she was given nitro, hydralazine, SL nitro, and a nitro drip, and her pain was relieved. Cardiac catheterization showed no change from prior studies, but pulmonary hypertension was noted, and the patient was treated with heparin, ASA/Plavix (home dose), and uptitrated labetalol for BP control. A PE CT showed a pulmonary nodule, and the patient was discharged home on ACETYLSALICYLIC ACID 81 MG PO DAILY, LIPITOR (ATORVASTATIN) 80 MG PO BEDTIME, CALTRATE 600 + D (CALCIUM CARBONATE 1,500 MG (...) 2 TAB PO DAILY, PLAVIX (CLOPIDOGREL) 75 MG PO QAM, NEXIUM (ESOMEPRAZOLE) 20 MG PO QAM, LASIX (FUROSEMIDE) 40 MG PO QAM, INSULIN 70/30 HUMAN 40 UNITS SC BID, IMDUR ER (ISOSORBIDE MONONITRATE (SR)) 60 MG PO DAILY, LABETALOL HCL 400 MG PO Q8H Starting Tonight (2/22), LEVOXYL (LEVOTHYROXINE SODIUM) 112 MCG PO DAILY, OXYCODONE 5-10 MG PO Q4H PRN Pain, ALDACTONE (SPIRONOLACTONE) 12.5 MG PO QAM, and DIOVAN (VALSARTAN) 160 MG PO DAILY, with instructions to take medications consistently with meals or on an empty stomach and to assess blood sugars and titrate insulin as per her doctor's instructions. She was to monitor her electrolytes with VNA in 1 week, continue diabetes teaching, and work with her VNA for aggressive diabetes management, with follow up with her outpt PCP and endocrinologist for titration of insulin and optimization of insulin regimen, as well as a pulmonary consult to evaluate for primary pulmonary disease, and a repeat chest CT in 6-12 months to follow up the pulmonary nodule. | Has patient ever been prescribed caltrate 600 + d ( calcium carbonate 1 , 500 mg ( ... ) | {
"answer_end": [
624
],
"answer_start": [
558
],
"text": [
"CALTRATE 600 + D (CALCIUM CARBONATE 1,500 MG (...) 2 TAB PO DAILY,"
]
} |
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. | has the patient had motrin | {
"answer_end": [
653
],
"answer_start": [
606
],
"text": [
"and her medication on admission was Motrin prn."
]
} |
This 39-year-old female with a history of discoid lupus and pericarditis presented with severe substernal chest pain after having prednisone and Plaquenil discontinued. She first developed arthralgias of various joints, which were treated with aspirin, Motrin and steroids. In 1985, she developed pleuritic substernal chest pain and was diagnosed at Westten Hospital with pericarditis. In 1988, she was seen at the Arthritis Clinic by Dr. Goerlitz and was treated with Plaquenil 200 bid, plus aspirin and Naprosyn. In 22 of May, she was diagnosed with a lupus flare and was put on prednisone 30 q am and in 23 of March, the steroids were tapered off and discontinued. However, she presented with increasing joint pain and had her prednisone restarted with Plaquenil 200 bid, Motrin 80 tid, prednisone 10 q am, Dilantin 200 bid, and prednisone 30 q day. Laboratory examination showed electrolytes within normal limits, CK of 76, white count of 4.7, hematocrit of 30, platelets of 352,000, mean corpuscular volume of 83, ESR of 88, oxygen saturation of 99% on room air, and urinalysis showed specific gravity of 1.026, 2+ protein, 10 to 15 white cells, 8 to 10 red blood cells and a few granular casts. Chest x-ray showed increased heart size, multiple thoracic compression fractures and osteopenia, and electrocardiogram showed sinus rhythm with frequent premature ventricular contractions at a rate of approximately 70. She was ruled out for a myocardial infarction, had an echocardiogram which showed a small amount of pericardial fluid, and was placed back on her Plaquenil 200 bid and prednisone 30 q day. The hematocrit remained stable between 27 and 30 without transfusions or further intervention, and she was discharged on medications including Plaquenil 200 bid, prednisone 20 q day, Dilantin 400 q day, L-thyroxine 0.2 q am, Motrin 800 tid, Carafate, iron and folate for follow-up in Rheumatology Clinic with Dr. Grondin. | Is there a mention of of prednisone usage/prescription in the record | {
"answer_end": [
168
],
"answer_start": [
130
],
"text": [
"prednisone and Plaquenil discontinued."
]
} |
The patient was admitted on 5/5/2006 with a history of mechanical fall, with the attending physician being Dr. Clemente Armand Bolstad, with a full code status and disposition of Rehabilitation. Medications on Admission included Amiodarone 100 QD, Colace 100 bid, lasix 40mg QD, Glyburide 5mg bid, Plaquenil 200mg bid, Isordil 20mg tid, Lisinopril 20mg QD, Coumadin 5mg 3dys/week, 2.5mg 4dys/week, Norvasc 10mg QD, Neurontin 300mg TID, with APAP prn. An override was added on 10/2/06 by Gerad E. Dancy, PA for POTENTIALLY SERIOUS INTERACTION: AMIODARONE HCL & WARFARIN with the reason for override being monitoring. The patient was rehydrated with IVF and PO's were encouraged, holding Glypizide while in house, Novolog sliding scale was started on 1/2, Low dose NPH 6 units BID was started on 1/2, bridged with lovenox and INR therapeutic 1/2 and restarted on home regimen of 5/2.5mg variable dose. Pain was controlled with TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Pain, Headache. A CT pelvis showed a right adnexal cyst which will need further characterization by US and outpatient follow up. The patient has an extensive cardiac history and the fall is not likely related to a cardiac issue as it appears mechanical, with no syncope, chest pain, etc. She was diagnosed with an NSTEMI with a small TnI leak, likely demand related in the setting of hypovolemia and the fall. Enzymes trended down. She was dry on admission and rehydrated with IVF, PO's encouraged, and became euvolemic by 1/2. Her JVP was up to 12cm, although it was difficult to gauge her volume status due to TR. She had a prolonged QT on admission, on telemetry, of unclear etiology, possibly starvation. This was monitored on telemetry until ROMI and drugs that confound were avoided. The QTc resolved to low 500s and a DDD pacer was functioning with V-pacing at 60bpm. Additional medications included NATURAL TEARS (ARTIFICIAL TEARS) 2 DROP OU BID, COLACE (DOCUSATE SODIUM) 100 MG PO BID, PLAQUENIL SULFATE (HYDROXYCHLOROQUINE) 200 MG PO BID, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, LISINOPRIL 20 MG PO DAILY HOLD IF: SBP <110, MILK OF MAGNESIA (MAGNESIUM HYDROXIDE) 30 MILLILITERS PO DAILY PRN Constipation, COUMADIN (WARFARIN SODIUM) 2.5 MG PO QPM, NORVASC (AMLODIPINE) 10 MG PO DAILY HOLD IF: SBP <110, NEURONTIN (GABAPENTIN) 300 MG PO TID, NEXIUM (ESOMEPRAZOLE) 20 MG PO DAILY, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, DULCOLAX RECTAL (BISACODYL RECTAL) 10 MG PR DAILY PRN Constipation, CLOTRIMAZOLE 1% TOPICAL TOPICAL TP BID, GLYBURIDE 5 MG PO BID, LASIX (FUROSEMIDE) 20 MG PO DAILY, and corrected pt restarted on lasix 20 qd on d/c. A PT consult was obtained 3/21 and to follow daily at rehab. Labs showed Na 146, CK 3320, CKMB 12.9, Trop 0.23--->0.10, AST 107, Cr 1.2-->1.6. Pain was controlled with TYLENOL (ACETAMINOPHEN) 650 MG PO Q4H PRN Pain, Headache, rehydrated with IVF, po's encouraged, holding Glypizide while in house, Novolog sliding scale was started on 1/2, Low dose NPH 6 units BID was started on 1/2, bridged with lovenox and INR therapeutic 1/2 and restarted on home regimen of 5/2.5mg variable | Has this patient ever been prescribed home regimens | {
"answer_end": [
899
],
"answer_start": [
812
],
"text": [
"lovenox and INR therapeutic 1/2 and restarted on home regimen of 5/2.5mg variable dose."
]
} |
Ms. Heit is a 67-year-old female who received a heart transplant in March 2006 and was transferred from an outside hospital after sustaining a right hip fracture. On admission, her plain films revealed a nondisplaced right femoral fracture and her EKG showed sinus tachycardia. She was given MEDICATIONS ON ADMISSION: Neoral 150 mg b.i.d., prednisone 8 mg daily, CellCept 1500 mg b.i.d., Protonix 20 mg daily, Pravachol 40 mg daily, diltiazem 360 mg daily, multivitamin one daily, magnesium oxide 400 mg daily, calcium and vitamin D 1800 mg daily, Fosamax weekly on Mondays, Colace 100 mg daily, Zocor 20 mg daily, Dulcolax 10 mg as needed for constipation, vitamin E 400 units daily, and vitamin C 500 mg b.i.d. She had a history of heparin-induced thrombocytopenia, which was treated with fondaparinux daily prior to the procedure and then discharged on aspirin for four weeks postprocedure. She underwent a dynamic hip screw procedure which was uncomplicated and allowed her to begin weightbearing on postoperative day 1, and was transfused with 2 units of packed red blood cells on the day after surgery with appropriate hematocrit rise. She received additional 2 units of packed red blood cells prior to discharge. DISCHARGE MEDICATIONS: Tylenol 650 mg every four hours as needed for pain, Protonix 40 mg daily, Pravachol 40 mg daily, Neoral (cyclosporine) 150 mg b.i.d., diltiazem extended release 360 mg daily, Caltrate plus D one tablet daily, Neoral (cyclosporine) 150 mg b.i.d., diltiazem extended release 360 mg daily, Fosamax 70 mg weekly, Dulcolax p.r. 10 mg as needed for constipation, and oxycodone 5-10 mg every six hours as needed for pain. She will continue her home medication regimen, be maintained on aspirin 325 mg for four weeks to prevent clot formation postsurgery, and take oxycodone as needed for pain. She has a followup appointment with orthopedic surgery, and will also be closely followed by transplant clinic in the Angeles with a walker and should continue aspirin 325 mg daily. | Was the patient ever given aspirin for clot | {
"answer_end": [
1790
],
"answer_start": [
1705
],
"text": [
"be maintained on aspirin 325 mg for four weeks to prevent clot formation postsurgery,"
]
} |
This is a 70-year-old woman with ischemic cardiomyopathy, coronary artery disease status post MI, insulin-dependent diabetes, peripheral vascular disease, and chronic renal insufficiency who presented in volume overload after a previous admission. She had been diuresed with a Lasix drip at 10 mg per hour and Zaroxolyn at 2.5 mg p.o. daily, and her Lopressor was held for a decompensated heart failure. She was then started on amiodarone and Coumadin for a new paroxysmal atrial fibrillation. Her Lasix drip was increased to 20 mg per hour and the Zaroxolyn was increased to b.i.d. After transition from Zaroxolyn to Diuril, which was given 250 mg IV b.i.d., she was prescribed Ativan 0.5 mg p.o. t.i.d. p.r.n. anxiety, Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Lantus 18 units subcutaneously nightly, Lopressor 25 mg p.o. b.i.d., Procrit 40,000 units subcutaneously every other week, Nitroglycerin sublingual p.r.n. chest pain, Aspirin 81 mg p.o. daily, Vitamin B12 subcutaneous injections at clinic, Iron 325 mg p.o. t.i.d., Metolazone p.r.n., Multivitamin one tablet p.o. daily, Torsemide 100 mg q.a.m. and 50 mg q.p.m., Coumadin 1 mg q.p.m., and Amiodarone 200 mg p.o. daily. Despite the dose of Coumadin being decreased from her home dose of 1 mg q.p.m. to a 0.5 mg q.p.m., her INR continued to rise greater than 200. She was started on q.a.c. NovoLog regimen with her Lantus insulin dose decreased from 18 units to 16 units and the NovoLog sliding scale was started. She was monitored on telemetry with no other events and required repletion of both potassium and magnesium despite her renal insufficiency throughout the admission in the setting of injected insulin in the setting of worsening renal failure, so, studies were also normal. She was continued on Aranesp through the admission and was discharged home on a similar regimen to her home regimen simply to Torsemide after the last discharge as her outpatient p.o. Torsemide regimen of 100 mg p.o. q.a.m. and 50 mg q.p.m., Lantus 12 units subcutaneously nightly, Ativan 0.5 mg p.o. t.i.d., Folate 1 mg p.o. daily, Lipitor 80 mg p.o. at bedtime, Multivitamin one tablet p.o. daily, Coumadin 1 mg q.p.m., Metolazone 2.5 mg p.o. daily as needed for fluid retention, Iron 325 mg p.o. t.i.d., and Aspirin 81 mg p.o. daily. She was maintained on a cardiac diet and prophylaxis with Coumadin and Nexium. Potassium and magnesium were repleted as needed and she was maintained on aspirin and Lipitor throughout the admission. She will follow up with her primary care provider, SRRH Cardiology Clinic, and Renal Clinic. | has the patient had procrit | {
"answer_end": [
898
],
"answer_start": [
845
],
"text": [
"Procrit 40,000 units subcutaneously every other week,"
]
} |
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. | Is the patient currently or have they ever taken nitroglycerin 1/150 (0.4 mg) | {
"answer_end": [
645
],
"answer_start": [
565
],
"text": [
"nitroglycerin 1/150 (0.4 mg) 1 tab SL q5min x 3 PRN chest pain hold if SBP <100,"
]
} |
A 57-year-old female with macromastia and abdominal skin laxity s/p massive weight loss 2/2 gastric bypass was admitted to plastic surgery on 5/8/07. On admission, the patient was prescribed 1. ACETAMINOPHEN 1000 MG PO Q6H, 2. LEVOTHYROXINE SODIUM 75 MCG PO QD, 3. QUINAPRIL 20 MG PO QAM, 4. RANITIDINE HCL 150 MG PO QD, 5. MULTIVITAMINS 1 CAPSULE PO QD, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, VITAMIN C ( ASCORBIC ACID ) 500 MG PO BID, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, KEFLEX ( CEPHALEXIN ) 500 MG PO QID, COLACE ( DOCUSATE SODIUM ) 100 MG PO BID, PEPCID ( FAMOTIDINE ) 20 MG PO BID, DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain (ref #901341233), on order for DILAUDID PO 2-4 MG Q3H (ref #901341233), INSULIN REGULAR HUMAN, supplemental (sliding scale) insulin, If receiving standing regular insulin, please give at same, SYNTHROID ( LEVOTHYROXINE SODIUM ) 75 MCG PO DAILY, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H, MILK OF MAGNESIA ( MAGNESIUM HYDROXIDE ), REGLAN ( METOCLOPRAMIDE HCL ) 10 MG IV Q6H PRN Nausea, ZOFRAN ( POST-OP N/V ) ( ONDANSETRON HCL ( POST-... ), on order for KCL IV (ref #964491549), POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM CHLORIDE, POTENTIALLY SERIOUS INTERACTION: QUINAPRIL HCL & POTASSIUM, SIMETHICONE 80 MG PO QID PRN Upset Stomach, MULTIVITAMIN THERAPEUTIC ( THERAPEUTIC MULTIVI... ) 1 TAB PO DAILY, TIGAN ( TRIMETHOBENZAMIDE HCL ) 200 MG PR Q6H PRN Nausea, ibuprfen. Do not drink/drive/operate machinery with pain medications., Take a stool softener to prevent constipation., 4. Continue your antibiotics as long as you have a drain in place., Sliding Scale (subcutaneously) SC AC+HS Medium Scale, If BS is 125-150, then give 0 units subcutaneously, 30 MILLILITERS PO DAILY PRN Constipation, 1 MG IV Q6H X 2 doses PRN Nausea, Number of Doses Required (approximate): 10, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, TYLENOL ( ACETAMINOPHEN ) 650 MG PO Q4H PRN Headache, DULCOLAX ( BISACODYL ) 5-10 MG PO DAILY PRN Constipation, DILAUDID ( HYDROMORPHONE HCL ) 2-4 MG PO Q3H PRN Pain. The patient tolerated all procedures without difficulty and post-op period was uneventful, and at discharge, the patient was afebrile with stable vitals, taking po's/voiding q shift, ambulating independently and pain was well-managed with Tigan (Trimethobenzamide HCl) 200 mg PR Q6H PRN Nausea, Tigan (Trimethobenzamide HCl) 300 mg PO Q6H PRN Nausea, Simethicone 80 mg PO QID PRN Upset Stomach, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, 1 mg IV Q6H x 2 doses PRN Nausea, 30 Milliliters PO Daily PRN Constipation and TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, DULCOLAX (Bisacody | Has this patient ever been on pain medications | {
"answer_end": [
1538
],
"answer_start": [
1468
],
"text": [
"ibuprfen. Do not drink/drive/operate machinery with pain medications.,"
]
} |
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. | What is the dosage of phoslo | {
"answer_end": [
737
],
"answer_start": [
656
],
"text": [
"Lipitor 80 mg nightly, Nephrocaps, Neurontin 300 mg daily, PhosLo 2001 mg t.i.d.,"
]
} |
A 54M with a history of CHF admitted with chest pain and troponin elevation likely due to a hypertensive emergency was found to have a 100% RCA lesion but well collateralized and no other CAD at cardiac catheterization. Keys to management were aggressive BP control with medications, low salt diet, and weight loss; cont ASA, statin, and Lasix 160 in AM, 120 in PM for volume control. Troponin trended down and the patient remained asymptomatic in house. The patient was monitored on tele with no events. The patient was also given Mucomyst, DM on diet control, and Hba1c pending. The patient was also found to have a history of OSA on CPAP which was likely contributing to pulmonary hypertension given the HCT 55. CPAP and weight loss were encouraged. The patient was discharged on Acetylsalicylic Acid 81 MG PO QD, Lasix (Furosemide) 160 MG QAM; 120 MG QPM PO 160 MG QAM, Lisinopril 80 MG PO QD, MVI Therapeutic (Therapeutic Multivitamins) 1 TAB PO QD, Norvasc (Amlodipine) 10 MG PO QD, Toprol XL (Metoprolol (Sust. Rel.)) 200 MG PO QD, Ambien (Zolpidem Tartrate) 5 MG PO QHS, and Depakote ER (Divalproex Sodium ER) 1,000 MG PO QD with instructions to take consistently with meals or on empty stomach, avoid grapefruit unless MD instructs otherwise, and give Ambien on an empty stomach (give 1hr before or 2hr after food). Additional comments were given to continue medications as prescribed, monitor BP, cut out salt, and lose weight. The patient was discharged in a stable condition with follow-up appointments with primary cardiologist and primary care doctor. | has the patient had mucomyst | {
"answer_end": [
541
],
"answer_start": [
505
],
"text": [
"The patient was also given Mucomyst,"
]
} |
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. | Previous celexa | {
"answer_end": [
948
],
"answer_start": [
923
],
"text": [
"Celexa ordered per psych."
]
} |
This is a 69 year-old woman with a history of congestive heart failure and hypertension who presented with a productive cough which was worsening over the past 3-4 days and fever to 101 with chills and shakes and increasing shortness of breath. She had a white blood cell count of 9.3 with 54% polys and 9.6 % eosinophils, a glucose of 377, and a chest x-ray without evidence of congestive heart failure or infiltrate. She was treated in the emergency room with Albuterol nebulizer and plans were to discharge her to home, however, her saturations dropped to 89% on room air with exercise in the emergency room and was admitted for further observation. She was started on intravenous Cefuroxime, and initially improved with decrease in cough and shortness of breath; however, the patient continued to desat with exercise. A repeat chest x-ray was performed which showed no change when compared to the admission film. Her sputum culture grew out Pen-sensitive E-coli and she was continued on her intravenous and then PO antibiotics. She continued to desat with exercise, however, and her cough persisted although she remained afebrile with a slightly elevated white count and moderate peripheral eosinophilia. Her chest exam remained rancorous and the reason for this remained unclear. Given the finding of E-coli in the sputum sample, in addition to the elevated eosinophilia and lack of finding on chest x-ray despite significant findings on chest exam, the possibility of a worm or parasitic disease was raised. She had a Persantine MIBI in March of 1996, on which she had no fixed or reversible defects, and was on nitroglycerin for stable angina - "chest heaviness" after climbing one flight of stairs, relieved by rest and one sublingual nitroglycerin. Her medications on admission included Lasix 40 mg. per day, Insulin 70/30 28 units q a.m. and 5 units q p.m., Verapamil SR 120 mg PO b.i.d., Enteric coated aspirin 325 mg q day, KCL 10 mEq PO q day, Premarin 0.625 mg PO q day, Zestril 20 mg b.i.d., Atenolol, recently discontinued, Tofranil 75 mg PO q HS, Albuterol inhaler two puffs inhaled q.i.d., and Potassium slow release 10 mEq PO q day. She was discharged to home with Albuterol inhaler and instructions to follow up with her primary physician in clinic for further evaluation including PFTs and possible chest CT if symptoms did not abate, and to finish a full ten day course of antibiotics for presumed bronchitis. At the time of discharge the patient's saturation was 92 to 93% on room air and dropping slightly to 90 to 91% with exercise, however she was tolerating this well and was getting relief from her Albuterol inhaler. | Has the patient had zestril in the past | {
"answer_end": [
2039
],
"answer_start": [
1985
],
"text": [
"Zestril 20 mg b.i.d., Atenolol, recently discontinued,"
]
} |
Mr. Gramby is a 43-year-old man with morbid obesity, type II diabetes, hypertension, hyperlipidemia, chronic renal insufficiency, and severe peripheral arterial disease status post femoral popliteal bypass in July which was complicated by repeated return of cellulitis x 2 who was admitted with cellulitis and volume overload. He was initially treated with courses of intravenous nafcillin and vancomycin for four weeks, having been seen by Vascular Surgery five days prior to admission and had been started on dicloxacillin for a third episode of cellulitis. He had also presented with fluid overload and spironolactone was added to his diuretic regimen. The patient was prescribed Atenolol 100 mg q.d., spironolactone, torsemide 160 mg b.i.d., Hyzaar 50/12.5 q. day, lisinopril 60 mg q. day, Neurontin 1200 mg t.i.d., Norvasc 10 mg q.a.m. and 5 mg q.p.m., Coumadin 8 mg, aspirin, Humalog sliding scale, Percocet, Pletal 100 mg b.i.d., Procrit, Zantac, nitroglycerin p.r.n., and NPH 80 q.a.m. and q.p.m. His torsemide was changed to IV and metolazone was added on the first day of admission and his electrolytes were replaced as needed. He was hypertensive on arrival, which was treated with Hydralazine initially and transitioned to his p.o. home medicines, with Hydralazine p.o. added on hospital day #9 to lower his systolic blood pressure to the range of the 120s-130s. His Coumadin was restarted when his INR was 2.2 and he his now in the therapeutic range and will need to be followed. The patient is on NPH and Humalog, with NPH doses increased to 90 units in the morning and 85 units at night, and the goal for this patient is below 150 particularly given the need for wound healing. Additional antibiotic coverage was added specifically of fluoroquinolone for anti-psuedomonal coverage for his diabetic foot ulcers, with surgical debridement done in the operating room with drainage of pus, but the metal showed could not be located even with fluoroscopy. The patient will complete a 14-day course of levofloxacin and clindamycin for these foot ulcers, and will be discharged home with visiting nursing care for b.i.d. wet-to-dry dressing changes. He will follow up with Jerold Cristopher Blazon, M.D. in one to two weeks, go home with visiting nurse care, and will need to see his nephrologist, vascular surgeons, primary care provider, and Bariatric Surgery following discharge. | Has this patient ever tried torsemide | {
"answer_end": [
745
],
"answer_start": [
656
],
"text": [
"The patient was prescribed Atenolol 100 mg q.d., spironolactone, torsemide 160 mg b.i.d.,"
]
} |
This 46-year-old male with a history of Insulin dependent diabetes, currently managed with 32 units of NPH Humulin, presented with pain with motion of the subtalar joint or the mid foot. He had a long history of ankle pain on the right side due to two fractures, one as a child and one due to a fall from a ladder, and was controlling his pain with Darvocet as well as intramuscular Tordal 15 to 30 mg four times a day. He was admitted as a same day surgery candidate and underwent tibiotalar fusion with cross-cannulated AO screws and local bone graft, with a tourniquet time of 1 hour and 57 minutes and received 2500 cc of crystalloid intraoperatively. His current medications include NPH Insulin 32 units every morning, Procardia XL 90 mg q.a.m., Lotensin 40 mg p.o. q.d., Lasix 40 mg p.o. q.d., potassium supplement, Ketorolac 15-30 mg intramuscularly q.i.d., and Darvocet N-100 one to four tablets q.d., with no known drug allergies. He was also prescribed Vicodan one to two p.o. q.3-4h. p.r.n., Naprosyn 500 mg p.o. b.i.d. as a substitute for the Tordal, and Halcion 0.125 to 0.25 mg p.o. q.h.s. p.r.n. Post-operatively, his motor and sensory examinations were intact and he was discharged on post-operative day three with the medications prescribed. He will follow-up with Dr. Norman Dutko in approximately three weeks at which time the cast will be changed and stitches removed. | has there been a prior nph humulin | {
"answer_end": [
115
],
"answer_start": [
68
],
"text": [
"currently managed with 32 units of NPH Humulin,"
]
} |
The patient had been taking Ativan of 3-4 mg q.d. for anxiety for the past two months and abruptly stopped taking it on March 1995 after which she started to have feelings of disorientation, and had been taking chloral hydrate 500 to 1000 mg q.h.s. for five days and Compazine with one dose. CURRENT MEDICATIONS: At home, patient took insulin NPH 25 units in the morning with Regular 10 units in the morning, aspirin 81 mg q.d., Lopressor 25 mg b.i.d., Compazine 5 mg q.6h. p.r.n. anxiety of which she took only one dose, and chloral hydrate 500 to 1000 mg q.h.s. for five days. On admission, her laboratory examination was significant for BUN of 17, creatinine of 1.0, glucose was 364, liver function tests were within normal limits, white count was 7.2, hematocrit was 36, and platelet count was 266. Neurology consultation was obtained who felt that patient's peripheral neuropathy was probably secondary to longstanding diabetes but felt that some of her symptomatology could be consistent with porphyria. Psychiatry felt that this episode was consistent with generalized anxiety disorder separated by post dysthymia and suggested phenothiazines which are proven to be safe in porphyria for treatment. She was started on Trilafon 2 to 4 mg p.o. p.r.n. q.6h. for anxiety and Keflex 500 mg p.o. t.i.d. for treatment. The patient was also seen to be orthostatic which was felt to be secondary to dehydration secondary to poor p.o. intake prior to admission and was treated with normal saline boluses and her orthostasis improved. Her Lopressor was also held with this episode of orthostasis. The Watson-Schwartz test done by Dr. Mohar on patient very early in the admission was negative which made an acute porphyria attack very unlikely. These episodes were felt to be secondary to a combination of anxiety attack and rapid taper of Ativan which she had been taking at moderately high doses for the last two months. Patient also developed urinary tract infection symptoms and her urine culture showed greater than 100,000 colonies of E. coli which were pansensitive. She was discharged to home on August in good condition on medications Aspirin 81 mg p.o. q.d., insulin NPH 25 units subcutaneously q.a.m., insulin regular 10 units subcutaneously q.a.m., Trilafon 2 mg p.o. q.6h., and Keflex 500 mg p.o. t.i.d. Follow-up will be with Dr. Dario Rodriquz. | Previous lopressor | {
"answer_end": [
521
],
"answer_start": [
409
],
"text": [
"aspirin 81 mg q.d., Lopressor 25 mg b.i.d., Compazine 5 mg q.6h. p.r.n. anxiety of which she took only one dose,"
]
} |
A 83-year-old male patient with a history of CAD, IMI, CABG (2000), HTN, and BPH presented with sore throat, cough, and weakness, and was admitted to a medical service with a diagnosis of viral syndrome. He had an EKG showing A-paced at 69, IMI, normal axis, and no acute ischemic changes, a MIBI showing an EF of 45% and multiple pulmonary nodules, a CXR was negative, and a CT Chest showed several pulmonary nodules in RUL inferiorly, the largest being 0.6cm, and other tiny nodules in the upper lobes bilaterally, 2-3mm, and several small nodes in the mediastinum with no LAD. CTAB, RRR were normal. He was given TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, CEPACOL 1-2 Lozenge PO Q4H PRN Other:sore throat, Vitamin B12 (Cyanocobalamin) 1,000 mcg IM QD x 3 doses, Dipyridamole 25 mg PO QPM, Lasix (Furosemide) 10 mg PO QD, Isordil (Isosorbide Dinitrate) 30 mg PO TID, Ativan (Lorazepam) 3.5 mg PO QHS PRN Insomnia, Inderal (Propranolol HCl) 10 mg PO QID, Norvasc (Amlodipine) 2.5 mg PO QD, Nitroglycerin 0.2% Topical TP BID Instructions: 1 inch, Zetia (Ezetimibe) 10 mg PO QD, Azithromycin 500 mg pack 500 mg PO QD x 4 doses, and Calcium Phosphate, Oral, Reason for override: aware. He had no significant fever or WBC and his symptoms improved on admission with no cough. He was observed O/N with IVF and improved in the morning and will be D/C'd on Azithromycin x 5 days. For the pulmonary nodules, he will follow-up with Dr. Muether as an outpatient for w/u. For Heme, he was given anemia, iron studies, B12, and folate sent and got B12 1000ug IM x 1 and was instructed to follow-up with the doctor's office to get injections for 2 more days, then monthly, likely due to a gastrectomy. He was given instructions to continue TYLENOL (Acetaminophen) 650 mg PO Q4H PRN Headache, CEPACOL 1-2 Lozenge PO Q4H PRN Other:sore throat, Ativan (Lorazepam) 3.5 mg PO QHS PRN Insomnia, Azithromycin 500 mg pack 500 mg PO QD x 4 days, B12 1000ug QD for 2 more days, then qmonth, and to call his doctor if he continues to feel unwell or returns to the hospital, and to go to the doctor's office on Thursday and Friday to receive the B12 injections. He was discharged in a stable condition. | What does the patient take tylenol ( acetaminophen ) for | {
"answer_end": [
667
],
"answer_start": [
616
],
"text": [
"TYLENOL (Acetaminophen) 650 mg PO Q4H PRN 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 a patient had imdur | {
"answer_end": [
2036
],
"answer_start": [
1912
],
"text": [
"7) Toprol XL 75 mg p.o. q. day., 8) Imdur 30 mg p.o. q. day., 9) Augmentin one tablet p.o. q. day for seven additional days."
]
} |
Patient Emilio R. Strausberg was admitted on 5/26/2004 with atrial fibrillation and calcaneous fracture and was discharged on 7/18/2004 with discharge orders including ECASA (Aspirin Enteric Coated) 325 MG PO QD, with a potentially serious interaction with Warfarin, Vitamin B12 (Cyanocobalamin) 1,000 MCG PO QD, Digoxin 0.25 MG PO QD, Colace (Docusate Sodium) 100 MG PO BID, Lasix (Furosemide) 60 MG PO BID, Oxycodone 5 MG PO Q6H PRN Pain, Coumadin (Warfarin Sodium) 5 MG PO QPM, with a potentially serious interaction with Atorvastatin, Metoprolol (Sust. Rel.) 300 MG PO QD, Accupril (Quinapril) 20 MG PO QD, Tiazac (Diltiazem Extended Release) 240 MG PO QAM, Lipitor (Atorvastatin) 80 MG PO QD, with a potentially serious interaction with Niacin, Vit. B-3 and Calcium, Niaspan (Nicotinic Acid Sustained Release) 1 GM PO QHS, Lantus (Insulin Glargine) 66 UNITS SC QPM, Insulin Lispro Mix 75/25 74 UNITS SC QAM, Glucometer 1 EA SC x1, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM. Override notices were added on 6/9/04 with reasons such as heart, home med, and home emd. The patient was rate controlled with IV metoprolol and diltiazem, instructed to continue ASA, continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->80), continue lasix, 60 bid (was 40po TID at start of hospitalization), and to continue home insulin. Diabetes education was provided. Mr. Schmider was given ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, with a POTENTIALLY SERIOUS INTERACTION: WARFARIN & ASPIRIN, VITAMIN B12 (CYANOCOBALAMIN) 1,000 MCG PO QD, DIGOXIN 0.25 MG PO QD, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LASIX (FUROSEMIDE) 60 MG PO BID, OXYCODONE 5 MG PO Q6H PRN Pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, on order for ECASA PO (ref # 23344198), on order for LIPITOR PO (ref # 90217884), POTENTIALLY SERIOUS INTERACTION: WARFARIN & ATORVASTATIN CALCIUM Reason for override: home 40mg, METOPROLOL (SUST. REL.) 300 MG PO QD, on order for DILTIAZEM PO (ref # 68655693), POTENTIALLY SERIOUS INTERACTION: METOPROLOL TARTRATE & DILTIAZEM HCL Reason for override: home med, on order for TIAZAC PO (ref # 86614276), on order for DILTIAZEM SUSTAINED RELEASE PO (ref #, ACCUPRIL (QUINAPRIL) 20 MG PO QD, TIAZAC (DILTIAZEM EXTENDED RELEASE) 240 MG PO QAM, LIPITOR (ATORVASTATIN) 80 MG PO QD, POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & NIASPAN (NICOTINIC ACID SUSTAINED RELEASE) 1 GM PO QHS, LANTUS (INSULIN GLARGINE) 66 UNITS SC QPM, INSULIN LISPRO MIX 75/25 74 UNITS SC QAM, GLUCOMETER 1 EA SC x1, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM, as well as continue rate control with home meds, continue lipitor/niacin (incr lipitor 40---> | What is the current dose of glucometer | {
"answer_end": [
935
],
"answer_start": [
913
],
"text": [
"Glucometer 1 EA SC x1,"
]
} |
This 64-year-old patient had a past medical history of non-small cell lung cancer, status post XRT and chemotherapy, right MC embolic stroke, status post right carotid endarterectomy, Graves’ disease, depression, diabetes, hypertension, asthma, temporal lobe epilepsy, and history of subclavian steal syndrome. On admission, her blood pressure was 66/44, pulse of 100, respiratory rate normal, and blood sugar of 133. She was found to be difficult to arouse and had 1 gm of vancomycin, magnesium and Levaquin 500 mg. Her medication on admission included Mechanical soft diet, aspirin 81 mg, baclofen 5 mg t.i.d., B12 1000 mg daily, iron sulfate 325 mg daily, Cymbalta 20 mg p.o. b.i.d., Neurontin 100 mg b.i.d., Lamictal 200 mg b.i.d., Prilosec 20 daily, levothyroxine, Glucophage 500 once a day, Reglan 10 once a day, niacin 500 once a day, Senna 2 tabs b.i.d., Zocor 20 mg once a day, Nicoderm patch, Colace 100 mg p.o. b.i.d., Lopressor 100 mg p.o. b.i.d., lidoderm 5% patch to the low back, Tylenol, ducolox, Mylanta, lactulose, Seroquel 100 mg, prednisone 50 mg, and Dilaudid 1 mg. She completed a ten-day course of vancomycin for a MRSA urinary tract infection and was treated with tramadol and Tylenol for pain. Her laboratory data showed creatinine of 1, ALT 25, AST 35, hematocrit 33, white count 6.6, and platelets 241,000. She was covered with antibiotics initially, then transitioned over to a ciprofloxacin 700 mg p.o. b.i.d. regime for a total of 12 days for a presumed urinary tract infection. She had a significant polypharmacy and enumerable sedating medications, including baclofen, Dilaudid and trazodone. Her Cymbalta was continued per outpatient follow-up and her Lamictal, as well as her Cymbalta, were maintained for her history of depression. Neurologically, she had a left-sided hemiparesis, as well as agnosia on the left side, and her mental status included intermittent disorientation. She was maintained on Novolog sliding scale for diabetes, QTc monitored with serial EKGs, and prior use of Haldol and other antipsychotics for behavioral modification. She was also continued on a replacement dose levothyroxine for her history of Graves' and a history of radioiodine ablation. For behavioral modification, as well as intermittent agitation and disorientation, the patient was maintained on p.r.n. Seroquel 100 mg p.o. b.i.d., as well as Zydis 5 mg p.o. b.i.d. p.r.n., which was titrated from standing to p.r.n. over the course of her hospitalization in order to try to decrease any sedating medications that may be altering her alertness and orientation. | What medications if any has the patient tried for intermittent agitation in the past | {
"answer_end": [
1049
],
"answer_start": [
1033
],
"text": [
"Seroquel 100 mg,"
]
} |
This 90+-year-old male with a complex past medical history including CAD, CHF, AF and diabetes mellitus presented to the SICU for removal of chronically MRSA-infected mesh from prior abdominal surgery. He was intubated with etomidate, succinylcholine and kept sedated with Versed and fentanyl. He received intraoperative vancomycin and levofloxacin as well as 2200 mL of lactated Ringer's. In an attempt to reverse anticoagulation, one unit of FFP was begun but then aborted due to hypotension, which resolved with epinephrine injection, likely due to transfusion reaction. Another unit of FFP was administered, with platelets also given at the request of the Plastic Surgery Team in light of aspirin and Plavix, which were continued due to the patient's cardiac stents. Despite bolus Lasix, the patient did develop CHF with symptomatic pulmonary edema and increased oxygen requirement, concomitantly becoming delirious. He developed hypertension refractory to beta-blockade, calcium channel blockers and IV ACE inhibitors, and was thus placed on a nitroglycerin drip, a furosemide drip with ginger blood product resuscitation to address bleeding and an elevated INR, responding well to this regimen and aggressive pulmonary toilet. The patient was advanced to clear liquids, on medications including Amiodarone 200 mg p.o. daily, Calcium, Colace 100 mg by mouth t.i.d., Coumadin alternating doses of 4 mg and 3 mg, Diltiazem CD 360 mg p.o. daily, Aspirin 81 mg p.o. daily, Folate 1 mg p.o. daily, Lisinopril 10 mg p.o. daily, Metamucil p.r.n., Clopidogrel 75 mg p.o. daily, Potassium, Protonix 40 mg p.o. daily, Simvastatin 80 mg p.o. daily, Synthroid 25 mcg p.o. daily, Thiamine 100 mg p.o. daily, Metoprolol SR 100 mg p.o. b.i.d., Zyprexa 2.5 mg at bedtime p.r.n., and Vancomycin for MRSA-infected mesh. He does experience more significant delirium with morphine and less so with sparing Dilaudid p.r.n., and Haldol is written p.r.n. as needed. Weaning off nitroglycerin drip, nitro paste added, hematocrit 25%, one unit of packed red blood cells with Lasix and potassium to be given, RISS, and PICC line consult ordered for anticipated long-term vancomycin. Services following the patient include Medicine, Dr. Harcar, patient's PCP, Cardiology, Dr. Pagliari, and Plastic Surgery, Dr. Dunshie. Patient anticipated to be transferred to the floor on 9/28/06. | What is the current dose of the patient's protonix | {
"answer_end": [
1612
],
"answer_start": [
1586
],
"text": [
"Protonix 40 mg p.o. daily,"
]
} |
Dion Scarberry (926-57-39-3) was admitted on 9/0/2005 with a diagnosis of COPD flare and right heart failure and was discharged on 5/28/05 at 02:00 PM with a disposition of Home w/ services. He had a number of medications including Acetylsalicylic Acid 81mg PO QD Starting in AM (7/17), Elavil (Amitriptyline HCL) 10mg PO QHS, Atenolol 25mg PO QD Starting in AM (7/17), Colace (Docusate Sodium) 100mg PO BID, Furosemide 20mg PO QD Starting Today (6/25), Guaifenesin 10ml PO TID Starting Today (6/25) PRN Other:cough, Oxycodone 5mg PO TID Starting Today (6/25) PRN Pain, Quinine Sulfate 325mg PO HS Starting Today (6/25), Senna Tablets (Sennosides) 2 Tab PO BID, MVI Therapeutic (Therapeutic Multivitamins) 1 Tab PO QD, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 Reason for override: will monitor, Zocor (Simvastatin) 20mg PO QHS, Morphine Controlled Release 15mg PO Q12H, Felodipine 5mg PO QD Food/Drug Interaction Instruction, Flonase (Fluticasone Nasal Spray) 1 Spray INH QD, Advair Diskus 500/50 (Fluticasone Propionate/...) 1 Puff INH BID, Caltrate+D (Calcium Carbonate 1,500mg (600...) 1 Tab PO BID, Novolog Mix 70/30 (Insulin Aspart 70/30) 35 Units QAM; 22 Units QPM SC 35 Units QAM 22 Units QPM, Prednisone Taper PO Give 60mg q 24 h X 5 dose(s), then Give 50mg q 24 h X 3 dose(s), then Give 40mg q 24 h X 3 dose(s), then Give 30mg q 24 h X 3 dose(s), then Give 20mg q 24 h X 3 dose(s), then Give 10mg q 24 h X 3 dose(s), then Give 5mg q 24 h X 3 dose(s), then Starting Today (6/25), Combivent (Ipratropium and Albuterol Sulfate) 2 Puff INH QID. He was also given a diet of 4 gram Sodium, activity to resume regular exercise, and follow up appointment(s) with primary care doctor at the BCCMC early next week. He had allergies to Erythromycins and was given Azithromycin and supplemental O2 and Levofloxacin and admitted with a diagnosis of COPD flare. Home meds include Atenolol 25mg PO qd, HCTZ 25mg PO qd, Felodipine 5mg PO qd, Zocor 20mg PO qhs, ASA 81mg PO qd, Advair 1 puff bid, Combivent 2 puffs qid, Loratidine 10mg PO qd, Guqifenesin 600mg PO q12h, Morphine 15mg PO q8-12h, Percocet 1-2 tab PO q6h, Quinine Sulfate 325mg PO qhs, Colace 100mg PO bid, Senna 2 tab PO qd, Calcium+Vim D 125 units PO qd, Elavil 10mg PO qhs. He was treated for COPD flare with supplemental O2, DuoNebs, and steroids and received a V/Q scan which reported a low probability of PE, as well as a cardiac MRI which demonstrated normal cardiac anatomy and function, with an LVEF of 73% and no valvular dysfunction. His diabetes was managed with his home regimen of Novolog and chronic pain and insomnia were managed with his out-pt regimen of morphine and oxycodone, and he was given Elavil for sleep. Because of his history of cancer, he was placed on Lovenox for anticoagulation. Additional Comments include the instruction to use his home oxygen when sleeping at night, the addition of Combivent inhalers and a steroid taper to his medicines, and to stop the hydrochlorathiazide (HCTZ) 25mg and take Lasix 20mg once a day. His discharge condition was stable, and he was instructed to continue Lasix 40mg PO QD at home and D/C home HCTZ, to do a slow prednisone | has there been a prior vit. b-3 | {
"answer_end": [
817
],
"answer_start": [
774
],
"text": [
"VIT. B-3 Reason for override: will monitor,"
]
} |
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. | What does the patient take albuterol nebulizer for | {
"answer_end": [
1438
],
"answer_start": [
1337
],
"text": [
"Albuterol Nebulizer 2.5 mg Neb Q2H PRN Shortness of Breath, 3/0.5 mg Inh Q6H PRN Shortness of Breath,"
]
} |
The patient is a 55 year old male with a history of noninsulin dependent diabetes mellitus, a significant heavy smoking history, and a family history of cardiac disease who was admitted with chest pain and worsening right great toe ulceration with lymphangitis. He had completed a course of Cipro and was given a dose of oxacillin before being sent to Sidecrestso Community Hospital for IV antibiotics and work-up. MEDICATIONS ON ADMISSION included Tylenol #3 and glyburide 10 mg p.o. q. day. No known drug allergies. He was then treated for the right toe cellulitis with IV antibiotics of gentamicin and Clindamycin, and was placed on atenolol with the dose increased to 75 mg p.o. q. day. On discharge, the patient was switched from Nitropaste to Isordil 10 mg p.o. t.i.d., and his glyburide was increased to 20 mg p.o. q. day. MEDICATIONS ON DISCHARGE included atenolol, aspirin, 325 mg po q day, Glyburide, 20 mg po q day, Tylenol #3, two tablets po x one p.r.n. for pain, and sublingual nitroglycerin, p.r.n. The patient was discharged to home and was to follow-up with Dr. Netti as an outpatient and with Dr. Frasso of AMH Cardiology. | Has the patient ever had tylenol #3 | {
"answer_end": [
492
],
"answer_start": [
440
],
"text": [
"included Tylenol #3 and glyburide 10 mg p.o. q. day."
]
} |
Lucien Lebel, an 889-75-18-3 patient, was admitted to the medical service on 3/26/2005 with a CHF flare and discharged on 6/4/2005 with a full code status and disposition of home with services. Medications prescribed upon discharge included ACETYLSALICYLIC ACID 81 MG PO QD, ATENOLOL 50 MG PO QAM Starting Today July, ENALAPRIL MALEATE 10 MG PO QD, LASIX (FUROSEMIDE) 80 MG PO QD Starting Today November, NPH INSULIN HUMAN (INSULIN NPH HUMAN) 60 UNITS SC QAM and QPM, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, PAXIL (PAROXETINE) 50 MG PO QD, SEROQUEL (QUETIAPINE) 800 MG PO QPM, DEPAKOTE ER (DIVALPROEX SODIUM ER) 1,000 MG PO QPM, LIPITOR (ATORVASTATIN) 60 MG PO QD, and POTENTIALLY SERIOUS INTERACTION: WARFARIN & ATORVASTATIN CALCIUM Reason for override: mda. The patient had a history of Afib, Type 2 DM on insulin, CAD, s/p MI 2000, and A fib/flutter, and was given 25 mg PO Lopressor x 2 in the ED which brought her HR down to 110s. The patient was also prescribed a diet of low cholesterol and saturated fat, ADA 1800 calories per day, 2 grams of sodium, and to measure weight daily, as well as to resume regular exercise, and follow-up appointments were scheduled with Dorsey Deases on 11/2 at 2:30 PM, Dr. Lavern Bringhurst on 2/2, and Dr. Lesley Bertling to draw INR's every 7 days. The patient was advised to follow up with Sol Kragt, the CHF nurse, maintain a careful low salt diet, not drink too many fluids, measure daily weights, be strict about taking insulin, and seek medical attention for any concerning symptoms, with a number of doses required of approximate 4. | Has the patient ever tried coumadin | {
"answer_end": [
507
],
"answer_start": [
468
],
"text": [
"COUMADIN (WARFARIN SODIUM) 5 MG PO QPM,"
]
} |
Patient Emilio R. Strausberg was admitted on 5/26/2004 with atrial fibrillation and calcaneous fracture and was discharged on 7/18/2004 with discharge orders including ECASA (Aspirin Enteric Coated) 325 MG PO QD, with a potentially serious interaction with Warfarin, Vitamin B12 (Cyanocobalamin) 1,000 MCG PO QD, Digoxin 0.25 MG PO QD, Colace (Docusate Sodium) 100 MG PO BID, Lasix (Furosemide) 60 MG PO BID, Oxycodone 5 MG PO Q6H PRN Pain, Coumadin (Warfarin Sodium) 5 MG PO QPM, with a potentially serious interaction with Atorvastatin, Metoprolol (Sust. Rel.) 300 MG PO QD, Accupril (Quinapril) 20 MG PO QD, Tiazac (Diltiazem Extended Release) 240 MG PO QAM, Lipitor (Atorvastatin) 80 MG PO QD, with a potentially serious interaction with Niacin, Vit. B-3 and Calcium, Niaspan (Nicotinic Acid Sustained Release) 1 GM PO QHS, Lantus (Insulin Glargine) 66 UNITS SC QPM, Insulin Lispro Mix 75/25 74 UNITS SC QAM, Glucometer 1 EA SC x1, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM. Override notices were added on 6/9/04 with reasons such as heart, home med, and home emd. The patient was rate controlled with IV metoprolol and diltiazem, instructed to continue ASA, continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->80), continue lasix, 60 bid (was 40po TID at start of hospitalization), and to continue home insulin. Diabetes education was provided. Mr. Schmider was given ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, with a POTENTIALLY SERIOUS INTERACTION: WARFARIN & ASPIRIN, VITAMIN B12 (CYANOCOBALAMIN) 1,000 MCG PO QD, DIGOXIN 0.25 MG PO QD, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LASIX (FUROSEMIDE) 60 MG PO BID, OXYCODONE 5 MG PO Q6H PRN Pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, on order for ECASA PO (ref # 23344198), on order for LIPITOR PO (ref # 90217884), POTENTIALLY SERIOUS INTERACTION: WARFARIN & ATORVASTATIN CALCIUM Reason for override: home 40mg, METOPROLOL (SUST. REL.) 300 MG PO QD, on order for DILTIAZEM PO (ref # 68655693), POTENTIALLY SERIOUS INTERACTION: METOPROLOL TARTRATE & DILTIAZEM HCL Reason for override: home med, on order for TIAZAC PO (ref # 86614276), on order for DILTIAZEM SUSTAINED RELEASE PO (ref #, ACCUPRIL (QUINAPRIL) 20 MG PO QD, TIAZAC (DILTIAZEM EXTENDED RELEASE) 240 MG PO QAM, LIPITOR (ATORVASTATIN) 80 MG PO QD, POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & NIASPAN (NICOTINIC ACID SUSTAINED RELEASE) 1 GM PO QHS, LANTUS (INSULIN GLARGINE) 66 UNITS SC QPM, INSULIN LISPRO MIX 75/25 74 UNITS SC QAM, GLUCOMETER 1 EA SC x1, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM, as well as continue rate control with home meds, continue lipitor/niacin (incr lipitor 40---> | Has patient ever been prescribed coumadin ( warfarin sodium ) | {
"answer_end": [
480
],
"answer_start": [
441
],
"text": [
"Coumadin (Warfarin Sodium) 5 MG PO QPM,"
]
} |
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 hydrochlorothiazide | {
"answer_end": [
586
],
"answer_start": [
555
],
"text": [
"Hydrochlorothiazide 25 mg q.d.,"
]
} |
This is a 59-year-old female with a history of rheumatic heart disease, endocarditis, diabetes mellitus, hypertension, and congestive heart failure who presented with increasing shortness of breath, nausea, vomiting, and abdominal pain. She was given recent Levaquin for an upper respiratory tract infection, then started on Flagyl for a possible C. difficile infection and was diuresed with IV Lasix with good output per report. She complained of 10/10 abdominal pain and was given some Dilaudid. Her hematocrit at one point required two units of packed red blood cells, and she was placed on a heparin drip at 950 units per hour to maintain a PTT between 60 and 80 secondary to atrial fibrillation that has been rate controlled with a beta-blocker. She was discharged on diltiazem 30 mg q.i.d. and a normal dosing of Nexium 40 mg p.o. q.d. while in-house. She was given Darvon and Codeine as needed for pain, and was prescribed Caltrate plus Vitamin D 600 mg, Maalox tablets, Magnesium oxide 400 mg, Multivitamin, Niferex 150 mg, and Lovenox 60 mg subcutaneously b.i.d. with a renal adjustment and NovoLog 15 units subcutaneously with breakfast and dinner. The patient was instructed to call Dr. Mccutchan office to coordinate her appointment for her valve repair in the next one to two weeks pending her surgeon's return and to call Dr. Doug Schlanger on March 2005 to discuss surgical plans and also to follow up. All her blood cultures should be followed up prior to her surgery and if any of her blood cultures become positive in the interim, a long course of antibiotic therapy should be started and surgery should be delayed at the discussion of the Cardiovascular Service. Her medications included Lasix 40 mg p.o. q.o.d. alternating with 80 mg p.o. Lasix q.o.d., Digoxin 0.125 mg q.o.d. alternating with 0.25 q.o.d., Lisinopril 20 mg p.o. q.d., Coumadin 6 mg p.o. q.o.d. alternating with 4 mg q.o.d., Omeprazole 20 mg b.i.d., Metformin 500 mg daily, Insulin 70/30 65 units q.a.m., 35 units q.p.m., Calcium 600 mg p.o. b.i.d., Magnesium 400 mg p.o. b.i.d., Multivitamin, Iron tablets, Actonel every Wednesday, Caltrate plus vitamin D 600 mg one tablet p.o. b.i.d., Maalox tablets quick dissolve, Magnesium oxide 400 mg p.o. b.i.d., Niferex 150 mg p.o. b.i.d., Colace 100 mg p.o. b.i.d., Senokot three tablets p.o. b.i.d., Codeine 15 mg to 30 mg p.o. q.4h. p.r.n. pain. She was required to increase her dosage of Nexium secondary to GERD-like symptoms and was maintained on a stable regimen of NPH 60 units in the morning, NPH 30 units in the evening, and NovoLog of 15 units in the morning with breakfast and 15 at dinner with a sliding scale. She was also transitioned to Lovenox 60 mg b.i.d. with a renal adjustment and was sent to the ED for diuresis where she was given 60 mg of Lasix. | What was the dosage prescribed of caltrate plus vitamin d | {
"answer_end": [
961
],
"answer_start": [
915
],
"text": [
"was prescribed Caltrate plus Vitamin D 600 mg,"
]
} |
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. | Previous levofloxacin | {
"answer_end": [
2552
],
"answer_start": [
2478
],
"text": [
"20 mEq b.i.d., fluticasone 44 mcg inhaled b.i.d., levofloxacin 500 mg q.d."
]
} |
The patient, a 60M with newly-diagnosed DM, hyperlipidemia, glaucoma, h/o EtOH abuse, and erectile dysfunction, presented to the ED for the second time in 3 days with unsteadiness and sleepiness. Workup including head CTA and MRI were negative, and he was discharged with Metformin and plans for Holter and TTE. He returned to the ED with BS 277. No fevers, headaches, focal neuro findings, vertigo, visual changes, CP, SOB, n/v, abd pain, dysuria, or joint pain were found. Labs were significant for glucose 314, elevated lipids (Chol 302, Trig 323, LDL 189), and HbA1c 11.1%. EKG had old j-point elevation laterally, physical and neuro exam were normal. Explanations for episodes considered were TIA of posterior circulation vs. seizure, less likely atypical migraine or sleep disorder. At the time of discharge, the patient was stable and feeling very good. He was given ACETYLSALICYLIC ACID 81 MG PO DAILY, LIPITOR (ATORVASTATIN) 10 MG PO DAILY, GLYBURIDE 2.5 MG PO DAILY X 60 doses, METFORMIN 500 MG PO BID, a low-fat house diet, and acyclovir this week but stopped Wed for possible neuro side effects. Aspirin dose was increased from 81 mg to 325 mg qd and a prescription for an automatic BP cuff for monitoring at home was given. To better manage blood sugars, glyburide was added which should be taken once a day in addition to metformin twice a day, and he should check his blood sugars 3-4 times per day. He will followup with Dr. Clesen on Monday, and will be evaluated this week with TTE with bubble-study to r/o intracardiac source or PFO and EEG if Neurology deems possibility of seizure. | Has a patient had metformin | {
"answer_end": [
1012
],
"answer_start": [
988
],
"text": [
"METFORMIN 500 MG PO BID,"
]
} |
The patient, a 77 year old woman, was admitted with complaint of urinary frequency and AMS. She has a possible allergy to Penicillins with a reaction of RASH and cannot tolerate floroquinolones. She was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, LISINOPRIL 10 MG PO QD Starting Today ( 6/25 ), KCL SLOW RELEASE PO ( ref # 761602437 ), TOPROL XL ( METOPROLOL SUCCINATE EXTENDED RELEASE ) 100 MG PO BID HOLD IF: hr<55 , sbp<95, LANTUS ( INSULIN GLARGINE ) 19 UNITS QAM SC QAM Starting Today ( 6/17 ), WARFARIN SODIUM 5 MG PO QPM Starting ROUTINE , 20:00 ( Standard Admin Time ), ROSIGLITAZONE 2 MG PO QD, FUROSEMIDE 20 MG PO BID Starting Today ( 6/25 ) PRN Other:LE edema, SIMVASTATIN 10 MG PO QHS, CEFPODOXIME PROXETIL 200 MG PO BID X 16 doses Starting Today ( 6/25 ) HOLD IF: rash, and DIGOXIN 0.125 MG PO QOD with Food/Drug Interaction Instruction to Give with meals. Her AFIB became tachy to 140's with an elevated troponin to 1.69 which rose to a max of 2.41 with no EKG changes and was rate controlled and started on Levofloxacin. She was given 2 doses of vancomycin to cover potential staph infection and had an adenosine MIBI that showed no perfusion defects. Her INR was increasing due to the levofloxacin effect and was switched to ceftriaxone consistant with blood culture succeptabilities. Follow up blood cultures on 0/27 demostrated gram positive cocci in clusters and antibiotics were d/c'd after repeat cultures were negative. Her cardiac workup included an echocardiogram with RV dialation and wall akinesis with apical sparing , a new finding since last echo in '03. We have altered cardiac medications for better rate control by cancelling the coreg( carvedelol ) and Norvasc( amilodipine ) and replacing them with a blood pressure medication, Toprol XL( Metoprolol XL ) to better control the rate of her atrial fibrillation and the digoxin was also added for heart rate control. The patient was discharged in good condition and was given instructions to take the full course of antibiotics which cover the next 8days, to take medications with meals or on empty stomach and to avoid high Vitamin-K containing foods, to call PCP with any changes in urinary symptoms, or fever >101.0, return to ER if any changes in mental status, chest pain, SOB, or syncope, and follow-up with PCP within the next week with INR and digoxin levels. Do not use lasix unless necessary and contact PCP if using more than 1-2 times per week due to possible toxicity with digoxin use. | Has this patient ever been prescribed cefpodoxime proxetil | {
"answer_end": [
750
],
"answer_start": [
705
],
"text": [
"CEFPODOXIME PROXETIL 200 MG PO BID X 16 doses"
]
} |
The 68-year-old female patient presented with lower extremity swelling and erythema at the lower pole of her sternal wound, and her past medical history includes hypertension, diabetes, hypothyroidism, hypercholesterolemia, COPD, GERD, depression, history of GI bleed on Coumadin therapy, and pulmonary hypertension. On admission, the patient was started on 1. Toprol 25 p.o. daily., 2. Valsartan 40 mg p.o. daily., 3. Aspirin 81 mg p.o. daily., 4. Plavix 75 mg p.o. daily., 6. Lasix 40 mg p.o. b.i.d., 7. Spironolactone 25 mg p.o. daily., 8. Simvastatin 20 mg p.o. daily., 9. Nortriptyline 50 mg p.o. daily., 10. Fluoxetine 20 mg p.o. daily., 11. Synthroid 88 mcg p.o. daily., and a Lasix drip and Diuril with antibiotics for coverage of possible lower extremity cellulitis. After transthoracic echocardiogram revealed an ejection fraction of 40% to 45% and a stable mitral valve, the patient was started on a Lasix drip and Diuril with improvement of symptoms, and the Pulmonary team was consulted and recommended regimen of Advair and steroid taper for her COPD, and she was empirically covered for pneumonia with levofloxacin and Flagyl and continued to diurese well on a Lasix drip. Her preadmission cardiac meds, as well as her Coumadin for atrial fibrillation, were restarted, and the patient required ongoing aggressive diuresis to eventually achieve a fluid balance of is negative 1 liter daily. Liver function tests, as well as amylase and lipase, were checked and noted to be normal, and the patient's nausea and vomiting resolved when her bowels began to move. The patient was discharged to home in good condition on hospital day #8 with medications including Enteric-coated aspirin 81 mg p.o. daily, Zetia 10 mg p.o. daily, Fluoxetine 20 mg p.o. daily, Advair Diskus one puff nebulized b.i.d., Lasix 60 mg p.o. b.i.d., NPH insulin 30 units subcutaneously q.p.m., NPH insulin 20 units subcutaneously q.a.m., Potassium slow release 30 mEq p.o. daily, Levofloxacin 500 mg p.o. q.24 h. x4 doses, Levothyroxine 88 mcg p.o. daily, Toprol-XL 100 mg p.o. daily, Nortriptyline 50 mg p.o. nightly, Prednisone taper 30 mg q.24 h. x3 doses, 20 mg q.24 h. x3 doses followed by a 10 mg q.24 h. x3 doses, then 5 mg q.24 h. x3 doses, Simvastatin 40 mg p.o. nightly, Diovan 20 mg p.o. daily, and Coumadin to be taken as directed to maintain INR 2 to 2.5 for atrial fibrillation, with followup appointments with her cardiologist, Dr. Schwarzkopf in one to two weeks with her cardiac surgeon, Dr. Carlough in four to six weeks, and VNA will monitor her vital signs, weight, and wounds, and the patient's INR and Coumadin dosing will be followed by S Community Hospital Anticoagulation Service at 300-135-5841. | Has this patient ever been on enteric-coated aspirin | {
"answer_end": [
1712
],
"answer_start": [
1672
],
"text": [
"Enteric-coated aspirin 81 mg p.o. daily,"
]
} |
Mr. Barriger is a 73-year-old gentleman who was admitted to the Cardiac Step-Down Floor after being a restrained driver in a motor vehicle collision. His past medical history includes myocardial infarction, hypertension, hypercholesterolemia, diabetes, renal cyst, and cataract, and a past surgical history of coronary stenting and cataract removal. He was prescribed Glyburide 100 mg p.o. b.i.d., Metformin 500 mg p.o. b.i.d., Aspirin 81 mg p.o. q. day., Zocor 80 mg p.o. q. day., Plavix 75 mg p.o. q. day., Prilosec 20 mg p.o. q. day., Isosorbide dinitrate 40 mg p.o. t.i.d., Atenolol 100 mg p.o. q. day., Tylenol 650 mg p.o. q.4h. p.r.n. pain., Colace 100 mg p.o. b.i.d., Ativan 1-2 mg IV p.r.n. anxiety., Oxycodone 5-10 mg p.o. q.6h. p.r.n. pain., Senna tablets 2 p.o. b.i.d., Keflex 250 mg p.o. q.i.d. x12 doses. Keflex should be completed on Monday night., Ambien 5 mg p.o. q.h.s., Tessalon 100 mg p.o. t.i.d. p.r.n. cough., Novalog slides., Maalox 1-2 tabs p.o. q.6h. p.r.n. pain. and Dilaudid 1-2 mg IV q.4h. p.r.n. pain. for pain control. He was also put on Lovenox 40 mg sub-Q. q. day for DVT prophylaxis and aspirin and Plavix for secondary cardiac and neurological prophylaxis. He was also started on Ancef 1 gm q.8h. with a PICC line which was placed later on the day. His pain was well controlled with the combination of Dilaudid and oxycodone and he was encouraged to take several deep breaths per hour to reduce the risk of atelectasis or pneumonia. He was seen by numerous consultants, and his white count improved dramatically and he was afebrile for more than 48 hours while on the Ancef. He was discharged to rehab with appointments with the mentioned doctors. | Why did the patient need maalox | {
"answer_end": [
988
],
"answer_start": [
948
],
"text": [
"Maalox 1-2 tabs 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 has patient been on for his incontinence in the past | {
"answer_end": [
512
],
"answer_start": [
436
],
"text": [
"he was treated with seven days of Bactrim for resolution of his incontinence"
]
} |
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 plaquenil ( hydroxychloroquine ) | {
"answer_end": [
1525
],
"answer_start": [
1480
],
"text": [
"PLAQUENIL (HYDROXYCHLOROQUINE) 200 MG PO BID,"
]
} |
A 79-year-old male with history of non-insulin dependent diabetes, coronary artery disease, congestive heart failure, hypertension, chronic renal failure, and left toe amputation on 7/1/06 was admitted for debridement and antibiotics. An MRA on 10/3/06 demonstrated on the right a multifocal high-grade stenosis of the proximal, anterior tibial, the tibioperoneal trunk and the proximal, posterior tibial arteries and included peroneal artery at the midcalf, two-vessel runoff and on the left diffuse high-grade stenoses of the anterior tibial, posterior tibial arteries and occlusion of the peroneal artery in the dorsalis pedis. The patient presented with bleeding from the site of the left toe amputation beginning two weeks ago associated with throbbing pain, soreness, erythema and swelling and exacerbated blood pressure when walking and only treated by narcotics. Neuro and Psych: The patient has delirium postoperatively for which he was placed on soft restraints and received Zyprexa. Cardiac: Upon admission, potassium was noted to be elevated and the patient had EKG changes associated with hyperkalemia and received Aspirin, Lopressor, Norvasc, Zocor, Plavix, PhosLo, Prandin for coronary artery disease related event prophylaxis. Blood pressure was controlled with isosorbide dinitrate, Norvasc, lisinopril, and Lopressor. Pulmonary: No events. Maintained oxygen saturation greater than 90% on room air. Renal: Creatinine was stable in the mid 3s and trended down to 2.6 at the time of discharge below his baseline of 4-5. Voiding without difficulty at the time of discharge. Maintained on his renal medications. FEN/GI: Tolerated regular diet. Lactulose and Colace to prevent constipation while taking narcotics, also had Dulcolax p.r.n. Zinc and Vitamin C was started per the Nutrition consult. Hematology: He received heparin for DVT prophylaxis. His hematocrit remained stable. He had some oozing from the right thigh but this resolved with a pressure dressing. ID: He was treated throughout his hospitalization with vancomycin, levofloxacin and Flagyl for methicillin-resistant Staphylococcus aureus that grew from the wound after the first and second irrigation and debridement. The levofloxacin and Flagyl were discontinued prior to discharge. He will continue his vancomycin at the time of discharge. Endocrine: Diabetes controlled. He was maintained on his Prandin and insulin sliding scale for glycemic control. He also received Vitamin D, Calcitriol, Nephrocaps, Epogen, and Aranesp. His incision remained clean, dry and intact without erythema or exudate. He was afebrile with stable signs at the time of discharge. ACTIVITY INSTRUCTIONS: He is nonweightbearing on the left lower extremity to protect the open toe. COMPLICATIONS: None. DISCHARGE LABS: Laboratory tests at the time of discharge include sodium 138, potassium 4.1, chloride 111, bicarbonate 21, BUN 35, creatinine 2.6, calcium 9.0, magnesium 1.9, vancomycin 19.5, white blood cell count 7.3, hemoglobin 9.9, hematocrit 30.2, platelets 221. DISCHARGE MEDICATIONS: His medications at discharge include aspirin 325 mg p.o. daily, vitamin C 500 mg p.o. b.i.d., calcitriol 0.5 mcg p.o. daily, Colace 100 mg p.o. daily, heparin 5000 units subcutaneous t.i.d., isosorbide dinitrate 10 mg p.o. t.i.d., lactulose 30 mL p.o. t.i.d., lisinopril 50 mg p.o. daily, Lopressor 50 mg p.o. q.6h., Prandin 0.5 mg p.o. with each meal, Aranesp 40 mcg subcutaneous every week, sliding scale insulin, insulin aspart 4 units, Tylenol p.r.n., Dilaudid 2-4 mg p.o. q.4h. as needed for pain, milk of magnesia as needed for constipation, Reglan for nausea, oxycodone for pain 5-10 mg p.o. q.4h. hours | Is there history of use of phoslo | {
"answer_end": [
1187
],
"answer_start": [
1128
],
"text": [
"Aspirin, Lopressor, Norvasc, Zocor, Plavix, PhosLo, Prandin"
]
} |
Patient Emilio R. Strausberg was admitted on 5/26/2004 with atrial fibrillation and calcaneous fracture and was discharged on 7/18/2004 with discharge orders including ECASA (Aspirin Enteric Coated) 325 MG PO QD, with a potentially serious interaction with Warfarin, Vitamin B12 (Cyanocobalamin) 1,000 MCG PO QD, Digoxin 0.25 MG PO QD, Colace (Docusate Sodium) 100 MG PO BID, Lasix (Furosemide) 60 MG PO BID, Oxycodone 5 MG PO Q6H PRN Pain, Coumadin (Warfarin Sodium) 5 MG PO QPM, with a potentially serious interaction with Atorvastatin, Metoprolol (Sust. Rel.) 300 MG PO QD, Accupril (Quinapril) 20 MG PO QD, Tiazac (Diltiazem Extended Release) 240 MG PO QAM, Lipitor (Atorvastatin) 80 MG PO QD, with a potentially serious interaction with Niacin, Vit. B-3 and Calcium, Niaspan (Nicotinic Acid Sustained Release) 1 GM PO QHS, Lantus (Insulin Glargine) 66 UNITS SC QPM, Insulin Lispro Mix 75/25 74 UNITS SC QAM, Glucometer 1 EA SC x1, Maalox-Tablets Quick Dissolve/Chewable 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM. Override notices were added on 6/9/04 with reasons such as heart, home med, and home emd. The patient was rate controlled with IV metoprolol and diltiazem, instructed to continue ASA, continue rate control with home meds, continue lipitor/niacin (incr lipitor 40--->80), continue lasix, 60 bid (was 40po TID at start of hospitalization), and to continue home insulin. Diabetes education was provided. Mr. Schmider was given ECASA (ASPIRIN ENTERIC COATED) 325 MG PO QD, with a POTENTIALLY SERIOUS INTERACTION: WARFARIN & ASPIRIN, VITAMIN B12 (CYANOCOBALAMIN) 1,000 MCG PO QD, DIGOXIN 0.25 MG PO QD, COLACE (DOCUSATE SODIUM) 100 MG PO BID, LASIX (FUROSEMIDE) 60 MG PO BID, OXYCODONE 5 MG PO Q6H PRN Pain, COUMADIN (WARFARIN SODIUM) 5 MG PO QPM, on order for ECASA PO (ref # 23344198), on order for LIPITOR PO (ref # 90217884), POTENTIALLY SERIOUS INTERACTION: WARFARIN & ATORVASTATIN CALCIUM Reason for override: home 40mg, METOPROLOL (SUST. REL.) 300 MG PO QD, on order for DILTIAZEM PO (ref # 68655693), POTENTIALLY SERIOUS INTERACTION: METOPROLOL TARTRATE & DILTIAZEM HCL Reason for override: home med, on order for TIAZAC PO (ref # 86614276), on order for DILTIAZEM SUSTAINED RELEASE PO (ref #, ACCUPRIL (QUINAPRIL) 20 MG PO QD, TIAZAC (DILTIAZEM EXTENDED RELEASE) 240 MG PO QAM, LIPITOR (ATORVASTATIN) 80 MG PO QD, POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & NIASPAN (NICOTINIC ACID SUSTAINED RELEASE) 1 GM PO QHS, LANTUS (INSULIN GLARGINE) 66 UNITS SC QPM, INSULIN LISPRO MIX 75/25 74 UNITS SC QAM, GLUCOMETER 1 EA SC x1, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, and Insulin Lispro Mix 75/25 54 UNITS SC QPM, as well as continue rate control with home meds, continue lipitor/niacin (incr lipitor 40---> | What medicines have previously been tried for rate control | {
"answer_end": [
1276
],
"answer_start": [
1211
],
"text": [
"instructed to continue ASA, continue rate control with home meds,"
]
} |
Patient Damion Prehn, a 60 year old male with coronary artery disease, hypertension, and hyperlipidemia, was admitted with increasing shortness of breath and intermediate MIBI as an outpatient in the setting of significant deconditioning and multiple cardiac risk factors. In the ED, his temperature was 98.6, his pulse was 70, his blood pressure was 141/69, and his saturation was 94% on room air. He was given ASA and Keflex for LE cellulitis, and his cardiac markers were negative. A cath revealed Subtotal RCA occlusion, 80% OM, and 50% mid LAD, and Cypher stents were placed in mid RCA to os and wedge elevated. EF 45% on stress echo and monitoring revealed 2 episodes of NSVT post-PCI. He was started on Atenolol 125 mg PO daily, Lipitor (Atorvastatin) 80 mg PO daily, Keflex (Cephalexin) 500 mg PO QID, Plavix (Clopidogrel) 75 mg PO daily, Enteric Coated ASA 325 mg PO daily, Lasix (Furosemide) 80 mg PO BID, Potassium Chloride Slow Rel. (KCL Slow Release) 10 MEQ PO daily, LISINOPRIL 5 MG PO DAILY, MICONAZOLE NITRATE 2% CREAM TP BID, MICONAZOLE NITRATE 2% POWDER TOPICAL TP BID, NIASPAN (NICOTINIC ACID SUSTAINED RELEASE) 0.5 GM PO QPM with instructions to take aspirin 30 minutes before-hand to prevent facial flushing. Alerts were overridden due to SERIOUS INTERACTION: MICONAZOLE NITRATE & ATORVASTATIN CALCIUM, POTENTIALLY SERIOUS INTERACTION: NIACIN, VIT. B-3 & ATORVASTATIN CALCIUM, POTENTIALLY SERIOUS INTERACTION: LISINOPRIL & POTASSIUM CHLORIDE, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & MICONAZOLE NITRATE, POTENTIALLY SERIOUS INTERACTION: SIMVASTATIN & NIACIN, VIT. B-3 and POTENTIALLY SERIOUS INTERACTION: POTASSIUM CHLORIDE & LISINOPRIL. He was discharged on 9/23/06 with code status full code and disposition home, a diet of house/low chol/low sat. fat, and instructions to measure weight daily and resume regular exercise. Follow up appointments were scheduled with Dr. Weakland, Primary Care 1-2 weeks and Dr. Trouser, Cardiology 571-491-1951 Please call in 1-2 days if you do not hear from the office. You must be seen in 2-4 weeks. Allergy is to Shellfish. ASA/Plavix were continued at current doses x 1 year, increased lasix from 40 mg PO daily to 80 mg PO BID, increased b-blocker, continued norvasc, and stopped isordil. Low dose potassium 10mEq was started as increased lasix, and lisinopril 5mg PO daily was started to prevent facial flushing. Patient was instructed to take aspirin 30 minutes before hand to prevent serious interaction between miconazole nitrate and atorvastatin calcium/simvastatin, and potassium chloride immediate rel. PO was ordered. Instructions were given to continue toe cream, check lytes in 2 days, and come to the ER if any concerning symptoms such as trouble breathing, chest pain, or leg swelling. Do NOT discontinue these medications without speaking to your doctor. | Has a patient had aspirin | {
"answer_end": [
1229
],
"answer_start": [
1150
],
"text": [
"instructions to take aspirin 30 minutes before-hand to prevent facial flushing."
]
} |
A 79-year-old male with history of non-insulin dependent diabetes, coronary artery disease, congestive heart failure, hypertension, chronic renal failure, and left toe amputation on 7/1/06 was admitted for debridement and antibiotics. An MRA on 10/3/06 demonstrated on the right a multifocal high-grade stenosis of the proximal, anterior tibial, the tibioperoneal trunk and the proximal, posterior tibial arteries and included peroneal artery at the midcalf, two-vessel runoff and on the left diffuse high-grade stenoses of the anterior tibial, posterior tibial arteries and occlusion of the peroneal artery in the dorsalis pedis. The patient presented with bleeding from the site of the left toe amputation beginning two weeks ago associated with throbbing pain, soreness, erythema and swelling and exacerbated blood pressure when walking and only treated by narcotics. Neuro and Psych: The patient has delirium postoperatively for which he was placed on soft restraints and received Zyprexa. Cardiac: Upon admission, potassium was noted to be elevated and the patient had EKG changes associated with hyperkalemia and received Aspirin, Lopressor, Norvasc, Zocor, Plavix, PhosLo, Prandin for coronary artery disease related event prophylaxis. Blood pressure was controlled with isosorbide dinitrate, Norvasc, lisinopril, and Lopressor. Pulmonary: No events. Maintained oxygen saturation greater than 90% on room air. Renal: Creatinine was stable in the mid 3s and trended down to 2.6 at the time of discharge below his baseline of 4-5. Voiding without difficulty at the time of discharge. Maintained on his renal medications. FEN/GI: Tolerated regular diet. Lactulose and Colace to prevent constipation while taking narcotics, also had Dulcolax p.r.n. Zinc and Vitamin C was started per the Nutrition consult. Hematology: He received heparin for DVT prophylaxis. His hematocrit remained stable. He had some oozing from the right thigh but this resolved with a pressure dressing. ID: He was treated throughout his hospitalization with vancomycin, levofloxacin and Flagyl for methicillin-resistant Staphylococcus aureus that grew from the wound after the first and second irrigation and debridement. The levofloxacin and Flagyl were discontinued prior to discharge. He will continue his vancomycin at the time of discharge. Endocrine: Diabetes controlled. He was maintained on his Prandin and insulin sliding scale for glycemic control. He also received Vitamin D, Calcitriol, Nephrocaps, Epogen, and Aranesp. His incision remained clean, dry and intact without erythema or exudate. He was afebrile with stable signs at the time of discharge. ACTIVITY INSTRUCTIONS: He is nonweightbearing on the left lower extremity to protect the open toe. COMPLICATIONS: None. DISCHARGE LABS: Laboratory tests at the time of discharge include sodium 138, potassium 4.1, chloride 111, bicarbonate 21, BUN 35, creatinine 2.6, calcium 9.0, magnesium 1.9, vancomycin 19.5, white blood cell count 7.3, hemoglobin 9.9, hematocrit 30.2, platelets 221. DISCHARGE MEDICATIONS: His medications at discharge include aspirin 325 mg p.o. daily, vitamin C 500 mg p.o. b.i.d., calcitriol 0.5 mcg p.o. daily, Colace 100 mg p.o. daily, heparin 5000 units subcutaneous t.i.d., isosorbide dinitrate 10 mg p.o. t.i.d., lactulose 30 mL p.o. t.i.d., lisinopril 50 mg p.o. daily, Lopressor 50 mg p.o. q.6h., Prandin 0.5 mg p.o. with each meal, Aranesp 40 mcg subcutaneous every week, sliding scale insulin, insulin aspart 4 units, Tylenol p.r.n., Dilaudid 2-4 mg p.o. q.4h. as needed for pain, milk of magnesia as needed for constipation, Reglan for nausea, oxycodone for pain 5-10 mg p.o. q.4h. hours | Has the pt. ever been on aranesp before | {
"answer_end": [
3403
],
"answer_start": [
3369
],
"text": [
"Prandin 0.5 mg p.o. with each meal"
]
} |
The patient is a 61-year-old man with a history of ischemic cardiomyopathy and congestive heart failure, who was initially treated with afterload reduction, digoxin and Lasix. A PA line was placed with RA 8, RV 76/4, TA 80/36, pulmonary capillary wedge pressure 34, and cardiac index 1.49. He was then treated with dobutamine, intravenous TNG, and nitroprusside with symptomatic relief and hemodynamic stabilization with wedge pressure falling to 18. TNG and Nipride were successfully weaned, however, the patient remained dobutamine dependent. One week prior to transfer, the patient was admitted to Ment Hospital for management of his congestive heart failure and grew gram positive cocci from two blood cultures. He was then started on vancomycin and defervesced, and subsequently grew gram negative rods in one out of four blood culture specimens. These were gram negative enteric rods, pan-sensitive, for which the patient was started on ampicillin 2 gm IV q. 6. At the time of discharge, the patient was stable, dobutamine dependent, without chest pain, able to ambulate from chair to commode without shortness of breath, palpitations, or light-headedness. His medications at time of discharge included dobutamine at 15 mcg per kilogram per minute; captopril 25 mg p.o. t.i.d.; digoxin 0.125 mg p.o. q.d.; Lasix 160 mg p.o. b.i.d.; potassium chloride 20 mEq p.o. b.i.d.; Coumadin 1 mg p.o. q.d.; Atrovent, two puffs q.i.d.; Azmacort, eight puffs b.i.d.; Pepcid 20 mg p.o. b.i.d.; Colace 100 mg p.o. t.i.d.; vancomycin 1 gm q. 12, discontinued 9-23 a.m. after 14 days; ampicillin 2 gm IV q. 6 (24 of June equals day number five); Halcion 0.125 p.o. q.h.s. prn; Serax 15 mg p.o. q. 6 hours prn. The patient's condition at time of discharge is fair and will be continuing care in the coronary care unit of the hospital inpatient near patient's home under the care of Doctor Daren Swasey. | Why is the patient prescribed digoxin | {
"answer_end": [
175
],
"answer_start": [
29
],
"text": [
"man with a history of ischemic cardiomyopathy and congestive heart failure, who was initially treated with afterload reduction, digoxin and Lasix."
]
} |
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. | What was the dosage prescribed of diltiazem | {
"answer_end": [
907
],
"answer_start": [
880
],
"text": [
"taking Diltiazem 60 t.i.d.,"
]
} |
This 75-year-old female vasculopath was admitted for further evaluation of her peripheral vascular disease which was suspected to be contributing to her new ulcerations and progressively worsening bilateral foot pain, foot mottling and wrist pain as an exacerbating factor to likely atheroembolic phenomenon, status post coronary catheterizations earlier in the year. She was placed on broad-spectrum antibiotics and plan was made for an MRA to evaluate her anatomy, unfortunately, the patient was unable to tolerate the MR and did experience some mental status changes that prevented further noninvasive imaging when she received some narcotic following her hemodialysis round. Over the ensuing days she required rather significant doses of Zyprexa and Haldol to contain agitation and delirium, as the patient would also get physical and violent. This appeared to sedate her sufficiently and over the following days, she did manage to calm significantly and returned to her baseline mental status. Cardiology was consulted during this time to optimize her prior to the OR and her primary cardiologist, Dr. Fugle, did make some recommendations including an echocardiogram that showed preserved ejection fraction and no wall motion abnormalities. Her beta blockade was titrated up and she was instructed to follow up with cardiology. She did tolerate hemodialysis throughout this time without undue difficulty and they offered an angiogram to delineate aortic and bilateral lower extremity runoff anatomy. After extensive discussions with the patient and the patient's family, the patient did agree to a left femoral to dorsalis pedis bypass graft which was performed on 0/25/2006 without complication. By time of discharge, she was tolerating a regular diet and ambulating at baseline with her rolling walker. The pain was well controlled with minimal analgesics that were not narcotic based. Medications on admission included Aspirin 325 mg p.o. daily, Plavix 75 mg p.o. daily, Cardizem 60 mg p.o. t.i.d., Lipitor 80 mg daily, Atrovent 2 puffs four times a day, Albuterol 2 puffs b.i.d., Renagel 806 mg p.o. every meal, Allopurinol 100 mg p.o. daily, Zaroxylyn 2.5 mg p.o. daily p.r.n. overload, Lantus 10 units subcutaneous nightly, Regular insulin sliding scale, Valium 5 mg p.o. b.i.d. p.r.n., Isordil 40 mg p.o. t.i.d., Hydralazine 20 mg p.o. t.i.d., Lopressor 75 mg p.o. t.i.d., Zantac 150 mg p.o. b.i.d., Aciphex 20 mg p.o. daily, Neurontin 300 mg p.o. post-dialysis, Metamucil, Nitroglycerine p.r.n., Procrit 40,000 units subcutaneously every week, Lilly insulin pen, unknown dosage 20 units every morning and 10 units every evening, Loperamide 2 tabs p.o. four times a day, Ambien 10 mg p.o. nightly p.r.n., Tylenol 325 mg p.o. every four hours p.r.n. pain, Albuterol inhaler 2 puffs b.i.d., Calcitriol 1.5 mcg p.o. every Monday and every Friday, Darbepoetin alfa 100 mcg subcutaneous every week, Ferrous sulfate 325 mg p.o. t.i.d., Prozac 40 mg p.o. daily, Motrin 400 mg p.o. every eight hours p.r.n. pain, Insulin regular sliding scale, and Sevelamer 800 mg p.o. t.i.d. Discharge instructions included touchdown weightbearing on the left heel, legs are to be elevated as much as possible while sitting or lying down, all home medications were to be resumed except for Lopressor, VNA was ordered to assist with wound care including Betadine paint to incisions daily, showering only, no bathing or immersion in water for prolonged periods of time, and follow-up visits with Dr. Amorose in one to two weeks and Dr. Morici primary care physician in one week. | has the patient used zyprexa in the past | {
"answer_end": [
760
],
"answer_start": [
701
],
"text": [
"she required rather significant doses of Zyprexa and Haldol"
]
} |
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 medications have been previously used for the treatment of pain | {
"answer_end": [
1219
],
"answer_start": [
1147
],
"text": [
"iron 325 mg p.o. t.i.d., Percocet 1 to 2 tablets p.o. q.4h. p.r.n. pain,"
]
} |
A 60 year old Spanish speaking woman with multiple cardiac risk factors and a two to three year history of exertional angina presented complaining of unstable chest pain. Dr. Maximo Bryum in C&O MEDICAL CENTER Clinic initiated an antianginal regimen, however the patient recently stopped taking Aspirin and her symptoms then recurred. The patient was given three sublingual Nitroglycerins after her primary M.D. was called and her pain resolved after approximately 15 minutes. On the 27 of January, 1995, the patient underwent a Dobutamine MIBBE on which she went 6 minutes and 48 seconds reaching a maximal heart rate of 154, a blood pressure of 172/82, with 2 mm ST depressions diffusely and moderate to severe reversible anterior and anteroseptal wall ischemia. Medications on admission included Atenolol 50 mg p.o. q.d., Axid 150 mg p.o. b.i.d., Enteric Coated Aspirin 325 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem 240 mg p.o. q.d., Lisinopril 10 mg p.o. q.d., Lopipd 600 mg p.o. q.d., Lasix 40 mg p.o. q.d., Insulin NPH 75 units sub-q q.a.m., 50 units q.p.m., Insulin Regular 25 units sub-q q.a.m., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, and Omeprazole 20 mg p.o. q.d. The Cardiology Team was consulted and serial CK, MB and EKG's were done, with Heparin initially started given the possibility that this was unstable angina. The patient's Insulin dosages were adjusted in the manner to keep her blood sugars in the approximately 200 range and she was discharged with medications including Enteric Coated Aspirin 325 mg p.o. q.d., Lasix 40 mg p.o. q.d., Lopid 600 mg p.o. q.d., Insulin NPH 100 units sub-q q.a.m., 70 units sub-q q.h.s., Insulin Regular 25 units sub-q q.a.m., Lisinopril 10 mg p.o. q.d., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, Omeprazole 20 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem CD 240 mg p.o. q.d., with follow-up care with her primary M.D., Dr. Jarvis Needy in the RINGBURG RITA'S PROPRES MEMORIAL HOSPITAL Clinic. | has there been a prior lopipd | {
"answer_end": [
946
],
"answer_start": [
919
],
"text": [
"Diltiazem 240 mg p.o. q.d.,"
]
} |
Lupe Rumble, a 42 year old female with a history of asthma, hypertension, obesity, hyperlipidemia, hyperglycemia, hirsutism, chiari malformation, spinal stenosis, and spinal syrinx, was admitted to the hospital with a recent asthma flare, productive cough, low grade fevers, shortness of breath, and wheezing. Her chest x-ray showed a linear opacity in the right lower lobe most consistent with platelike atelectasis, but could not rule out resolving or new pneumonia. Treatment included ALBUTEROL INHALER 2 PUFF INH QID, ALBUTEROL NEBULIZER 2.5 MG NEB Q4H, Advair Diskus 500/50 (Fluticasone Propionate/...), Combivent (Ipratropium and Albuterol Sulfate) 2 PUFF INH TID, LISINOPRIL 20 MG PO DAILY, Singulair (Montelukast) 10 MG PO DAILY, and a prednisone taper starting at 60 mg q 24 h x 2 doses, then 50 mg daily x 3 days, then 40 mg daily x 3 days, then 30 mg daily x 3 days, then 20 mg daily x 3 days, and then 10 mg daily x 2 days and stop. The peak flow had improved to 250 and ambulating oxygen saturation was 92-94% at discharge. The patient was also advised to try a nicotine patch and was given Lovenox as a prophylaxis. Her lisinopril was increased to 20mg due to hypertension, and she was discharged on order for KCL IMMEDIATE RELEASE PO (ref #) with instructions to continue all home medications, a prednisone taper, nebs, and advair, singulair, albuterol, and combivent. Smoking cessation was encouraged and she was interested in trying a nicotine patch. | shortness of breath meds on in past | {
"answer_end": [
557
],
"answer_start": [
522
],
"text": [
"ALBUTEROL NEBULIZER 2.5 MG NEB Q4H,"
]
} |
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. | Is there a mention of of warfarin usage/prescription in the record | {
"answer_end": [
1560
],
"answer_start": [
1541
],
"text": [
"Aspirin & Warfarin,"
]
} |
Ms. Dozois is a 64-year-old female admitted to MICU on 2/19/2005 for neutropenia, nausea, vomiting, abdominal pain, and shortness of breath, requiring intubation and pressors. Her medical problems included severe COPD (on home O2 2 liters baseline sat below 90s), nonsmall cell lung cancer (diagnosed in 1999, status post multiple chemotherapy regimens, most recently ALIMTA from 1/29/2005 to 09), diabetes, obesity, and chronic renal insufficiency. Her MEDICATIONS ON ADMISSION included Avapro, Lipitor, Decadron, ranitidine, Humalog, allopurinol, Alimta, Flonase, Vitamin D, B12, and Colace. She was initially treated with vancomycin, Levaquin, and aztreonam along with Flagyl empirically, and later changed to Levaquin only on 10/25/2005 to treat an enterococcal UTI and possible nosocomial pneumonia. She had thrombocytopenia and required multiple red blood transfusions to maintain her hematocrit greater than 26, though she was never hemodynamically unstable. She also required multiple platelet transfusions to keep her platelets greater than 30,000. She responded well initially to three units of packed red blood cells over 7/28/2005 and 09. However, in the setting of her GI bleed from a sloughing mucosa secondary to resolving neutropenic enteritis and recent chemo, she required multiple further RBC transfusions to keep her hematocrit greater than 30. Hematology was consulted secondary to suboptimal busted platelet levels status post transfusions, which was felt to be secondary to poor marrow response in the setting of recent chemo (workup was negative for other possible causes refractory thrombocytopenia, nystatin, allopurinol, were held given possible worsening of her thrombocytopenia). Surgery was consulted and she was managed conservatively with antibiotics initially and then with bowel rest. TPN was started on 4/21/2005, given her bowel rest for a neutropenic enteritis. She was changed to standing insulin on 10/25/2005 and her Lantus was up titrated along with sliding scale insulin to maintain blood sugars in the 80s to 120s. She is no longer neutropenic and was off Neupogen for one week and will stay and finish the 14-day course of Levaquin for coverage. On discharge her hematocrit and platelets were stable respectively at 29.8 and 46,000 and she had not required a transfusion in greater than 24 hours prior to discharge. Her DISCHARGE MEDICATIONS included Tylenol 650 to 1000 mg PO q. 6h PRN pain, headache, if fever is greater than 101, Peridex mouth wash 10 mL twice a day, nystatin mouth wash 10 mL swish and swallow 4 x day as needed, oxycodone 5 mg PO q. 6h PRN pain, simethicone 80 mg PO q.i.d. PRN gaseousness, trazodone 25 mg PO at bedtime, miconazole nitrate 2% powder topical BID to areas between skin folds including under the right breast, Nexium 20 mg PO daily, Lantus 30 mg subcutaneous daily, DuoNeb 3/0.5 mg Nebs q. 3 h. PRN shortness of breath, aspart 4 units before each meal subcutaneously, folate 3 mg PO daily, Avapro 150 mg PO daily, meclizine 25 mg PO TID, Combivent 2 puffs inhaled q.i.d., Vitamin D 125 0.25 mcg PO daily. She will follow up with infectious disease and hematology for her neutropenia, which has since resolved, and will stay and finish the 14-day course of Levaquin for UTI coverage. | Is there a mention of of tpn usage/prescription in the record | {
"answer_end": [
1898
],
"answer_start": [
1819
],
"text": [
"TPN was started on 4/21/2005, given her bowel rest for a neutropenic enteritis."
]
} |
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. | How much iron sulfate does the patient take per day | {
"answer_end": [
1601
],
"answer_start": [
1544
],
"text": [
"iron sulfate 325 mg p.o. q.d., Motrin 800 mg p.o. t.i.d.,"
]
} |
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. | Was the patient ever prescribed heparin | {
"answer_end": [
835
],
"answer_start": [
817
],
"text": [
"ENOXAPARIN SODIUM,"
]
} |
The patient is a 54-year-old man with nonischemic dilated cardiomyopathy who presents with weight gain, weakness, and azotemia. He was admitted with decompensated heart failure and was treated with dobutamine, seretide, and diuretics with good effect, functioning on ACE inhibitor. Two weeks prior to presentation, Digoxin 0.125 mg q.o.d., Imdur 30 mg q.d., hydralazine 25 mg t.i.d., torsemide was being held, Coumadin 1 mg q.d., carvedilol 3.125 mg b.i.d., allopurinol 100 mg q.d., Glucophage, and glyburide were administered. On 2/19/03, Diuril was added to his regimen and his creatinine was noted to increase from 2.6 to 3.6 and diuretics were subsequently held. The patient was loaded on amiodarone, unfortunately still required low dose dobutamine to maintain his cardiac output and was transferred back to the floor and continued to have decrease urine output on maximal diuretic doses and ionotropes. On 6/8/03, the renal surgery recommended that the dobutamine be stopped in order to enhance renal perfusion and Lasix be increased to 80 mg per hour. He has beyond less invasive measures such as digoxin and ACE inhibitors, and he is now dobutamine dependent dobutamine between 1 and 2.5 mcg/kg/minute to maintain his cardiac output, currently loaded on amiodarone without any further events. He has a chronic osteomyelitis, currently in a six-week course of ceftazidime, vancomycin, Flagyl, and Diflucan for complicated osteomyelitis, end date is on 2/30/03. He has diabetes and was on oral hypoglycemic as an outpatient, however, now this renal function, he has been transitioned over to insulin with his standing doses of Lantus with a lispro sliding scale. The patient was started on TPN for quite severe malnutrition and has increasing albumin with increased appetite. Additionally, he is on maintenance doses of hydrocortisone and was seen by Psychiatry, who suggested starting low dose of Zyprexa in the evening, which has greatly improved his mood. He is planned to be evaluated by Plastic Surgery prior to discharge for final plans whether a flap or healing by secondary retention. The patient currently is stable and would be discharged with home dobutamine and frequent and careful follow up by his primary cardiologist Dr. Mongiovi. | Has this patient ever been on dobutamine | {
"answer_end": [
251
],
"answer_start": [
193
],
"text": [
"with dobutamine, seretide, and diuretics with good effect,"
]
} |
Mary Urbieta, a 56-year-old male with a history of ESRD, CAD, and CHF (EF 20-25%), was admitted to the hospital with Hypotension and NSTEMI. Upon discharge he was placed on a Full Code status, a renal diet (FDI), and walking as tolerated, and was instructed to avoid grapefruit unless MD instructs otherwise. His BP was 66/30 after 5.5 liters were removed, and rose to 73/40 after 1 liter of NS was given. Labs showed WBC 5, TnI 0.37, CK 153, CKMB 8.2, and EKG NSR, 1st deg AVB, LAE, LVH, old TWI in 1, L, V5, V6, more pronounced ST dep in V5 than 6/4, and CXR R pl effusion, CMG. Ischemia was managed with medical management with Asa, Beta Blocker, Imdur, Zocor, NTG PRN, and a PET scan was ordered to assess for viable myocardium and ischemia. The results showed a small region of myocardial scar/hibernation along with mild residual stress induced peri-infarct ischemia in the distal LAD distribution and moderate global LV systolic dysfunction, essentially unchanged from his prior study of February 2003. A BNP was sent and pending, and an echo revealed EF 30% and mod AI. He was placed on Acetysalicylic Acid 325 mg PO QD, Colace (Docusate Sodium) 100 mg PO BID, Enalapril Maleate 10 mg PO BID, NPH Humulin Insulin 2 units QAM; 3 units QPM SC 2 units QAM 3 units QPM, NTG 1/150 (Nitroglycerin 1/150 (0.4 mg)) 1 tab SL q5min x 3 PRN chest pain, Zocor (Simvastatin) 40 mg PO QHS, on order for Nephrocaps PO (ref #12327843), Potentially Serious Interaction Simvastatin & Niacin, Vit. B-3 Reason for override: home regimen, Imdur (Isosorbide Mononit.(SR)) 30 mg PO QD, Nephrocaps (Nephro-Vit RX) 2 tab PO QD, Nexium (Esomeprazole) 20 mg PO QD, Toprol XL (Metoprolol (Sust. Rel.)) 200 mg PO QHS, Persantine and viability cardiac PET scan 5/19/04, and SQ heparin for DVT prophylaxis. He was alerted to the Definite Allergy (or Sensitivity) to ACE Inhibitors. Follow-up appointments were made with the cardiologist, primary care physician, and Dr Alan Mcratt, and the family was called to stress the importance of follow up with the cardiologist, Dr Ivrin, and to adhere to dietary restrictions, fluid intake, and medications. | Is there a mention of of zocor ( simvastatin ) usage/prescription in the record | {
"answer_end": [
1383
],
"answer_start": [
1350
],
"text": [
"Zocor (Simvastatin) 40 mg PO QHS,"
]
} |
Ms. Dozois is a 64-year-old female admitted to MICU on 2/19/2005 for neutropenia, nausea, vomiting, abdominal pain, and shortness of breath, requiring intubation and pressors. Her medical problems included severe COPD (on home O2 2 liters baseline sat below 90s), nonsmall cell lung cancer (diagnosed in 1999, status post multiple chemotherapy regimens, most recently ALIMTA from 1/29/2005 to 09), diabetes, obesity, and chronic renal insufficiency. Her MEDICATIONS ON ADMISSION included Avapro, Lipitor, Decadron, ranitidine, Humalog, allopurinol, Alimta, Flonase, Vitamin D, B12, and Colace. She was initially treated with vancomycin, Levaquin, and aztreonam along with Flagyl empirically, and later changed to Levaquin only on 10/25/2005 to treat an enterococcal UTI and possible nosocomial pneumonia. She had thrombocytopenia and required multiple red blood transfusions to maintain her hematocrit greater than 26, though she was never hemodynamically unstable. She also required multiple platelet transfusions to keep her platelets greater than 30,000. She responded well initially to three units of packed red blood cells over 7/28/2005 and 09. However, in the setting of her GI bleed from a sloughing mucosa secondary to resolving neutropenic enteritis and recent chemo, she required multiple further RBC transfusions to keep her hematocrit greater than 30. Hematology was consulted secondary to suboptimal busted platelet levels status post transfusions, which was felt to be secondary to poor marrow response in the setting of recent chemo (workup was negative for other possible causes refractory thrombocytopenia, nystatin, allopurinol, were held given possible worsening of her thrombocytopenia). Surgery was consulted and she was managed conservatively with antibiotics initially and then with bowel rest. TPN was started on 4/21/2005, given her bowel rest for a neutropenic enteritis. She was changed to standing insulin on 10/25/2005 and her Lantus was up titrated along with sliding scale insulin to maintain blood sugars in the 80s to 120s. She is no longer neutropenic and was off Neupogen for one week and will stay and finish the 14-day course of Levaquin for coverage. On discharge her hematocrit and platelets were stable respectively at 29.8 and 46,000 and she had not required a transfusion in greater than 24 hours prior to discharge. Her DISCHARGE MEDICATIONS included Tylenol 650 to 1000 mg PO q. 6h PRN pain, headache, if fever is greater than 101, Peridex mouth wash 10 mL twice a day, nystatin mouth wash 10 mL swish and swallow 4 x day as needed, oxycodone 5 mg PO q. 6h PRN pain, simethicone 80 mg PO q.i.d. PRN gaseousness, trazodone 25 mg PO at bedtime, miconazole nitrate 2% powder topical BID to areas between skin folds including under the right breast, Nexium 20 mg PO daily, Lantus 30 mg subcutaneous daily, DuoNeb 3/0.5 mg Nebs q. 3 h. PRN shortness of breath, aspart 4 units before each meal subcutaneously, folate 3 mg PO daily, Avapro 150 mg PO daily, meclizine 25 mg PO TID, Combivent 2 puffs inhaled q.i.d., Vitamin D 125 0.25 mcg PO daily. She will follow up with infectious disease and hematology for her neutropenia, which has since resolved, and will stay and finish the 14-day course of Levaquin for UTI coverage. | Has the patient had ranitidine in the past | {
"answer_end": [
576
],
"answer_start": [
515
],
"text": [
"ranitidine, Humalog, allopurinol, Alimta, Flonase, Vitamin D,"
]
} |
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. | Has this patient ever tried micronase. | {
"answer_end": [
476
],
"answer_start": [
454
],
"text": [
"Micronase 5 mg po q d,"
]
} |
A 66-year-old gentleman with a medical history significant for coronary artery disease and two prior MIs presented with substernal chest pain while walking that lasted 2-3 hours and was relieved by rest and sublingual nitroglycerin. He was admitted and cardiac catheterization revealed 90% proximal LAD stenosis, 90% mid LAD and 100% distal LAD stenosis, 100% mid LVB1, 80% mid circumflex, 70% proximal D1, 70% proximal PDA, and a right dominant circulation, with diffuse coronary calcification and extensive diffuse disease with small distal vessels. LAD in stent restenosis and collateral flow diffusely small left main. On 4/15/05, the patient underwent CABG x4 with SVG1 to RCA, and sequential graft of SVG2 to D1 and then OM1, with LIMA to LAD and an LAD endarterectomy. On arrival to the hospital, he was given 150 mg of Plavix, heparin 500 units for 48 hours, and aspirin that same night. He was also started on Enteric-coated aspirin 325 mg p.o. daily, atenolol 75 mg p.o. daily, Colace 100 mg p.o. t.i.d., oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n. pain, Plavix 75 mg p.o. daily, Lantus 38 units subcutaneously at bedtime, NovoLog 18 units subcutaneous q.a.m., and Lasix with good effect. He required the transfusion of a unit of packed red blood cells and neosynephrine transiently, which was weaned off on postoperative day #2. He was also noted to have a preoperative urinary tract infection of E. coli for which he was started on levofloxacin on 0/5/05 and treated for five days. The patient was followed by the Diabetes Management Service for blood sugar control and was transitioned from IV insulin to subcutaneous insulin postoperatively. He was discharged to home in good condition on postoperative day #7 on the following medications and is to have a follow-up appointment with his cardiologist, Dr. Abusufait, in one to two weeks, and with his cardiac surgeon, Dr. Cederberg, in four to six weeks. | What medicines have previously been tried for pain | {
"answer_end": [
1062
],
"answer_start": [
988
],
"text": [
"Colace 100 mg p.o. t.i.d., oxycodone 5 mg to 10 mg p.o. q.6h. p.r.n. pain,"
]
} |
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 lasix ( furosemide ) | {
"answer_end": [
2598
],
"answer_start": [
2564
],
"text": [
"LASIX (FUROSEMIDE) 20 MG PO DAILY,"
]
} |
The patient, a 77 year old woman, was admitted with complaint of urinary frequency and AMS. She has a possible allergy to Penicillins with a reaction of RASH and cannot tolerate floroquinolones. She was prescribed ACETYLSALICYLIC ACID 81 MG PO QD, LISINOPRIL 10 MG PO QD Starting Today ( 6/25 ), KCL SLOW RELEASE PO ( ref # 761602437 ), TOPROL XL ( METOPROLOL SUCCINATE EXTENDED RELEASE ) 100 MG PO BID HOLD IF: hr<55 , sbp<95, LANTUS ( INSULIN GLARGINE ) 19 UNITS QAM SC QAM Starting Today ( 6/17 ), WARFARIN SODIUM 5 MG PO QPM Starting ROUTINE , 20:00 ( Standard Admin Time ), ROSIGLITAZONE 2 MG PO QD, FUROSEMIDE 20 MG PO BID Starting Today ( 6/25 ) PRN Other:LE edema, SIMVASTATIN 10 MG PO QHS, CEFPODOXIME PROXETIL 200 MG PO BID X 16 doses Starting Today ( 6/25 ) HOLD IF: rash, and DIGOXIN 0.125 MG PO QOD with Food/Drug Interaction Instruction to Give with meals. Her AFIB became tachy to 140's with an elevated troponin to 1.69 which rose to a max of 2.41 with no EKG changes and was rate controlled and started on Levofloxacin. She was given 2 doses of vancomycin to cover potential staph infection and had an adenosine MIBI that showed no perfusion defects. Her INR was increasing due to the levofloxacin effect and was switched to ceftriaxone consistant with blood culture succeptabilities. Follow up blood cultures on 0/27 demostrated gram positive cocci in clusters and antibiotics were d/c'd after repeat cultures were negative. Her cardiac workup included an echocardiogram with RV dialation and wall akinesis with apical sparing , a new finding since last echo in '03. We have altered cardiac medications for better rate control by cancelling the coreg( carvedelol ) and Norvasc( amilodipine ) and replacing them with a blood pressure medication, Toprol XL( Metoprolol XL ) to better control the rate of her atrial fibrillation and the digoxin was also added for heart rate control. The patient was discharged in good condition and was given instructions to take the full course of antibiotics which cover the next 8days, to take medications with meals or on empty stomach and to avoid high Vitamin-K containing foods, to call PCP with any changes in urinary symptoms, or fever >101.0, return to ER if any changes in mental status, chest pain, SOB, or syncope, and follow-up with PCP within the next week with INR and digoxin levels. Do not use lasix unless necessary and contact PCP if using more than 1-2 times per week due to possible toxicity with digoxin use. | vancomycin | {
"answer_end": [
1097
],
"answer_start": [
1042
],
"text": [
" She was given 2 doses of vancomycin to cover potential"
]
} |
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 | Was the patient ever prescribed levothyroxine sodium | {
"answer_end": [
645
],
"answer_start": [
608
],
"text": [
"Levothyroxine Sodium 100mcg PO daily,"
]
} |
Mr. Gramby is a 43-year-old man with morbid obesity, type II diabetes, hypertension, hyperlipidemia, chronic renal insufficiency, and severe peripheral arterial disease status post femoral popliteal bypass in July which was complicated by repeated return of cellulitis x 2 who was admitted with cellulitis and volume overload. He was initially treated with courses of intravenous nafcillin and vancomycin for four weeks, having been seen by Vascular Surgery five days prior to admission and had been started on dicloxacillin for a third episode of cellulitis. He had also presented with fluid overload and spironolactone was added to his diuretic regimen. The patient was prescribed Atenolol 100 mg q.d., spironolactone, torsemide 160 mg b.i.d., Hyzaar 50/12.5 q. day, lisinopril 60 mg q. day, Neurontin 1200 mg t.i.d., Norvasc 10 mg q.a.m. and 5 mg q.p.m., Coumadin 8 mg, aspirin, Humalog sliding scale, Percocet, Pletal 100 mg b.i.d., Procrit, Zantac, nitroglycerin p.r.n., and NPH 80 q.a.m. and q.p.m. His torsemide was changed to IV and metolazone was added on the first day of admission and his electrolytes were replaced as needed. He was hypertensive on arrival, which was treated with Hydralazine initially and transitioned to his p.o. home medicines, with Hydralazine p.o. added on hospital day #9 to lower his systolic blood pressure to the range of the 120s-130s. His Coumadin was restarted when his INR was 2.2 and he his now in the therapeutic range and will need to be followed. The patient is on NPH and Humalog, with NPH doses increased to 90 units in the morning and 85 units at night, and the goal for this patient is below 150 particularly given the need for wound healing. Additional antibiotic coverage was added specifically of fluoroquinolone for anti-psuedomonal coverage for his diabetic foot ulcers, with surgical debridement done in the operating room with drainage of pus, but the metal showed could not be located even with fluoroscopy. The patient will complete a 14-day course of levofloxacin and clindamycin for these foot ulcers, and will be discharged home with visiting nursing care for b.i.d. wet-to-dry dressing changes. He will follow up with Jerold Cristopher Blazon, M.D. in one to two weeks, go home with visiting nurse care, and will need to see his nephrologist, vascular surgeons, primary care provider, and Bariatric Surgery following discharge. | Has the patient had multiple levofloxacin prescriptions | {
"answer_end": [
2062
],
"answer_start": [
2011
],
"text": [
"levofloxacin and clindamycin for these foot ulcers,"
]
} |
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 a patient had levofloxacin | {
"answer_end": [
1804
],
"answer_start": [
1779
],
"text": [
"LEVOFLOXACIN & AMIODARONE"
]
} |
Mr. Zack Nieman is a 62-year-old white man with ischemic cardiomyopathy, status post coronary artery bypass graft in 1985 with left internal mammary artery to left anterior descending, saphenous vein graft to posterior descending artery, saphenous vein graft to obtuse marginal branch, and a repeat coronary artery bypass graft done in 1995 with saphenous vein graft to first diagonal, saphenous vein graft to obtuse marginal, and saphenous vein graft to posterior descending artery. He had multiple episodes of pulmonary congestion and was admitted to Rorea Valley Health for IV diuresis. EKG revealed atrial flutter with variable block (2:1 versus 3:1), rate around 120, left bundle branche block, and echocardiogram revealed ejection fraction about 25% with 2+ mitral regurgitation. On admission, his temperature was 97.1, pulse 103, blood pressure 148/94, respirations 18, and O2 saturation 97% on two liters. Because of his rapid ventricular response, Digoxin was started with a loading dose of 0.5 mg, then 0.25 mg times two q. six hours, and the patient was then on a maintenance dose of Digoxin at 0.125 mg p.o. q. day, and his Digoxin level has been maintained around 0.9. For his rate control, the amiodarone was also increased to 400 mg q. day, and the patient was started on anticoagulation with heparin. The patient underwent cardioversion through his AICD by the Electrophysiological Service with successful conversion to normal sinus rhythm, and was loaded with Coumadin and meanwhile on heparin until INR between 2-3. The patient developed hyperthyroidism secondary to amiodarone, treated with PTU, then developed hypothyroidism, treated with Levothyroxine. He was discharged on Amiodarone 400 mg p.o. q.d., Captopril 25 mg p.o. t.i.d., clonazepam 1 mg p.o., Lasix 80 mg p.o. b.i.d., glipizide 5 mg p.o. q.d., levothyroxine sodium 100 mcg p.o. q.d., magnesium oxide 420 mg p.o. q.d., Lopressor 25 mg p.o. b.i.d., nitroglycerin 1/150 (0.4 mg) one tab sublingual q. five minutes times three, Coumadin 5 mg p.o. q. day until INR between 2-3 then the dose needs to be adjusted accordingly to maintain INR between 2-3, Simvastatin 20 mg p.o. q. h.s., Klonopin 0.5 mg p.o. q. a.m., Digoxin 0.125 mg p.o. q.d., isosorbide, mononitrate-SR 30 mg p.o. q.d., and troglipazone 400 mg p.o. q. day. | Has this patient ever been on troglipazone | {
"answer_end": [
2300
],
"answer_start": [
2220
],
"text": [
"isosorbide, mononitrate-SR 30 mg p.o. q.d., and troglipazone 400 mg p.o. q. day."
]
} |
Ms. Elter is an 83-year-old Spanish-speaking female with history of CAD, distant three-vessel CABG, CRI, NSTEMI in 4/20 and type II diabetes who presented to the ED with PND, dyspnea on exertion, and chest heaviness with no fevers or chills and no sick contacts, and EMS had given her Lasix and Nitrospray. She was briefly on a nonrebreather mask and responded to 80 mg of IV Lasix, with her potassium level reaching 5.8 and Kayexalate administered. Her medications included aspirin, metoprolol, allopurinol, valsartan, glipizide, Lipitor, and nifedipine, with her oxygen saturation eventually reaching the high 90s on a couple of liters of oxygen and her chest x-ray full set negative. She was treated with aspirin, beta-blockers, and statin for coronary artery disease, experienced a CHF flare with an elevated BNP which was managed with Lasix and Diuril, and her after load was reduced with ARB and her previous home calcium channel blocker was weaned off. She had a transient new atrial fibrillation and ventricular ectopy which resolved spontaneously, and was placed on humidified room air with nasal saline sprays and Afrin due to her coronary artery disease. She was transfused a total of 3 units to keep her hematocrit greater than 30 and Coumadin was initially started given her new onset of atrial fibrillation, but ultimately only aspirin was given after consideration of risks versus benefits. She had some constipation which was relieved with stool softeners and the patient received a PPI. Her DM-2 was managed with regular sliding scale insulin with good blood sugar control and her glipizide was held given her worsening creatinine clearance, and her allopurinol was changed to q.72h. from q.o.d. due to the creatinine clearance and she had some left heel and foot pain thought to be secondary to gout, which improved at the time of discharge. Her hematocrit dropped from 29 to 25, her guaiac was negative on the 3/20/04, and she was sent home with VNA support to follow up on her weights and fluid status and with home physical therapy. Her medications at the time of discharge included Lasix 20 mg p.o. q.d., Lipitor 80 mg p.o. q.d., Metoprolol sustained release 100 mg p.o. b.i.d., Colace 100 mg p.o. b.i.d. p.r.n. for constipation, Allopurinol 100 mg p.o. q.72h., Aspirin 325 mg p.o. q.d., and Valsartan 160 mg p.o. q.d. | Has this patient ever tried aspirin | {
"answer_end": [
539
],
"answer_start": [
475
],
"text": [
"aspirin, metoprolol, allopurinol, valsartan, glipizide, Lipitor,"
]
} |
This 63-year-old male was transferred from LMC with a positive stress test and a history of CABG LIMA-D1, V-OM1, V-OM2, V Y-graft to PDA and PLV. Upon admission, he was diagnosed with CAD and presented with exertional angina. A nuclear stress revealed inferior scar and small area of anterior ischemia, and he was then transferred to CTMC for a cath. His medications on transfer included Dilantin 300/300/250, Glyburide 10 BID, Metformin 850 TID, Toprol 100 Daily, ASA 325 Daily, Isordil 20 TID, Lasix 20 QOD, Lipitor 40 Daily, Neurontin, Celondin 300 TID, Digoxin 0.25 Daily, and Benazepril 10 Daily. His hospital course included CV: Cath LIMA-LAD, DM: holding Metformin and restarting Glyburide and RISS, Neuro: Cont Neurontin 300 TID, Dilantin 200/200/250, and Celondin, and he was switched to Plavix 75 Daily, Atorva to Simva in house, Benazepril to Lisinopril 10, and Digoxin 0.25. He was discharged with instructions to take all medications as prescribed, with a full code status and disposition of Home. Medications at discharge included DIGOXIN 0.25 MG PO DAILY, LASIX (FUROSEMIDE) 20 MG PO EVERY OTHER DAY, GLYBURIDE 10 MG PO BID, ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID, DILANTIN (PHENYTOIN) 200 MG QAM; 250 MG QPM PO BEDTIME, TOPROL XL (METOPROLOL SUCCINATE EXTENDED RELEASE) 100 MG PO DAILY Food/Drug Interaction Instruction, NEURONTIN (GABAPENTIN) 300 MG PO TID, PLAVIX (CLOPIDOGREL) 75 MG PO DAILY, BENAZEPRIL 10 MG PO DAILY, GLUCOPHAGE (METFORMIN) 850 MG PO TID, and CELONTIN (METHSUXIMIDE) 300 MG PO TID. | What is her current dose of isordil ( isosorbide dinitrate ) | {
"answer_end": [
1184
],
"answer_start": [
1140
],
"text": [
"ISORDIL (ISOSORBIDE DINITRATE) 20 MG PO TID,"
]
} |
A 77-year-old woman presented to the ED with sudden onset of severe sharp chest pain, diaphoresis, and nausea; she was given nitro, hydralazine, SL nitro, and a nitro drip, and her pain was relieved. Cardiac catheterization showed no change from prior studies, but pulmonary hypertension was noted, and the patient was treated with heparin, ASA/Plavix (home dose), and uptitrated labetalol for BP control. A PE CT showed a pulmonary nodule, and the patient was discharged home on ACETYLSALICYLIC ACID 81 MG PO DAILY, LIPITOR (ATORVASTATIN) 80 MG PO BEDTIME, CALTRATE 600 + D (CALCIUM CARBONATE 1,500 MG (...) 2 TAB PO DAILY, PLAVIX (CLOPIDOGREL) 75 MG PO QAM, NEXIUM (ESOMEPRAZOLE) 20 MG PO QAM, LASIX (FUROSEMIDE) 40 MG PO QAM, INSULIN 70/30 HUMAN 40 UNITS SC BID, IMDUR ER (ISOSORBIDE MONONITRATE (SR)) 60 MG PO DAILY, LABETALOL HCL 400 MG PO Q8H Starting Tonight (2/22), LEVOXYL (LEVOTHYROXINE SODIUM) 112 MCG PO DAILY, OXYCODONE 5-10 MG PO Q4H PRN Pain, ALDACTONE (SPIRONOLACTONE) 12.5 MG PO QAM, and DIOVAN (VALSARTAN) 160 MG PO DAILY, with instructions to take medications consistently with meals or on an empty stomach and to assess blood sugars and titrate insulin as per her doctor's instructions. She was to monitor her electrolytes with VNA in 1 week, continue diabetes teaching, and work with her VNA for aggressive diabetes management, with follow up with her outpt PCP and endocrinologist for titration of insulin and optimization of insulin regimen, as well as a pulmonary consult to evaluate for primary pulmonary disease, and a repeat chest CT in 6-12 months to follow up the pulmonary nodule. | Why has the patient been prescribed oxycodone | {
"answer_end": [
957
],
"answer_start": [
923
],
"text": [
"OXYCODONE 5-10 MG PO Q4H PRN Pain,"
]
} |
Reginald Burgos, a 76-year-old male with MMP, was admitted with chronic diarrhea of unclear etiology, likely malabsorption. He was put on a lactose free diet, NPO, and started on Imodium as diarrhea was not thought to be due to an acute infectious process. Lab tests were WNL. Medications prescribed include Acetylsalicylic Acid 81 mg PO QD, Atenolol 50 mg PO QD (hold if sbp <100, hr <60), Enalapril Maleate 20 mg PO BID (hold if sbp <100), Potassium Chloride on order for KCL Immediate Release PO (ref #61864355), Nifedipine (Extended Release) (Nifedipine (SL...)) 60 mg PO QD (hold if sbp <100, hr <60), Lipitor (Atorvastatin) 20 mg PO QHS, Zantac (Ranitidine HCl) 150 mg PO BID, Metformin 500 mg PO BID, Imodium (Loperamide HCl) 2-4 mg PO Q6H PRN Diarrhea, and Protonix (Pantoprazole) 40 mg PO QD. Follow up appointments were scheduled with Dr. Detillier (GI) 3/5 2pm, colonoscopy 6/18 9:30am, and Dr. Gaboriault (PCP) 0/8 1:30pm. He was treated with Cipro/Flagyl, but diarrhea persisted after the course was completed and he was given Protonix. He was also instructed to take Phosphate Soda the night before the colonoscopy, and to call 522-750-9060 for more directions. Allergies include CLOPIDOGREL and Penicillins. Discharge condition is stable. | What is the current dose of metformin | {
"answer_end": [
707
],
"answer_start": [
683
],
"text": [
"Metformin 500 mg PO BID,"
]
} |
This 60-year-old male presented with a two week history of paroxysmal nocturnal dyspnea and dyspnea on exertion, possibly related to stress from the recent death of the patient's sister-in-law. His past medical history was significant for hypertension of approximately 10 years, non-insulin dependent diabetes mellitus of approximately 12 years, left Bell's palsy in 1985 treated with prednisone, and type IV hypolipoproteinemia. An EKG showed new anterolateral changes since the EKG taken a year earlier, and he was admitted with a diagnosis of Myocardial Infarction, Congestive Heart Failure, and Hypertension. His medications included Micronase 10 mg po bid, Persantine 60 mg po tid, aspirin one po q d, Lisinopril 5 mg po q d, and Atenolol 50 mg po q d. He had a 20 pack year history of smoking and social ethanol consumption. The patient was managed with gentle Lasix diuresis and the beta blocker was held due to concern for wall motion abnormalities. He was anticoagulated on heparin and loaded on Coumadin, and his medications on discharge included Lasix 40 mg po q d, Captopril 37.5 mg po tid, Ecotrin 325 mg po q d, Coumadin 5 mg po q h.s., magnesium oxide two tablets po q d, Isordil 10 mg po tid with meals, and Micronase 10 mg po bid. The patient was stable on discharge and was to follow up with Dr. Luciano Catignani in his office on Tuesday, 15 of October, at 3 p.m. | Has a patient had beta blocker | {
"answer_end": [
957
],
"answer_start": [
860
],
"text": [
"gentle Lasix diuresis and the beta blocker was held due to concern for wall motion abnormalities."
]
} |
This 57-year-old female with a distant history of ovarian cancer, rheumatoid arthritis with systemic lupus erythematosus features, and history of TTP, status post splenectomy, was admitted with fever, shortness of breath, and pleuritic chest pain. She was initially given cefuroxime and levofloxacin in the emergency department for a presumed community acquired pneumonia, as well as Lasix. Her medications included diltiazem 240 mg a day, lisinopril 40 mg a day, Naprosyn 500 mg b.i.d., NPH insulin 24 units subcutaneously q.a.m., Entex-LA, and Cardizem-CD 240 mg p.o. q.d. She underwent thoracentesis and multiple bilateral therapeutic pleuracentesis, and was diuresed aggressively with Lasix, with her oxygen requirement being down from initially 5 to 6 liters per nasal cannula prior to discharge. A continuous Doppler wave form was found and she underwent abdominal CT scan, which did not show any evidence of venous or lymphatic obstruction. Initially, she was started on cefuroxime and azithromycin by the General Medicine team, and her Legionella urine antigen became positive and levofloxacin was added given recommendations from the Infectious Disease Service. She was off of O2 except that she had desaturations to 86% with ambulation, therefore, she was discharged home with p.r.n. oxygen, on Lasix 80 mg b.i.d., insulin sliding scale, lisinopril 40 mg a day, and Cardizem-CD 240 mg p.o. q.d. and levofloxacin 500 mg times 14 days. An elevated platelet count up to 800 and an elevated CA-125 level was discussed with her GYN oncologist, and she was to follow-up with her doctor in one week. | What is the dosage of insulin | {
"answer_end": [
1347
],
"answer_start": [
1325
],
"text": [
"insulin sliding scale,"
]
} |
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 albuterol | {
"answer_end": [
2455
],
"answer_start": [
2376
],
"text": [
"Pulmonary symptoms included asthma which was continued on albuterol inhaler PRN"
]
} |
The patient was admitted on 4/20/2006 with an Altered Mental Status. A team meeting was held on 3/25/06 and the patient was started on 250 mg b.i.d. of Depakote and Haldol was reduced to just Monday-Wednesday-Friday 1 mg before hemodialysis and 1 mg p.r.n. agitation. On 0/16/06, the patient was diagnosed with pneumonia and started on ceftriaxone IV and Flagyl, which was switched to cefpodoxime and Flagyl for discharge. The patient began to spike fevers on 11/29/06 and was started on antibiotics of ceftriaxone and Flagyl, which was switched to cefpodoxime and Flagyl for discharge, and the cefpodoxime should be dosed after dialysis on Monday-Wednesday-Friday. In terms of endocrine, the patient ultimately discontinued on a regimen of 7 units of Lantus q.a.m. and q.p.m. with 5 units aspart q.a.c. breakfast and lunch and 4 units of aspart q.a.c. dinner. His sliding scale was very light and he is only to be covered with one to two units of aspart during the night as insulin stacks in this patient very easily. At the time of discharge, the patient's fingersticks were well controlled in the 100-200 range and his mental status was A&O x3 and appropriate. Medications on discharge included PhosLo 2001 mg p.o. t.i.d., Depakote 250 mg p.o. b.i.d., folate 1 mg p.o. daily, Haldol 1 mg IV on Monday-Wednesday-Friday given prior to hemodialysis, labetalol 350 mg p.o. b.i.d., lisinopril 80 mg p.o. daily, Flagyl 500 mg p.o. t.i.d. for 14 days, thiamine 100 mg p.o. daily, Norvasc 10 mg p.o. daily, gabapentin 300 mg p.o. q.h.s., cefpodoxime 200 mg p.o. three times a week on Monday-Wednesday-Friday for eight doses given after hemodialysis, Nephrocaps one tablet p.o. daily, sevelamer 2004 mg p.o. t.i.d., Advair diskus 250/50 one puff b.i.d., Nexium 20 mg p.o. daily, Lantus 7 units subcutaneous b.i.d. once in the morning and once evening, aspart 4 units subcutaneous before dinner and 5 units subcutaneous before breakfast and 5 units subcutaneous before lunch, aspart sliding scale starting at blood sugar less than 125 give 0 units, blood sugar 125-300 give 0 units, blood sugar 301-350 give 1 unit, blood sugar 351-400 give 2 units, blood sugar 400-450 give 2 units, albuterol butt paste topical daily, and then p.r.n. Tylenol 650 mg p.r.n. pain, headache, or temperature, albuterol inhaler p.r.n. wheezing, Haldol 1 mg | What was the dosage prescribed of aspart | {
"answer_end": [
1916
],
"answer_start": [
1850
],
"text": [
"aspart 4 units subcutaneous before dinner and 5 units subcutaneous"
]
} |
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. | What medications has the patient ever tried for recurrent uti prevention | {
"answer_end": [
1021
],
"answer_start": [
942
],
"text": [
"She was given a five-day course of levofloxacin (used to address recurrent UTI)"
]
} |
A 56-year-old morbidly obese female with abdominal skin laxity due to massive weight loss after gastric bypass was admitted to plastics for panniculectomy. The patient tolerated the procedure without difficulty and the post-operative period has been uneventful. At discharge, the patient is afebrile with stable vitals, taking PO's/voiding q shift and has ambulated independently with some difficulty given body habitus. Pain has been well managed and incisions are clean, dry, and intact. JP's with moderate serosanguinous output remain in place. The patient was discharged to rehab in a stable condition, with instructions to continue antibiotics as long as drains are in place, change drain sponges daily, strip drains twice daily, sponge baths only while drains are in place, walking as tolerated, no lifting more than 10 pounds, no jogging, swimming, or aerobics for 4-6 weeks, and to monitor/return for signs of infection. Medications prescribed include TYLENOL (Acetaminophen) 1000 mg PO Q6H, KEFLEX (Cephalexin) 500 mg PO QID, COLACE (Docusate Sodium) 100 mg PO BID, PEPCID (Famotidine) 20 mg PO BID, DILAUDID (Hydromorphone HCL) 2-4 mg PO Q4H PRN Pain, INSULIN REGULAR HUMAN Sliding Scale (subcutaneously) SC Q4H Low Scale, LEVOTHYROXINE SODIUM 75 mcg PO daily, MAALOX-TABLETS QUICK DISSOLVE/CHEWABLE 1-2 TAB PO Q6H PRN Upset Stomach, MILK OF MAGNESIA (Magnesium Hydroxide) 30 milliliters PO daily PRN Constipation, METOCLOPRAMIDE HCL 10 mg IV Q8H PRN Nausea, QUINAPRIL 20 mg PO daily, SIMETHICONE 40 mg PO QID PRN Upset Stomach, Other:gas, and STYKER PAIN PUMP (Bupivacaine 0.5%) 400 milliliters IV Q24H Instructions: Rate = 4ml/hr. The patient has a probable allergy to Morphine and Code Status is Full Code. | Is there history of use of levothyroxine sodium | {
"answer_end": [
1270
],
"answer_start": [
1233
],
"text": [
"LEVOTHYROXINE SODIUM 75 mcg PO daily,"
]
} |
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. | has there been a prior lasix drip | {
"answer_end": [
492
],
"answer_start": [
403
],
"text": [
"increased the Lasix drip from 10 mg an hour to 20 mg an hour after 200 mg IV Lasix bolus,"
]
} |
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 this patient ever tried synthroid | {
"answer_end": [
1297
],
"answer_start": [
1273
],
"text": [
"Synthroid 150 mcg daily,"
]
} |
The patient is a 37-year-old gentleman with known coronary artery disease who underwent coronary artery bypass grafting times three with bilateral internal mammary arteries and a saphenous vein graft. The patient was found to have extremely pronounced atherosclerosis of his coronary arteries and had an entirely smooth postoperative course. He was maintained on low molecular weight Dextran for 48 hours for his endarterectomy and was started on enteric coated aspirin on the first day of his operation. The patient diuresed very well and was started on beta blockers. On discharge, the patient's medications included Tenormin, 75 mg po q day; enteric coated aspirin, one po q day; Carafate, 1 gram po q.i.d.; iron sulfate, 325 mg po q day; Percocet and Colace. | Has this patient ever been treated with beta blockers. | {
"answer_end": [
569
],
"answer_start": [
505
],
"text": [
"The patient diuresed very well and was started on beta blockers."
]
} |
This 64-year-old patient had a past medical history of non-small cell lung cancer, status post XRT and chemotherapy, right MC embolic stroke, status post right carotid endarterectomy, Graves’ disease, depression, diabetes, hypertension, asthma, temporal lobe epilepsy, and history of subclavian steal syndrome. On admission, her blood pressure was 66/44, pulse of 100, respiratory rate normal, and blood sugar of 133. She was found to be difficult to arouse and had 1 gm of vancomycin, magnesium and Levaquin 500 mg. Her medication on admission included Mechanical soft diet, aspirin 81 mg, baclofen 5 mg t.i.d., B12 1000 mg daily, iron sulfate 325 mg daily, Cymbalta 20 mg p.o. b.i.d., Neurontin 100 mg b.i.d., Lamictal 200 mg b.i.d., Prilosec 20 daily, levothyroxine, Glucophage 500 once a day, Reglan 10 once a day, niacin 500 once a day, Senna 2 tabs b.i.d., Zocor 20 mg once a day, Nicoderm patch, Colace 100 mg p.o. b.i.d., Lopressor 100 mg p.o. b.i.d., lidoderm 5% patch to the low back, Tylenol, ducolox, Mylanta, lactulose, Seroquel 100 mg, prednisone 50 mg, and Dilaudid 1 mg. She completed a ten-day course of vancomycin for a MRSA urinary tract infection and was treated with tramadol and Tylenol for pain. Her laboratory data showed creatinine of 1, ALT 25, AST 35, hematocrit 33, white count 6.6, and platelets 241,000. She was covered with antibiotics initially, then transitioned over to a ciprofloxacin 700 mg p.o. b.i.d. regime for a total of 12 days for a presumed urinary tract infection. She had a significant polypharmacy and enumerable sedating medications, including baclofen, Dilaudid and trazodone. Her Cymbalta was continued per outpatient follow-up and her Lamictal, as well as her Cymbalta, were maintained for her history of depression. Neurologically, she had a left-sided hemiparesis, as well as agnosia on the left side, and her mental status included intermittent disorientation. She was maintained on Novolog sliding scale for diabetes, QTc monitored with serial EKGs, and prior use of Haldol and other antipsychotics for behavioral modification. She was also continued on a replacement dose levothyroxine for her history of Graves' and a history of radioiodine ablation. For behavioral modification, as well as intermittent agitation and disorientation, the patient was maintained on p.r.n. Seroquel 100 mg p.o. b.i.d., as well as Zydis 5 mg p.o. b.i.d. p.r.n., which was titrated from standing to p.r.n. over the course of her hospitalization in order to try to decrease any sedating medications that may be altering her alertness and orientation. | has there been a prior aspirin | {
"answer_end": [
590
],
"answer_start": [
576
],
"text": [
"aspirin 81 mg,"
]
} |
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 pt. ever been on humalog insulin ( insulin lispro ) before | {
"answer_end": [
560
],
"answer_start": [
492
],
"text": [
"HUMALOG INSULIN (INSULIN LISPRO) Sliding Scale (subcutaneous) SC AC,"
]
} |
Harrison Fullwood was admitted on 4/3/2005 for ICD placement for HCM. On 7/13/05, Medtronic Dual Chamber DDI/ICD was placed under general anesthesia with a CODE STATUS of Full Code and disposition of Home. ECHO 5/13 showed septal thickness 16mm, posterior wall thickness 19mm with preserved EF 65% and LV outflow tract peak gradient 125mmHg. Holter monitoring 0/2 without any arrhythmias. On admission PE, VS 96.4 74 140/90 20 93% RA. Labs/Studies included CBC, BMP, Coags wnl, EKG NSR. TW flat V5/V6 (old), CXR (portable): cardiomegaly, no e/o ptx, PA/lat CXR AM after no ptx, leads in place, no overt failure. The patient was prescribed Albuterol, Advair 250/50 bid, Rhinocort 2 sprays bid, Atrovent 2 puff qid, Singulair 10mg qhs, Nexium 40mg daily, Lasix 20mg daily (inc to 40 or 60 during period), Kcl 20meq daily, Verapamil 120mg daily, Patanol 1-2 OU bid prn, Loratidine 10mg daily, Zocor 20mg qhs, Effexor 75mg daily, Metformin 1250mg bid, Mgoxide 500mg daily, Ambien prn, Amox prior to procedures. On order for Motrin PO (ref# 234611479), the patient had a POSSIBLE allergy to Aspirin; reaction is Unknown. The patient was instructed to take Keflex for a 3 day total course, take all medications with food, and avoid grapefruit unless MD instructs otherwise. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A. ENDO: ISS. restarted Metformin on morning of d/c. NEURO: cont Effexor. On discharge, the patient was prescribed Albuterol Inhaler 2 puff inh QID PRN Shortness of Breath, Wheezing, Lasix (Furosemide) 20 mg PO QD Starting Today (10/19) with instructions to titrate his dose 20mg/40mg/60mg as he normally does depending on his degree of swelling, Motrin (Ibuprofen) 600 mg PO Q6H PRN Pain, Headache, Magnesium Oxide 560 mg PO QD, Verapamil Sustained Release 120 mg PO QD Starting Today (10/19) with instructions to confirm home dose and resume home dose, Keflex (Cephalexin) 250 mg PO QID X 10 doses, Zocor (Simvastatin) 20 mg PO QHS, Ambien (Zolpidem Tartrate) 10 mg PO QHS PRN Insomnia, Loratadine 10 mg PO QD, Potassium Chloride Slow Rel. (KCl Slow Release) 20 mEq PO QD As per AH Potassium Chloride Policy, each 20 mEq dose to be given with 4 oz of fluid, Metformin 1,250 mg PO BID Starting IN AM (10/19), Rhinocort Aqua (Budesonide Nasal Inhaler) 2 Spray Inh BID, Singulair (Montelukast) 10 mg PO QD, Effexor XR (Venlafaxine Extended Release) 75 mg PO QD Number of Doses Required (approximate): 5, Advair Diskus 250/50 (Fluticasone Propionate/...) 1 Puff Inh BID, Nexium (Esomeprazole) 40 mg PO QD, Oxycodone 10 mg PO Q4H PRN Pain, and Atrovent HFA Inhaler (Ipratropium Inhaler) 2 Puff Inh QID. November of 2004, HF symptoms were controlled on Lasix and at baseline he could work. The patient was also advised to take all medications with food and to avoid grapefruit unless MD instructs otherwise, and to take Keflex for a 3 day total course and to take all other medications as the same. The patient was also given Diet instructions to measure his weight daily, fluid restriction, house/low chol/low sat. fat, and house/ADA 2100A. | has there been a prior metformin | {
"answer_end": [
1460
],
"answer_start": [
1417
],
"text": [
"ISS. restarted Metformin on morning of d/c."
]
} |
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. | cipro | {
"answer_end": [
1701
],
"answer_start": [
1649
],
"text": [
"from 10/5/06 with probable enterogram-negative rods."
]
} |
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 there been a prior asa | {
"answer_end": [
2271
],
"answer_start": [
2258
],
"text": [
"ASA 81 PO QD,"
]
} |
The patient is a 74 year-old gentleman with a history of aortic stenosis, non-insulin dependent diabetes mellitus, hypertension, and hypercholesterolemia who underwent a cardiac catheterization and aortic valve replacement on July, 2001. His echocardiogram revealed severe aortic stenosis with mitral annular calcification, left ventricular hypertrophy, 1+ aortic insufficiency, and a mild tricuspid regurgitation with an ejection fraction of 55%. His past medical history is notable for non-insulin dependent diabetes mellitus, depression, hypertension, hypercholesterolemia, and gout. The patient had no known drug allergies and was taking Simvastatin, Lopressor 50 mg p.o. b.i.d., Allopurinol 300 mg once a day, Lasix 40 mg three times a day, Captopril, Potassium replacement, and a Multivitamin upon admission. His physical examination was unremarkable, with a right carotid bruit and palpable distal pulses. He was seen in consultation by Oral Medicine for carious teeth, and his coronary arteriogram demonstrated a 50% lesion of his left anterior descending coronary artery, 60% second diagonal, and a 60% lesion of the right coronary artery. He underwent aortic valve replacement with a #23 Carpentier-Edwards bioprosthetic valve and coronary artery bypass grafting times two with saphenous vein graft to the left anterior descending coronary artery and the saphenous vein graft to the posterior descending. His postoperative course was complicated only by mild confusion which has cleared and he is to be discharged to rehabilitation in good condition on Enteric coated aspirin 325 mg p.o. q. day, Lithium 300 mg twice a day, Potassium supplementation 20 mEq once a day, Pravachol 40 mg once a day, Glyburide 1.25 mg twice a day, Parnate 10 mg twice a day, and Lasix 20 mg once a day. He is to be discharged to the care of Dr. Kim E Scow, Cardiovascular Division at Hany Medical Center. | Has this patient ever tried captopril | {
"answer_end": [
756
],
"answer_start": [
715
],
"text": [
"Lasix 40 mg three times a day, Captopril,"
]
} |
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 used klor-con ( kcl slow release ) in the past | {
"answer_end": [
710
],
"answer_start": [
616
],
"text": [
"KLOR-CON (KCL SLOW RELEASE) 20 MEQ PO DAILY (each 20 mEq dose to be given with 4 oz of fluid),"
]
} |
A 60 year old Spanish speaking woman with multiple cardiac risk factors and a two to three year history of exertional angina presented complaining of unstable chest pain. Dr. Maximo Bryum in C&O MEDICAL CENTER Clinic initiated an antianginal regimen, however the patient recently stopped taking Aspirin and her symptoms then recurred. The patient was given three sublingual Nitroglycerins after her primary M.D. was called and her pain resolved after approximately 15 minutes. On the 27 of January, 1995, the patient underwent a Dobutamine MIBBE on which she went 6 minutes and 48 seconds reaching a maximal heart rate of 154, a blood pressure of 172/82, with 2 mm ST depressions diffusely and moderate to severe reversible anterior and anteroseptal wall ischemia. Medications on admission included Atenolol 50 mg p.o. q.d., Axid 150 mg p.o. b.i.d., Enteric Coated Aspirin 325 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem 240 mg p.o. q.d., Lisinopril 10 mg p.o. q.d., Lopipd 600 mg p.o. q.d., Lasix 40 mg p.o. q.d., Insulin NPH 75 units sub-q q.a.m., 50 units q.p.m., Insulin Regular 25 units sub-q q.a.m., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, and Omeprazole 20 mg p.o. q.d. The Cardiology Team was consulted and serial CK, MB and EKG's were done, with Heparin initially started given the possibility that this was unstable angina. The patient's Insulin dosages were adjusted in the manner to keep her blood sugars in the approximately 200 range and she was discharged with medications including Enteric Coated Aspirin 325 mg p.o. q.d., Lasix 40 mg p.o. q.d., Lopid 600 mg p.o. q.d., Insulin NPH 100 units sub-q q.a.m., 70 units sub-q q.h.s., Insulin Regular 25 units sub-q q.a.m., Lisinopril 10 mg p.o. q.d., Nitroglycerin 1/150th one tablet sublingual q. 5 minutes x 3 p.r.n. chest pain, Omeprazole 20 mg p.o. q.d., Coumadin 10 mg p.o. q.h.s., Diltiazem CD 240 mg p.o. q.d., with follow-up care with her primary M.D., Dr. Jarvis Needy in the RINGBURG RITA'S PROPRES MEMORIAL HOSPITAL Clinic. | Previous omeprazole | {
"answer_end": [
1224
],
"answer_start": [
1198
],
"text": [
"Omeprazole 20 mg p.o. q.d."
]
} |
Mr. Legions is a 54 year old professor who presented to Menjack Hospital Medical Center with recurrent substernal chest pain one day after coronary artery bypass graft (5 vessel bypass) 8 years ago. His coronary risk factors include a positive family history and a previous diagnosis of hyperlipidemia. He was given Lovastatin 40 mg q q.m. and 20 mg q p.m., as well as enteric-coated aspirin one tablet q day. At Skaggssin Hospital, he was given IV nitroglycerin, IV heparin, Nifedipine SL, and morphine, in addition to aspirin and Lovastatin. The patient's pain was relieved with four sublingual nitroglycerin and an EKG demonstrated one sublingual nitroglycerin and these EKG changes resolved. He was treated symptomatically with Tylenol and started on Biaxin 500 mg po bid, and also received a five day course of oral Biaxin with Cholestyramine one packet po q hs, Lopressor 50 mg po tid, and Sublingual nitroglycerin 1/150 tablets to be taken prn. The patient had episodes of fever, achieving a maximum temperature of 101.4, and a chest x-ray on 0/26/95 demonstrated evidence of early congestive heart failure. The patient was treated with daily doses of IV Lasix with resolution of his rales. He was admitted to the Cardiac Intensive Care Unit on IV heparin and nitroglycerine as well as continuation of his aspirin and Lovastatin. His pain was treated with morphine sulfate and relieved with four sublingual nitroglycerin. An EKG demonstrated one sublingual nitroglycerin and these EKG changes resolved. After 24 hours pain-free, the patient was transferred to the Cardiac Step-Down floor and the IV nitroglycerin and IV heparin were discontinued. An echocardiogram demonstrated inferior and posterior hypokinesis with an ejection fraction of approximately 46%, and the patient underwent a submax MIBI to assess coronary perfusion of the heart. The exercise component of this examination demonstrated EKG changes consistent with ischemic coronary flow. Nuclear imaging demonstrated a fixed apical lateral defect in the patient's heart consistent with a healed or healing transmural infarct. The patient also complained of progressive anterior and lateral thigh pain, symptoms consistent with an upper respiratory viral infection, and rales 4 to 5 cm above the bases bilaterally. He was discharged to home with followup in MERH under Drs. Dwayne Ariel Bremme with the medications Enteric-coated aspirin 325 mg po q day, Cholestyramine one packet po q hs, Lovastatin 20 mg po q hs, Lopressor 50 mg po tid, and Sublingual nitroglycerin 1/150 tablets to be taken prn with chest pain. | What was the dosage prescribed of lovastatin | {
"answer_end": [
357
],
"answer_start": [
303
],
"text": [
"He was given Lovastatin 40 mg q q.m. and 20 mg q p.m.,"
]
} |
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